Children With Juvenile Idiopathic Arthritis at Increased Risk for Depression and Adjustment Disorders

Risks for depression and adjustment disorders are increased among children with juvenile idiopathic arthritis (JIA), according to study findings published in The Journal of Rheumatology.

Investigators assessed differences in psychiatric morbidity among children with JIA vs their healthy peers.

A national matched cohort study was conducted using data from the Danish National Patient Registry. Children with 5 hospital visits indicating a diagnosis of JIA according to   International Classification of Diseases, 10th revision, codes were included in the analysis. Each child with JIA was age- and sex-matched with 100 children without diagnoses of JIA or psychiatric disease. 

The primary study outcome was diagnosis of psychiatric disease. Additional analyses were performed to determine if parental socioeconomic status, age at diagnosis, or disease severity influenced the relationship between psychiatric morbidity and JIA.

Psychiatric diagnoses were analyzed as a combined group and in subgroups of depression, anxiety, obsessive-compulsive disorder, eating disorders, and adjustment disorders (reaction to severe stress).

A total of 2086 children with JIA were included in the analysis and matched with 208,600 of their healthy peers (control group).

No significant between-group differences were noted for parental education level, parental psychiatric diagnoses, level of family income, or percentage of single parents.

During follow-up, 9.92% of children in the JIA cohort were diagnosed with a psychiatric disorder vs 8.45% in the control cohort.

After adjusting for socioeconomic variables and parental psychiatric disease, children with JIA were shown to be at 17% greater risk for any psychiatric diagnosis (adjusted hazard ratio [aHR], 1.17; 95% CI, 1.02-1.34) vs the control group.

Subgroup analysis based on individual psychiatric conditions revealed children with JIA were at greater risk for depression (aHR, 1.66; 95% CI, 1.23-2.24) and adjustment disorders (aHR, 1.28; 95% CI, 1.00-1.63), specifically. No differences were noted among risk for anxiety, eating disorders, or obsessive-compulsive disorder between children with JIA vs the control group.  

Parental socioeconomic factors were not found to significantly affect the association between JIA and psychiatric diagnoses. Additionally, no significant differences in risk for psychiatric diagnoses were found when stratified by sex or level of disease severity among children with JIA.

Study limitations included reduced generalizability, possible underdiagnosis of psychiatric conditions among the control cohort, and a lack of long-term follow-up data on disease activity in adulthood.

“In our study, we found no clear modification of SES on the association between JIA and psychiatric diagnosis. The lack of modification of SES might be because of the Danish healthcare system, which provides free treatment for all,” the study authors noted.

Disclosure: One or more study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.