PROMIS Anxiety scale is responsive in assessing suicide risk in adolescents with spine concerns

This study aimed to evaluate the responsiveness of Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety Scale with the Ask Suicide-Screening Questions (ASQ) and associations of suicide risk in adolescents with spine concerns.

Adolescents ages 10-18 referred to a pediatric orthopedic institution for spine concerns who simultaneously completed both the PROMIS Pediatric Anxiety Computer Adaptive Test and the ASQ were retrospectively reviewed. Positive ASQ scores (≥ 1 yes response) were compared to negative ASQ scores. Elevated PROMIS Anxiety was defined as scores ≥ 51, indicating minimum mild severity. Logistic regression followed by ROC analysis determined the PROMIS Anxiety threshold.

Of 8089 adolescents with spine concerns, 4.2% (338) had positive ASQs. Elevated (≥ mild severity) PROMIS Anxiety indicated a sixfold risk of a positive ASQ than those with PROMIS Anxiety scores within normal limits (OR 6.35, 95% CI 5.07-7.99). Multivariate analysis revealed older age (OR 1.08, 95% CI 1.02-1.15), female sex (OR 1.61, 95% CI 1.23-2.15), English vs. Spanish language (OR 2.17, 95% CI 1.39-3.53), public vs. private insurance type (OR 1.37, 95% CI 1.05-1.77), and higher PROMIS Anxiety scores (OR 1.10, 95% CI 1.09-1.12) were associated with a positive ASQ. A PROMIS Anxiety threshold of 44.5 (AUC = 0.80) was associated with a positive ASQ.

Increased anxiety is clearly associated with suicide risk in youth with spine concerns with an acceptable AUC. PROMIS Anxiety may be a readily available, useful clinical adjunct of suicide risk, prompting further evaluation in youth with spine concerns in settings that do not routinely screen for suicide risk.