AccScience Publishing / HPR / Online First / DOI: 10.36922/HPR0482
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RESEARCH ARTICLE

Psychological distress, personality traits, coping strategies, and functional recovery after elective spinal surgery: A longitudinal study

Friederike Weidemann1,2* ,  Johanna Tendai Zishiri3 ,  Nora M. Laskowski4,5 ,  Stefan Budde6 ,  Astrid Müller5 ,  Dorothea Daentzer7
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1 Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
2 Department of Intensive Care Medicine, HELIOS Medical Center Schwerin, University Campus of MSH Medical School Hamburg, Schwerin, Germany
3 Department of Internal Medicine III, Darmstadt Hospital, Darmstadt, Germany
4 University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
5 Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
6 Department of Trauma and Orthopaedic Surgery, Evangelisches Klinikum Bethel University Hospital OWL, University of Bielefeld, Bielefeld, Germany
7 Department of Orthopaedic Surgery, Hannover Medical School, DIAKOVERE Annastift, Hannover, Germany
HPR, 0482 https://doi.org/10.36922/HPR0482
Received: 9 January 2026 | Revised: 29 June 2026 | Accepted: 1 July 2026 | Published online: 22 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Psychological factors are frequently associated with pain and disability after spine surgery, yet their independent contribution to functional recovery remains unclear.

Objective: To investigate whether preoperative psychopathology and coping styles predict functional outcome 12 months after elective spine surgery and to assess longitudinal psychosocial changes.

Methods: Of 121 eligible adults, 106 completed the 12-month follow-up (65.1% women; mean age 61.6 ± 13.1 years). The primary outcome was change in the Oswestry Disability Index (ODI; ΔODI = the baseline score minus the 12-month score), with unfavorable outcome defined as ΔODI ≤ 15. Secondary outcomes included pain intensity, anxiety and depression, personality traits, and coping styles. Assessments were performed preoperatively and at 12 months postoperatively. Longitudinal changes, associations with ODI, and predictors of unfavorable outcome were analyzed.

Results: ODI improved significantly from baseline to follow-up (p < 0.001; d = 0.70), but only 22.1% of participants achieved a favorable functional improvement (ΔODI >15). Anxiety symptoms decreased over time, whereas depressive symptoms and personality traits remained stable. Higher preoperative anxiety and depression were associated with greater postoperative pain but did not independently predict unfavorable functional outcome.

Conclusion: Elective spine surgery was associated with statistically significant improvements in disability and reduced anxiety over the 12-month follow-up period. However, only a minority of patients achieved the predefined threshold for favorable functional improvement. The findings do not support the investigated psychosocial variables as independent predictors of functional recovery but underscore the importance of considering psychological well-being within an integrated biopsychosocial framework.

Keywords
Elective spine surgery
Oswestry Disability Index
Psychological distress
Coping strategies
Functional recovery
Biopsychosocial model
Funding
None.
Conflict of interest
The authors declare that they have no conflicts of interest.
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Health Psychology Research, Print ISSN: 2420-8124, Published by AccScience Publishing
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