woman holding head with chronic pain
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In the peer-reviewed journal article “Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis,” published in March 2025, a group of researchers designed a study to explore the association between chronic pain and mental health. This is an important topic because previous evidence shows the presence of chronic pain can exacerbate mental health symptoms, and the presence of mental health disorders can exacerbate the experience of chronic pain.

We’ve published an article on this topic before:

Anxiety, Depression, and Chronic Pain

However, that article used data from a single source, whereas the article we introduce above – a meta-analysis – examined data from 376 studies conducted in 50 countries with data on almost 350,000 patients with chronic pain. Here’s the stated goal of this new research:

“To evaluate the prevalence of depression and anxiety among adults with chronic pain and identify factors that moderate prevalence.”

Upon a review of the existing data, the researchers launched the study for this reason:

Depression and anxiety are common among adults with chronic pain, but their prevalence is unclear.

We’ll share the data from the new study and compare it to the data in our previous article to learn whether the meta-analysis uncovered different results, and what those results might mean for supporting people with co-occurring chronic pain and mental health disorders. If results show demonstrable associations between chronic pain and mental health, and identify factors that impact prevalence of mental health disorders among people with chronic pain, then we can incorporate this new information into our comprehensive treatment plans.

Prevalence of Anxiety and Depression Among People with Chronic Pain

First, let’s define chronic pain as pain that lasts for three months or longer. Studies show that around 21% of adults in the U.S. experience chronic pain. Research shows the consequences of chronic pain include, but are not limited to:

  • Sleep
  • Cognition
  • Brain function
  • Mood/mental health
  • Cardiovascular health
  • Sexual function
  • Quality of life

It’s important to take a moment to try to understand what being in pain all the time for over three months is like. Think about an injury that involves pain, like a sprained ankle, a cut, or a burn. At first, it hurts. In some cases, the pain is significant. But if the injury is not very serious, the pain begins to fade quickly – within a day or so and may be gone within a week for cut or a burn, or possibly two weeks to a month for something like a sprained ankle. And even so, the pain gradually subsides during that time.

Chronic pain is different: it may not fade and it doesn’t go away. Hence the name. Can you imagine being in significant pain for longer than three months?

That’s what the 21% of adults in the U.S. with chronic pain experience every day of their lives. Upon reflection, it’s easy to see how chronic pain can lead to the negative consequences we list above. Now let’s look at the primary outcomes of the study we introduce above.

Mental Health Issues and Chronic Pain

Among adults with chronic pain:

  • Prevalence of depressive symptoms: 39.3%
  • Prevalence of depressive disorders:
    • Major depressive disorder (MDD): 36.7%
    • Persistent depressive disorder (PDD): 6.3%
  • Prevalence of anxiety symptoms: 40.2%
  • Prevalence of anxiety disorders:
    • Generalized anxiety disorder (GAD): 16.7%
    • Panic disorder (PD): 7.5%
    • Seasonal affective disorder (SAD): 2.2%

Those are the big picture figures. Next, we’ll look at what factors impact the presence of mental health issues among people with chronic pain.

Chronic Pain and Mental Health: Mediating Factors

A mediating factor, as we imply above, is a factor that influences the relationship between two variables in an experiment. In this study, researchers identified factors that influenced the relationship between chronic pain and mental health.

Among adults with chronic pain, mediating factors included specific pain condition, age, and gender. Here we list the mediating factors resulting that increased mental health issues:

Highest: Fibromyalgia
  • Depression: 54.0% of patients with fibromyalgia had depression
  • Anxiety: 55.5% of patients with fibromyalgia had anxiety
Lowest: Arthritis
  • Depression, 29.1% of patients with arthritis had depression
  • Anxiety, 17.5% of patients with arthritis had anxiety
Highest by Age: Younger People
  • Younger people showed higher rates of depressive symptoms
  • Younger people showed higher rates of anxiety symptoms
Highest by Gender: Women
  • Major depressive disorder (MDD): 36.7% of women with chronic pain had MDD
  • Generalized anxiety disorder (GAD): 16.7% of women with chronic pain had GAD

We’ll discuss these results below.

Chronic Pain and Mental Health: How This Information Helps

When we compare the prevalence rates on the co-occurrence of chronic pain and mental health disorders such as anxiety and depression reported in this study with those reported previously, we see significant differences. While previous studies here and here show rates of co-occurrence between 5 percent and 30 percent, this large-scale meta-analysis, with a sample set ten times greater than the studies in those links, show rates of co-occurrence of around 40 percent for both chronic pain and anxiety and chronic pain and depression.

Those differences help because they offer us the most reliable data to date on the prevalence of co-occurring chronic pain and anxiety/depression. The takeaway here, for providers, is that among people with chronic pain, the prevalence of mental health disorders is greater than previously reported.

Therefore, when patients assessed by mental health providers present with anxiety or depression, those providers can inquire about the presence or absence of chronic pain. And when patients assessed by physicians present with chronic pain, those physicians can inquire about the presence of mental health symptoms related to anxiety and/or depression.

In both cases, providers can make referrals for appropriate treatment, since chronic pain and mental health symptoms can exacerbate one another, i.e. the presence of can increase symptoms of the other.

There is good news for people with co-occurring chronic pain and anxiety, co-occurring chronic pain and depression, and co-occurring chronic pain + anxiety and depression. Two types of psychotherapy can help patients with any combination of these co-occurrences:

Both these techniques can help patients identify patterns of thought, emotion, and behavior that impact pain and mental health, and learn strategies, techniques, and skills to mitigate negative symptoms, improve daily function, and enhance overall wellness and wellbeing.

Finding Support: Resources

If you or someone you know needs professional treatment and support for a mental health disorder, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources: