PERCEIVED SOCIAL SUPPORT AND MENTAL HEALTH IN ADOLESCENT IDIOPATHIC SCOLIOSIS: MEDIATING EFFECTS OF RESILIENCE

Xin-Hua Li^*Jing-Jing LiuZhongming Wu

• Nanjing Drum Tower Hospital, Nanjing, China

Background: Adolescents idiopathic scoliosis (AIS) experience elevated risks of psychological distress, yet the psychosocial mechanisms underlying this burden remain insufficiently understood. This study aimed to determine the prevalence of psychological distress in adolescents with AIS, examine the associations between perceived social support, resilience, and psychological distress, and assess whether resilience mediates the relationship between perceived social support and psychological distress. Methods: In this cross-sectional study, 229 adolescents aged 12–18 years with confirmed AIS were recruited from a tertiary spine surgery center. Participants completed the Symptom Checklist-90 (SCL-90), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Connor–Davidson Resilience Scale (CD-RISC). Socio-demographic and clinical data were recorded. The prevalence of clinically significant psychological distress (SCL-90 ≥160) was determined. Group comparisons were conducted using t-tests or ANOVA, and Pearson's correlations were used for associations. Structural equation modeling (SEM) tested the direct and mediated effects of perceived social support and resilience on psychological distress. Results: The median age was 14 years (IQR: 13–16), and 73.8% were female. Clinically significant psychological distress was present in 55.0% of participants. There was no significant difference in mean SCL-90 scores by gender (female: 137.4±36.1 vs. male: 141.1±37.8, p=0.497) or residence (p=0.712). Adolescents from families with monthly income <3,000 RMB had higher prevalence of psychological distress (65.1%) compared to those from families ≥3,000 RMB (34.1%, p=0.001). Perceived social support (MSPSS) and psychological resilience (CD-RISC) were negatively correlated with psychological distress (SCL-90) (r = –0.44 and r = –0.47, both p < 0.001), indicating moderate negative associations according to conventional effect size guidelines. SEM revealed that resilience partially mediated the relationship between perceived social support and psychological distress (indirect effect: β = -0.19, 95% CI: -0.28 to - 0.11, p < 0.001). Model fit indices were excellent (Comparative Fit Index [CFI] = 0.984, RMSEA = 0.046). Conclusions: Over half of adolescents with AIS experience significant psychological distress. Higher perceived social support and resilience are associated with better mental health outcomes, and resilience partially mediates the impact of social support. Psychosocial assessment and targeted interventions to strengthen support and resilience should be integrated into AIS management.