Pediatric spine surgeons report high perceived patient mental health burden and limited screening in scoliosis care.

BACKGROUND: Adolescents seeking treatment for scoliosis often present with comorbid mental health concerns. Yet, standardized screening, evaluation, and care protocols remain lacking. This study examines pediatric orthopedic providers' perceptions of patient mental health burden and screening practices in spine deformity care. METHODS: Fifty-four pediatric spine surgeons from a multi-center AIS registry were anonymously surveyed. Closed-ended responses were tallied, and sentiment analysis was applied to open-ended responses. RESULTS: Twenty-eight surgeons (52%) responded, most with over ten years of experience in high-volume practices. Many estimated that up to half of their patients face mental health challenges, noting a slight increase in burden. Despite this, only 12 (42%) reported structured screening (e.g., SRS, PROMIS) and 6 (21%) used informal methods (observations, conversations). Among the 16 (57%) screening, PROMIS and depression/suicide screens were most common. Few reported reliable follow-up: only 2 (7%) indicated their teams "probably" follow up on low scores, while 11 (39%) felt follow-up was unlikely. Most (64%) believed they were not adequately addressing concerns. Referrals were typically prompted by positive screens or observations, but barriers, like limited provider availability, access issues, and insurance constraints, often hindered them. When made, referrals were usually directed in-house. CONCLUSION: Significant gaps exist in addressing mental health in pediatric scoliosis care. While providers report to recognize the burden, few conduct routine screenings, and follow-up and referrals remain inconsistent. Findings highlight the need for standardized protocols and improved access to mental health resources within scoliosis care. LEVEL OF EVIDENCE: IV.