Patients with psychiatric diagnoses have lower quality of life than other patients with juvenile rheumatic disease: a prospective study

Abstract

Objectives: Transition of adolescents with chronic diseases from paediatric healthcare to adult care requires attention to maintain optimal treatment results. We examined changes in health-related quality of life (HRQoL) and disease activity among JIA patients with or without concomitant psychiatric diagnoses after transfer to an adult clinic.

Methods: We prospectively followed 106 consecutive patients who were transferred from the New Children's Hospital to the Helsinki University Hospital Rheumatology outpatient clinic between April 2015 and August 2019 and who had at least one follow-up visit. HRQoL was measured using 15D, a generic instrument.

Results: The patients' median age at transfer was 16 years and disease duration 4.0 years. Patients were followed for a median of 1.8 years. Disease activity and overall HRQoL remained stable, but distress (dimension 13 of 15D) increased during follow up (P=0.03). At baseline, patients with at least one psychiatric diagnosis had lower overall 15D scores [mean 0.89 (s.d. 0.14) vs 0.95 (s.d. 0.05), P <0.01] and higher disease activity [DAS28mean 1.88 (s.d. 0.66) vs 1.61 (s.d. 0.31), P = 0.01] than patients without psychiatric diagnoses. The difference in overall 15D persisted over the study period.

Conclusion: Transition-phase JIA patients with psychiatric diagnoses had lower HRQoL than other JIA patients. Despite reduced disease activity and pain, HRQoL of patients with psychiatric diagnoses remained suboptimal at the end of follow-up. Our results highlight the necessity of comprehensive care and support for transition-phase JIA patients.

Keywords: distress; health-related quality of life; juvenile idiopathic arthritis; mental health; transition of care.

Fig. 1

Health-related quality of life (15D scores) of 106 JIA patients during 1.8 years of follow-up Numbers on the outer ring represent the 15 dimensions of HRQoL measured: 1, mobility; 2, vision; 3, hearing; 4, breathing; 5, sleeping; 6, eating; 7, speech; 8, excretion; 9, usual activities; 10, mental function; 11, discomfort and symptoms; 12, depression; 13, distress; 14, vitality; 15, sexual activity. Significant differences (P <0.05) between groups in any dimension are accompanied by a P-value.

Fig. 2

Distribution of patient age at JIA diagnosis (solid bar) and at psychiatric diagnosis (open bar) of 17 patients with both a JIA diagnosis and a psychiatric diagnosis

Fig. 3

Health-related quality of life (15D scores) of 17 JIA patients with psychiatric (F) diagnosis and 89 patients without F diagnosis during 1.8 years of follow-up (A) HRQoL in patients with (n=17) or without (n=89) a psychiatric diagnosis at first visit. (B) HRQoL in patients with (n=17) or without (n=89) a psychiatric diagnosis at last follow-up visit. Numbers on the outer ring represent the 15 dimensions of HRQoL measured: 1, mobility; 2, vision; 3, hearing; 4, breathing; 5, sleeping; 6, eating; 7, speech; 8, excretion; 9, usual activities; 10, mental function; 11, discomfort and symptoms; 12, depression; 13, distress; 14, vitality; 15, sexual activity. Significant differences (minimum important difference, 0.015) between groups in any dimension are accompanied by a P-value.