Factors Protecting Against Co-Occurring Pain, Psychological, and Somatic Symptom Trajectories in Adolescence

To determine the relative impact of multilevel protective factors on co-occurring pain, psychological, and somatic symptom (co-PPSS) trajectories from late childhood through early adolescence.

We conducted secondary analyses of longitudinal Adolescent Brain Cognitive Development (ABCD) Study data collected from 2016 to 2023. Youth were classified into asymptomatic, low/stable, moderate/persistent, and high/worsening co-PPSS trajectories derived from annual parent-reported symptom data. Child (coping skills), family (parental wellbeing, parental acceptance, family harmony), and peer-level (peer acceptance, prosocial behavior) protective factors were assessed across years using youth- and parent-reported surveys. Multinomial logistic regression examined the association of these factors with risk of higher co-PPSS trajectories. We report standardized adjusted relative risk ratios (adj.RRR) with 95% confidence intervals ([CIs]).

We included data from 8,817 youth (aged 9.92±0.63 yrs. at baseline, 14.08±0.68 at year five), 2,270 (25.8%) and 677 (7.7%) of whom were classified with moderate/persistent or high/worsening co-PPSS trajectories. Apart from parental wellbeing and prosocial behavior, each protective factor was associated with a reduced relative risk for a high/worsening and moderate/persistent trajectory. Higher parental acceptance was associated with a 28% (RRR 0.72 [CI 0.66, 0.79]) and 15% (RRR 0.85 [CI 0.80, 0.92]) reduced relative risk for a high/worsening and moderate/persistent co-PPSS trajectory, respectively. High (vs. low) peer acceptance was also associated with reduced relative risk for the high/worsening (RRR 0.34 [0.27, 0.42]) and moderate/persistent (RRR 0.48 [0.40, 0.56]) trajectories.

Findings underscore the potential importance of enhancing youths' family support, coping, and positive peer relationships to co-PPSS resilience.