Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers

Knight, Andrea; Vickery, Michelle; Faust, Lauren; Muscal, Eyal; Davis, Alaina M.; Harris, Julia G.; Hersh, Aimee O.; Rodriguez, Martha; Onel, Karen; Rubinstein, Tamar; Washington, Nina T.; Weitzman, Elissa R.; Conlon, Hana; Woo, Jennifer M.P.; Gerstbacher, Dana; Scheven, Emily von

doi:10.1002/acr.23683

Cited by 27 publications

(28 citation statements)

References 34 publications

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“…However, current systems of care fall short in providing such services. While most surveyed pediatric rheumatologists and behavioral health providers affiliated with the Childhood Arthritis and Rheumatology Research Alliance (CARRA) recommended routine screening for mental health disorders in youth with SLE, only 2% of practices reported routine screening with a standardized instrument (42,43). The CARRA Mental Health Workgroup members rated mental health screening as the most feasible and actionable area of study in their mental health research agenda (44).…”

Section: Discussionmentioning

confidence: 99%

Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus

Chang

Davis

Klein‐Gitelman

et al. 2020

Arthritis Care & Research

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Objective. Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. We undertook this study to examine the association between psychiatric disorders and hydroxychloroquine adherence and to determine whether psychiatric treatment modifies this association. Methods. We identified incident hydroxychloroquine users among youth with SLE (ages 10-24 years) using de-identified US commercial insurance claims in Optum Clinformatics Data Mart (2000-2016). Adherence was estimated using medication possession ratios (MPRs) over a 365-day time period. Multivariable linear regression models were used to estimate the effect of having any psychiatric disorder on MPRs, as well as the independent effects of depression, anxiety, adjustment, and other psychiatric disorders. We tested for interactions between psychiatric diagnoses and treatment with psychotropic medications or psychotherapy. Results. Among 873 subjects, 20% had a psychiatric diagnosis, most commonly depression. Only adjustment disorders were independently associated with decreased MPRs (β-0.12, P = 0.05). We observed significant crossover interactions, in which psychiatric disorders had opposite effects on adherence depending on the receipt of psychiatric treatment. Among youth with any psychiatric diagnosis, psychotropic medication use was associated with a 0.15 increase in the MPR compared with no psychotropic medication use (P = 0.02 for interaction). Among youth with depression or anxiety, psychotherapy was also associated with a higher MPR compared with no psychotherapy (P = 0.05 and P < 0.01 for interaction, respectively). Conclusion. The impact of psychiatric disorders on medication adherence differed by whether youth had received psychiatric treatment. Improving recognition and treatment of psychiatric conditions may increase medication adherence in youth with SLE.

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Section: Discussionmentioning

confidence: 99%

Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus

Chang

Davis

Klein‐Gitelman

et al. 2020

Arthritis Care & Research

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“…94 Barriers and facilitators for such screening have been identified both from the patient and the professional perspective (Table 2). [93][94][95][96] Interventions in this area potentially should aim to lift and/or remove these barriers while enhancing the facilitators and in so doing will potentially improve mental health care for young people with RMD.…”

Section: Mental Health Strategies and Interventions In Rheumatology Smentioning

confidence: 99%

“…96 The major barrier reported by trainees in adult medicine was training with respect to this age group and the second barrier was time 108 echoing other studies, 109,110 including two addressing care of young people with SLE. 94,95 Attention is, therefore, needed with respect both to workforce competency in addressing mental health of young people with RMD and also how supportive the health-care system is to enable this to happen-how developmentally appropriate 111 and youth-friendly 112 is it? Are young people offered the opportunity to be seen independent of the caregiver, are the consultation times allocated long enough to enable mental health issues to be addressed?…”

Section: Workforce Competency and Service Level Issuesmentioning

confidence: 99%

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<p>Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology</p>

Palman¹,

McDonagh²

2020

OARRR

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“…However, evidence suggests that services for pediatric physical health LTCs are not routinely set up in this way, staff time and resources are limited, access to psychological support is patchy, and there are long wait lists for child and adolescent mental health services (Wiener et al, 2015 ; Cruikshank et al, 2016 ; Davis et al, 2017 ). Further, there are currently significant gaps in the evidence base for the best type of psychological support for children with physical health LTCs (Kazak et al, 2015 ; Knight et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness

Wigham

Watts²,

Zubala

et al. 2020

Front. Psychol.

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Background: Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs. Methods: The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively. Results: Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites. Conclusions: The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.

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Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers

Cited by 27 publications

References 34 publications

Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus

Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus

<p>Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology</p>

Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness

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