Clinical predictors of psychological distress in patients presenting for evaluation of a spinal disorder

Abstract

Background context: Psychological distress has been shown to adversely affect the treatment outcomes of many spinal disorders. Most physicians do not routinely use psychological screening questionnaires. Additionally, physicians have not performed well when assessing patients for psychological distress while using clinical impression alone.

Purpose: The purpose of our study was to evaluate the clinical factors that most accurately predict the presence of psychological distress in patients presenting for the evaluation of a spinal disorder.

Study design: This is a retrospective study.

Patient sample: Three hundred eighty-eight consecutive patients presented for an initial evaluation of a spinal disorder at a tertiary spine clinic.

Outcome measures: Oswestry disability index (ODI), visual analog scale (VAS), and distress risk assessment method (DRAM).

Methods: Three hundred eighty-eight consecutive patients presenting for the evaluation of a spinal disorder with a completed DRAM, ODI, and VAS were evaluated. The DRAM was used to classify the patients' level of psychological distress. Clinical variables such as history of depression, use of antidepressants, use of other psychotropic medications, history of surgery, and history of chronic pain syndromes along with ODI and VAS scores were used to develop a model to predict a patient's level of psychological distress.

Results: Our model was highly accurate (92%), sensitive (92%), and specific (95%) in predicting a patient's level of psychological distress. If patients' VAS is 4 or 5, their ODI is less than 45, and they are not on any psychotropic medications, they likely will fall into the normal group. Patients with a VAS greater than 7, currently taking antidepressants or other psychotropic medications, an ODI greater than 58, and a history of surgery are likely to fall into the higher distressed categories of distressed depressive or distressed somatic.

Conclusions: A patient's clinical history, ODI, and VAS scores can predict their level of psychological distress. In general, patients with higher VAS pain scores, higher ODI scores (>58), and those taking an antidepressant or another psychotropic medication were likely to have high levels of psychological distress. The predictive clinical factors noted in this study are readily available to most physicians treating spinal disorders and may be helpful in improving their ability to detect patients with psychological distress, counseling them on realistic outcomes, and possibly improve their treatment outcomes.

Keywords: Anxiety; Clinical predictors; Depression; Distress Risk Assessment Method; Oswestry Disability Index; Outcomes measurements; Psychological distress; Spinal disorders; Visual analog scale.