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J Pain. 2013 Jul;14(7):689-98. doi: 10.1016/j.jpain.2013.01.777. Epub 2013 Apr 30.

Factor structure of the children's depression inventory in a multisite sample of children and adolescents with chronic pain.

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  • 1Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Department of Psychiatry, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.


This study examined the factor structure of the Children's Depression Inventory (CDI) among children and adolescents with chronic pain using exploratory and confirmatory factor analysis in a large, multisite sample of treatment-seeking youth. Participants included 1,043 children and adolescents (ages 8-18) with a range of chronic pain complaints who presented for initial evaluation at 1 of 3 tertiary care pediatric chronic pain clinics across the United States. They completed the CDI and reported on pain intensity and functional disability. Factor analysis was conducted using a 2-step (exploratory and confirmatory) approach. Results supported a 5-factor model for the CDI with good fit to the data. The distribution and item-total correlations of the somatic items (eg, pain complaints, fatigue) were explored in this sample. Results indicate that the CDI is a useful tool for assessing depressive symptoms in youth with chronic pain, but some caution is warranted in interpreting the clinical significance of scores in light of the overlap of specific symptoms common to both pain and depression.


The CDI can be considered a valid tool for assessing mood symptoms in children with chronic pain. Caution is encouraged when interpreting the clinical significance of scores due to symptom overlap between chronic pain and depression.

Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

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