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High numbers of youth with rheumatic disease experience mental health problems

A young woman sits on the floor with her back against the wall, her knees pulled up to her chest.

Research out of the IWK indicates up to 40 percent of youth with juvenile idiopathic arthritis (JIA), a type of chronic rheumatic disease, are experiencing significant mental health symptoms, including those associated with major depressive disorder, pain disorder, social phobia and anxiety.  The study, a first in Canada, looked at how many adolescents with JIA had signs of depression or anxiety.

“As JIA is often diagnosed when children are quite young, many of the children I met as toddlers are now teenagers and even young adults,” says rheumatologist and researcher Dr. Elizabeth Stringer. “One thing that I have found especially difficult in my practice, is seeing the onset and evolution of mental health problems in my patients.”

An article entitled “High Rates of Symptoms of Major Depressive Disorder and Panic Disorder in a Canadian Sample of Adolescents With Juvenile Idiopathic Arthritis” was recently published in The Journal of Rheumatology.  The study highlighted the ongoing need for mental health screening protocols and services when it came to youth with JIA.

The participants in the study were all 12 or older.  Forty percent scored high enough on the Revised Childhood Anxiety and Depressive Disorder Scale (RCAD) to indicate their symptoms were compatible with at least one mental health disorder. The most common disorder was major depressive disorder (24 percent) and a close second was panic disorder (23 percent). Social phobia was third (16 percent) and separation anxiety was fourth (14 percent). About 15 percent of adolescents scored highly for more than one disorder.

“We need to do what we can to destigmatize mental health illness through routine screening and advocate for our patients in accessing timely and appropriate mental health care,” says Stringer, the senior author of the study. “We also need to communicate with our colleagues in mental health and help educate them about rheumatic disease and vice versa – mental health and physical health do not exist in silos.”

The study resonated with the patients that took part. 98 percent of those asked agreed to do the study which consisted of an anonymous RCAD survey and some questions about their arthritis.

“This research emphasizes the importance of health care providers attending to the overall well-being of youth with JIA,” says psychologist and co-author Dr. Joanne Gillespie. “It is important to remember the burden that chronic illnesses can carry, and we must look at overall coping, in addition to the physical symptoms of arthritis that teens may be experiencing. Routinely asking questions about anxiety and depression as part of a clinic visit helps to normalize mental health challenges and creates space for those individuals experiencing difficulties in these areas to let health care providers know what’s going on for them and obtain support.”

“This study is an important reminder of the significant mental health needs of kids with chronic medical conditions,” says Dr. David Lovas, a child and adolescent psychiatrist and co-author on the study. “I hope this study reminds healthcare providers to have more routine discussions with their patients about how they are coping and what supports they may need.

Considered one of the most common causes of chronic disability in children in Canada, JIA affects about 1 in 1000 children.

Lydia Li, Dalhousie Medical student and lead author, was supported by the Dalhousie Medical Research Foundation Bergmann-Porter Studentship.