Associations of depression and sociodemographic characteristics with patient activation among those presenting for spine surgery

Emmanuel L. McNeely, Rahul Sachdev, Rafa Rahman, Bo Zhang, Richard L. Skolasky

Research output: Contribution to journalArticlepeer-review


Purpose: To investigate the associations of sociodemographic characteristics and PROMIS domain scores with patient activation among patients presenting for spine surgery at a university-affiliated spine center. Methods: Patients completed a survey collecting demographic and social information. Patients also completed the Patient-Reported Outcomes Measurement Information System (PROMIS) and Patient Activation Measure questionnaires. The associations of PROMIS scores and sociodemographic characteristics with patient activation were assessed using linear and ordinal logistic regression (patient activation stage as ordinal). Results: A total of 1018 patients were included. Most respondents were white (84%), married (73%), and female (52%). Patients were distributed among the 4 activation stages as follows: stage I, 7.7%; stage II, 12%; stage III, 26%; and stage IV, 55%. Mean (±standard deviation) patient activation score was 70 ± 17 points. Female sex (adjusted coefficient [AC] = 4.3; 95% confidence interval [CI] 2.1, 6.4) and annual household income >$80,000 (OR = 3.7; 95% CI 0.54, 6.9) were associated with higher patient activation scores. Lower patient activation scores were associated with worse PROMIS Depression (AC = −0.31; 95% CI −0.48, −0.14), Fatigue (OR = −0.19; 95% CI −0.33, −0.05), Pain (OR = 0.22; 95% CI 0.01, 0.43), and Social Satisfaction (OR = 0.33; 95% CI 0.14, 0.51) scores. Conclusion: Depression and socioeconomic status, along with PROMIS Pain, Fatigue, and Social Satisfaction domains, were associated with patient activation. Patients with a greater burden of depressive symptoms had lower patient activation; conversely, women and those with higher income had greater patient activation. Level of evidence: Level 1.

Original languageEnglish (US)
Pages (from-to)8-13
Number of pages6
JournalJournal of Orthopaedics
StatePublished - Jul 1 2021


  • Depression
  • Patient activation
  • Socioeconomic status
  • Spine surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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