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

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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 improve acceptance and accessibility of mental health intervention, including routine mental health screening and availability of disease-specific mental health resources.

Keywords: Children; Mental health; Mental health interventions; Patient-engaged approach; Rheumatology; Survey.

Fig. 1

Results are shown for the prevalence of mental health problems reported by patients with rheumatological disease, categorized by clinician-diagnosed disorders and self-diagnosed symptoms. The category for other mental health problem includes bipolar disorder/psychosis, oppositional defiant disorder and substance abuse

Fig. 2

Results are shown for linear regression models comparing Likert ratings for level of comfort with mental health providers between patients and parents. Models were adjusted for patient age, gender, disease duration, and patient/parent visual assessment score for disease-related health. *p < 0.01, **p < 0.001, ***p < 0.0001. Beta coefficients were as follows for: psychiatrist (0.44), counselor/therapist in your community (0.65), school counselor/therapist (0.74), psychologist in your community (0.78), psychologist at rheumatologist office (0.60), social worker at rheumatologist office (0.85), rheumatologist (0.74), PCP (0.78), social worker at PCP office (0.81)

Fig. 3

Results are shown for the top five barriers to seeking mental health services for patients, rated by patients and parents