Using a Mental Health Care Navigator to Overcome Barriers to Care in Childhood-Onset Systemic Lupus Erythematosus

Mental health (MH) disorders are common in childhood-onset systemic lupus erythematosus (cSLE), yet MH care use in this population is low. We developed an MH care navigator program at our institution to address barriers to MH care in cSLE. Here, we describe findings from the program.

We performed descriptive analysis of patients with cSLE in our program, including demographics, anxiety and depression screening results, MH diagnoses, and MH referrals.

All patients with cSLE at our institution were included (N = 79). The mean age at program start was 16 years, 81% of patients were female, and 32% were Asian. At least one validated depression and anxiety screening was completed in 70 (88%) and 68 (86%) patients, respectively. Of those screened, 16 (24%) had moderate or higher scores for depression and 21 (32%) had moderate or higher scores for anxiety. Twenty-four (30%) patients received new MH services after the program started, with 75% of those having previously accessed MH services. Neuropsychologic testing was completed in 37% (7 of 19) of patients diagnosed after program start, versus 25% (15 of 60) of those diagnosed before the program.

MH disease is common in cSLE, yet access to MH care is inadequate. Over one-quarter of our patients screened in the moderate or higher range for depression or anxiety. Our MH care navigator facilitated both screening and comprehensive psychosocial assessment, leading to timely and appropriate referrals. This model may improve care for patients with cSLE and could be replicated in other pediatric rheumatology programs.