Introduction

Children with adolescent idiopathic scoliosis (AIS) have reduced quality of life related to poor self-image, perhaps because cosmetic concerns. However, there has not been a large-database epidemiologic study on the association between psychiatric disorders and scoliosis. Using the Korean National Health Insurance database, we asked: (1) How common are psychiatric disorders among children with AIS? And (2) After controlling for gender, age, insurance type, and residential district, are psychiatric disorders more common among children with AIS than among age-matched controls?

Methods

A retrospective analysis was conducted using sample datasets from the Health Insurance Review and Assessment Service from 2012 to 2016, which is a 10% randomly extracted sample of total inpatients and outpatients each year. The mean number of total patients in each dataset was 1,047,603±34,534. The mean number of children with AIS was 7409±158 for each year. Age criteria of 10 to 19 years was applied for the matching. Mood disorders, anxiety disorders, and behavioral disorders were selected as possibly associated disorders with AIS. Children with AIS who had any of the disorders above were identified, and prevalence was obtained based on diagnostic codes. As an exploratory analysis, clinically meaningful variables were selected among the available codes in the dataset, and univariable logistic regression test was performed for each variable. Multivariable logistic regression test with advanced variables was performed to identify the adjusted odds ratios (OR) of psychiatric disorders in children with AIS.

Results

The mean prevalence of psychiatric disorders in children with AIS from 2012 to 2016 was 6.8±0.4%. Compared with children who did not have AIS, and after controlling for gender, age, insurance type, and residential district, children with AIS were more likely to have psychiatric disorders in all 5 years. The adjusted ORs of psychiatric disorders in children with AIS compared with children who did not have AIS ranged from 1.47 to 1.74 (2012: OR 1.60 [95% CI 1.46-1.75]; p<0.001, 2013: OR 1.73 [95% CI 1.58-1.89]; p<0.001, 2014: OR 1.74 [95% CI 1.59-1.91]; p<0.001, 2015: OR 1.71 [95% CI 1.56-1.88]; p<0.001, 2016: OR 1.47 [95% CI 1.33-1.62]; p<0.001). 

Discussion

Considering the higher prevalence of psychiatric disorders in children with AIS compared to children who did not have AIS, children with AIS and their parents should be counselled about the increased risk of deteriorating mental health of the patients, and surgeons should provide early referral to pediatric psychiatrists. Further studies should investigate the effect of the factors related to AIS, such as curve type, Cobb angle and treatment modality.