Adolescence can be a particularly fraught time for a person’s mental health, and having to deal with a rheumatic disease only increases the stress and anxiety. Disorders such as rheumatic musculoskeletal disease (RMD) and juvenile idiopathic arthritis (JIA) can cause patients significant mental distress. How can you take that into consideration in light of your therapeutic relationship with these patients?
Recently, a study in Open Access Rheumatology examined the mental health of young patients relating both to their rheumatic diseases and their transition from adolescence to adulthood.¹ What are some of the most common and serious mental health concerns to be mindful of when dealing with these patients?
Having depression in tandem with rheumatic diseases can be very problematic for adolescent patients. The researchers note that young patients with JIA who have depression and anxiety symptoms have a worse quality of life, while citing studies that suggest these psychological symptoms themselves may be associated with pain and disability. They report that adolescent patients with systemic lupus erythematosus (SLE) often have difficulty coping psychologically with the management of their disease, while facing an increased risk of depression. Medical professionals should be cognizant of this tendency when working with young patients and consider recommending cognitive behavioral therapy for those with mild or moderate depression symptoms.2
2. Illness uncertainty
One of the most frustrating aspects of chronic illness can be illness uncertainty, which is defined as “the inability to determine the meaning of illness-related events.”3 Not knowing why an illness-related event is happening and not being able to predict when the next one may occur can create significant levels of anxiety. In young patients with JIA and other relapsing and remitting conditions, illness uncertainty also correlates with greater illness distress and difficulty with psychological functioning, according to the researchers. Illness uncertainty can also affect the mental health and well-being of young patients with SLE.
3. Procedure-based anxiety
Anxiety associated with rheumatic disorders can often be exacerbated by treatment and procedures. The researchers report that patients with RMD often feel stress about medication and blood test-based disease management. Young patients with JIA being treated with methotrexate often experienced anxiety related to blood tests, nausea, and fear of needles. Patients may be helped with minimal sedation, topical numbing agents, over-the-counter analgesics, and play therapy, especially when transitioning to an adult healthcare settting.4 Medical professionals working with these patients should also be mindful of how painful these procedures can be for young patients and recommend coping mechanisms, including distractions and educating parents on language to use to help reduce anxiety.5
4. Parental mental health
While working with young patients, medical professionals may also want to consider the mental health struggles of their parents. Parents watching their children undergo painful procedures can also experience significant levels of anxiety. High levels of anxiety and depression have also been reported in parents of children with JIA. These anxieties can lead to a lower quality of life not only for the patient but for the entire family. Parents’ mental health is as much of a concern as that of patients, so take steps to reduce stress and anxiety.
5. Pediatric-to-adult health transition
Making the transition from a pediatric to adult healthcare setting is a particularly vulnerable time for a young patient with a rheumatic disorder, according to the researchers, although they didn’t find a consistent correlation between this transition and psychological outcomes such as depression and anxiety. Keep in mind that these patients may have dealt with their illness for much of their young lives. Healthcare professionals can consider using tools that measure transition readiness such as the Transition Readiness Assessment Questionnaire for patients between 16 and 26 years of age.
- Palman J, McDonagh JE. Young minds: mental health and transitional care in adolescent and young adult rheumatology. Open Access Rheumatol. 2020;12:309-321. doi:10.2147/OARRR.S228083
- Thabrew H, Stasiak K, Hetrick SE, et al. Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev. 2018;12(12):CD012488. doi:10.1002/14651858
- McCormick KM. A concept analysis of uncertainty in illness. J Nurs Scholarsh. 2002;34(2):127-131. doi:10.1111/j.1547-5069.2002.00127.x
- Elitsur R, Hollenbeck A, Tasan L, et al. Efficacy and cost savings with the use of a minimal sedation/anxiolysis protocol for intra-articular corticosteroid injections in children with juvenile idiopathic arthritis: a retrospective review of prospectively collected data. Pediatr Rheumatol Online J. 2019;17(1):11. doi:10.1186/s12969-019-0312-y
- Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics. 2008;122(Supplement 3):S134-S139. doi:10.1542/peds.2008-1055f