The role of activity restriction in the association between pain and depression: A study of pediatric patients with chronic pain

Research provides ample evidence that children with chronic and debilitating medical illnesses are at increased risk for psychological and psychosocial maladjustment. Functional impairment is believed to contribute to psychosocial distress in pediatric populations, yet little is known about the specific factors that predict increased risk. Results from the total sample (N = 73) supported a conceptual model specifying that restriction of normal activities (e.g., playing with friends, attending school) would mediate the association between chronic pain and symptoms of depression. However, this process differed somewhat in preadolescent and adolescent patients. That is, among younger children (5-12 years of age), pain predicted activity restriction, which, in turn, predicted depressed affect, and activity restriction mediated the association between pain and depressed affect. In contrast, among older children (ages 13-18), activity restriction did not serve an analogous mediating role because pain was not associated with symptoms of depression in this group. Instead, pain exerted direct effects on activity restriction, and activity restriction exerted direct effects on depressed affect.