Psychosocial functioning.

The Multidimensional Anxiety Scale for Children Second Edition (MASC-2 [20, 21]) was used to assess anxiety symptoms from 2013 to 2018 before transitioning to the Patient-Reported Outcomes Measurement Information System: Pediatric Short Form v2.0-Anxiety 8a (PROMIS-Anxiety [22]). The MASC-2 is a 50-item self-report measure that assesses anxiety symptoms in children and adolescents. Participants rated how frequently they endorse each item in terms of recent functioning (e.g., “I worry about what other people think of me” and “I feel restless and on edge”) on a four-point Likert-type scale ranging from 0 (“never”) to 3 (“often”). Items are summed to calculate a MASC-2 Total score, which can then be translated into a corresponding T-score. T-scores greater than 60 are considered clinically significant (60–64 = Slightly Elevated; 65–69 = Elevated; >70 = Very Elevated). In the current sample, internal consistency was excellent (α=0.94 at both Time 1 and Time 2).

The PROMIS-Anxiety is an eight-item self-report measure that assesses anxiety in children and adolescents. Participants rated the items (e.g., “I felt like something awful might happen” and “I worried when I went to bed at night”) in the context of the past seven days. The PROMIS-Anxiety uses a five-point Likert-type scale ranging from 1 (“never”) to 5 (“almost always”). Scores are totaled to determine the raw score, which is translated into a T-score. T-scores greater than 50 are considered clinically significant (50–55 = Mild; 55–65 = Moderate; >65 = Severe). The PROMIS-Anxiety shows good construct validity and is responsive to change in pediatric musculoskeletal chronic pain populations [23]. In the current sample, internal consistency was excellent (α=0.93 at Time 1, α=0.94 at Time 2).

To address the fact that some participants completed the MASC-2 while others completed the PROMIS-Anxiety to assess anxiety symptoms, T-scores from each measure were used and collapsed into one ‘Anxiety Symptoms T-score’ variable (M=50, SD=10) for the current study. T-scores of </=40–59 are considered within the average range, with higher scores indicating increased anxiety symptoms. The results of independent samples t-tests did not reveal significant differences between MASC-2 and PROMIS scores at both Time 1 and Time 2 (p’s > .05).

The Children’s Depression Inventory −2 (CDI-2 [24]) was used to assess patients’ depressive symptoms from 2013–2018 until transitioning to the Patient-Reported Outcomes Measurement Information System: Pediatric Short Form v2.0-Depressive Symptoms 8a (PROMIS-Depression [22]). The CDI-2 is a self-report questionnaire that assesses depressive symptoms in children and adolescents. The inventory is made up of 28 items, and each item presents three statements of increasing symptomatology between which the participant must choose. The items are scored 0 to 2, with a total possible raw score of 54. The raw scale score is translated into a corresponding T-score, with higher T-scores indicating greater levels of depressive symptoms. The CDI-2 is a widely used measure to assess depressive symptoms in youth and has good reliability (α = 0.88) in prior studies (e.g., Chow et al., 2016 [1]). In the current sample, internal consistency was excellent (α=0.91 at Time 1, α=0.90 at Time 2).

The PROMIS-Depression is an eight-item self-report measure that assesses depressive symptoms in children and adolescents. Participants rated items (e.g., “I could not stop feeling sad” and “It was hard for me to have fun”) in the context of the past seven days. The PROMIS-Depression uses a five-point Likert scale ranging from 1 (“never”) to 5 (“almost always”). Scores are totaled to determine the raw score, which is then translated into a T-score. T-scores greater than 50 are considered clinically significant (50–55 = Mild; 55–65 = Moderate; >65 = Severe). The PROMIS-Depression shows good construct validity and is responsive to change in pediatric musculoskeletal chronic pain populations [23]. In the current sample, internal consistency was excellent (α=0.95 at both Time 1 and Time 2).

To address the fact that some participants completed the CDI-2 while others completed the PROMIS-Depression to assess depressive symptoms, t-scores from each measure were used and collapsed into one ‘Depressive Symptoms T-score’ variable (M=50, SD=10) for the current study. T-scores of </=40–59 are considered within the average range, with higher scores indicating increased depressive symptoms. The results of independent samples t-tests at Time 1 and Time 2 did not reveal significant differences between CDI-2 and PROMIS scores (p’s ≥ .05).