CHRONIC ABDOMINAL PAIN AND DEPRESSIVE SYMPTOMS IN ADOLESCENTS: AN INSTITUTIONAL CROSS-SECTIONAL STUDY FROM PUDUCHERRY, INDIA

Abstract

Background & Aims: Abdominal pain is common in adolescence, yet the association between frequent abdominal pain and depressive symptoms remains poorly characterized in Indian adolescents. This study aimed to determine the prevalence of depressive symptoms in adolescents with frequent abdominal pain and examine associated functional impairments. Methods: A prospective cross-sectional study was conducted at the Department of Pediatrics, Sri Lakshmi Narayana Institute of Medical Science Medical College & Hospital, Puducherry, India. A total of 950 adolescents aged 13-18 years (mean age, 16.3 ± 1.8 years; 48% male) completed structured interviews and self-administered questionnaires. Depressed mood was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Abdominal pain frequency over the previous year was categorized as rare (0-1 episode/week), occasional (2-3 episodes/week), or daily (>4 episodes/week). Results: Daily abdominal pain was reported in 4.8% of adolescents, with 15.3% reporting occasional pain. Overall, 18.2% of adolescents demonstrated significant depressive symptoms (CES-D score

≥23). The risk for depression increased dramatically from 4.5% with rare pain to 41.3% with daily pain (p<0.001), representing a 9-fold increase. Adolescents with daily pain were significantly more likely to miss school 10 or more days annually (43.5% vs. 18.5%, p<0.001), report reduced social participation, and experience multiple depressive symptoms including sadness, loneliness, and fatigue. Multivariate logistic regression identified daily pain as the strongest independent predictor of depression (adjusted OR=13.2, 95% CI: 6.1-28.6). Female adolescents demonstrated higher depression prevalence (21.4% vs. 14.8% in males), with a female-to-male ratio of 2.2:1 among those with daily pain and depression. Conclusions: Adolescents with frequent abdominal pain demonstrate substantially elevated risk for depressive symptoms and significant functional impairments in school attendance and social functioning. Chronic abdominal pain should be recognized as a pain syndrome with important psychosocial sequelae, warranting integrated multidisciplinary management including mental health screening and intervention. Early recognition and treatment may prevent progression to severe mood disorders and reduce long-term psychiatric morbidity.