A Double Burden? A mixed method investigation into the experiences of paediatric chronic pain and mental health symptoms

: (Alternative Format Thesis)

Abstract

Adolescents often experience emotional and physical challenges from childhood to adulthood. For a number of adolescents, these emotional challenges develop into more severe mental health symptoms or even diagnosed mental health disorders, e.g., anxiety, depression and eating disorders. Importantly, adolescence is a key stage for the development of chronic pain symptoms. The challenges associated with mental health or chronic pain symptoms have been shown to impact adolescent functioning and have a lifelong impact. Previous literature has revealed that adolescents with chronic pain often experience symptoms of anxiety and depression. Similarly, anxiety and behavioural disorders have been revealed as early risk factors for chronic pain. However, missing in the current literature is an exploration of a wide variety of mental health symptoms experienced by adolescents with chronic pain and the impact that these co-occurring pain and mental health symptoms may have on adolescent functioning.

My doctoral research aimed to examine the experiences of adolescents who experience chronic pain and mental health symptoms and consider how these co-occurring symptoms might challenge and affect adolescents’ functioning and subsequent treatment. To obtain a comprehensive understanding of the particular challenges adolescents with co-occurring symptoms face, I adopted a mixed method, multi-informant perspective within this thesis.

This body of work comprises three studies: two empirical studies that employ a mixed methodological approach in adolescents and clinicians and a scoping review. In Chapter 3 I present my cross-sectional quantitative adolescent study which expands on the lack of knowledge revealed in the scoping review by exploring the challenges faced by adolescents aged 11-19 with co-occurring pain and mental symptoms and investigating how these challenges influence their functioning. Through this self-report online survey, I reveal that adolescents with co-occurring symptoms report significantly worse social functioning than adolescents who experience pain only or who do not experience any pain or mental health symptoms. Results also highlight the need to develop standardised assessment and treatment plans to understand the symptoms presented by adolescents with co-occurring symptoms fully. In Chapter 4, I present a qualitative clinician study to explore clinicians' perceptions surrounding their perceived challenges in treating adolescents with co-occurring chronic pain and mental health symptoms. The results of this study generated two themes: ‘tangled threads’ and ‘the difficult-to-pursue holistic approach’. The ‘tangled threads’ theme reflects how clinicians’ perceive that prior interactions between adolescents and clinicians have engendered mistrust toward clinicians, with clinicians describing how they needed to ‘undo’ this anticipated harm to restore trust. Whilst theme two, ‘the difficult-to-pursue holistic approach,’ describes how disconnected service provision is a barrier to effective treatment for adolescents who experience co-occurring pain and mental health symptoms. The overall results of this qualitative research study highlight a need for clinician education across services to address the lack of understanding of the interactions between pain and mental health symptoms and call for an integrated, holistic approach when treating co-occurring symptoms. In Chapter 5, I present a scoping review to uncover emerging evidence that informs practice in the field of chronic pain and mental health, while also identifying any existing knowledge gaps. Results of the scoping review, which only identified two relevant articles, unveil that little research surrounding chronic pain and primary psychological disorders is being conducted. Thus, little is known about the specific challenges to functioning in adolescents with these co-occurring conditions.

Findings from this doctoral research may help advance our understanding of the specific challenges experienced by adolescents with co-occurring pain and mental health symptoms and provide further guidance to future research surrounding the need to investigate primary psychological disorders in an adolescent chronic pain population. These findings also provide evidence to advance the adoption of an integrated, holistic approach within clinical practice and education for professionals treating adolescents who experience both pain and mental health symptoms. This integrated, holistic approach would ensure clinicians are adequately equipped to effectively assess and treat adolescents with co-occurring chronic pain and mental health symptoms.

Date of Award	24 Apr 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Abbie Jordan (Supervisor), Line Caes (Supervisor) & Chris Eccleston (Supervisor)