Correlation of the Standardized Cosmesis and Health Nasal Outcomes Survey With Psychiatric Screening Tools

Abstract

Abstract Background Identifying mental health disorders, including body dysmorphic disorder (BDD), is important prior to rhinoplasty surgery; however, these disorders are underdiagnosed, and screening tools are underutilized in clinical settings. Objectives The authors sought to evaluate the correlation of a rhinoplasty outcomes tool (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]) with psychiatric screening tools. Methods Patients presenting for rhinoplasty consultation were prospectively enrolled and administered mental health instruments to assess depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and BDD (BDD Questionnaire-Aesthetic Surgery [BDDQ-AS]) as well as the SCHNOS rhinoplasty outcomes scale. Convergent validity of SCHNOS scores with these mental health instruments was assessed as well as calculation of an optimal SCHNOS-C score to screen for BDD. Results A total 76 patients were enrolled in the study. The average SCHNOS-O score (standard deviation) was 46.1 (34.0) and the average SCHNOS-C score was 61.1 (27.0). Five (7%) patients screened positive for depression, and 24 (32%) patients screened positive for mild, 5 (7%) for moderate, and 4 (5%) for severe anxiety. Twenty-four (32%) patients screened positive for BDD by BDDQ-AS scores. SCHNOS-O and SCHNOS-C did not correlate with Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 scores; SCHNOS-C did correlate with BDDQ-AS. A score of 73 or greater on SCHNOS-C maximized the sensitivity and specificity of also screening positive for BDD with BDDQ-AS. This score correlated with a sensitivity of 62.5%, specificity of 80.8%, and number needed to diagnose of 2.3, meaning for every 2 patients with a score of ≥73 on SCHNOS-C, 1 will have a positive BDDQ-AS score. Conclusions SCHNOS-C correlates with BDDQ-AS and may help screen rhinoplasty patients at higher risk for BDD. Level of Evidence: 2