Clinically Significant Psychological and Emotional Distress in 32% of Adolescent Idiopathic Scoliosis Patients

Abstract

Study design: Prospective study of 92 patients.

Objectives: To determine if the incidence of clinically significant psychological and emotional distress in adolescent idiopathic scoliosis (AIS) patients is higher than the general population and if this correlates with deformity severity.

Summary of background data: Adolescents with scoliosis may exhibit a less positive outlook on life, suffer from lower self-esteem, and have more difficulty connecting with peers; however, there is conflicting evidence whether different stages of treatment prompt different psychological problems and the long-term psychological effect of scoliosis.

Methods: Patients aged 12-21 years with a diagnosis of AIS were included. The Behavioral Assessment System for Children, Second Edition (BASC-2), is a validated 139-item survey normed on more than 1 million children in the United States. It can detect clinical and subclinical levels of psychosocial problems in five domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. The BASC-2 self-report form was completed by 92 adolescents with AIS (mean age = 14 years; range 12-18) and a parent. BASC-2 scale scores were compared to validated age-matched normative data. Comparisons were made between those undergoing surgery (n = 31), bracing (n = 31), or observation (n = 30) at the start of treatment.

Results: 32% (29/92) of patients scored in the clinically significant range in at least one of the subscales. There were no clinically significant emotional or behavioral differences when stratified by treatment type (p = .560), Cobb angle (0.630), or age (0.313). Twenty-one percent (19/92) of parent responses deemed their kids as having clinically significant emotional or behavioral differences. In only 34% (10/29) of the cases did children and parent concurrently report clinically significant psychological difficulties, such that 66% of parents were unaware that their child has clinically significant emotional or behavioral problems.

Conclusions: AIS patients undergoing observation, bracing, and surgery are all at risk for clinically significant psychological symptoms.

Level of evidence: Level II.

Keywords: Adolescent idiopathic scoliosis; BASC-2 Behavioral Emotional Screening; Parent report; Psychosocial risk; Self report.