Abstract
Background:
We have limited understanding of the connections between pediatric orthopedics and sports medicine and mental health. While orthopedic disorders and injuries can cause mood disturbance, trauma-related symptoms, anxiety, and diminished quality of life, the factors determining these associations are understudied. Mental health screeners such as the Patient Health Questionnaire (PHQ), the General Anxiety Disorder (GAD) scale, and the Patient-Reported Outcomes Measurement Information System (PROMIS) have been validated for use in pediatric populations. However, there remains a dearth of research examining best treatment practices and process for implementation of screening in the context of subspeciality care such as pediatric orthopedics.
We performed a retrospective cohort study of mental health diagnoses in a tertiary pediatric orthopedics referral center to improve understanding of factors associated anxiety and depression in young people with orthopedic disorders.
Hypothesis:
We hypothesized higher prevalence of anxiety, and depressive disorders in pediatric orthopedic and sports medicine patients.
Methods:
We reviewed records in our electronic data warehouse for patients ages 6-26 years seen in Indiana University Orthopedic Surgery and Sports Medicine from 2020-2024. We built three cohorts:
Cohort 1: Patients with co-occurring physical and mental health diagnoses including anxiety, depression, panic disorder, psychological factors impacting medical disorder, acute stress reaction, and PTSD diagnosed by PCP and entered as ICD-10 codes.
Cohort 2: Patients endorsed symptoms of anxiety and depression through a positive screening test (e.g., PHQ and GAD) at their PCP.
Cohort 3: Patients seen in Pediatric Orthopedics who were part of either Cohort 1 or Cohort 2, and thus diagnosed with anxiety, depression, or a similar disorder.
Results:
From January 2020 to December 2024, 61,978 patients were seen in Orthopedic Surgery and Sports Medicine and of those patients 11,460 (Cohort 1) were diagnosed with anxiety, depression, an adjustment or trauma disorder. 24,596 had screening completed at previous PCP appointment and of those, 13,659 (Cohort 2) screened positive for anxiety and depression. In total, 17,575 (Cohort 3) patients were diagnosed or screened positive for co-occurring mental health conditions. This represents a prevalence of ~ 28.4% in our population.
Conclusion:
We found a very high prevalence (28.4%) of anxiety, depression, and related mental health diagnoses in pediatric orthopedics. This represents a rate higher than the general population (2-8%), and also higher than the pediatric chronic disease population (15-17%). Young people with orthopedic disorders represent a uniquely vulnerable population. Future work should focus on identifying risk factors for mental health disorders.