Psychiatric Comorbidity Linked to Health Care Use Among Youth With Newly Diagnosed SLE

Youth with newly diagnosed SLE commonly experience psychiatric comorbidity and have greater health care use.

Psychiatric comorbidity, observed in one-thirds of youth with systemic lupus erythematosus (SLE), is associated with a greater number of ambulatory and emergency department visits, according to research results published in The Journal of Rheumatology.

Researchers conducted a retrospective cohort study to examine the effect of psychiatric diagnoses on health care use in youth with SLE.

Data, including patient demographics, medical diagnoses, and medications, were collected from a large insurance database (Clinformatics Data Mart) from 2000 to 2013.

Eligible patients were aged 10 to 24 years with an incident diagnosis of SLE who had been enrolled for at least 24 months. Age- and sex-matched control participants who did not have complex chronic conditions were also included in the study.

Patients with SLE were divided into 3 categories: no psychiatric diagnosis; a psychiatric diagnosis in the 12 months before diagnosis of SLE; or an incident psychiatric diagnosis in the 12 months after diagnosis of SLE.

Primary outcome measures included the number of health care visits in the first 12 months, which were categorized as ambulatory (primary care, rheumatology, or nephrology), emergency, and inpatient. All visits were also classified as psychiatric or nonpsychiatric.

Patients (N=650) with an incident diagnosis of SLE had a mean age of 18.4 years; 88% were girls and women and 56% were White.

[M]ental health interventions that decrease healthcare use could decrease healthcare costs.

A higher percentage of participants with a preexisting or incident psychiatric diagnosis had a stroke or seizure than those without a psychiatric diagnosis (14% vs 10% vs 6%, respectively; P =.02).

Among participants with newly diagnosed SLE, 227 (35%) also had psychiatric diagnoses; 122 (19%) had a preexisting diagnosis; and 105 (16%) had an incident diagnosis.

Compared with patients with SLE, the control participants demonstrated a significantly lower prevalence of psychiatric diagnoses than participants with SLE. Depression, anxiety, adjustment disorder, and other psychiatric disorders were more common among patients with SLE than control participants (P <.01, P <.01, P <.001, and P <.001, respectively).

Participants with vs without a preexisting psychiatric diagnosis had more ambulatory visits (incidence rate ratio [IRR], 1.4; 95% CI, 1.2-1.6; P <.001) and more emergency visits (IRR, 1.4; 95% CI, 1.1-1.9; P <.05).

Similarly, participants with vs without incident psychiatric diagnoses had more ambulatory (IRR, 1.6; 5% CI, 1.4-1.9; P <.001) and more emergency visits (IRR, 1.7; 95% CI, 1.3-2.2; P <.001).

In addition, participants with vs without any psychiatric diagnosis had more primary care visits.

Approximately one-thirds of the participants with SLE and psychiatric comorbidity (35%) had any psychiatric visits.

Study limitations included a bias toward White patients with private health insurance.

According to the study authors, “Mental health interventions that minimize the effect of frequent medical visits are likely to have positive downstream effects on school performance, peer relationships, and family dynamics. Further, mental health interventions that decrease healthcare use could decrease healthcare costs.”


Davis A, Faerber J, Ardalan K, et al. The effect of psychiatric comorbidity on healthcare utilization for youth with newly diagnosed systemic lupus erythematosus. J Rheumatol. 2023;50:204-212. doi:10.3899/jrheum.220052