Association between adolescent idiopathic scoliosis and mental health concerns: a retrospective cohort study using a Japanese health insurance claims database.

Abstract

To investigate the association between adolescent idiopathic scoliosis (AIS) diagnosis and the subsequent incidence of mental health concerns. This retrospective cohort study used a Japanese health insurance claims database from 2013 to 2024. We identified patients aged 10-18 years newly diagnosed with AIS. Each patient was matched with up to 10 controls by birth year and sex. The primary outcome was a composite of schizophrenia, anxiety, mood, and eating disorders. Hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for age, sex, fiscal year, comorbidities, and parental mental health concerns. Subgroup analyses were performed according to age and spinal orthosis use. We identified 9251 patients with AIS and 67,104 matched controls. AIS was associated with an increased risk of the composite outcome (HR 1.23; 95% CI 1.13-1.35). AIS was associated with increased risks of anxiety (HR 1.23; 95% CI 1.10-1.38), mood (HR 1.16; 95% CI 1.03-1.29), and eating disorders (HR 1.52; 95% CI 1.10-2.11). Age-stratified analyses showed that AIS was associated with increased risks of anxiety and mood disorders in adolescents aged 13-18 years; the incidence of eating disorders was highest in the 10-12-year group (HR 1.77; 95% CI 1.05-2.97). Patients with AIS treated with spinal orthosis exhibited a higher incidence of eating disorders than those without orthosis treatment (1.2% vs. 0.4%, p < 0.01). AIS diagnosis was associated with a higher incidence of subsequent mental health concerns, with the patterns of association varying by age and disorder type.