Children with juvenile idiopathic arthritis (JIA) experience anxiety and depression at higher rates than their peers without the condition, which takes a toll on their quality of life, a new study shows.
However, the relationship between mental health and aspects of JIA disease requires further study, the researchers noted.
The study, “Depression And Anxiety In Patients With Juvenile Idiopathic Arthritis: Current Insights And Impact On Quality Of Life, A Systematic Review,” was published in Open Access Rheumatology: Research and Reviews.
Chronic illnesses can have a significant impact on the mental health of patients. Yet, understanding the link between JIA and both depression and anxiety is still lacking, and is further complicated by the ever-changing landscape of available treatments and classifications of JIA, particularly in the past few decades.
Given the rising prevalence of mental health disorders, researchers in the U.S. and Canada conducted a systematic review of the literature of depression and anxiety in JIA to determine gaps in existing data, and identify areas warranting further investigation to improve care for these children.
They identified 28 relevant articles published between 2009 and 2019. About three-quarters examined depression, about half investigated anxiety, and just under a third examined the interplay between mental health and JIA disease characteristics. Three studies included adults, while the remaining 25 included children. Most studies were conducted outside of the United States.
Results revealed that rates of depression among children with JIA ranged from 7% to 36%, while anxiety ranged from 7% to 64%. This wide range in results could be due to differences in the socioeconomic backgrounds of the patients and the tools used to assess mental health, as well as small sample sizes in selected studies, the scientists said.
“These prevalence rates are at least as high as the general pediatric population,” the researchers said. They added that most studies found significantly higher levels of anxiety and/or depressive symptoms in children with JIA than in healthy children.
As for the link between disease characteristics and depression/anxiety, a substantial proportion of studies reported a correlation between JIA disease activity markers and depression symptoms, including aggravated depression/anxiety in people with active disease.
Yet, other studies found no association. Likewise, physical impairment and pain significantly correlated with more severe depression/anxiety in most studies, but not all.
Broadly, the reviewed studies suggested that these mental health disorders reduce quality of life. As the researchers expected, depression had the most significant impact on social and emotional measurements. Similar findings were generally reported for anxiety. Sleep and school productivity were also affected by depression and anxiety.
In addition, studies involving parents and caregivers of children with JIA suggested that their mental health was affected as well.
Among the studies’ limitations, the team noted that most looked at symptoms at one point in time, precluding longitudinal assessments of mental health. Also, most studies were small, did not analyze JIA subtypes, and included mostly white patients.
“Though gaps persist in our knowledge of how depression and anxiety influence specific disease factors in JIA, the recent literature clearly points to the role that depression and anxiety symptoms have on quality of life, both for the child with JIA and their family,” the researchers said.
“Pediatric rheumatologists need to consider addressing these symptoms if they wish to promote improved quality of life for their patients,” they added.