A Quality Improvement Project Assessing Prevalence of Depression in Orthopedic Spine Patients

Individuals with back pain who have spine conditions or are undergoing spine surgery may have depression that can lead to negative post-surgical outcomes, such as complications and poor quality of life. Currently depression is not assessed as part of the treatment plan or preoperative visit for spine patients at an urban academic medical center. This project determined the prevalence of depression and need for routine depression screening and referral in orthopedic spine patients at an urban academic medical center. Inclusion criteria were: adults ages 21 and up; the ability to speak, read, and write English; and a candidate for spine surgery or other spine treatment. Current clinic practices for depression screening and referral were evaluated. To establish a depression prevalence rate, eligible participants were invited to be screened for depression using the Patient Health Questionnaire (PHQ-9) tool. The average PHQ-9 score was 11, correlating with moderate depression. Participants scoring above 10 reported depression caused by pain and loss of function in daily activities prior to and after spine care treatment. Recognizing depression in spine patients prior to surgery could lead to earlier interventions, such as counseling, that could promote positive surgical outcomes including better quality of life, stronger self-efficacy in post-operative recovery, and a decrease in depressive symptoms. Initiating counseling along with conservative management of spine conditions and pain could enhance non-surgical treatment. Keywords: spine surgery, depression, Patient Health Questionnaire, perioperative screening, surgical outcomes