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

Objective: 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. Methods: 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]). Results: 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. Discussion: Findings underscore the potential importance of enhancing youths’ family support, coping, and positive peer relationships to co-PPSS resilience.