A novel analysis of more than 375 published studies concluded that the association between chronic pain and rates of depression and anxiety is staggering.

The study, led by investigators at Johns Hopkins Medicine, found that 40% of adults with chronic pain experienced “clinically significant depression and anxiety.” Among those most at risk, the analysis showed, were women, younger adults and people with fibromyalgia.

For decades, research has provided evidence of clear links between pain and mood, but the new study’s leaders say the co-occurrence levels they identified pose a significant public health concern that should require routine screening in clinical settings, better access to specialty care and development of innovative therapies.

Historically, studies show that people with chronic pain and both depression and anxiety lack consistent access to specialized pain clinics focused on acute pain, and are routinely excluded from clinical trials for pain management.

“Right now, we have effective psychological treatments for depression and anxiety, and effective psychological treatments for chronic pain, but these treatments are often siloed. In fact, many studies exclude people with chronic pain who have depression or anxiety from clinical trials. We need integrated treatments that address chronic pain and mental health together,” says Rachel Aaron, first author of the study, which appears in JAMA Network Open.