Background/Purpose: Juvenile myositis (JM) negatively affects health-related quality of life due to chronic weakness, skin/muscle damage, multiorgan dysfunction, and side effects of immunosuppression. While JM’s impact on physical functional outcomes is well documented, there is a paucity of research assessing mental health comorbidities and their association with physical health outcomes in this high-risk population. This pilot study will assess feasibility of mental health screening in JM and test associations of mental health symptoms with disease outcome measures and healthy behaviors in JM.

Methods: Patients with JM aged 5-21 years old and their parents will be eligible for enrollment at Duke University Medical Center (Durham, NC) and Hospital for Sick Children (Toronto, ON). Self-report mental health screening for patients 12+ years old will be conducted using Pediatric Symptom Checklist-17 (PSC-17), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7); parents of all patients will complete a proxy-report version of PSC-17. Disease outcome measures will include: Physician/Patient/Parent Global Assessments of Disease Activity, Disease Activity Score, Manual Muscle Testing-8, Childhood Myositis Assessment Scale, Cutaneous Dermatomyositis Disease Area and Severity Index, Extramuscular Disease Global Assessment, Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility and Upper Extremity Function, and muscle enzymes. Self-report and parent-proxy data on healthy behaviors, including medication adherence (Domains of Subjective Extent of Nonadherence), PROMIS Physical Activity, and photoprotection (Measures of Sun Exposure and Sun Protection Practices for Behavioral and Epidemiological Research) will be collected. Rates of completion of PSC-17/PHQ-9/GAD-7 and missingness of data will be calculated to assess feasibility. Acceptability of these measures will be assessed by 5-point Likert scale. Comparison of disease outcomes and healthy behaviors in screen positive vs negative patients will be conducted using two-sample t-tests. A follow-up survey will be sent to parents of screen positive patients 1 month after the visit to assess barriers to obtaining mental health care for their child.

Results: This study will operationalize and establish: 1) feasibility of mental health screening in JM (data completeness using 3 validated measures); 2) relationship of mental health symptoms with disease severity and physical function; 3) potential mechanisms for differential health outcomes in JM patients with mental health comorbidities (i.e. differences in medication adherence, physical activity, and photoprotection).

Conclusion: This study represents the first attempt to demonstrate feasibility of routine mental health screening in JM. Pilot data will be used to inform the design and conduct of larger multicenter studies of mental health in JM across the CARRA network. Findings could potentially be generalized to other pediatric rheumatology practices and patient populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/feasibility-and-pilot-study-of-mental-health-screening-in-juvenile-myositis/