Self-Reported Psychological Distress in Adolescent and Young Adult Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion

BACKGROUND: Patients with scoliosis are at risk of psychological distress, which may influence outcomes following corrective surgery. Using Patient-Reported Outcomes Measurement Information System (PROMIS) measures, we aimed to determine the prevalence of self-reported anxiety and depression in adolescent and young adult patients preparing for posterior spinal fusion (PSF), evaluate their association with postoperative outcomes, assess overlap with pre-existing diagnoses, and examine relationships between PROMIS and Scoliosis Research Society (SRS-22r) measures. METHODS: A cohort of patients aged 11 to 26 with adolescent idiopathic scoliosis (AIS) or young adult idiopathic scoliosis (yAdIS) undergoing PSF were retrospectively enrolled at a single academic medical center between 2019 and 2025. Patients completed PROMIS and SRS-22r instruments preoperatively and at ∼6 weeks postoperatively. Self-reported psychological distress was defined using established PROMIS T-score thresholds for anxiety and depression, while clinical diagnoses were abstracted from the medical record. RESULTS: Of 103 patients completing preoperative PROMIS assessments, 76% (n=78) completed follow-up. Preoperative rates of self-reported depression and anxiety were 27% and 52%, respectively, compared with clinical diagnosis rates of 7% and 16%. Female sex and older age were associated with self-reported anxiety. PROMIS anxiety scores significantly improved postoperatively (Δ-3.4±8.6, P=0.001). SRS-22r self-image improved (Δ+1.1±0.8), while function (Δ-0.7±0.8, P<0.0001) and pain scores (Δ-0.4±0.9, P<0.0001) worsened postoperatively. Higher preoperative anxiety and depression scores correlated with worse postoperative pain interference, physical function, self-image, and functional SRS-22r scores, and independently predicted worse SRS-22r self-image and function after multivariable adjustment. CONCLUSIONS: Self-reported psychological distress is prevalent among adolescent and young adult patients preparing for spinal fusion, with over half endorsing anxiety and/or depression preoperatively. Although distress improved following surgery, worse baseline anxiety and depression scores independently predicted poorer short-term functional and self-image outcomes. LEVEL OF EVIDENCE: Level III: retrospective cohort study.