Is There an Association Between Psychiatric Disorders and Adolescent Idiopathic Scoliosis? A Large-database Study

Abstract

Background Children with adolescent idiopathic scoliosis (AIS) have reduced quality of life related to poor self-image, perhaps because of cosmetic concerns. However, there has not been a large-database epidemiologic study on the association between psychiatric disorders and scoliosis. Questions/purposes Using the Korean National Health Insurance database, we asked: (1) How common are psychiatric disorders among children with AIS? (2) After controlling for gender, age, insurance type, and residential district, are psychiatric disorders more common among children with AIS than among age-matched controls? Methods A retrospective analysis was conducted using sample datasets from the Health Insurance Review and Assessment Service from 2012 to 2016, which is a 10% randomly extracted sample of total inpatients and outpatients each year. The mean number of total patients in each dataset was 1,047,603 ± 34,534. The mean number of children with AIS was 7409 ± 158 for each year. The age criteria was 10 to 19 years for the matching. Mood disorders, anxiety disorders, and behavioral disorders were selected as disorders possibly associated with AIS. We identified children with AIS who had any of the disorders above, and we obtained the prevalence of these disorders based on diagnostic codes. As an exploratory analysis, clinically meaningful variables were selected among the available codes in the dataset, and a univariable logistic regression test was performed for each variable. A multivariable logistic regression test with advanced variables was performed to identify the adjusted odds ratios of psychiatric disorders in children with AIS. Results The median (range) prevalence of psychiatric disorders in children with AIS from 2012 to 2016 was 7% (6% to 7%). Compared with children who did not have AIS, and after controlling for gender, age, insurance type, and residential district, children with AIS were more likely to have psychiatric disorders in all 5 years. The adjusted ORs of psychiatric disorders in children with AIS compared with children who did not have AIS ranged from 1.47 to 1.74 (2012: OR 1.60 [95% CI 1.46 to 1.75]; p < 0.001; 2013: OR 1.73 [95% CI 1.58 to 1.89]; p < 0.001; 2014: OR 1.74 [95% CI 1.59 to 1.91]; p < 0.001; 2015: OR 1.71 [95% CI 1.56 to 1.88]; p < 0.001; 2016: OR 1.47 [95% CI 1.33 to 1.62]; p < 0.001). Conclusion Considering the higher prevalence of psychiatric disorders in children with AIS compared with children who did not have AIS, children with AIS and their parents should be counseled about the increased risk of deteriorating mental health of the patients, and surgeons should provide early referral to pediatric psychiatrists. Further studies should investigate the effect of the factors related to AIS, such as curve type, Cobb angle, and treatment modality. Level of Evidence Level III, prognostic study.

Disordered Eating and Body Image Concerns in Young Adult Women With Scoliosis

“…Considering elevated problems with self-image and body shape, clinicians who work with young adult women with scoliosis should routinely assess for mental health difficulties in this population, which may facilitate the early identification of young adult women with scoliosis who can benefit from psychological interventions. 38 Cognitive-behavioral interventions may help young adult women with scoliosis develop coping mechanisms for addressing physical pain and psychosocial problems. While in the current study the temporal association between mental health problems and disordered eating was not able to be determined, it is likely that diminished mental health not only serves as risk factor for emerging disordered eating, but also continues to be adversely impacted as an individual develops more severe disordered eating.…”

Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review

“…1 2 During and after diagnosis, affected patients and their caregivers report numerous physical, psychological, and social care needs. [1][2][3][4] Effective management of scoliosis therefore requires holistic care that addresses these complex needs-failing to do so can lead to poor physical and mental health outcomes. 1 3 5 Several systematic reviews have been published on surgical, bracing, and exercise interventions to improve outcomes in pediatric patients with adolescent idiopathic scoliosis (AIS).…”

“…Scoliosis can dramatically alter a child or adolescent’s daily life 1 2. During and after diagnosis, affected patients and their caregivers report numerous physical, psychological, and social care needs 1–4. Effective management of scoliosis therefore requires holistic care that addresses these complex needs—failing to do so can lead to poor physical and mental health outcomes 1 3 5…”

Academic-related factors and daily lifestyle habits associated with adolescent idiopathic scoliosis: a case-control study

“…Patients with mild or moderate AIS are usually asymptomatic. Nevertheless, as the curvature progresses, severe spinal deformity and the resulting surgical treatment [ 3 ] may induce lasting negative physical [ 1 , 7 , 8 ], psychological [ 9 , 10 ] and socioeconomic consequences [ 11 , 12 ]. Therefore, early detection, diagnosis and treatments are necessary and the research on the etiology is of great importance for identifying high-risk population and formulate tailored prevention.…”