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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Werner, Mads

CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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Volume 16, Issue 1


Functional disability and depression symptoms in a paediatric persistent pain sample

Jaclyn Broadbent
  • Corresponding author
  • School of Psychology, Geelong, Deakin University, Australia
  • Royal Children’s Hospital, Melbourne, Australia
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Melanie D. Bertino
  • The Victorian Rehabilitation Centre, Melbourne, Australia
  • Royal Children’s Hospital, Melbourne, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Leah Brooke
  • Colorado Department of Public Health & Environment, Melbourne Australia
  • Royal Children’s Hospital, Melbourne, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Matthew Fuller-Tyszkiewicz
  • School of Psychology, Geelong, Deakin University, Australia
  • Royal Children’s Hospital, Melbourne, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ George Chalkiadis
  • Colorado Department of Public Health & Environment, Melbourne Australia
  • Royal Children’s Hospital, Melbourne, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.05.006


Background and Aims

Clinicians treating paediatric chronic pain conditions understand that persistent pain, functional ability, and symptoms of depression often co-exist, yet these relationships have only been described to a limited extent by research. This paper more closely examines the relationship between symptoms of depression and subtypes of functional disability.


Participants included a clinical sample of children and adolescents (N = 239) referred to a paediatric multidisciplinary pain clinic for treatment of persistent or recurrent (chronic) pain in Australia. The majority of participants were female, (76.6%), and were aged 7–17 years (mean age at the time of presentation was 13.8 years). Data from standardized instruments and interview data were collected from a clinical file audit. The Pediatric Outcomes Data Collection Instrument (PODCI) was used as a measure of functional difficulties performing activities of daily living, and the Children’s Depression Inventory (CDI) was used to measure depressive symptoms.


High rates of depression and functional disability were observed, but were not associated with one another beyond relatively weak associations. Contrary to prior studies using different measures of physical functioning, depression symptoms were not associated with PODCI functional disability beyond a minor association with anhedonia symptoms (primarily driven by the pain/comfort subscale of the PODCI).

Conclusions and Implications

We argue that prior research has measured physical functional limitations in paediatric pain sufferers in a way that is heavily influenced by psychosocial factors, in particular by the symptoms of clinical depression. In contrast, using a measure of physical functioning (PODCI) less influenced by psychosocial factors suggests that the relationship between physical functioning during activities of daily living (e.g., use of upper limbs, basic gross and fine motor skills, basic mobility) and depression is weaker, despite both being heightened in this sample. Unlike other functional disability measures, the Pediatric Outcomes Data Collection Instrument (PODCI) may allow researchers to assess functional limitations somewhat independently of depression symptoms. This conclusion requires replication in further studies, but if confirmed, then the PODCI could be advocated as a useful measure to obtain a more ‘pure’ measure of functional difficulties due to pain, relatively independent of depression.

This article offers supplementary material which is provided at the end of the article.

Keywords: Depression; Mental health; Chronic pain; Paediatric; Physical functioning


  • [1]

    King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011;152:2729–38.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [2]

    Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, van der Wouden JC. Pain in children and adolescents: a common experience. Pain 2000;87:51–8.PubMedCrossrefGoogle Scholar

  • [3]

    Roth-Isigkeit A, Thyen U, Stöven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics 2005;115:152–62.CrossrefGoogle Scholar

  • [4]

    Hunfeld JAM, Perquin CW, Duivenvoorden HJ, Hazebroek-Kampschreur AAJM, Passchier J, van Suijlekom-Smit LWA, van der Wouden JC. Chronic pain and its impact on quality of life in adolescents and their families. J Pediatr Psychol 2001;26:145–53.CrossrefPubMedGoogle Scholar

  • [5]

    Zernikow B, Wager J, Hechler T, Hasan C, Rohr U, Dobe M, Blankenburg M. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr 2012; 12:54.Web of SciencePubMedGoogle Scholar

  • [6]

    McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Davidson K, Zeltzer L. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain 2008;9: 771–83.Web of SciencePubMedCrossrefGoogle Scholar

  • [7]

    Kashikar-Zuck S, Goldschneider KR, Powers SW, Vaught MH, Hershey AD. Depression and functional disability in chronic pediatric pain. Clin J Pain 2001;17:341–9.CrossrefPubMedGoogle Scholar

  • [8]

    Gauntlett-Gilbert J, Eccleston C. Disability in adolescents with chronic pain: patterns and predictors across different domains of functioning. Pain 2007;131:132–41.Web of SciencePubMedCrossrefGoogle Scholar

  • [9]

    Walker LS, Garber J, Greene J. Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. J Abnormal Psychol 1993;102: 248–58.CrossrefGoogle Scholar

  • [10]

    Daltroy L, Liang M, Fossel A, Goldberg M. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. J Pediatr Orthopaedics 1998;18:561–71.CrossrefGoogle Scholar

  • [11]

    Kovacs M. The Children’s Depression Inventory (CDI). Psychopharmacol Bull 1985;21:995–8.PubMedGoogle Scholar

  • [12]

    Blumberg SH, Izard CE. Discriminating patterns of emotions in 10-and 11-yr-old children’s anxiety and depression. J Personal Social Psychol 1986;51:852.CrossrefGoogle Scholar

  • [13]

    Timbremont B, Braet C, Dreessen L. Assessing depression in youth: relation between the Children’s Depression Inventory and a structured interview. J Clin Child Adolesc Psychol 2004;33:149–57.CrossrefGoogle Scholar

  • [14]

    Eccleston C, Crombez G, Scotford A, Clinch J, Connell H. Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents. Pain 2004;108:221–9.PubMedCrossrefGoogle Scholar

  • [15]

    Kashikar-Zuck S, Flowers SR, Claar RL, Guite JW, Logan DE, Lynch-Jordan AM, Wilson AC. Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain. PAIN® 2011;152:1600–7.CrossrefWeb of ScienceGoogle Scholar

  • [16]

    Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments normative values from the general population. J Bone Joint Surg 2002;84:208–15.CrossrefGoogle Scholar

  • [17]

    do Monte FA, Ferreira MNL, Petribu KCL, Almeida NC, Gomes JB, Mariano MH, Souza MAN. Validation of the Brazilian version of the pediatric outcomes data collection instrument: a cross-sectional evaluation in children and adolescents with juvenile idiopathic arthritis. BMC Pediatrics 2013;13:177.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [18]

    Misterska E, Adamczak K, Kaminiarczyk-Pyzałka D, Adamczyk K, Głowacki J, Niedziela M, Glowacki M. The Pediatric Outcomes Data Collection instrument for Polish sample with juvenile idiopathic arthritis: psychometric properties of proxy version. Int J Rheumatic Dis 2015.Web of ScienceGoogle Scholar

  • [19]

    Valovich McLeod TC, Bay RC, Parsons JT, Sauers EL, Snyder AR. Recent injury and health-related quality of life in adolescent athletes. J Athletic Train 2009;44:603–10.CrossrefGoogle Scholar

  • [20]

    Dietz FR, Compton SP. Outcomes of a simple treatment for complex regional pain syndrome type I in children. Iowa Orthopaedic J 2015;35:175.Google Scholar

  • [21]

    Field A. Discovering statistics using IBM SPSS statistics. Sage; 2013.Google Scholar

  • [22]

    Cohen J. Statistical power analysis for the behavioral sciences. Routledge Academic; 2013.Google Scholar

  • [23]

    Claar RL, Walker LS. Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory. Pain 2006;121:77–84.CrossrefPubMedGoogle Scholar

  • [24]

    Fichtel A, Larsson B. Psychosocial impact of headache and comorbidity with other pains among Swedish school adolescents. Headache 2002;42:766–75.PubMedCrossrefGoogle Scholar

  • [25]

    Mohammad S, Di Lorenzo C, Youssef NN, Miranda A, Nurko S, Hyman P, Saps M. Assessment of abdominal pain through global outcomes and recent FDA recommendations in children: are we ready for change? J Pediatr Gastroenterol Nutr 2014;58:46–50.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [26]

    Kashikar-Zuck S, Vaught MH, Goldschneider KR, Graham TB, Miller JC. Depression, coping, and functional disability in juvenile primary fil romyalgia syndrome. J Pain 2002;3:412–9.CrossrefGoogle Scholar

  • [27]

    Kaczynski KJ, Simons LE, Claar RL. Anxiety, coping, and disability: a test of mediation in a pediatric chronic pain sample. J Pediatr Psychol 2011:jsr024.Web of ScienceGoogle Scholar

  • [28]

    Simons LE, Sieberg CB, Claar RL. Anxiety and functional disability in a large sample of children and adolescents with chronic pain. Pain Res Manage 2012;17:93.CrossrefGoogle Scholar

  • [29]

    McCracken L, Turk D. Behavioral and Cognitive–Behavioral Treatment for Chronic Pain: Outcome, Predictors of Outcome, and Treatment Process; 2002.Google Scholar

About the article

Deakin University, School of Psychology, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.

Received: 2017-01-25

Revised: 2017-05-05

Accepted: 2017-05-19

Published Online: 2017-07-01

Published in Print: 2017-07-01

Ethical issues: Research was approved by Children’s Pain Management Clinic at the Royal Children’s Hospital and at Deakin University. This study collected data retrospectively from a database of previous patients at the pain clinic who had given their consent for their data to be used in future research.

Conflicts of interest: The author(s) have no competing or potential conflicts of interest.

Funding: No funding sources were provided.

Citation Information: Scandinavian Journal of Pain, Volume 16, Issue 1, Pages 192–197, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.05.006.

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