Does Substance Abuse Predict the Development of Mental Health Disorders in Adolescent Idiopathic Scoliosis Patients?

Abstract

Retrospective cohort study. This study aimed to determine whether substance abuse among adolescent idiopathic scoliosis (AIS) patients is associated with increased odds of subsequent new-onset mental health disease (MHD). MHD prevalence in patients with a substance abuse history has been well-described. However, the impact of current or historical substance abuse/dependence in AIS patients on the risk of subsequent development of new-onset MHDs is unknown. The New York SPARCS database was reviewed to identify all 10-25-year-old AIS patients and stratified by prior or concurrent substance abuse (AIS-Sub) versus no history of substance abuse (AIS-NoSub). Cohorts were 1:1 propensity score-matched, and various comparisons were made, including incidence of subsequent MHDs. Binary stepwise logistic regressions were utilized to calculate odds ratios (OR) of developing any MHDs based on baseline substance abuse. 386 AIS patients were included (193 AIS-Sub and 193 AIS-NoSub). At baseline, there were no significant differences between patient cohorts in demographic factors. AIS-Sub patients had higher rates of new-onset subsequent overall MHDs (16.1% vs. 3.6%, P<0.001), with only depressive disorder showing a significantly higher incidence when examining individual MHDs (10.9% vs. 0.5%, P<0.001). Logistic regression analyses revealed that baseline substance abuse was independently associated with subsequent diagnosis of either any MHD (OR=6.8, 95% CI: 2.6-17.3, P=0.001), or new-onset depressive disorder (OR=47.0, 95% CI: 3.9-568.7, P=0.002); but was not associated with the development of anxiety, stress, sleep, or eating disorders. AIS patients with prior or current substance abuse/dependence were at increased 2-year risk of developing any new-onset MHD, specifically depressive disorders. This data may guide preoperative screening and optimization efforts for surgeons, as MHDs have been associated with poor outcomes following spine surgery. Level III-retrospective cohort study.