Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Depression in children with abdominal pain in the emergency department

Pediatric Research volume 98, pages 1033–1038 (2025)Cite this article

Abstract

Objective

This cross-sectional study examined depression and associated impairment in youth presenting to a pediatric emergency department (PED) with abdominal pain.

Methods

Participants were 11–17 years old, presenting to a PED with idiopathic abdominal pain. Participants completed demographics, pain, pain-related impairment, and depression surveys. Depression was assessed using the Patient Health Questionnaire (PHQ-9A). Scores ≥10 met depression threshold and ≥1 on item 9 indicated self-harm ideation. Mean difference and logistic regression analyses were conducted.

Results

Among 169 participants, 29.6% reported depression and 9.4% endorsed self-harm ideation. Depression was associated with Latinx ethnicity (X2 = 4.02, p = 0.045), higher pain intensity (Z = −3.09, p = 0.002), and higher pain-related impairment (Z = −4.86, p < 0.001). In regression analyses, pain-related impairment and Latinx ethnicity were independently associated with depression (OR = 3.89 [95%CI, 1.22–12.40]; OR = 1.13 [95%CI, 1.06–1.21]). Self-harm ideation was not associated with study variables.

Conclusions

Results highlight the need for enhanced mental health screening for youth presenting with idiopathic abdominal pain in the ED, particularly for Latinx youth. Early identification of depression and high pain-related impairment may inform interventions and improve outcomes.

Impact

  • Nearly 30% of youth, 11–17 years old, presenting to the ED with idiopathic abdominal pain screened positive for depression and 9.4% reported self-harm ideation.

  • The higher likelihood of depression among Latinx youth experiencing pain emphasizes the importance of including diverse samples in future ED research to explore mechanisms contributing to poorer mental health in minoritized populations.

  • Results highlight the need for enhanced mental health screening in youth presenting to the emergency department with idiopathic abdominal pain.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The de-identified dataset analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Soltani, S., Kopala-Sibley, D. C. & Noel, M. The co-occurrence of pediatric chronic pain and depression. Clinical Journal of Pain 35, 633–643 (2019).

    Article  PubMed  Google Scholar 

  2. Campo, J. V. et al. Recurrent Abdominal Pain, Anxiety, and Depression in Primary Care. Pediatrics 113, 817–824 (2004).

    Article  PubMed  Google Scholar 

  3. Hyams, J. S., Burke, G., Davis, P. M., Rzepski, B. & Andrulonis, P. A. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. The Journal of Pediatrics 129, 220–226 (1996).

    Article  CAS  PubMed  Google Scholar 

  4. Youssef, N. N., Atienza, K., Langseder, A. L. & Strauss, R. S. Chronic Abdominal Pain and Depressive Symptoms: Analysis of the National Longitudinal Study of Adolescent Health. Clinical Gastroenterology and Hepatology 6, 329–332 (2008).

    Article  PubMed  Google Scholar 

  5. Cunningham, N. R. et al. Risk categorization predicts disability in pain-associated functional gastrointestinal disorders (FGIDs) after 6 months. J Pediatr Gastroenterol Nutr 64, 685–690 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mulvaney, S., Lambert, E. W., Garber, J. & Walker, L. S. Trajectories of symptoms and impairment for pediatric patients with functional abdominal pain: a 5-year longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry 45, 737–744 (2006).

    Article  Google Scholar 

  7. Stone, A. L. et al. Subgroups of Pediatric Patients With Functional Abdominal Pain: Replication, Parental Characteristics, and Health Service Use. The Clinical Journal of Pain 36, 897–906 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Caperell, K., Pitetti, R. & Cross, K. P. Race and Acute Abdominal Pain in a Pediatric Emergency Department. Pediatrics 131, 1098–1106 (2013).

    Article  PubMed  Google Scholar 

  9. Pollack, E. S. Pediatric abdominal surgical emergencies. Pediatric Annals 25, 448–457 (1996).

    Article  CAS  PubMed  Google Scholar 

  10. Smith, J. & Fox, S. M. Pediatric abdominal pain: an emergency medicine perspective. Emergency Medicine Clinics 34, 341–361 (2016).

    Article  PubMed  Google Scholar 

  11. Lee, W. H. et al. Pediatric Abdominal Pain in Children Presenting to the Emergency Department. Pediatr Emerg Care 37, 593–598 (2021).

    Article  PubMed  Google Scholar 

  12. Pennel, D. J. L., Goergen, N. & Driver, C. P. Nonspecific abdominal pain is a safe diagnosis. Journal of Pediatric Surgery 49, 1602–1604 (2014).

    Article  PubMed  Google Scholar 

  13. Loening-Baucke, V. & Swidsinski, A. Constipation as Cause of Acute Abdominal Pain in Children. The Journal of Pediatrics 151, 666–669 (2007).

    Article  PubMed  Google Scholar 

  14. Rinderknecht, A. S., Ho, M., Matykiewicz, P. & Grupp-Phelan, J. M. Referral to the Emergency Department by a Primary Care Provider Predicts Severity of Illness. Pediatrics 126, 917–924 (2010).

    Article  PubMed  Google Scholar 

  15. Doan, Q. et al. Utility of MyHEARTSMAP for Universal Psychosocial Screening in the Emergency Department. The Journal of Pediatrics 219, 54–61.e1 (2020).

    Article  PubMed  Google Scholar 

  16. Lipsitz, J. D. et al. Psychopathology and disability in children with unexplained chest pain presenting to the pediatric emergency department. Pediatr Emerg Care 26, 830–836 (2010).

    Article  PubMed  Google Scholar 

  17. Scott, E. G., Luxmore, B., Alexander, H., Fenn, R. L. & Christopher, N. C. Screening for Adolescent Depression in a Pediatric Emergency Department. Academic Emergency Medicine 13, 537–542 (2006).

    Article  PubMed  Google Scholar 

  18. Walker, L. S., Sherman, A. L., Bruehl, S., Garber, J. & Smith, C. A. Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood. PAIN 153, 1798–1806 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wuerz, R. C., Milne, L. W., Eitel, D. R., Travers, D. & Gilboy, N. Reliability and Validity of a New Five-level Triage Instrument. Academic Emergency Medicine 7, 236–242 (2000).

    Article  CAS  PubMed  Google Scholar 

  20. Williamson, A. & Hoggart, B. Pain: a review of three commonly used pain rating scales. Journal of Clinical Nursing 14, 798–804 (2005).

    Article  PubMed  Google Scholar 

  21. Dworkin, R. H. et al. Considerations for extrapolating evidence of acute and chronic pain analgesic efficacy. PAIN® 152, 1705–1708 (2011).

    Article  PubMed  Google Scholar 

  22. Treede, R.-D. et al. A classification of chronic pain for ICD-11. Pain 156, 1003–1007 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kent, M. L. et al. The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions. Journal of Pain 18, 479–489 (2017).

    Article  PubMed  Google Scholar 

  24. Varni, J. W. et al. PROMIS Pediatric Pain Interference Scale: an item response theory analysis of the pediatric pain item bank. Journal of Pain 11, 1109–1119 (2010).

    Article  PubMed  Google Scholar 

  25. Varni, J. W. et al. Psychometric properties of the PROMIS® pediatric scales: precision, stability, and comparison of different scoring and administration options. Quality of Life Research 23, 1233–1243 (2014).

    Article  PubMed  Google Scholar 

  26. Johnson, J. G., Harris, E. S., Spitzer, R. L. & Williams, J. B. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. Journal of Adolescent Health 30, 196–204 (2002).

    Article  Google Scholar 

  27. Kroenke, K., Spitzer, R. L. & Williams, J. B. W. The PHQ-9. Journal of General Internal Medicine 16, 606–613 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Manea, L., Gilbody, S. & McMillan, D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ 184, E191–E196 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gilbody, S., Richards, D., Brealey, S. & Hewitt, C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. Journal of General Internal Medicine 22, 1596–1602 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gamwell, K. L., Mara, C. A., Hommel, K. A., Kashikar-Zuck, S. & Cunningham, N. R. Establishing Clinical Cut-points on the Pediatric PROMIS-Pain Interference Scale in Youth With Abdominal Pain. Clinical Journal of Pain 38, 173–181 (2022).

    Article  Google Scholar 

  31. Falla, K. et al. Anxiety and Depressive Symptoms and Disorders in Children and Adolescents with Migraine: A Systematic Review and Meta-analysis. JAMA Pediatrics 176, 1176–1187 (2022).

  32. Spatuzzo, M. et al. Abdominal pain in children: the role of possible psychosocial disorders. Eur Rev Med Pharmacol Sci 25, 1967–1973 (2021).

    CAS  PubMed  Google Scholar 

  33. Tegethoff, M., Belardi, A., Stalujanis, E. & Meinlschmidt, G. Comorbidity of Mental Disorders and Chronic Pain: Chronology of Onset in Adolescents of a National Representative Cohort. The Journal of Pain 16, 1054–1064 (2015).

    Article  PubMed  Google Scholar 

  34. Wrona, S. K., Melnyk, B. M. & Hoying, J. Chronic Pain and Mental Health Co-Morbidity in Adolescents: An Urgent Call for Assessment and Evidence-Based Intervention. Pain Management Nursing 22, 252–259 (2021).

    Article  PubMed  Google Scholar 

  35. Anderson, K. O., Green, C. R. & Payne, R. Racial and ethnic disparities in pain: causes and consequences of unequal care. Journal of Pain 10, 1187 (2009).

    Article  PubMed  Google Scholar 

  36. Green, C. R. et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine 4, 277–294 (2003).

    Article  PubMed  Google Scholar 

  37. Hooper, L. M., Mier-Chairez, J., Mugoya, G. C. T. & Arellano, B. Depressive symptoms, assessment, and treatment in Latino/a adolescents: A brief review. Current Psychiatry Reviews 12, 150–162 (2016).

    Article  Google Scholar 

  38. Garcia, C., Skay, C., Sieving, R., Naughton, S. & Bearinger, L. H. Family and Racial Factors Associated With Suicide and Emotional Distress Among Latino Students. Journal of School Health 78, 487–495 (2008).

    Article  PubMed  Google Scholar 

  39. Flores, G. et al. The health of Latino children: urgent priorities, unanswered questions, and a research agenda. Jama 288, 82–90 (2002).

    Article  PubMed  Google Scholar 

  40. Kemper, A. R., Hostutler, C. A., Beck, K., Fontanella, C. A. & Bridge, J. A. Depression and Suicide-Risk Screening Results in Pediatric Primary Care. Pediatrics 148, e2021049999 (2021).

    Article  PubMed  Google Scholar 

  41. Shain, B. et al. Suicide and suicide attempts in adolescents. Pediatrics 138, e20161420 (2016).

Download references

Acknowledgements

Dr. Sarah R. Martin is supported by the National Institutes of Health National Institute for Child Health and Human Development [K23HD105042, PI: Martin].

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Care, University of California Irvine School of Medicine, Orange, CA, USA

    Sarah R. Martin, Michelle A. Fortier & Zeev N. Kain

  2. Center on Stress & Health, University of California Irvine, Orange, CA, USA

    Sarah R. Martin, Michelle A. Fortier & Zeev N. Kain

  3. Emergency Medicine, Children’s Hospital of Orange County, Orange, CA, USA

    Sarah R. Martin, Theodore W. Heyming & Luis H. Salas

  4. Department of Emergency Medicine, University of California Irvine, Orange, CA, USA

    Theodore W. Heyming

  5. Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA

    Michelle A. Fortier

  6. Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, CA, USA

    Michelle A. Fortier, Heather C. Huszti & Meredith L. Dennis

  7. Yale University Child Study Center, New Haven, CT, USA

    Zeev N. Kain

  8. Children’s Hospital of Orange County, Orange, CA, USA

    Zeev N. Kain

Authors
  1. Sarah R. Martin
    View author publications

    Search author on:PubMed Google Scholar

  2. Theodore W. Heyming
    View author publications

    Search author on:PubMed Google Scholar

  3. Michelle A. Fortier
    View author publications

    Search author on:PubMed Google Scholar

  4. Luis H. Salas
    View author publications

    Search author on:PubMed Google Scholar

  5. Heather C. Huszti
    View author publications

    Search author on:PubMed Google Scholar

  6. Meredith L. Dennis
    View author publications

    Search author on:PubMed Google Scholar

  7. Zeev N. Kain
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Each author has met the Pediatric Research authorship requirements. The authors that met each criterion are listed below. Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data: Drs. Martin, Heyming, Fortier, Huszti, Dennis, Kain, and Mr. Salas Drafting the article or revising it critically for important intellectual content: Drs. Martin, Heyming, Fortier, Huszti, Dennis, Kain, and Mr. Salas. Final approval of the version to be published: Drs. Martin, Heyming, Fortier, Huszti, Dennis, Kain, and Mr. Salas.

Corresponding author

Correspondence to Sarah R. Martin.

Ethics declarations

Competing interests

Dr. Zeev N. Kain serves as a consultant for Edwards Life Sciences and Pacira and is the President of the American College of Perioperative Medicine. All other authors have no conflicts of interest to report.

Ethical approval and consent to participate

Parents provided informed consent and children provided assent prior to participating in the study. Ethical approval for all study procedures was obtained from the Children’s Hospital of Orange County Institutional Review Board (#220577).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martin, S.R., Heyming, T.W., Fortier, M.A. et al. Depression in children with abdominal pain in the emergency department. Pediatr Res 98, 1033–1038 (2025). https://doi.org/10.1038/s41390-025-03871-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41390-025-03871-y

Search

Advanced search

Quick links