New Guidance on Mental Health Screening in Pediatric Rheumatology

A recently released guidance document approved by the ACR provides a framework for considering mental health concerns in pediatric patients with rheumatic diseases, filling a need highlighted by patient advocacy groups.^1,2

Guidance Document Origin

Often under-recognized and undertreated, both anxiety and depression are common in young people with rheumatic disease, further compromising their quality of life.

The U.S. currently faces a pediatric mental health crisis, given both the high prevalence of these concerns and the shortage of pediatric mental health specialists. Many patients and their families build close relationships at their rheumatologist’s office, which they often view as their primary medical home. Considering all these factors, as well as the special challenges of mental health in young people with rheumatic disease, members of the pediatric rheumatology community have been discussing what role they should play in addressing mental health.

The ACR and the Childhood Arthritis and Rheumatology Research Alliance (CARRA) have long recognized the need for guidance statements to address mental health concerns in pediatric rheumatology settings. A team of two behavioral health specialists and two pediatric rheumatologists spearheaded the efforts of a broader team consisting of providers, patients and caregivers.

One of the leaders was Tamar B. Rubinstein, MD, MS, a pediatric rheumatologist and an associate professor at the Albert Einstein College of Medicine, New York City. Much of the momentum for the development of the guidance statements originated from the patient advocacy community, which has long pushed for more holistic management of children with rheumatic conditions, she says.

Dr. Tamar Rubinstein

Intersection of Rheumatic Disease & Mental Health

The social, emotional and physiological connections between rheumatic disease manifestations and mental health problems are often complexly interwoven. In some cases, rheumatic disease processes may directly contribute to mental health issues (e.g., poor mental health and depression in neuropsychiatric lupus).

Another key contributor to the guidance statements, Andrea M. Knight, MD, MSCE, a pediatric rheumatologist and an associate professor at the University of Toronto, points out that an open question remains on how pathophysiological processes stemming from rheumatic disease may directly impact mental health (e.g., greater depression risk from increased systemic inflammation).

Moreover, mental health plays a huge role in modulating pain perception, and non-pharmacological approaches, such as cognitive behavioral interventions, can positively modulate disease features, such as pain and fatigue (e.g., in patients with lupus).^3,4 Such issues as poor treatment adherence or missed clinic appointments related to mental health can directly impact disease management and outcomes.