Session Information
Date: Sunday, November 8, 2015
Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster I: Lupus, Scleroderma, JDMS
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Depression and anxiety are common in adolescents with SLE. Barriers to mental
health intervention in pediatric rheumatology care are unclear. We aimed to
determine current provider practices and perceived barriers to mental health
care for adolescents with SLE.
Methods:
We conducted a web-based survey from May-June 2015 among members of the
Childhood Arthritis and Rheumatology Research Alliance (CARRA). Inclusion
criteria were providers caring for adolescents with SLE, with an available
email address. The survey assessed provider demographics, current practices and
barriers for mental health care of adolescents with SLE. Participants rated
potential barriers on a 4-point Likert scale as:
“never=0”, “sometimes=1”, “often=2” or “very often=3”. We defined significant
barriers as those rated “often” or “very often”, and ranked them by frequency.
We used multivariable negative binomial regression to examine associations of demographics
with the number of significant barriers to mental health care. Provider covariates
included: type (attending or trainee MD/DO, NP, PA); sex; years in practice;
mental health training. Practice covariates included: setting; location; size;
upper age limit of patients treated; SLE population size and insurance
composition; presence of a specialized SLE clinic; involvement in SLE research.
Results:
Of 375 eligible CARRA members, 120 (32%) responded. After exclusions (13
incomplete, 6 not in clinical care), 101 were analyzed. Eighty percent of
respondents were attending physicians, 43% had >10 years in practice, 95%
were university-affiliated and 72% were female. Fifty-four percent said
identification of depression/anxiety in adolescents with SLE was currently inadequate
and 47% said treatment was inadequate. Routine screening for depression and
anxiety was supported by 84% and 71%, respectively, and 89% thought screening should
occur in outpatient rheumatology. Although 54% reported practicing routine
informal mental health screening, only 9% used a standardized screening tool. The
most frequent barriers to routine screening in rheumatology were limited time
and staff resources (Table 1). The most frequent barriers to treatment were
limited availability and long waiting lists for mental health providers. Mental
health training beyond medical school (IRR=0.34, 95% CI 0.16-0.73, p<0.01) and
experience treating adults with SLE (IRR=0.36, 95% CI 0.20-0.64, p<0.01) were
associated with fewer barriers. Interest in receiving training for mental
health evaluation was endorsed by 90% and prescribing mental health medications
by 60% of respondents.
Conclusion: Significant
barriers exist to addressing the need perceived by rheumatologists for improved
mental health care of adolescents with SLE. On-site resources and enhanced
mental health training for pediatric rheumatologists may help overcome these
barriers.
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Table 1: Significant Barriers to Mental Health Care for Adolescents with SLE as Perceived by Respondents (N=101)
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Perceived Barriers to Routine Mental Health Screening*
|
Rank
|
N (%) of Respondents
|
|
Limited time during the encounter
|
1 |
77 (76) |
|
Lack of staff resources to screen |
2 |
74 (73) |
|
Limited availability of mental health providers |
3 |
66 (65) |
|
Lack of staff resources to follow up results |
4 |
65 (64) |
|
Lack of institutional support |
5 |
55 (54) |
|
Limited space |
6 |
45 (44) |
|
Provider lack of mental health knowledge |
7 |
29 (28) |
|
Patient willingness to be screened |
8 |
28 (27) |
|
Parent willingness to have child screened |
9 |
24 (23) |
|
Language barriers |
10 |
13 (12) |
|
Provider discomfort with results |
11 |
15 (14) |
|
Confidentiality concerns |
12 |
10 (9) |
|
|
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|
Perceived Barriers to Mental Health Treatment*
|
Rank
|
N (%) of Respondents
|
|
Limited availability of locations of mental health providers |
1 |
76 (75) |
|
Long waiting lists for mental health providers |
2 |
76 (75) |
|
Parent/patient uncertainty about where to obtain services |
3 |
63 (62) |
|
Time burden for patients/families |
4 |
61 (60) |
|
Insurance concerns |
5 |
59 (58) |
|
Cost to patients/families |
6 |
53 (52) |
|
Patient perceived lack of usefulness of mental health services |
7 |
49 (48) |
|
Transportation problems |
8 |
49 (48) |
|
Provider lack of knowledge of available mental health providers |
9 |
41 (40) |
|
Patient/parent concerns about what others will think |
10 |
41 (40) |
|
Parent perceived lack of usefulness of mental health services |
11 |
39 (38) |
|
Patient/parent distrust of mental health providers |
12 |
34 (33) |
|
Communication barriers between medical & mental health providers |
13 |
29 (28) |
|
Language barriers |
14 |
21 (20) |
|
Confidentiality concerns |
15 |
13 (12) |
|
* Potential barriers in survey were based on known correlates of unmet need for mental health services from the Methods for the Epidemiology of Child and Adolescent Mental Disorders Study (Flisher et al. Psychol Med 1997, 27(5):1145-1154), and known factors affecting integrated mental health care in primary care settings (Gunn et al. Journal of clinical psychology 2009, 65(3):235-252). |
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To cite this abstract in AMA style:
Knight A, Vickery M, Muscal E, Davis A, Harris J, Soybilgic A, Onel K, Schanberg LE, Rubinstein T, Gottlieb BS, Wright T, von Scheven E. Current Provider Practices and Perceived Barriers for Mental Health Care of Adolescents with SLE [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/current-provider-practices-and-perceived-barriers-for-mental-health-care-of-adolescents-with-sle/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-provider-practices-and-perceived-barriers-for-mental-health-care-of-adolescents-with-sle/