Adolescent Pain, Anxiety, and Depressive Problems

A Twin Study of Their Co-occurrence and The Relationship to Substance Use

Simona Scaini; Giorgia Michelini; Stefano De Francesco; Corrado Fagnani; Emanuela Medda; Maria Antonietta Stazi; Marco Battaglia

Disclosures

Pain. 2022;163(3):e488-e494.

Abstract and Introduction

Abstract

Data on the etiological factors underlying the co-occurrence of common adolescent pain with anxiety and depression symptoms are very limited. Opioid prescriptions for adolescent pain problems are on the rise in North America and constitute a risk factor for diversion, misuse, and substance use. In this study, we aimed to investigate the phenotypic and etiological association among pain, depression, and anxiety and to test their link to substance use in adolescents. By taking advantage of the Italian National Twin Registry and of the relatively low incidence of opioid prescriptions in Italy, we applied multivariate modelling analyses to 748 Italian adolescent twins (374 pairs, mean age 16 ± 1.24 years). Twins' responses to the Achenbach Youth Self-Report questionnaire were used to build a composite adolescent pain index and to measure anxiety, depression, and substance use. All monozygotic within-pair correlations were higher than the dizygotic correlations, indicating genetic influences for adolescent pain, anxiety, and depressive problems. A common latent liability factor influenced by genetic and environmental elements shared among pain, depression, and anxiety provided the best fit to explain the co-occurrence of adolescent pain, anxiety, and depression problems. A common phenotypic factor capturing all 3 phenotypes was positively associated (β = 0.19,

Abstract and Introduction
Methods
Results
Discussion
References
Appendix

Table 1. Phenotypic and Within-Pair Twin Correlations among variables.
	Affective problems‡ (3.31 ± 2.77)	Anxiety problems (2.75 ± 1.89)	Pain (0.96 ± 1.11)	Substance Use (0.67 ± 1.07)
Phenotypic twin correlations
Affective problems	1	—	—	—
Anxiety problems	0.55*	1	—	—
PAIN	0.36*	0.31*	1	—
Substance use	0.22*	0.06	0.15*	1
Within-pair twin correlations
MZ	0.57*	0.31*	0.19†	0.09
DZ	0.43*	0.20*	0.04	0.07

Mean and SD are presented in parentheses.
*P < 0.01.
†P < 0.05.
‡Within-pair twin correlations are significantly different.
DZ, dizygotic twins; MZ, monozygotic twins.

Table 2. Model-fitting analyses.
Model	Compared with model	ep	−2LL	df	AIC	diffLL	Δdf	P
1. Saturated	—	54	−1852.41	2178	−6208.41	—	—	—
2. Cholesky	1	21	−1817.7	2211	−6239.7	34.71	33	0.39
3. Independent pathway	2	21	−1816.97	2211	−6238.97	—	—	—
4. Common pathway	2	18	−1813.54	2215	−6243.54	4.16	4	0.39
5. Common pathway + drop Cs1, Cs2, Cs3, As2, As3	4	13	−1811.9	2220	−6251.9	1.64	5	0.9

Bold indicates the best-fitting model.
As = specific additive genetic factors (ie, scale-specific additive genetic factors) (1 = affective problems, 2 = anxiety problems, and 3 = pain). Cs = specific shared environmental factors (ie, scale-specific shared environmental factors) (1 = affective problems, 2 = anxiety problems, and 3 = pain).
A, additive genetic factors; AIC, Akaike information criterion; C, shared environmental factors; df, degrees of freedom; Diff.df, difference in degrees of freedom; Diff.LL, difference in twice the negative log-likelihood statistic; E, unique environmental factors; ep, estimated parameters; −2LL, twice the negative log-likelihood statistic.

Table 3. Genetic and environmental contributions accounted for by common and specific factors under the best-fitting common pathway model.
	A_C	A_S	C_C	C_S	E_C	E_S	a2	c2	e2
Affective problems	0.16 (0.00–0.40)	0.22 (0.11–0.33)	0.21 (0.02–0.39)	—	0.20 (0.11–0.32)	0.21 (0.11–0.31)	0.38 (0.15–0.60)	0.21 (0.02–0.39)	0.41 (0.32–0.51)
Anxiety problems	0.12 (0.00–0.31)	—	0.16 (0.02–0.30)	—	0.15 (0.08–0.24)	0.57 (0.48–0.67)	0.12 (0.00–0.31)	0.16 (0.02–0.30)	0.72 (0.62–0.82)
Pain	0.05 (0.00–0.13)	—	0.06 (0.01–0.13)	—	0.06 (0.03–0.11)	0.83 (0.76–0.89)	0.05 (0.00–0.13)	0.06 (0.01–0.13)	0.89 (0.83–0.93)

A_C, additive genetic effects on the common factor; A_S, scale-specific additive genetic effects; a2, total additive genetic effects; C_C, shared environmental effects on the common factor; C_S, scale-specific shared environmental effects; c2, total shared environmental effects; E_C, unique environmental effects on the common factor; E_S, scale-specific unique environmental effects; e2, total unique environmental effects.

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Adolescent Pain, Anxiety, and Depressive Problems

A Twin Study of Their Co-occurrence and The Relationship to Substance Use

Abstract and Introduction

Abstract

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

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