Moderate to Severe Symptoms of Anxiety and Depression Reported in Approximately One-Quarter of Children With JIA

Girl by window with chin resting on hand
Eight year old girl sits beside window on rainy day in contemplation
Using PROMIS measures, the researchers evaluated the prevalence of symptoms of depression and anxiety among children with juvenile idiopathic arthritis.

Among children with juvenile idiopathic arthritis (JIA), approximately 1 in 4 reported moderate to severe symptoms of anxiety and depression, both correlated with pain and stress, according to study results published in The Journal of Rheumatology.

Prior studies have reported higher rates of depression and anxiety among children with chronic diseases, with data showing that 7% to 36% of patients with JIA had depressive symptoms and 7% to 64% had anxiety symptoms.

The aim of the current study was to determine anxiety and depressive symptoms in children with JIA, using Patients Reported Outcomes Measurement Information System (PROMIS), and to assess the correlation between these symptoms and disease manifestations.

The cross-sectional study included 84 children (63 girls; mean age, 14 years) with JIA and a parent proxy from 2 pediatric rheumatology clinics, Children’s Wisconsin and Indiana University, from March to November 2019.

All participants completed PROMIS measures on depression, anxiety, stress, and pain. Mobility assessment was completed using the Childhood Health Assessment Questionnaire (CHAQ), and disease activity was determined using the clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10).

The majority of patients (70%) had inactive or low disease activity, according to cJADAS10.

Mean PROMIS t-scores for depressive and anxiety symptoms were lower in children with JIA compared with those in a historical control cohort, with a mean t-score of 50 on both PROMIS depressive and anxiety symptoms.

The patient mean PROMIS pediatric depressive symptoms t-score was 45.2±9.3, with a t-score of less than 50 (normal) in 56 patients (67%); 50 to 54 or less (mild) in 13 patients (15%); 55 to 64 or less (moderate) in 14 patients (17%); and  65 or greater (severe) in 1 patient (1%).

The mean PROMIS pediatric anxiety t-score was 44.4±9.13, with a t-score of less than 50 (normal) in 59 patients (70%); 50 to 54 or less (mild) in 11 patients (13%); 55 to 64 or less (moderate) in 13 patients (16%); and 65 or greater (severe) in 1 patient (1%).

Researchers noted a significant positive correlation between patient age and the PROMIS pediatric depressive symptom t-scores (r=0.36; P =.0008); depressive symptoms t-scores were higher among older patients. Similarly, there was a significant positive correlation between patient mobility, as measured by the CHAQ, with the PROMIS pediatric depressive symptoms t-scores (r=0.32; P =.0029). However, no significant correlation was identified between patient age or mobility and the PROMIS pediatric anxiety t-scores.

There was a positive correlation between the PROMIS pediatric anxiety and the PROMIS pediatric depressive symptoms with pain (r=0.47 and r=0.64, respectively; P <.0001) and stress (r=0.79 and r=0.75, respectively; P <.0001), but not with sex, JIA subtype, disease duration, or disease activity. Patients with higher pain interference or psychologic stress scores had higher depressive and anxiety symptom scores.

The study had several limitations, including the cross-sectional design; assessment of mental health symptoms at a single timepoint; a heterogeneous control cohort; potential selection bias as patients were self-selected instead of using a random sample; and limited generalizability as most patients had inactive or low disease activity and long disease durations.

“The use of PROMIS measures provides a unique opportunity for researchers to better evaluate and compare findings on the relationship between JIA and mental health. Future studies, particularly prospective, multicenter, and longitudinal with larger and more diverse populations, are needed to help further understand the incidence, prevalence, and potential risk factors for depression and anxiety in JIA,” the researchers concluded.


Fair DC, Nocton JJ, Panepinto JA, et al. Anxiety and depressive symptoms in juvenile idiopathic arthritis correlate with pain and stress using PROMIS measures. J Rheumatol.  Published online August 1, 2021. doi:10.3899/jrheum.210101