By Jen A. Miller

When teenagers and young adults with hip pain are seen by University of Iowa Health Care specialists in the Department of Orthopedics and Rehabilitation,  they are also often struggling with mental health issues, including depression, anxiety, and fear of further injury when returning to sports.

This can be a difficult road, given their young age and high physical demands in sports. Not only are conditions like hip dysplasia and hip impingement painful; young people may also experience isolation from their friend group that is commonly tied to their youth sports participation.  

“Hip dysplasia and hip impingement cause pain and disability,” says Michael Willey, MD, assistant professor in the Department of Orthopedics and Rehabilitation. “Young patients are also often isolated from their friend group because their social life is tied to sports and other activities that they’re not able to participate in because of their hip pain.”

Three years ago, Willey and colleagues implemented screening questionnaires for psychological characteristics for these patients. They recently published their findings in the Journal of Bone and Joint Surgery.

In the study, patients between the ages of 10 and 25 with hip pain were screened to collect information about different aspects of their mental health and alert physicians as to which of their patients may be at risk for depression and other mental health problems.

Out of the 500 patients who completed the screening at their initial clinic visit, 10.6% had moderate or greater depression symptoms, and 26.9% had severe psychological distress. These rates were higher than those of adolescents and young adults without hip conditions, pointing to an additional mental health burden young people with hip pain often experience.

The research team also found that young adults (ages 20 to 24) had a higher likelihood of moderate or greater depression symptoms compared with adolescents (ages 10 to 19). Female patients, patients who had undergone a prior surgery, and overweight patients also had a higher risk of severe psychological distress. Additionally, adolescent and young adults with depression and psychological distress reported greater hip pain and dysfunction.  

Based on these findings, Willey and colleagues are creating ways to help patients access mental health services as part of their care.

“We feel that addressing mental health issues can be even more impactful than rehabilitation, medications, and surgery for those with hip conditions,” Willey says. “We need effective mental health interventions to help patients cope with pain and support recovery.”

While mental health screenings are not commonly part of orthopedic clinical care, the study results show the importance of including mental health screening as part of a patient’s comprehensive care plan. So far, adding mental health screenings have helped the care team connect their adolescent and young adult patients with additional resources, with the ultimate goal of providing in-clinic, same-day mental health care for patients as needed.