Background/Purpose: There are high rates of anxiety and depression in youth with rheumatologic diseases, with known impact on health-related outcomes. Thus, it is important to effectively screen and manage mental health concerns in the context of pediatric medical care. We developed guidance statements for pediatric rheumatologists to support assessment and management of mental health concerns. These statements were developed by a multi-disciplinary team of experts, including patient/caregiver stakeholders, drawing from mental health research in rheumatology and the broader pediatric literature.

Methods: Key concepts and content areas for the statements were first developed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mental Health Workgroup at the 2019 annual CARRA meeting. Subsequently, the CARRA Mental Health Taskforce panel was formed, consisting of 10 rheumatologists, 6 pediatric behavioral health providers, 4 patients, 3 parents, and 3 members who were both behavioral/healthcare providers and parents. The Taskforce (divided into screening and management subgroups) convened multiple times between October 2019 and March 2021 to review relevant literature and modified statements based on findings. The statements were graded based on the Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence, then disseminated to the entire Taskforce for additional modification/review before being shared with the broader CARRA membership for open review from May June 2021. Feedback was integrated by Taskforce leadership before a final set of 34 statements was sent for evaluation by a random sample of the broader CARRA membership (n=123) using a well-established method of consensus gathering (modified Delphi method) from January 2022 January 2023. A timeline of activities is provided in Table 1. An enriched sample of all active behavioral health providers (n=11) and parents/patients (n=12) in CARRA was included to ensure their voice was represented. This entire group was invited to submit asynchronous consensus ratings for each statement by email. Panel members rated their agreement on the draft statements on a scale from 1 (inappropriate) to 9 (appropriate). Items that failed to achieve consensus were reviewed and an additional round of voting was conducted with select items. To be approved as final guidance statements, median agreement ratings were required to be at 80% or greater (with an appropriate median rating of 7-9).

Results: Of the 123 queried, 80 responded (65%) and nearly all of the respondents (n=77, 96%) agreed to participate. A second round of voting occurred on 4 selected items, with greater than 70% participation. Of the 34 statements, 31 statements achieved consensus (Table 1). Bolded statements in Table 2 reflect those that achieved final consensus.

Conclusion: Consensus was achieved for all the mental health screening statements, as well as for a majority of statements related to the management of mental health concerns and clinic environment/education. It is the goal that these recommendations be used to help improve both mental health- and health-related outcomes for youth with rheumatological conditions.

Table 1. Timeline of the Development of the Mental Health Guidance Statements

Table 2. Consensus Data for Statements Addressing Pediatric Mental health in Pediatric Rheumatological Populations

ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-mental-health-guidance-statements-for-pediatric-rheumatology/