Orthopedic and musculoskeletal conditions in adolescence: The role of psychological screening in clinical care

Table 1 Provisional comparison of selected psychological measures relevant to adolescent musculoskeletal care

Instrument	Main construct/use	Approximate burden	Evidence context	Essential caveat
PHQ-2	Initial screening for depressive symptoms	2 items	Pediatric and adolescent clinical settings[17,90,92]	A positive result requires further assessment and is not diagnostic
PHQ-9	Assessment of depressive symptom severity after an initial concern or positive brief screen	9 items	Used in adolescent orthopedic and pediatric subspecialty workflows[17,88,94]	Any endorsement of item 9 requires prompt direct safety clarification regardless of the total score
GAD-2/GAD-7	Initial assessment and quantification of anxiety symptoms	2 or 7 items	General adolescent and pediatric mental-health populations[16,89,90]	Orthopedic-specific validation and optimal thresholds remain limited
PROMIS pediatric measures	Anxiety, depressive symptoms, pain interference, physical function, and related domains	Short forms or computerized adaptive testing	Pediatric and selected MSK populations[89,95,96]	Use the scoring documentation and reference population applicable to the selected version
Pain catastrophizing scale for children	Catastrophic thoughts and feelings related to pain	13 items	Pediatric chronic-pain populations[58,59,91,92]	Reference values are not universal diagnostic or referral thresholds
Fear of pain questionnaire for children	Pain-related fear and activity avoidance	24 items	Pediatric chronic-pain populations[91,93]	Interpretation should distinguish adaptive caution from persistent function-limiting avoidance

It is intended as a provisional clinical orientation rather than a prescribing guide. The instruments have not been uniformly validated across adolescent orthopedic diagnoses, languages, cultures, or treatment settings. Before implementation, clinicians should verify the official version, age range, scoring instructions, translation status, licensing or registration requirements, and locally appropriate response pathways. Cutoff values should not be transferred across populations without validation. PHQ: Patient Health Questionnaire; GAD: Generalized Anxiety Disorder; PROMIS: Patient-Reported Outcomes Measurement Information System; MSK: Musculoskeletal.