Clinical Reference Points for the Screen for Child Anxiety-related Disorders in 2 Investigations of Youth With Chronic Pain

Clin J Pain. 2019 Mar;35(3):238-246. doi: 10.1097/AJP.0000000000000667.


Objective: Anxiety is common in pediatric chronic pain and is related to a higher risk for poor outcomes; thus, there is a need for effective clinical screening methods to identify youth with chronic pain and co-occurring anxiety. The Screen for Child Anxiety-related Disorders (SCARED) is a validated measure that defines clinically significant anxiety using the traditional clinical cut-off, but in pain populations, may fail to screen in youth with subclinical anxiety that may also be at increased risk. Two studies aimed to devise a clinically meaningful approach to capture anxiety severity in pediatric chronic pain.

Materials and methods: Study 1 (n=959) and Study 2 (n=207) were completed at 2 separate pediatric pain clinics, where the SCARED was administered along with measures of disability, activity limitations, pain intensity, quality of life, and pain catastrophizing. Groups with different levels of anxiety were compared on clinical outcomes via multivariate analyses of variance or independent samples t tests.

Results: A tertile solution suggested the following anxiety groupings based on the SCARED: minimal (0 to 12), subclinical (13 to 24), and clinical (≥25). Across both studies, the tertile solution was generally superior in classifying different levels of pain-related outcomes.

Discussion: Future directions include testing the utility of this anxiety classification system to identify youth with subclinical levels of anxiety for early intervention focused on both pain and anxiety management.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anxiety / classification
  • Anxiety / complications
  • Anxiety / diagnosis
  • Anxiety Disorders / classification
  • Anxiety Disorders / complications*
  • Anxiety Disorders / diagnosis*
  • Child
  • Chronic Pain / complications*
  • Chronic Pain / diagnosis
  • Chronic Pain / psychology*
  • Female
  • Humans
  • Male
  • Severity of Illness Index