Marano G, Del Prete PM, Mazza O, Traversi G, Mazza M. Orthopedic and musculoskeletal conditions in adolescence: The role of psychological screening in clinical care. World J Transl Med 2026; 12(3): 124390 [DOI: 10.5528/wjtm.124390]
Corresponding Author of This Article
Marianna Mazza, MD, PhD, Assistant Professor, Department of Neuroscience, Head-Neck and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. marianna.mazza@policlinicogemelli.it
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Marano G, Del Prete PM, Mazza O, Traversi G, Mazza M. Orthopedic and musculoskeletal conditions in adolescence: The role of psychological screening in clinical care. World J Transl Med 2026; 12(3): 124390 [DOI: 10.5528/wjtm.124390]
World J Transl Med. Sep 28, 2026; 12(3): 124390 Published online Sep 28, 2026. doi: 10.5528/wjtm.124390
Orthopedic and musculoskeletal conditions in adolescence: The role of psychological screening in clinical care
Giuseppe Marano, Pietro Marcello Del Prete, Osvaldo Mazza, Gianandrea Traversi, Marianna Mazza
Giuseppe Marano, Pietro Marcello Del Prete, Marianna Mazza, Department of Neuroscience, Head-Neck and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Giuseppe Marano, Pietro Marcello Del Prete, Marianna Mazza, Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Osvaldo Mazza, Department of Spine Surgery, Bambino Gesù Children’s Hospital IRCCS, Rome 00168, Italy
Gianandrea Traversi, Unit of Medical Genetics, Department of Laboratory Medicine, Ospedale Isola Tiberina-Gemelli Isola, Rome 00168, Italy
Author contributions: Marano G, Del Prete PM, Mazza O and Traversi G performed the literature search and contributed to the analysis and interpretation of the evidence; Marano G, Del Prete PM and Mazza M drafted the manuscript; Marano G and Mazza M conceived and designed the review, critically revised the manuscript for important intellectual content and supervised the study; Mazza O contributed orthopedic and clinical expertise; Traversi G contributed to the interpretation of biological and translational aspects; all authors reviewed and approved the final version of the manuscript.
AI contribution statement: The authors gratefully acknowledge the use of Gemini (Google, June 2026) for language editing, text refinement, assistance in improving clarity and readability of the manuscript, and support in the design and refinement of illustrative figures. All outputs were generated and used under the authors’ full supervision, guidance, and direction. The tool was not used for data analysis, interpretation of findings, or generation of scientific conclusions, which remain entirely the re-sponsibility of the authors. OpenAI ChatGPT Work (accessed July 24, 2026) was used to assist with the graphic layout and construction of editable vector elements for Figures 1 and 2. No generative image model, third-party templates, icon libraries, or externally licensed graphic resources were used. The figures were produced as fully editable PowerPoint files and exported as lossless PNG files at 400 dpi at publication size. All scientific content, labels, relationships, connector semantics, and final design decisions were independently reviewed and approved by the authors, who assume full responsibility for their accuracy.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Marianna Mazza, MD, PhD, Assistant Professor, Department of Neuroscience, Head-Neck and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. marianna.mazza@policlinicogemelli.it
Received: June 15, 2026 Revised: July 18, 2026 Accepted: July 29, 2026 Published online: September 28, 2026 Processing time: 82 Days and 5.5 Hours
Abstract
Adolescence represents a critical developmental period characterized by profound biological, psychological, and social changes. During this stage, musculoskeletal (MSK) disorders (idiopathic scoliosis, sports-related injuries, limb deformities, chronic MSK pain) are common reasons for orthopedic consultation. Increasing evidence suggests that these conditions are frequently associated with significant psychological distress, including anxiety, depression, body image disturbances, and reduced quality of life. Despite this growing recognition, mental health screening is rarely incorporated into routine orthopedic assessment, leading to potential underdiagnosis of psychiatric symptoms that may influence treatment outcomes. This purposive narrative review, informed by a structured literature search, examines the available evidence on the relationship between orthopedic and MSK conditions and mental health in adolescents, with particular attention to the clinical implications for MSK care. We discuss the psychological burden associated with common orthopedic conditions and review the neurobiological and behavioral mechanisms linking pain, emotional distress, and functional impairment. The available literature indicates that psychological factors, including pain catastrophizing, fear-avoidance behaviors, and depressive symptoms, may be associated with pain perception, rehabilitation engagement, and postoperative recovery, although the evidence is predominantly observational and does not establish causality. The review also summarizes brief psychological screening and symptom-monitoring instruments that may be applicable to orthopedic settings, while acknowledging important differences in validation, scoring, licensing, and clinical interpretation. Emerging multidisciplinary care models involving orthopedic specialists, psychologists, and rehabilitation professionals are discussed as potentially useful approaches to improve recognition, referral, and care coordination, although evidence for their effect on orthopedic outcomes remains limited. Recognizing and addressing mental health issues in adolescents with orthopedic disorders may represent a critical step toward more comprehensive, patient-centered MSK care. In appropriately resourced orthopedic clinics, psychological screening may support the recognition of adolescents requiring targeted clinical assessment or referral. Current evidence does not establish that screening itself, or referral following a positive result, improves orthopedic, functional, or psychosocial outcomes. Prospective adolescent-specific studies are needed to evaluate the incremental benefit, optimal timing, acceptability, potential harms, and resource requirements of screening linked to structured assessment and follow-up.
Core Tip: Adolescents with orthopedic and musculoskeletal conditions may experience anxiety, depressive symptoms, body image concerns, pain catastrophizing, fear avoidance, and reduced quality of life. These factors may coexist with pain, functional limitation, treatment burden, and rehabilitation difficulties. This review examines the available evidence and discusses how brief validated psychological measures may support clinical assessment when appropriate systems exist for interpretation, safety evaluation, referral, and follow-up. However, screening is not diagnostic, and its optimal frequency and effectiveness in improving orthopedic outcomes remain uncertain. More prospective adolescent-specific research is needed.
