The influence of preoperative mental health on postoperative outcomes has been well-studied; however, there is limited literature available assessing the correlation between mental health at time of outcome assessment following surgery. The goal of this study is to determine the degree to which pain, physical function, and disability outcomes may be affected by the mental health of patients at time of survey in the anterior cervical discectomy and fusion (ACDF) population. Retrospective correlation study. Patients who had undergone ACDF, excluding those with acute trauma, infection, or malignancy as indications for surgery, were selected, totaling 618 participants. Outcomes studied included 12-item Short Form (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Patient Health Questionnaire-9 (PHQ-9), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), visual analog scale (VAS) back and leg pain, and Neck Disability Index (NDI) scores. A prospectively maintained single-surgeon registry was searched for patients who had undergone ACDF, excluding those with acute trauma, infection, or malignancy as indication for surgery. Patient-reported outcomes (PROs) were collected preoperatively and at several time points up to 2 years postoperatively. Outcomes studied included 12-item Short Form (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Patient Health Questionnaire-9 (PHQ-9), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), visual analog scale (VAS) back and leg pain, and Neck Disability Index (NDI) scores. Relationships between mental health, SF-12 MCS and PHQ-9, were compared to each other at each time period studied via Pearson's correlation tests. Six hundred and eighteen patients were included in the study. SF-12 MCS correlated positively with PROMIS-PF at all time points (|r|=0.373-0.509) and with SF-12 PCS at 6 months (r=0.256) and 1-year (r=0.427). SF-12 MCS negatively correlated at all periods with VAS Neck (|r|=0.319-0.634), VAS Arm (|r|=0.248-0.634), and NDI (|r|=0.449-0.629) (p≤0.034, all). PHQ-9 negatively correlated at all periods with PROMIS PF (|r|=0.443-0.757) and SF-12 PCS at all periods (|r|=0.359-0.722). At all periods, PHQ-9 positively correlated with VAS Neck (|r|=0.495-0.683), VAS Arm (|r|=0.332-0.701), and NDI (|r|=0.582-0.816) (p≤0.021, all). Poor mental health at time of outcome collection was associated with inferior physical function, increased neck and arm pain, and increased disability regardless of mental health form used. PHQ-9 had a stronger correlation with all outcome measures. Mental health is potentially a large contributor to inferior outcomes following ACDF. Optimization of mental health in both the preoperative and postoperative stages may lead to improved patient-reported outcomes. This abstract does not discuss or include any applicable devices or drugs.