School Functioning in Adolescents With Chronic Pain: The Role of Depressive Symptoms in School Impairment

Objective To explore associations between depressive symptoms and school functioning, including school attendance, academic performance, self-perceived academic competence, and teacher-rated school adjustment among predominantly Caucasian and female adolescent chronic pain patients. Methods A total of 217 clinically referred adolescents (aged 12–17 years) and their parents completed measures of pain characteristics, depression, and school functioning. Additional data were collected from school records and teacher reports. Results Depressive symptoms strongly correlated with school functioning indicators. In linear regression analyses, higher levels of depressive symptoms predicted more school impairment. A model testing whether depressive symptoms mediated the association between current pain intensity and parent perceptions of the interference of pain on school functioning was supported by the data. Conclusions Depressive symptoms play a key role in influencing the extent of school impairment in adolescents with chronic pain. Interventions to alleviate depressive symptoms may enhance treatments designed to improve school functioning in this population. Key words adolescents; depression; pain; school functioning. Pediatric chronic pain is a pervasive problem, affecting an estimated 15–20 % of children (APS, 2001; Goodman & McGrath, 1991). A subset of these children experience pain-related functional disability that can severely decrease quality of life in many areas (Gauntlett-Gilbert & Eccleston, 2007; Perquin et al., 2000). In a recent large community-based study of school-age children in Germany, 30 % of children in the age group of 4–18 years reported pain lasting 6 months or longer, with half of these children endorsing significant functional impairment due to pain (Roth-Isigkeit, Thyen, Stoven, Schwarzenberger, & Schmucker, 2005). Other recent studies have shown that pain characteristics, such as duration and intensity, cannot fully explain the functional outcomes of chronic pain conditions in children and adolescents (Ecclesto