Addressing Mental Health for Adolescents with Lupus and Other Chronic Disease

Statement of Problem

Adolescence is a time of peak risk for depression and anxiety in childhood. Adolescent patients with chronic disease such as lupus have additional psychological stress associated with their illness and its treatment, increasing their risk of depression, anxiety, and suicidal thoughts compared to their healthy counterparts. Optimizing mental health through efforts to improve early recognition and treatment of depression and anxiety in adolescents with lupus and other chronic disease is important for achieving the best clinical and psychosocial outcomes. However, adolescents with chronic disease may face barriers to recognition of mental health problems as well as to mental health treatment access. For example, in lupus, a condition in which minorities comprise much of the affected population, patients may experience suboptimal mental health care due to cultural stigma, as well as racial and socioeconomic disparities in healthcare access.

In order to better understand the psychosocial impact of lupus on adolescent patients, Dr. Knight's team examined anxiety and depression in this population and found a high prevalence of depression and anxiety in one third of youth with systemic lupus erythematosus (SLE) and the SLE-like syndrome of mixed connective tissue disease. Depression was found to occur more frequently in those of non-white race, with suicidal ideation being significantly higher than in healthy peers. Depression in youth with SLE was associated with increased disease activity and damage, as well as longer disease duration. However, the high rates of depression and anxiety in youth with SLE were similar to age and sex-matched peers with type 1 diabetes mellitus, suggesting that the general burden of chronic disease played a central role in depression and anxiety, although potential disease-specific effects such as SLE-mediated central nervous system inflammation need further investigation.

Despite prevalent depression and anxiety symptoms, mental health treatment rates for youth with SLE were poor, and those with depression had less frequent primary care visits than those without. Mental health treatment rates were also lower for youth with SLE than their diabetic peers. This work highlights the unmet and disparate mental health needs of pediatric patients with SLE, implicating an important role for pediatric rheumatology providers in improving access to mental health care and interventions.

Ongoing research in this area is focused on developing interventional strategies to improve mental health care for adolescents with chronic disease. Current investigations explore the perceptions, preferences, and barriers to mental health care from the perspectives of patients with SLE and their parents, as well as those of clinicians. Dr. Knight also has research underway to understand the impact of depression on longitudinal outcomes for adults with childhood-onset SLE, as well as racial and ethnic disparities in psychiatric diagnoses and treatment in a national Medicaid population of adolescents with SLE. Future research plans include a characterization of the impact of depression and anxiety on patient-oriented and other health-related outcomes and testing of interventional strategies to improve mental and overall health for youth with SLE.

Suggested Citation

The Children's Hospital of Philadelphia, PolicyLab. Addressing Mental Health for Adolescents with Lupus and Other Chronic Disease [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].