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From PHQ-2 to SRS-22: how a depression screening tool relates to SRS scores in patients with adolescent idiopathic scoliosis

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Abstract

Purpose

The aim of our study was to determine the relationship between Patient Health Questionnaire (PHQ) scores—a simple, validated depression screening tool—and Scoliosis Research Society (SRS)-22 questionnaire scores in patients with idiopathic scoliosis (IS).

Methods

IS patients screened for depression with the PHQ-2 who completed the SRS-22 over a 2-year period were reviewed. If PHQ-2 scores were positive (> 3), the more comprehensive PHQ-9 was administered. Median SRS-22 scores between positive and negative PHQ screens were compared. Nonparametric correlation between PHQ and SRS-22 Mental Health (MH) domain was performed. The ability of the MH domain to discriminate between patients with positive versus negative screens and patients with moderate–severe depression risk versus no–mild risk was evaluated with ROC analysis.

Results

521 patients were included. Patients with + PHQ-2 screens had significantly lower total and individual domain SRS scores, especially within the MH domain (4.0 vs. 3.2). For those with moderate-severe depression risk, total and individual domain scores were also significantly lower (MH domain, 4.0 vs. 3.0, p < 0.05). A weak, but significant correlation was observed between the PHQ and MH domain scores (rho = 0.32, p < 0.001). A cut-off of ≥ 3.6 on the MH domain demonstrated sensitivity of 0.75 and specificity of 0.86 for identifying patients at no–mild risk for depression.

Conclusion

Recognizing mental health conditions is critical to successful IS treatment as psychosocial conditions can negatively affect treatment outcomes. IS patients scoring < 3.6 on the SRS-22 MH domain should be considered for depression screening due to an increased risk of moderate–severe depression.

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Funding

No external funding was received for this study. This study was supported by the Division of Orthopedics & Scoliosis, Rady Children’s Hospital, San Diego.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Health System, 3000 Erwin Road, Durham, NC, 27705, USA

    Anthony A. Catanzano

  2. Division of Orthopedics and Scoliosis, Rady Children’s Hospital, San Diego, CA, USA

    Peter O. Newton, Carrie E. Bartley & Tracey P. Bastrom

  3. School of Medicine, University of California, San Diego, CA, USA

    Vrajesh J. Shah

  4. Department of Orthopedics and Sports Medicine, Seattle Children’s Hospital, Seattle, WA, USA

    Burt Yaszay

Authors
  1. Anthony A. Catanzano
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  2. Peter O. Newton
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  5. Carrie E. Bartley
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  6. Tracey P. Bastrom
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Contributions

Conception or design of the work; or Acquisition, analysis, or interpretation of data for the work: AAC, PON, VJS, BY, CEB, TPB. Drafting or critically revising the work: AAC, PON, VJS, BY, CEB, TPB. Final approval of the version to be published: AAC, PON, VJS, BY, CEB, TPB.

Corresponding author

Correspondence to Anthony A. Catanzano.

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Conflict of interest

Anthony A. Catanzano, Jr., MD. No conflicts. Peter O. Newton, MD No funding was received for this work. Disclosures outside of the submitted work include: DePuy Synthese Spine: Grant paid to institution/research support, royalties or licenses paid to me, consulting fees, speakers bureau, payment for development of educational programs, patents: Anchoring systems and methods for correcting spinal deformities (8540754); Low profile spinal tethering systems (8123749); screw placement guide (79811117); compressor for use in minimally invasive surgery (7189244). Scoliosis Research Society: Grant paid to institution, board membership. EOS Imaging: Grant paid to institution. Nuvasive: Grant paid to institution. Orthopediatrics: Grant paid to institution. Stryker/K2M: Grant paid to institution, royalties or licenses paid to me, consulting fees, patent: Posterior spinal fixation. Alphatech: Grant paid to institution. Mazor Robotics: Grant paid to institution. Setting Scoliosis Straight Foundation: Grants paid to institution, board membership (unpaid). Thieme Publishing: Royalties or licenses paid to me. Cubist: Consulting fees, participation on a Data Safety Monitoring Board. Mirus: Consulting fees. Globus Medica: Consulting fees. Pacira: Consulting fees. International Pediatric Orthopedic Think Tank: Board membership (unpaid). Electrocore: Stock or stock options. Rady Children’s Specialists of San Diego: Board membership (unpaid). Vrajesh J. Shah, BS No conflicts. Burt Yaszay, MD No funding was received for this work. Disclosures outside of the submitted work include: Biogen: Paid consultant. DePuy, A Johnson & Johnson Company: Paid consultant; Paid presenter or speaker; Research support to institution. Globus Medical: IP royalties. Stryker/K2M: Paid consultant; Paid presenter or speaker; Research support to institution. Nuvasive: IP royalties; Paid consultant; Research support to institution. Orthopediatrics: IP royalties. Pacira: Paid consultant. Medtronic: Paid consultant. POSNA: Board or committee member. Scoliosis Research Society: Board or committee member. Spine Deformity: Editorial or governing board. Children’s University Medical Group: Board membership (unpaid). Setting Scoliosis Straight: Board membership (unpaid). Global Spine Outreach: Research support to institution; Board membership (unpaid). Carrie E. Bartley, MA No conflicts. Tracey P. Bastrom, MA No conflicts.

Ethical statement

IRB approval was obtained for this study.

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This study was conducted at Rady Children’s Hospital, San Diego, CA, USA

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Catanzano, A.A., Newton, P.O., Shah, V.J. et al. From PHQ-2 to SRS-22: how a depression screening tool relates to SRS scores in patients with adolescent idiopathic scoliosis. Spine Deform 12, 125–131 (2024). https://doi.org/10.1007/s43390-023-00759-x

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