Mental Health and Mental Illness in Pediatric Orthopaedic Surgery: A Systematic Review.

Abstract

Mental health disorders are known to correlate with poorer outcomes in orthopaedic surgery, yet research focusing on pediatric orthopaedic patients remains sparse. This study aims to evaluate publication trends on mental health within pediatric orthopaedic surgery over the past two decades. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches in PubMed, Embase, and Web of Science identified articles published between January 1, 2003 and July 17, 2023, focusing on mental health in pediatric orthopaedic patients. Study year, specific Diagnostic and Statistical Manual of Mental Disorders (DSM-5) condition, orthopaedic diagnoses, and patient-reported outcome measures (PROs) were extracted. A total of 2,629 articles were screened, and 69 met the inclusion criteria. Linear regression revealed a significant positive association between year and number of publications (<i>P</i> < .001). From 2003 to 2013, an average of 1.55 papers were published per year, increasing to 5.20 per year from 2014 to 2023, peaking at 8 in 2018 and 2021. Attention-deficit/hyperactivity disorder (ADHD) was the most frequently explored DSM-5 diagnosis, present in 40% of studies, with 60% of ADHD studies focusing on traumatic fractures. Adolescent idiopathic scoliosis (AIS) was the most common orthopaedic diagnosis (31%), followed by traumatic fractures (16%). AIS research predominantly (95%) addressed general mental health rather than specific DSM-5 conditions. Overall, the two most utilized PROs were the Scoliosis Research Society (SRS) questionnaire (16%) and the Patient-Reported Outcomes Measurement Information System (PROMIS) (9.1%). ADHD's association with traumatic fractures suggests the need for enhanced postoperative guidance due to challenges with compliance. Continued focus on nuanced mental health concerns-those that may not meet DSM-5 criteria-but still impact recovery could significantly enhance patient care, and PROs like the SRS and PROMIS have proven valuable in detecting subtle but clinically relevant psychosocial markers. Standardizing the use of these tools across pediatric orthopaedic care could lead to more personalized treatment plans and improved long-term outcomes for patients with both orthopaedic and mental health challenges.<h4>Key concepts</h4>(1)Over the last two decades, mental health research within pediatric orthopaedic surgery has surged, confirming that clinicians are increasingly recognizing the importance of psychological well-being in young patients.(2)Attention-deficit/hyperactivity disorder (ADHD) stands out as the most frequently studied specific DSM-V diagnosis. Notably, children with ADHD appear more susceptible to traumatic fractures, hinting at a need for extra vigilance and tailored postoperative guidance.(3)Adolescent idiopathic scoliosis (AIS) draws the most attention among pediatric orthopaedic conditions; however, most AIS-focused studies address overall mental health rather than drilling into any single disorder-signaling a gap in targeted DSM-5-based research.(4)Among many PROs used, the scoliosis research society questionnaire and the Patient-Reported Outcomes Measurement Information System emerge as top picks for gauging overall functioning and mental wellness.<i>Level of Evidence</i>: IV, Systematic Review.