Cross-Cutting Disease Factors Predictive of Mental Health in Youth With Rheumatologic Disease

Cross-cutting disease factors, including appearance-altering comorbidities, may predict mental health issues, such as anxiety and depression, in youth with rheumatologic disease, according to results of a survey presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

Although mental health issues are common in youth with rheumatologic disease, limited data are available on the factors that affect mental health in this population.

Patients aged between 14 and 24 years with rheumatologic disease and the parents of youth aged between 8 and 24 years who were enrolled through the Arthritis Foundation, Lupus Foundation of America, and Cure JM Foundation were eligible for the study. An online survey was used to collect data on mental health from patients with juvenile arthritis, juvenile dermatomyositis, or systemic lupus erythematosus (SLE).

The primary outcome of the study was any diagnosis of a mental health issue. Cross-cutting factors, including disease duration, active disease status, current steroid therapy, history of flare after remission, and appearance-altering comorbidities, were determined. Logistic regression models were used to explore the association between any clinician- or self-diagnosed mental health issues and disease factors for the combined youth/parent population and for youth and parents separately.

The study sample included 123 youth and 324 parents; 210 patients had juvenile arthritis, 173 had juvenile dermatomyositis, and 64 had SLE. Of 447 patients, 293 (65%) had any self-reported mental health issue, and 154 (35%) had none. There was no difference between groups with regard to age distribution, sex, race, education level, household income, or rheumatologic diagnosis. However, mental health issues were more common among patients with appearance-altering comorbidities (51% vs 36%, P =.003). The prevalence of clinician-diagnosed depression, anxiety, suicidal thoughts, and self-injury were 35%, 39%, 16%, and 7%, respectively.

Appearance-altering comorbidities (psoriasis, stretch marks, alopecia, skin ulceration, and visible scarring) were associated with increased risk for mental health issues in the combined youth/parent population (odds ratio [OR], 1.76; 95% CI, 1.18-2.64) and in the parents-only population (OR, 1.83; 95% CI, 1.13-2.97). Appearance-altering comorbidities were also predictors of anxiety (OR, 2.19; 95% CI, 1.39-3.43) and depression (OR, 1.79; 95% CI, 1.18-2.73) in the combined youth/parent population. The risk for suicidal ideation or self-harm was increased among patients with a history of flare after remission (OR, 2.46; 95% CI, 1.28-4.71).

“These findings are helpful for identifying targets for mental health screening in youth with rheumatologic disease, and should be addressed in screening recommendations,” the study authors concluded.

Reference

Danguecan A, Fawole O, Reed M, et al. Using a patient-engaged approach to identify cross-cutting disease factors impacting mental health in youth with rheumatologic disease. Presented at: ACR Convergence 2020; November 5-9, 2020, Abstract 1175.