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

Pediatric Rheumatology

Tamar Rubinstein¹  Kaveh Ardalan²  Suzanne Schrandt³  Laura Marrow³  Donna Napoli⁴  Miranda Moyer⁴  Michael Napoli⁴  Michelle V. Reed⁴  Angela Chapson⁴  Andrea Knight⁵  Oluwatunmise A. Fawole⁶  Anne Paul⁷  Esi Morgan⁷  Mitali Dave⁸  Shari Hume⁸  Shannon Malloy⁸  Ashley Danguecan⁹  Karen Onel^1,10  R. Paola Daly^1,11  Judy Barlin^1,11  Vincent Delgaizo^1,12  Martha Rodriguez^1,13  Erica Lawson^1,14  Emily von Scheven^1,14  Julia G. Harris^1,15  Aimee Hersh^1,16 

[1] Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY, USA;Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA;Northwestern University Feinberg School of Medicine, Chicago, IL, USA;Duke University Medical Center, Durham, NC, USA;Arthritis Foundation, Atlanta, GA, USA;Children’s Hospital of Philadelphia, Philadelphia, PA, USA;Children’s Hospital of Philadelphia, Philadelphia, PA, USA;University of Pennsylvania, Philadelphia, PA, USA;Division of Rheumatology, Hospital for Sick Children, M5G1X8, Toronto, ON, Canada;University of Toronto Faculty of Medicine, Toronto, ON, Canada;Children’s Hospital of Philadelphia, Philadelphia, PA, USA;University of Pennsylvania, Philadelphia, PA, USA;New York University Grossman School of Medicine, New York, NY, USA;Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA;Cure JM Foundation, Leesburg, VA, USA;Division of Rheumatology, Hospital for Sick Children, M5G1X8, Toronto, ON, Canada;Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA;Lupus Foundation of America, Washington, D.C, USA;Patient-Centered Outcomes Research Institute, Washington, D.C, USA;The Childhood Arthritis and Rheumatology Research Alliance, Milwaukee, WI, USA;Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA;University of California San Francisco, San Francisco, CA, USA;University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO, USA;University of Utah, Salt Lake City, UT, USA;

关键词: Children;    Mental health;    Patient-engaged approach;    Rheumatology;    Mental health interventions;    Survey;   

DOI  :  10.1186/s12969-021-00503-7

来源: Springer

【 摘 要 】

BackgroundMental 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.MethodsWe 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.ResultsParticipants 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.ConclusionSelf-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.

【 授权许可】

CC BY