Is There an Association Between Psychiatric Disorders and Adolescent Idiopathic Scoliosis? A Large-database Study

Cosmetic appearance in adolescent idiopathic scoliosis: Predictive factors and evaluation of the TAPS and SRS-22 self-image subdomains before and after posterior spinal fusion

BACKGROUND

Despite being one of the main drivers of patients' satisfaction, the cosmetic appearance after posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has not yet been thoroughly investigated. This study evaluated the self-perceived cosmetic outcomes following posterior spinal fusion in patients with AIS using the SRS-22 and Trunk Appearance Perception Scale (TAPS).

HYPOTHESIS

It is possible to highlight outcome differences before and after surgery, and to determine correlations between these self-image assessments and radiographic as well as implant-related parameters.

PATIENTS AND METHODS

A multicenter retrospective analysis on data prospectively collected between February 2011 and November 2021. AIS patients requiring surgery and with a 1-year follow-up were included. Pre- and postoperative radiographic data, including Cobb angle, clavicle angle, pelvic and sacral obliquity, and thoracic kyphosis, were compared with patient-reported outcomes. Statistical analyses evaluated correlations between self-image subdomains and surgical outcomes.

RESULTS

Data from 123 patients were available (101 females, 22 males). Considerable improvements in cosmetic self-perception were observed postoperatively, with both TAPS and SRS-22r scores increasing one year after surgery. Coronal parameters such as major Cobb angle and clavicle angle were the primary drivers of preoperative self-image perception. In particular, the Cobb angle increased from 41.06 ± 33.29 ° in patients who did not perceive a back deformity to 65.86 ± 12.46 ° in patients who perceived a severe deformity (p = 0.009). Similarly, the clavicle angle increased from 0.31 ± 0.53 ° to 2.8 ± 2.49 ° (p = 0.02). Postoperative cosmetic appearance was correlated to implant density and thoracic kyphosis (T2-T5). Implant density decreased from 1.65 ± 0.3 to 1.47 ± 0.13 in patients with no perceived deformation and slight deformation of the back, respectively (p = 0.03); and from 1.65 ± 0.27 to 1.51 ± 0.15 in patients with no perceived deformation and slight deformation of the front, respectively (p = 0.04). The T2 - T5 kyphosis increased from 17.25 ± 9.36 ° to 38.72 ° (p = 0.05) in patients with poorer forward bending perception, and decreased from 26.61 ° to 19.9 ± 10.15 ° (p = 0.04) in patients with better cosmetic appearance in the SRS Q6.

DISCUSSION

Posterior fusion significantly enhances self-perceived trunk appearance in AIS patients. The coronal alignment has a more marked influence on preoperative cosmetic appearance, whereas postoperative sagittal alignment and implant density play a more critical roles in the postoperative self-image assessment.

LEVEL OF EVIDENCE

III.

Impact of surgical treatment for adolescent idiopathic scoliosis on maternal and obstetric outcomes: a meta-analysis

PURPOSE

To compare the maternal and obstetric health outcomes between pregnant AIS patients treated surgically (AIS surgery), pregnant AIS patients treated conservatively (AIS conservative), and pregnant healthy controls.

METHODS

A systematic review and meta-analysis were conducted according to the PRISMA guidelines (PROSPERO: CRD42023439219). PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched for relevant studies. The risk ratios (RR) and mean differences (MD) were calculated for dichotomous and continuous variables. Heterogeneity was assessed using the chi2 and I2 tests. A fixed-effects or random-effects model was used based on heterogeneity results.

RESULTS

Nine studies involving 4718 women were included. The frequency of caesarean section was higher in the AIS surgery group than in the healthy controls (RR 1.54, 95% CI 1.19 to 1.99), but not compared to the AIS conservative group (RR 1.28, 95% CI 0.96 to 1.69). Patients in the AIS surgery group were more likely to receive general anesthesia during caesarean section than were healthy controls (RR 11.69, 95% CI 3.03 45.13). Patients in the AIS surgery group reported more back pain during pregnancy than healthy controls (RR 4.02, 95% CI 1.20 to 13.49), but not compared to the AIS conservative group (RR 0.81, 95% CI 0.58 1.15). The AIS surgery group had worse scores on the SRS-22 pain and function domains than the healthy controls. There were no differences in marital status or the number of children between the groups.

CONCLUSION

Pregnant AIS patients treated surgically may have a higher risk of caesarean section and more back pain during pregnancy compared to healthy controls. The AIS surgery group also had worse scores on the SRS-22 pain and function domains than the healthy controls. However, there were no differences in marital status or number of children between the groups.

Advances in 3D correction of adolescent scoliosis: The superiority of scoliocorrector fatma-UI in rotational realignment

This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI (SCFUI) with direct vertebral rotation (DVR) in treating adolescent idiopathic scoliosis (AIS). SCFUI has shown promising results in three-dimensional spinal correction, providing superior rotational alignment compared to DVR and achieving significant improvements in coronal and sagittal planes. Additionally, SCFUI's advanced design reduces risks associated with AIS surgeries and enhances overall patient outcomes. Economic analysis reveals SCFUI as a cost-effective option, potentially lowering long-term healthcare costs by minimizing complications and revisions. Our findings suggest that SCFUI is a viable, innovative approach in AIS treatment, meeting clinical and economic demands in orthopedic care.

Evaluating the prevalence of psychiatric comorbidities associated with pediatric scoliosis utilizing ResearchMatch

PURPOSE

The goal of this study is to characterize the self-reported prevalence of psychiatric comorbidities among patients with adolescent scoliosis.

METHODS

Eligible patients across the US were surveyed using ResearchMatch, a validated online platform. The survey collected patient demographics, type of scoliosis, scoliosis treatment received, and the mental health diagnoses and interventions.

RESULTS

Nearly all (98%) of the 162 respondents were patients themselves, the remainder of which were parents. The majority of whom were female (93%), Caucasian (85%), and diagnosed with idiopathic scoliosis (63%). The median age of diagnosis was 13 (IQR 11-18). Most respondents had mild to moderate scoliosis (65%), and 17% received surgical treatment. 76 of 158 (48%) responded that scoliosis affected their overall mental health, and 92 (58%) had received a mental health diagnosis-76% were diagnosed after their scoliosis diagnosis. Of the 92 with mental health diagnoses, the most common diagnoses were clinical depression (83%), anxiety (71%), negative body image (62%). Over 80% of patients received medical treatment or therapy. Of those with depression, 38.4% received counseling and 45.2% received medication. 52% of the respondents also had immediate family members with mental health diagnoses, with siblings (48%) having the highest proportion.

CONCLUSION

According to the CDC, the prevalence of US teenagers with diagnosed depression was found to be 3.9% and anxiety disorder to be 4.7%, notably higher among adolescent girls. In this national sample, over half of adolescent scoliosis patients report psychiatric comorbidity, often diagnosed years later. The most prevalent psychiatric condition is depression, anxiety, and body-image disturbances. These findings highlight the importance of awareness of the psychiatric impact of adolescent scoliosis, and importance of screening and treatment of comorbid mental health conditions.

LEVEL OF EVIDENCE

IV.

Implementing a Halo Gravity Traction Program: A Multidisciplinary Endeavor

Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement.

Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study

BACKGROUND CONTEXT

Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce.

PURPOSE

To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up.

STUDY DESIGN

Comparative cohort study.

PATIENT SAMPLE

A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation.

OUTCOME MEASURES

HRQoL (SF-36, SRS-22r, ODI).

METHODS

The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison.

RESULTS

In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains.

CONCLUSIONS

Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.

"Am I different?" Coping and mental health among teenagers with adolescent idiopathic scoliosis: A qualitative study

PURPOSE

To explore the stressors, coping strategies, and mental health of adolescents diagnosed with idiopathic scoliosis.

DESIGN AND METHODS

This study adopted a descriptive qualitative study design. Twelve participants were recruited from a local non-government organization in Hong Kong. Semi-structured interviews were conducted to collect data. Verbatim transcriptions of interviews were coded and analyzed using thematic analysis. The guideline of the Consolidated Criteria for Reporting Qualitative Studies was used to report the findings.

RESULTS

Five themes were identified: "Disease- and treatment-induced changes and stressors", "Cognitive assessment and personal perceptions", "Behavioral and emotional coping strategies", "Social interactions and social support", and "Deteriorating or thriving in psychological development and well-being".

CONCLUSIONS

Adolescents with idiopathic scoliosis experienced a variety of physical and psychological stressors. It is imperative to prioritize efforts to promote adaptive coping and activate social support systems to achieve better outcomes in this population.

PRACTICAL IMPLICATIONS

Healthcare providers should aim to comprehend the experiences of adolescents with idiopathic scoliosis for improved clinical interactions and holistic care. Future research should prioritize coping-based interventions, to enhance adaptive coping behaviors and the well-being of this population.

Association of Functional Gastrointestinal Disorders with Adolescent Idiopathic Scoliosis

Numerous adolescents diagnosed with adolescent idiopathic scoliosis (AIS) often manifest symptoms indicative of functional gastrointestinal disorders (FGIDs). However, the precise connection between FGIDs and AIS remains unclear. The study involved adolescents drawn from sample datasets provided by the Korean Health Insurance Review and Assessment Service spanning from 2012 to 2016, with a median dataset size of 1,446,632 patients. The AIS group consisted of individuals aged 10 to 19 with diagnostic codes for AIS, while the control group consisted of those without AIS diagnostic codes. The median prevalence of FGIDs in adolescents with AIS from 2012 to 2016 was 24%. When accounting for confounding factors, the analysis revealed that adolescents with AIS were consistently more prone to experiencing FGIDs each year (2012: adjusted odds ratio (aOR), 1.21 [95% confidence interval (CI), 1.10-1.35], p < 0.001; 2013: aOR, 1.31 [95% CI, 1.18-1.46], p < 0.001; 2014: aOR, 1.24 [95% CI, 1.12-1.38], p < 0.001; 2015: aOR, 1.34 [95% CI, 1.21-1.49], p < 0.001; and 2016: aOR, 1.35 [95% CI, 1.21-1.50], p < 0.001). These findings suggest that AIS is correlated with an elevated likelihood of FGIDs, indicating that AIS may function as a potential risk factor for these gastrointestinal issues. Consequently, it is recommended to provide counseling to adolescents with AIS, alerting them to the heightened probability of experiencing chronic gastrointestinal symptoms.

Does a Preoperative Mental Health Diagnosis Affect Pain Management in Patients With Adolescent Idiopathic Scoliosis Undergoing Surgery?

BACKGROUND

Patients with adolescent idiopathic scoliosis (AIS) are typically treated surgically with posterior spinal fusion (PSF) when the curve continues to progress beyond 45 to 50 degrees. In adult patients, studies have shown that preoperative psychiatric diagnoses are associated with poorer clinical outcomes after lumbar spine surgery. This study aims to address whether a preoperative mental health disorder affects outcomes in pediatric patients with AIS treated with PSF.

METHODS

We conducted a retrospective study of pediatric patients with a history of AIS requiring operative treatment with PSF at a single center with a minimum of 2-year follow-up. These patients were split into 2 groups: a subset that had a mental health disorder (MHD), and a control group. The MHD subset included patients with anxiety disorder, major depressive disorder, bipolar disorder, manic disorder, obsessive-compulsive disorder, attention deficit hyperactivity disorder, and stress disorder. The 2 groups were compared using independent student t -test and χ 2 analysis.

RESULTS

A total of 417 patients were included in the study. Ninety-three patients were included in the MHD group, and 324 patients were included in the control group. The mean pain score for the MHD group was greater (3.93) compared with the control group (3.34). The PCA demands during inpatient stay for the MHD group were also greater (236.7) compared with the control group (140.0). There was no significant difference in the length of stay in the hospital between the MHD group (4.7 days) and the control group (4.6 days). There was a greater number of patients in the MHD cohort (25.8%) still using narcotic pain medication at first follow-up compared with the control group (12.0%).

CONCLUSION

This study suggests that patients with AIS with a preoperative mental health disorder undergoing PSF experience more pain after surgery and require more pain medication during their recovery.

LEVEL OF EVIDENCE

III. This is a retrospective review of pediatric patients with adolescent idiopathic scoliosis and a preoperative mental health diagnosis and their pain management requirements during the recovery period from posterior spinal fusion.

From PHQ-2 to SRS-22: how a depression screening tool relates to SRS scores in patients with adolescent idiopathic scoliosis

PURPOSE

The aim of our study was to determine the relationship between Patient Health Questionnaire (PHQ) scores-a simple, validated depression screening tool-and Scoliosis Research Society (SRS)-22 questionnaire scores in patients with idiopathic scoliosis (IS).

METHODS

IS patients screened for depression with the PHQ-2 who completed the SRS-22 over a 2-year period were reviewed. If PHQ-2 scores were positive (> 3), the more comprehensive PHQ-9 was administered. Median SRS-22 scores between positive and negative PHQ screens were compared. Nonparametric correlation between PHQ and SRS-22 Mental Health (MH) domain was performed. The ability of the MH domain to discriminate between patients with positive versus negative screens and patients with moderate-severe depression risk versus no-mild risk was evaluated with ROC analysis.

RESULTS

521 patients were included. Patients with + PHQ-2 screens had significantly lower total and individual domain SRS scores, especially within the MH domain (4.0 vs. 3.2). For those with moderate-severe depression risk, total and individual domain scores were also significantly lower (MH domain, 4.0 vs. 3.0, p < 0.05). A weak, but significant correlation was observed between the PHQ and MH domain scores (rho = 0.32, p < 0.001). A cut-off of ≥ 3.6 on the MH domain demonstrated sensitivity of 0.75 and specificity of 0.86 for identifying patients at no-mild risk for depression.

CONCLUSION

Recognizing mental health conditions is critical to successful IS treatment as psychosocial conditions can negatively affect treatment outcomes. IS patients scoring < 3.6 on the SRS-22 MH domain should be considered for depression screening due to an increased risk of moderate-severe depression.

Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery

STUDY DESIGN

Observational case control.

OBJECTIVE

The objective of this study was to evaluate the prevalence of opioid use two years after surgical correction of adolescent idiopathic scoliosis (AIS) and its association with preoperative mental health.

SUMMARY OF BACKGROUND DATA

Studies of opiate use have reported that up to 80% of users began their addiction with misuse of prescription opioids. Identifying opioid use and those at risk in the AIS population is critical for optimal outcomes.

MATERIALS AND METHODS

A query of a multicenter prospective AIS surgical fusion registry was performed to identify patients of all curve types with responses to question 11 on the Scoliosis Research Society-22 questionnaire at two years postoperative. Question 11 asks about pain medication usage for the patient's back with five specific responses: narcotics daily, narcotics weekly or less, non-narcotics daily, non-narcotics weekly/less, or none. Ordinal regression was used to evaluate the association between preoperative Scoliosis Research Society-22 Mental Health (MH) domain scores and two-year postoperative pain medication usage.

RESULTS

A total of 2595 patients who underwent surgery from 2002 to 2019 met inclusion. The average primary curve was 56±12°, average age 14.7±3 years, and 81.5% were female. Forty (1.5%) patients reported utilizing opioids two years after surgery, and a significant difference in preoperative MH scores was observed. Patients taking daily opioids postoperatively had the lowest median preoperative MH score (3.75), followed by non-narcotic group (4), and no medication (4.2, P <0.001). Three patients reporting opioid use postoperatively reported preoperative usage. The rate of two-year postoperative medication use based on the year of surgery demonstrated a small linear decrease in opioid use over time, with a slight increase in nonopioid daily use.

CONCLUSIONS

Less than 2% of patients reported taking opioids for back pain two years after surgical correction of AIS. A lower MH score before surgery may place a patient at increased risk for opioid use two years after surgery. An analysis of the year of surgery suggests that changes in prescription practices over time may be occurring.

LEVEL OF EVIDENCE

4.

The evolution of pre-operative SRS scores over time in patients with adolescent idiopathic scoliosis

PURPOSE

To determine if preoperative Health Related Quality of Life (HRQoL) has declined in the past two decades for patients with Adolescent Idiopathic Scoliosis (AIS), as measured by the Scoliosis Research Society (SRS) questionnaire.

METHODS

A retrospective review was conducted on AIS patients that underwent surgery at a single institution between 2002 and 2022. Patients were included if they completed an SRS questionnaire preoperatively. A multivariate linear regression was performed with the SRS domains as the dependent variables. The independent variables were surgery year, gender, race/ethnicity, BMI, Lenke type, and major Cobb angle. A second regression was performed where the SRS scores for AIS patients were dichotomized as being above or below normal based on a threshold set at two standard deviations below the mean SRS scores of a healthy adolescent population. The binary SRS scores were used as the outcome of interest in a second regression.

RESULTS

A total of 1380 patients (79.2% female, mean age 14.9 ± 2.0 years old) were included for analysis. Surgery year had a negative association with Pain (coefficient = - 0.03, p < 0.0001), Activity (coefficient = - 0.02, p < 0.0001), Mental Health (coefficient = - 0.01, p < 0.0001), and Total score (coefficient = - 0.01, p < 0.0001), indicating declining HRQoL over time. Similarly, AIS patients became more likely to fall below 2SD of the healthy adolescent means in Pain (OR: 1.061, p < 0.0001), Appearance (OR: 1.023, p = 0.0301), Activity (OR: 1.044, p = 0.0197), and Total score (OR: 1.06, p < 0.0001).

CONCLUSION

Over the past two decades, patients with surgical AIS have experienced a significant decline in various HRQoL domains preoperatively.

Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review

Background

Pediatric patients affected by scoliosis have complex psychological and social care needs, and may benefit from psychosocial interventions. We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.

Methods

Literature was identified by searching Medline, PsycINFO, Embase, EBSCO Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception to 20 March 2022. Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included. Article eligibility, data extraction, and quality assessment (using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies) were performed by two independent researchers. Findings are presented using narrative synthesis.

Results

We identified ten studies, all of which focused on adolescent idiopathic scoliosis. Studies included a total of 1007 participants, most of whom were female. Three studies focused on patients undergoing bracing, six on patients undergoing spinal surgery, and one on patients broadly. Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity. Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes. Several studies examined the efficacy of brief educational interventions; most did not report clear evidence of their efficacy. The methodological quality of studies was often unclear due to limitations in articles' reporting quality.

Conclusions

Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited, with interventions involving frequent patient-provider interactions showing the most promise. Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population, with emphasis on multidisciplinary teams delivering holistic care.

Trial registration number

PROSPERO number CRD42022326957.

Disordered Eating and Body Image Concerns in Young Adult Women With Scoliosis

Background

Researchers have called for more investigation into disordered eating behaviors in females with scoliosis.

Objective

The objective of the current study was to assess the associations between body image concerns, disease-specific indicators of scoliosis (ie, age of diagnosis, having undergone bracing treatment, being told by a physician your scoliosis required surgery, having a spinal fusion), quality of life, and disordered eating in a sample of young adult women diagnosed with idiopathic scoliosis during adolescence.

Design

This study was cross-sectional in design.

Methods

Participants were 177 young adult women ages 18 to 30 years diagnosed with idiopathic scoliosis by a physician who completed questionnaires online.

Results

Undergoing bracing treatment (r = -.440; P < .001), greater age at scoliosis diagnosis (r = .563; P < .001), being told scoliosis required surgery (r = -.196; P < .050), annual income (r = .306; P < .001), level of education (r = .228; P < .010), and race/ethnicity (r = -.213; P < .050) were associated with the EDE-Q Global Score. The Body Shape Questionnaire Total Score and EDE-Q Global Score (r = .848; P < .001) and EDE-Q Weight Concern Score (r = .813; P < .001) were associated. The strongest correlations between the EDE-Q and the SRS-22-Revised Subscales were generally evidenced on the SRS-22-Revised Mental Health Subscale (rs ranged from -.200 to -.371; P < .001). After controlling for annual income, highest level of education, undergoing bracing treatment, and age of scoliosis diagnosis, the Body Shape Questionnaire Total Score was significantly correlated with the EDE-Q Eating Concern Score (standardized beta coefficient = .618; P < .001).

Conclusions

These findings underscore the importance of assessing body image concerns in young adult women with scoliosis experiencing disordered eating as this information may provide valuable information relevant to treatment planning.

Adolescent Idiopathic Scoliosis and Mental Health Disorders: A Narrative Review of the Literature

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. The condition begins in puberty, affects 1–4% of adolescents, and disproportionately affects young women. Our aim was to comprehensively examine the association between AIS and risk for depression, anxiety, eating disorders, psychotic disorders, and personality dysfunctional mechanisms. Methods: Literature review of related articles published in PubMed, Google Scholar, and Scopus up to 15 July 2021. Results: A total of 30 studies were deemed eligible, examining the effects of AIS upon mental health, and using appropriate psychometric inventories. Studies highlighted the association of brace treatment with elevated anxiety. In addition, mental health conditions and traits (e.g., anxiety and depressive symptoms, neuroticism) were detected more frequently amongst AIS patients compared to healthy controls. Conclusions: AIS represents a risk factor for mental health disorders. More longitudinal studies, utilizing accurate psychometric instruments, are warranted, to reveal the current impact of AIS on the mental health of youngsters, along with the tailoring of well-targeted interventions to reduce the burden of mental health issues in adulthood.