Psychological Distress Is Common and Associated with Greater Hip Dysfunction in Adolescents and Young Adults

Psychological distress is increasing in adolescents and young adults, but comprehensive screening programs are not commonly incorporated into orthopaedic clinical practice. We implemented a screening program for depression symptoms and psychological distress in adolescents and young adults with hip pain. The aims of this study were to report the prevalence and risk factors and determine the relationship with patient-reported pain and dysfunction.

Patients 10 to 24 years of age presenting for hip pain at an initial clinic visit completed the Patient Health Questionnaire-9 (PHQ-9), the 17-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) tool, and the International Hip Outcome Tool-12 (iHOT). Two outcome levels for depression symptoms using the PHQ-9 were compared (mild or less versus moderate or greater), and 3 outcome levels for psychological distress using the OSPRO-YF were compared (none or mild versus moderate versus severe). Age, sex, body mass index, previous surgery, and the hip diagnosis were entered into logistic regression models to predict outcomes for the levels of depression symptoms and psychological distress. iHOT scores were compared between groups using the Wilcoxon rank-sum test and the Kruskal-Wallis test followed by pairwise Wilcoxon rank-sum tests.

Among 500 patients who completed screening, 10.6% had moderate or greater depression symptoms and 26.9% had severe psychological distress. Multivariable logistic regression revealed that young adults (age, 20 to 24 years) had higher odds of moderate or greater depression symptoms compared with adolescents (age, 10 to 19 years) (odds ratio, 2.09; p = 0.016). Female patients (risk ratio [RR], 1.86; p = 0.026), patients who had undergone a prior surgery (RR, 2.29; p = 0.025), and overweight patients (RR, 2.10; p = 0.008) had a higher risk of severe psychological distress. Both moderate or greater depression symptoms and increasing levels of psychological distress were significantly associated with lower iHOT scores (all p < 0.001).

Psychological distress was common in adolescents and young adults with hip pain and was associated with greater patient-reported hip pain and dysfunction. Young adults had a greater risk of depression symptoms. Severe psychological distress was more common in female patients, overweight patients, and those who had undergone failed prior hip surgery.

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.