title: Psychological distress in a Department of Veterans Affairs spine patient population.
abstract: BACKGROUND
  The veteran population presents a unique confluence of biopsychosocial factors in the treatment of spinal conditions. In addition to poorer health status and higher numbers of chronic medical conditions compared with the general population, previous reports have highlighted the high prevalence of psychological disorders within the Department of Veterans Affairs (VA) health system. To our knowledge, no study has specifically evaluated psychological distress in patients with a spinal disorder within the VA health system.
  
  
  OBJECTIVE
  To determine the prevalence of psychological distress among spine patients in a VA hospital and if higher levels of distress correlated with patient demographics and self-reported patient outcome scores.
  
  
  METHODS
  Cross-sectional evaluation of adult patients at a regional VA outpatient orthopedic spine surgery clinic.
  
  
  METHODS
  One hundred forty-nine adult patients presenting for treatment of spine-related disorders.
  
  
  METHODS
  Patients were evaluated using the Distress and Risk Assessment Method (DRAM), a validated survey consisting of the Zung Depression Scale and the Modified Somatic Perception Questionnaire. In addition, self-reported pain, disability, and quality of life were assessed using the visual analog scale (VAS) for neck or back pain and the Neck Disability Index or Oswestry Disability Index (ODI) depending on the patient's location of pain.
  
  
  METHODS
  The DRAM survey was used to determine the prevalence of psychological distress by classifying patients into normal, at-risk, and severe distress groups. Visual analog scale scores for neck and back pain, and self-reported disability scores, and demographic data including age, gender, combat experience, and use of antidepressant, anxiolytic, or narcotic medications were obtained at the time of enrollment.
  
  
  RESULTS
  The DRAM survey identified 79.9% of patients as having some degree of psychological distress, whereas the remaining 20.1% were classified as normal. Among those with psychological distress, 43.6% of patients were categorized as severe distress. Compared with the normal group, a history of combat was more frequent in all distressed patient groups including the at-risk (p=.04) and severe distress (p=.009) groups. Those in the severe distress category more commonly reported the use of narcotics (p=.043) and antidepressant/anxiolytics medications (p=.0001). Those in the severe distress group had significantly higher ODI scores (p<.0001) and back pain VAS scores (p=.0360) compared with the normal group.
  
  
  CONCLUSIONS
  We identified a large number of patients (80%) with some level of psychological distress and 43% with severe distress. The percent of patients with severe psychological distress in the VA was double that previously reported in a non-VA patient setting. Patients with severe distress had higher ODI scores, back pain VAS scores, use of narcotics and antidepressants, and a reported history of combat when compared with those without distress.
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Patton
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Lawrence
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Woodbury
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: Michael D
authors.initials: MD
authors.lastname: Daubs
mesh_terms: D001416:Back Pain / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D019547:Neck Pain / Q000150:complications / Q000523:psychology; D010147:Pain Measurement; D015995:Prevalence; D011788:Quality of Life; D013122:Spinal Diseases / Q000150:complications* / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*