Insomnia and Pain May Be Markers for Mental Health Disorder Onset Among Youth

In youth, risk for developing significant mental health disorders was associated with insomnia and chronic pain. These findings were published in the journal Pain.

This study was part of the Calgary Biopsychosocial Risk for Adolescent Internalizing Disorders (CBRAID) study which was part of a longitudinal research program evaluating premorbid risk factors for the onset of mood and anxiety disorders among youth. In this study, participants (N=145) aged 11-17 years underwent the Mini International Neuropsychiatric Interview for children and adolescents (MINI), Patient Reported Outcomes Measurement Information System (PROMIS)-Pain Interference, Pain Catastrophizing Scale for Children (PCS-C), Insomnia Severity Index (ISI), and Youth Self Report (YSR) evaluations at baseline. At 9- and 18-month follow-ups, participants underwent reevaluation using MINI.

Study participants’ mean age was 13.74 (SD, 1.56) years, 63.8% were girls, and 67.2% were White. Their parents’ mean age was 43.5 (SD, 6.08) years, 92.0% of parent participants were women, and 35.1% of parents had a diagnosis of depression, 5.2% had a diagnosis of anxiety, and 55.7% were diagnosed with both.

At baseline, 5.2% of the adolescents had depression, 6.9% anxiety, and 23.6% suicidality. During the follow-up, new onset anxiety occurred among 10.3%, depression among 14.9%, and suicidality among 14.3%.

In the correlation analysis evaluating the relationship between 15 demographic and clinical characteristics, 54 significant correlations were observed. The strongest positive correlations were observed between pain interference and pain severity (r, 0.63; P <.01), baseline depressive and anxiety symptoms (r, 0.60; P <.01), and anxiety disorder onset and depressive disorder onset (r, 0.53; P <.01). The strongest negative correlations were between pain catastrophizing and gender (r, -0.28; P <.01), baseline anxiety symptoms and gender (r, -0.26; P <.01), and baseline depressive symptoms and gender (r, -0.25; P <.01).

The onset of depressive disorder associated with pain catastrophizing (odds ratio [OR], 2.56; P =.002), baseline affective symptoms (OR, 1.99; P =.002), pain interference (OR, 1.86; P =.007), insomnia severity (OR, 1.79; P =.017), and pain severity (OR, 1.67; P =.041).

Onset of anxiety disorder associated with insomnia severity (OR, 2.61; P <.002), baseline anxiety symptoms (OR, 2.12; P =.007), and gender (OR, 0.11; P =.039).

Suicidality onset associated with baseline affective symptoms (OR, 3.69; P <.001), chronic pain (OR, 3.40; P =.048), pain interference (OR, 2.15; P =.003), and pain severity (OR, 1.90; P =.020) whereas severity of suicidality associated with baseline affective symptoms (OR, 4.26; P <.001), pain interference (OR, 3.34; P =.001), and pain severity (OR, 2.15; P =.034).

The best-fit models included gender, affective symptoms, and pain catastrophizing for predicting depression onset (area under the curve [AUC], 0.8549); gender, age, and anxiety for predicting anxiety onset (AUC, 0.8821); and gender, affective symptoms, and pain interference for predicting suicidality (AUC, 0.8104).

These findings may not be generalizable, as the sample predominantly comprised White mother-daughter pairs with higher socioeconomic status.

“[T]his study demonstrated that pain and insomnia are premorbid markers of risk for first lifetime onsets of depressive and anxiety disorders and suicidality, even adjusting for baseline subclinical symptoms and sociodemographic factors,” concluded the study authors.