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Keywords: PROMIS; pediatric craniofacial; language-discordant care

Background: Children with craniofacial differences face communication, appearance, and care-navigation challenges that may shape psychosocial well-being beyond what clinical diagnosis or insurance type alone captures. Language-discordant care — when patients or caregivers require interpreter services — adds an additional barrier that may contribute to unmet psychosocial need. Pediatric PROMIS measures provide standardized self-report of symptoms not routinely assessed in surgical care, but their longitudinal use to characterize language-associated psychosocial vulnerability in pediatric craniofacial populations remains limited.

Objective: To evaluate whether Spanish-language interpreter need — a marker of language-discordant care for the patient or caregiver — is associated with longitudinal pediatric PROMIS psychosocial outcomes in craniofacial patients.

Methods: We retrospectively reviewed patients aged 8–17 years with cleft-related/isolated Pierre Robin sequence, hemifacial microsomia/Goldenhar, or syndromic craniofacial diagnoses who completed self-reported pediatric PROMIS Anger, Anxiety, Depressive Symptoms, and Peer Relationships assessments. Encounters requiring Spanish-language interpretation for the patient and/or caregiver were classified as Spanish-language interpreter–required (Spanish-LEP). Linear mixed-effects regression models with random patient intercepts evaluated repeated PROMIS T-scores. Fixed effects included Spanish-LEP status, insurance type, broad diagnosis group, developmental school-age group, and sex. Baseline-only sensitivity analyses used each patient's first eligible PROMIS encounter.

Results: From 558 PROMIS encounters across 233 patients (45% Spanish-LEP, 76% publicly insured, 52% female, 75% cleft-related/PRS), patients from English-proficient encounters reported lower PROMIS Anxiety (β=−3.35, p=0.02) and Depressive Symptoms scores (β=−3.13, p=0.03) than patients from Spanish-LEP encounters, indicating greater internalizing symptom burden in the Spanish-LEP group. Developmental school-age group was associated with emotional distress: elementary-school-aged patients had higher Anxiety than middle-school-aged patients (β=+3.18, p<0.01); both elementary- and high-school-aged patients had higher Depressive Symptoms (β=+4.49 and β=+3.21; both p<0.001); and high-school-aged patients had higher Anger (β=+2.42, p<0.01). Insurance type, broad diagnosis group, sex, and Peer Relationships showed no significant adjusted associations. Baseline-only analyses confirmed the Anxiety (β=−3.88, p=0.03) and Depressive Symptoms findings (β=−3.60, p=0.03).

Conclusions: Language-discordant care, marked by Spanish-language interpreter need, was independently associated with higher Anxiety and Depressive Symptoms in pediatric craniofacial patients at baseline and across repeated PROMIS assessments. Longitudinal PROMIS screening may help identify language-associated psychosocial vulnerability not captured by insurance type or broad diagnosis group alone, and guide targeted psychosocial support in pediatric craniofacial care.