No Difference in Patient Health Questionnaire-4 Score Outcomes in Multiple Surgeries for Cleft Lip & Palate Management
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1682
Abstract
Cleft lip and palate (CL/P) often requires multiple surgical interventions throughout childhood and adolescence, including palatoplasty, alveolar bone grafting, and rhinoplasty.1 On average, patients with bilateral and unilateral CL/P undergo approximately 10 and 9.4 surgeries, respectively.2 Repeated surgical procedures may contribute to significant psychological distress, including depression.3 The Patient Health Questionnaire-4 (PHQ-4) is a validated tool used to screen for depression and anxiety in clinical populations.4 Our institution's pediatric plastic surgery division has implemented the PHQ-4 for depression and anxiety screening for patients with CL/P.1 We aim to evaluate whether patients with positive PHQ-4 scores (≥3) have undergone a greater number of CL/P-related surgeries compared to those with negative PHQ-4 scores.
This is a retrospective cohort study of surgically treated patients with isolated CL/P and a PHQ-4 screening recorded between 2020-2024 aged 11-25. Data collected included highest ever reported PHQ-4 score, number and type of procedures prior to the highest score, and psychiatric diagnosis. Statistical analysis employed Whitney-Mann U and Fishers Exact tests comparing patients who scored PHQ+ or PHQ- with significance defined as p ≤.05. This study received institutional review board approval.
A total of 54 patients were identified, with 26.6% (n=16) having a positive PHQ-4 score (PHQ+). Of those with a PHQ+ score, 9 were female and 7 were male, with a mean age of 16 (±2.63) years, compared to 13 females and 25 males with a mean age of 16 (±2.75). Fisher exact testing revealed statistical significance for PHQ+ and general anxiety disorder (31.25%, p=<.01) and major depressive disorder (37.5%, p=<.01) diagnoses. There was no statistical significance between the number of procedures and PHQ-4 positivity (p=.3978), as the PHQ+ group had 8.5 (±3.4) and the PHQ- group had 9.47 (±3.98) total CL/P related surgeries. Further, the Whitney-Mann U test revealed no statistical significance between PHQ-4 positivity for patients aged 11-14 (p=.6101), 15-16 (p=.5680), 17-18 (p=.9185), and 19-23 (p=.6688) and total procedures.
The was no correlation between number of CL/P related surgeries and positive PHQ-4. These findings support previous literature showing no impact of multiple surgeries on anxiety and depression symptoms in 11-17-year-olds with CL/P.5 However, our research supports the use of PHQ-4 as a screening tool for patients with CL/P as there was correlation between PHQ+ and psychiatric diagnosis.