Narrative medicine intervention for mental wellbeing in Juvenile Myositis and juvenile idiopathic arthritis

Children with juvenile dermatomyositis (JDM) and juvenile idiopathic arthritis (JIA) have increased rates of anxiety and depression (15-65%) when compared to healthy children. Narrative medicine, a group-based intervention that allows patients to reflect on medical experiences, improves patient-reported outcomes with reduces depression rates in adults. Given limited data in pediatric rheumatology, this study assesses feasibility of a patient-targeted narrative medicine intervention and its impact on mental health burden in JDM and JIA.

We prospectively recruited patients ages 6 to 21 with JDM and JIA for a narrative medicine intervention. Participants were divided by diagnosis and age into four narrative medicine groups, with six sessions held over 3 months. Demographic and medical information were collected by chart review. Patients completed pre- and post-intervention questionnaires including Patient-Reported Outcomes Measurement Information System Depression Scale, Generalized Anxiety Disorder-7 (GAD-7), Childhood Attitude Towards Illness Scale, Patient Health Questionnaire-8 (PHQ-8), and CoVID Stress Scale.

Twelve patients with JDM (67% female) and nine with JIA (78% female) participated in the narrative medicine intervention. All patients participated in at least 50% of sessions and 91% participated in at least four of the six sessions. Wilcoxon signed-rank test revealed no statistically significant difference between pre- and post-intervention questionnaires for any scales. Sub-analysis of those with elevated GAD-7 and PHQ-8 pre-intervention showed a trend towards improvement in anxiety (p=0.057) and no change for depression (p=0.171).

Ninety-one percent participated in at least four of the six sessions, demonstrating feasibility. This exploratory study showed trend toward improved anxiety following narrative medicine session participation for those with elevated GAD-7.