Mental health screening in pediatric rheumatology: a feasibility study

Despite the call for inclusion of routine mental health screening in pediatric rheumatology practice, the practical aspects of implementation in real world clinical settings have not yet been demonstrated. The aims of this study were: (1) to determine the acceptability and practicality of mental health screening in patients with Juvenile Idiopathic Arthritis (JIA) during routine visits at a pediatric hospital multidisciplinary clinic; (2) to understand the frequency and severity of anxiety and depressive symptoms within this sample.

Patients with JIA aged 8-17 were invited to participate during their routine clinic appointments. Patients completed three questionnaires on an iPad: PROMIS Pediatric Anxiety (v3), PROMIS Pediatric Depression (v3), and an acceptability questionnaire. Caregivers completed an acceptability questionnaire. Participants were provided with feedback on their scoring profile and relevant mental health resources during their clinic visit.

Forty patient-parent dyads participated during routine follow-up appointments at the Rheumatology Clinic at BC Children's Hospital between April and August 2024 (mean patient age = 13.5 years; 23 (57.5%) females). Overall, 92% of patients and 95% of caregivers reported the screening process to be 'Acceptable' or 'Completely Acceptable'. The mean PROMIS Anxiety t-score was 51.79 (SD = 11.06) and the mean PROMIS Depression t-score was 50.54 (SD = 7.62). Six patients (15%) had elevated or very elevated anxiety scores, and two patients (5%) had elevated depression scores.

There was high acceptability of the mental health screening process among patients and caregivers. The mean anxiety and depression scores were similar to the general population with a small proportion of patients reporting elevated scores. Mental health screening is practical within rheumatology clinic visits and should be considered by health professionals providing care for youth with JIA.