Engaging patients and parents to improve mental health intervention for youth with rheumatological disease

• Published in: Pediatric Rheumatology 2021-02, Vol.19 (1), p.19-14, Article 19
• Main Authors: Fawole, Oluwatunmise A, Reed, Michelle V, Harris, Julia G, Hersh, Aimee, Rodriguez, Martha, Onel, Karen, Lawson, Erica, Rubinstein, Tamar, Ardalan, Kaveh, Morgan, Esi, Paul, Anne, Barlin, Judy, Daly, R Paola, Dave, Mitali, Malloy, Shannon, Hume, Shari, Schrandt, Suzanne, Marrow, Laura, Chapson, Angela, Napoli, Donna, Napoli, Michael, Moyer, Miranda, Delgaizo, Vincent, Danguecan, Ashley, von Scheven, Emily, Knight, Andrea
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Advisors; Age; Analysis; Anxiety - epidemiology; Anxiety - physiopathology; Anxiety - therapy; Arthritis; Arthritis, Juvenile - psychology; Children; Children & youth; Collaboration; Cross-Sectional Studies; Depression - epidemiology; Depression - physiopathology; Depression - therapy; Dermatomyositis - psychology; Disease; Families & family life; Female; Health care; Health services; Health Services Accessibility - standards; Health surveys; Humans; Internet-Based Intervention; Intervention; Lupus; Lupus Erythematosus, Systemic - psychology; Male; Medical screening; Mental disorders; Mental health; Mental Health - standards; Mental health interventions; Mental Health Services - standards; Parents & parenting; Parents - psychology; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patient compliance; Patient Participation; Patient-engaged approach; Patients; Pediatrics; Peer tutoring; Psychiatric services; Psychological aspects; Rheumatology; Survey; Surveys; Teenagers; Youth
• ISSN: 1546-0096; 1546-0096
• DOI: 10.1186/s12969-021-00503-7

Mental health disorders are common in youth with rheumatological disease yet optimal intervention strategies are understudied in this population. We examined patient and parent perspectives on mental health intervention for youth with rheumatological disease. We conducted a mixed methods cross-sectional study, via anonymous online survey, developed by researchers together with patient/parent partners, to quantitatively and qualitatively examine youth experiences with mental health services and resources in North America. Patients ages 14-24 years with juvenile idiopathic arthritis, juvenile dermatomyositis, or systemic lupus erythematous, and parents of patients ages 8-24 with these diseases were eligible (not required to participate in pairs). Participants self-reported mental health problems (categorized into clinician-diagnosed disorders vs self-diagnosed symptoms) and treatments (e.g. therapy, medications) received for the youth. Multivariate linear regression models compared patient and parent mean Likert ratings for level of: i) comfort with mental health providers, and ii) barriers to seeking mental health services, adjusting for potential confounders (patient age, gender, disease duration, and patient/parent visual analog score for disease-related health). Participants indicated usefulness of mental health resources; text responses describing these experiences were analyzed by qualitative description. Participants included 123 patients and 324 parents. Patients reported clinician-diagnosed anxiety (39%) and depression (35%); another 27 and 18% endorsed self-diagnosed symptoms of these disorders, respectively. 80% of patients with clinician-diagnosed disorders reported receiving treatment, while 11% of those with self-diagnosed symptoms reported any treatment. Patients were less comfortable than parents with all mental health providers. The top two barriers to treatment for patients and parents were concerns about mental health providers not understanding the rheumatological disease, and inadequate insurance coverage. Over 60% had used patient mental health resources, and over 60% of these participants found them to be helpful, although text responses identified a desire for resources tailored to patients with rheumatological disease. Self-reported mental health problems are prevalent for youth in this sample with rheumatological disease, and obstacles to mental health treatment include disease-related and logistic factors. Strategies are needed to