Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities

Abstract

Co-occurrence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly noted in the literature. Yet, little is known empirically about population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with anxiety and/or depression symptoms (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million US adults, or 4.9% of the adult population, have co-occurring chronic pain and A/D symptoms. Unremitted A/D symptoms co-occurred in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. Conversely, chronic pain co-occurred in the majority (55.6%) of US adults with unremitted A/D symptoms, compared with a chronic pain prevalence of 17.1% among those without A/D symptoms. The likelihood of experiencing functional limitations in daily life was highest among those experiencing co-occurring symptoms, compared with those experiencing chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty doing errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment in improving functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms.

Figure 1.

Visualizing prevalence of chronic pain alone, anxiety and/or depression symptoms alone, and co-occurrence. Data Source: National Center for Health Statistics, National Health Interview Survey, 2019. A/D, anxiety/depression; CP, chronic pain.

Figure 2.

Visualizing prevalence of functional disparities among US adults who have chronic pain only, depression and/or anxiety symptoms only, and co-occurring symptoms. A/D, anxiety/depression only; CP, chronic pain only; CO, co-occurring chronic pain and anxiety/depression symptoms; Neither, neither chronic pain nor anxiety/depression symptoms are present. Data Source: National Center for Health Statistics, National Health Interview Survey, 2019.