Background/Purpose: Emerging data reveals that depression and anxiety disorders are highly prevalent in adult patients with systemic lupus erythematosus (SLE). These disorders are associated with increased healthcare utilization and poor outcomes. The prevalence of depression and anxiety disorders and their effect on children with lupus is unclear. We therefore aimed to characterize depression and anxiety in a cohort of children with SLE and the lupus-like syndrome of mixed connective tissue disease (MCTD). 

Methods: The study is a cross-sectional analysis of pediatric-onset SLE and MCTD patients followed by CHOP rheumatology and nephrology. Subjects were consecutively recruited and consented at outpatient clinic visits. The presence of depression and anxiety disorders was measured by Patient Health Questionnaire 9 (PHQ-9) and the Screen for Child Anxiety Related Disorders (SCARED), using iPads and REDCap database technology. Scores of >=5 on the PHQ-9 and >=25 on the SCARED identified depression and anxiety symptoms, respectively, and educational handouts with psychiatric referral were given for subjects with positive screens. In addition, positive screens for suicide risk on the PHQ-9 were administered a suicide prevention protocol. Demographic characteristics as well as mental health history, disease duration, manifestations, medications, and activity were also measured.   

Results: Forty-five patients were recruited, of which 38 had SLE and 7 had MCTD. The mean age of the study cohort was 15.6 years (SD 3.1) and 87% were female. The median PHQ-9 score was 4 (IQR 1,12) and depressive symptoms were identified in 9 patients (20%). Suicidal thoughts in the past 2 weeks were identified in 7 patients (16%), however, none required emergent psychiatric intervention. The mean SCARED score was 17.4 (SD 10.9) and anxiety symptoms were identified in 10 patients (22%).

Conclusion: Depression and anxiety symptoms, as well as recent suicidal thoughts were prevalent in the study cohort of children with pediatric lupus and MCTD, at frequencies higher than those reported in the general pediatric and adolescent population. Further investigation is needed to characterize the effects of these symptoms on clinical outcomes, quality of life and healthcare utilization.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-anxiety-and-suicidal-thoughts-in-a-cohort-of-pediatric-lupus-and-mixed-connective-tissue-disease-patients/