Psychosocial outcome in juvenile chronic arthritis: a nine-year follow-up

To describe the long-term psychosocial outcome in a prospectively followed cohort of patients with juvenile chronic arthritis (JCA), to assess the associations between psychosocial outcome and disease variables and to explore family stressors as predictors of long-term psychosocial and physical outcome.

Fifty-two patients with JCA were assessed psychosocially at first admission to a pediatric rheumatology clinic and were reassessed 9 years later. Assessment methods included semi-structured psychiatric interviews and standardized parental questionnaires and self-reports.

At follow-up, 9 patients (17%) fulfilled the criteria for a psychiatric diagnosis and 8 (15%) had mild to moderate impairment in psychosocial functioning (children's or adult Global Assessment Scale). Mental health and psychosocial functioning were significantly improved from the first hospital admission to follow-up. In patients < 18 years of age (n = 26), psychosocial functioning at follow-up correlated with physical disability according to the Childhood Health Assessment Questionnaire (r = -0.52, p < 0.01). Psychosocial outcome was unrelated to other measures of disease severity. Chronic family difficulties in the disease course predicted psychosocial functioning at follow-up in patients < 18 years old (R2 = 0.22). Chronic family difficulties at disease onset, together with gender and chronic family difficulties in the disease course, predicted psychosocial functioning at follow-up in patients > or = 18 years old (R2 = 0.61). Family stressors were unrelated to the physical outcome.

The long-term psychosocial outcome was favorable in most of the patients. Psychosocial outcome was predicted by chronic family difficulties, but was not closely related to disease severity at follow-up.