Perceived social support and mental health in adolescent idiopathic scoliosis: mediating effects of resilience

Adolescents with idiopathic scoliosis (AIS) experience elevated risks of psychological distress, yet the psychosocial mechanisms underlying this burden remain insufficiently understood. This study aimed to determine the prevalence of psychological distress in adolescents with AIS and to investigate the roles of perceived social support and resilience as protective factors. In this cross-sectional study, 229 adolescents aged 12-18 years with confirmed AIS were recruited from a tertiary spine surgery center. Participants completed the Symptom Checklist-90 (SCL-90), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Connor - Davidson Resilience Scale (CD-RISC). Socio-demographic and clinical data were recorded. The prevalence of clinically significant psychological distress (SCL-90 ≥ 160) was determined. Mediation analysis was conducted using structural equation modeling with bias-corrected bootstrapping (5,000 samples) to test the indirect effect of resilience between perceived social support and psychological distress. The median age was 14 years, and 73.8% were female. Clinically significant psychological distress was present in 55.0% of participants. There was no significant difference in mean SCL-90 scores by gender (female: 137.4 ± 36.1 vs. male: 141.1 ± 37.8, <i>p</i> = 0.497) or residence (<i>p</i> = 0.712). Adolescents from families with monthly income < 3,000 CNY had higher prevalence of psychological distress (65.1%) compared to those from families ≥3,000 CNY (34.1%, <i>p</i> = 0.001). Higher MSPSS and CD-RISC scores were each significantly associated with lower SCL-90 scores (<i>r</i> = -0.44 and <i>r</i> = -0.47, <i>p</i> < 0.001). SEM revealed that resilience partially mediated the relationship between perceived social support and psychological distress (indirect effect: β = -0.19, 95% CI: -0.28 to -0.11, <i>p</i> < 0.001). Model fit indices were excellent (CFI = 0.984, RMSEA = 0.046). Over half of adolescents with AIS experience significant psychological distress. Higher perceived social support and resilience are associated with better mental health outcomes, and resilience partially mediates the impact of social support.