National mental health burden in adults with spinal deformity: a propensity-matched analysis using the All of Us Research Program.

PURPOSE: Adult spinal deformity (ASD) is a chronic musculoskeletal condition characterized by abnormal spinal curvature and adverse psychological well-being. However, the mental health burden of ASD remains poorly characterized. This retrospective cross-sectional cohort study compared the prevalence and odds of mental health conditions in the ASD population to a matched general population cohort using the nationally representative All of Us Research Program.

METHODS

ASD patients (n = 6531) were identified using ICD-9/10. Using 1:1 nearest neighbor propensity matching without replacement (caliper = 0.05), 6396 ASD patients were matched to 6396 general population controls. Logistic regression was performed to compute odds ratios (OR) and 95% confidence-intervals (CI) for mental health outcomes.

RESULTS

After matching, mean age was 58.0 and 76% were female. Compared to the general population, ASD patients had higher unadjusted rates of depression (37.6% vs. 11.3%), anxiety (41.6% vs. 12.1%), post-traumatic stress disorder (PTSD) (7.2% vs. 2.2%), bipolar disorder (7.1% vs. 2.1%), schizophrenia/psychosis (2.4% vs. 0.9%), substance use disorders (24.3% vs. 9.7%), eating disorders (1.4% vs. 0.4%), and attention-deficit hyperactivity disorder (ADHD) (5.3% vs. 1.4%). On logistic regression, ASD patients had higher odds of depression (OR = 2.06, CI = 1.90-2.23, P < 0.001), anxiety (OR = 2.24, CI = 2.07-2.43, P < 0.001), and ADHD (OR = 2.87, CI = 2.32-3.54, P < 0.001). ASD patients also exhibited significantly elevated odds for eating disorders, bipolar disorder, PTSD, and substance use disorder (P < 0.05).

CONCLUSIONS

ASD patients in the United States have a substantially elevated mental health burden than the general populace. Routine mental health screenings and psychological assessments can be beneficial for this vulnerable population.