ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 134

Evaluation of Self-report Screening Measures in the Detection of Depressive and Anxiety Disorders Among Children and Adolescents with Systemic Lupus Erythematosus

Michelle Quilter1, Katherine Cost 2, Reva Schachter 3, Julie Couture 4, Ashley Danguecan 5, Lawrence Ng 6, Daniela Dominguez 6, Linda Hiraki 7, Deborah Levy 8, Earl D. Silverman 9, Kate Neufeld 10, Andrea Knight 11 and Daphne Korczak 2, 1Dept. of Psychiatry, Hospital for Sick Children, Dept. of Psychiatry, University of Toronto, Toronto, Ontario, Canada, 2Dept. of Psychiatry, Hospital for Sick Children, Dept. of Psychiatry, University of Toronto, Toronto, Canada, 3Dept. of Psychiatry, Hospital for Sick Children,, Toronto, Canada, 4Division of Pediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada, 5Hospital for Sick Children, Toronto, Canada, 6Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada, 7Division of Rheumatology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada, 8Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada, 9Division of Rheumatology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada, 10University of Toronto, The Hospital for Sick Children, Toronto, Canada, 11SickKids Research Institute, Toronto, Canada

Meeting: 2020 Pediatric Rheumatology Symposium

Keywords: , , , ,

Session Information

The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.

Date: Saturday, May 2, 2020

Title: Poster Session 3

Session Type: ACR Abstract Session

Session Time: 4:15PM-5:15PM

Background/Purpose: Screening for co-morbid psychiatric disorder is of high clinical importance in childhood-onset systemic lupus erythematosus (cSLE). However, there are no validated screening measures for depressive and anxiety symptoms among children with cSLE.  We aimed to (1) investigate depressive and anxiety disorder prevalence in a cSLE cohort by diagnostic psychiatric interview and (2) determine the sensitivity and specificity of the Centre for Epidemiologic Studies Depression Scale for Children (CES-DC)1 and the Screen for Childhood Anxiety and Related Disorders (SCARED)2 to identify disorder.

Methods: Patients between the ages of 8 and 18 years with cSLE or incipient cSLE (ACR/SLICC classification criteria) were recruited from the paediatric SLE clinic at the Hospital for Sick Children between July 2017 and September 2019. Participants completed demographic questionnaires, CES-DC and SCARED Child (C) and Parent (P) self-report screening measures. DSM-V depressive and anxiety disorder diagnoses were made by gold standard semi-structured psychiatric interview3. Receiver operating characteristics (ROC) analyses (area under the curve) evaluated the diagnostic performance of the self-report screening measures to detect depressive and anxiety disorder against gold standard DSM-V diagnoses. Sensitivity, Specificity, Positive and Negative Predictive values (PPV and NPV) were determined at a range of cut-points for each self-report measure. Correlation by spearman analysis determined the association between depressive disorder diagnostic status and CES-DC total.

Results: Seventy-two parent-child dyads were recruited and 56 interviews were completed. CES-DC and SCARED-(C) self-report measures for all participants interviewed were available for analysis. SCARED-(P) measures were incomplete for 6 participants. Mean participant age was 15.4 years (SD = 2.1). Eighty-four percent of the cohort were female. The mean scores for self-report measures were: CES-DC = 15 (range 1-49, SD 12), SCARED-C = 22 (range 2-61, SD 14) and SCARED-P = 13 (range 0-36, SD 8). Screen positivity (CES-DC  ≥ 15) for depressive disorder was 35% (vs. cohort disorder prevalence of 5%). Screen positivity (SCARED ≥ 25) for anxiety disorder was 39% (vs. cohort disorder prevalence of 16%). ROCAUC for the CES-DC was 0.98 (cut-point 38, sensitivity 100%, specificity 96%, PPV 96%, NPV 100%). ROCAUC for the SCARED-(C) was 0.7 (cut-point 32, sensitivity 56%, specificity 85%, PPV 42%, NPV 91%). The ROCAUC for the SCARED-(P) did not reach statistical significance. Association between CES-DC total score and depressive disorder diagnosis was moderately positive (s = 0.37, p < 0.01).

Conclusion: Diagnostic threshold for psychiatric disorder is higher for CES-DC and SCARED-(C) in cSLE compared with other at-risk populations. Cautious interpretation of self-report screening measures is warranted in cSLE.  

Figure 1. Flow diagram as per Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines illustrating the enrolment of patients in the study.

Disclosure: M. Quilter, None; K. Cost, None; R. Schachter, None; J. Couture, None; A. Danguecan, None; L. Ng, None; D. Dominguez, None; L. Hiraki, None; D. Levy, None; E. Silverman, None; K. Neufeld, None; A. Knight, None; D. Korczak, None.

To cite this abstract in AMA style:

Quilter M, Cost K, Schachter R, Couture J, Danguecan A, Ng L, Dominguez D, Hiraki L, Levy D, Silverman E, Neufeld K, Knight A, Korczak D. Evaluation of Self-report Screening Measures in the Detection of Depressive and Anxiety Disorders Among Children and Adolescents with Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/evaluation-of-self-report-screening-measures-in-the-detection-of-depressive-and-anxiety-disorders-among-children-and-adolescents-with-systemic-lupus-erythematosus/. Accessed .

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