EP8.62 Psychological Characteristics Associated with Self-Harm Ideation in Adolescents and Young Adults with Hip Conditions

Abstract

Abstract Objective Mental health conditions are common in adolescents and young adults, with increased prevalence in those with musculoskeletal conditions, associated with greater pain and dysfunction as well as worse treatment outcomes. The aims of this study are to (1) report the prevalence of self-harm ideation in adolescents and young adults with hip conditions, (2) the association with psychological distress, and (3) the impact of treatment on self-harm ideation prevalence Methods 500 consecutive patients aged 10-24 years old presenting to an adolescent and young adult hip clinic completed the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF), Patient Health Questionnaire 9 (PHQ-9), and International Hip Outcome Tool-12 (iHOT-12). The primary outcome was self-harm thoughts (yes/no), defined by a positive response to the PHQ-9 question addressing self-harm ideation. Patients reporting self-harm were matched 1:1 with those who reported none/mild and severe psychological distress without self-harm ideation. Chi-square or Fisher’s exact tests were used to assess the difference between patients with and without self-harm ideation. Results Self-harm ideation was reported by 24/500 (4.8%). Those with severe psychological distress were significantly more likely to report self-harm ideation when compared to those with none/mild distress (OR=7.9, adjusted p<0.001) or moderate distress (OR=4.9, adjusted p=0.002). Hip surgery was performed in 19/24 patients that reported self-harm ideation. After surgery, 73% (11/15) reported resolution of self-harm ideation. Pre-operative self-harm ideation was associated with a decreased improvement in iHOT after surgical treatment compared to none/mild (mean 22.9 vs 48.0, p=0.005), or severe psychological distress (mean 22.93 vs 41.17, p<0.05) without a positive response to self-harm ideation. Discussion Self-harm ideation was present in about 1 in 20 adolescents and young adults presenting for evaluation to a young adult hip clinic, and self-harm ideation had a significant association with psychological distress, negative mood, and markers of anxiety and kinesiophobia on the OSPRO-YF. Self-harm ideation was shown to resolve in the majority of patients through effective multidisciplinary treatment of their psychological distress and hip pathology but was associated with worse clinical outcomes. Incorporating screening tools into orthopaedic clinics can be an effective and efficient way to identify those with self-harm ideation.