Identifying Targets for Improving Mental Healthcare of Adolescents with Systemic Lupus Erythematosus: Perspectives from Pediatric Rheumatology Clinicians in the United States and Canada

Abstract

Pediatric rheumatology clinicians perceive a need for improved mental healthcare of adolescents with SLE. Potential strategies to overcome barriers include enhanced mental health training for pediatric rheumatologists, standardized rheumatology-based mental health practices, and better integration of medical and mental health services.

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

“…Regrettably, despite the majority support for mental health screening of patients, only 2% of both behavioral health providers and previously‐surveyed pediatric rheumatologists reported universal screening occurring in the rheumatology setting . Top barriers to mental health screening and subsequent treatment reported by behavioral health providers and pediatric rheumatologists included limited time, staff resources, and mental health providers . Additional top barriers reported by behavioral health providers were lack of screening protocol, lack of social worker involvement, and time/cost burden to patients and families.…”

“…We evaluated the survey responses and performed descriptive statistics for provider characteristics, beliefs, and current practices, excluding ineligible responders and incomplete responses (those for which surveys were not submitted). In order to characterize the distinct perspective of behavioral health providers, we compared their beliefs about mental health intervention to those of CARRA pediatric rheumatologists who had participated in a published survey study conducted in 2015 (n = 119; 35% response rate) . We further compared beliefs for behavioral health providers to 2 subgroups of the CARRA rheumatologists, composed of those with a high level of behavioral health support at their clinic site (n = 77, reporting “very” accessible) versus those with a low level of behavioral health support (n = 38, reporting “somewhat” or “not very” accessible) at their clinic site (accessibility level missing for 4 subjects).…”

“…While studies have indicated that collaborative mental and medical care models in primary care are effective in connecting pediatric patients to mental health services , little is known about optimal models for youth with chronic illnesses in subspecialty care settings such as pediatric rheumatology. A national study of pediatric rheumatologists indicated a need for improved mental health care for adolescents with lupus; however major barriers to mental health intervention included limited staff time, resources, and availability of behavioral health providers .…”

Mental health care for youth with rheumatologic diseases – bridging the gap

“…Thus, the current systems of care fall short in terms of meeting the mental health needs for youth with rheumatologic diseases. In a survey by the Childhood Arthritis and Rheumatology Research Alliance (CARRA), which includes pediatric rheumatologists from both US and Canada, 52% of surveyed members reported inadequate symptom identification; and 45% reported inadequate treatment of depression and anxiety in adolescents with SLE, identifying limited staff resources and availability of mental health providers as top barriers to mental health intervention [ 70 ]. These barriers are not exclusive to pediatric rheumatology settings and have been cited as barriers to identification and management of psychosocial problems within general pediatrics settings as well [ 65 ].…”

“…In a CARRA survey of 130 pediatric rheumatologists, two-thirds reported formal mental health training only in medical school and nearly 10% reported no training at all. Importantly, the respondents with higher levels of mental health training perceived a lower frequency of barriers to mental health screening, and greater than 90% of respondents expressed interest in further mental health training [ 70 ]. These data highlight the potential value that mental health education for pediatric rheumatologists may have on improving care for youth with rheumatologic diseases.…”