This study assessed levels of depression in youth presenting to a pediatric emergency department (ED) with abdominal, chest, or head pain complaints and examined associations between depression and pain-related impairment. Participants included 238 patients ages 8-17 years old presenting to the ED with abdominal, chest, or head pain who screened negative for mental health risk during ED triage screening. Participants completed depression (via PHQ-9A) and pain-related impairment (via PROMIS Pain Interference) measures after ED triage. In this sample, 27.4% met the threshold for Major Depressive Disorder, approximately 10% reported severe levels of depression or endorsed acute self-harm ideation, and depression severity was positively associated with pain-related impairment. Current results highlight a need to reexamine mental health screening procedures in the pediatric ED and the importance of screening for depression in pediatric patients with pain complaints. Early identification and intervention for depression may help improve pain-related outcomes in this population.