The risk of depression and anxiety is not increased in individuals with juvenile idiopathic arthritis – results from the south-Swedish juvenile idiopathic arthritis cohort

Abstract

Background Children with chronic diseases are reported to have increased risk of psychiatric comorbidity. Few studies have investigated this risk in juvenile idiopathic arthritis (JIA), with conflicting results. We performed a population-based, longitudinal cohort study of the risk of depression and anxiety in south-Swedish patients with juvenile arthritis. Methods The south-Swedish JIA cohort (n = 640), a population-based cohort with validated JIA diagnosis 1980 – 2010 and comparators, a reference group of 3200 individuals free from JIA, matched for sex, year of birth and residential region, was used. Data on comorbid diagnosis with depression or anxiety were obtained from the Skåne Healthcare Register, containing all healthcare contacts in the region, from 1998 to 2019. We used Cox proportional models for the calculation of hazard ratios. Results During the study period, 1998 to 2019, 93 (14.5%) of the individuals in the JIA group were diagnosed with depression, and 111 (17.3%) with anxiety. Corresponding numbers among the references was 474 (14.8%) with depression and 557 (17.4%) with anxiety. Hazard ratio for depression was 1.1 (95% CI 0.9 – 1.5) in females and 0.8 (95% CI 0.5 – 1.4) in males, and for anxiety 1.2 (95% CI 0.9 – 1.5) in females and 0.6 (95% CI 0.4 – 1.1) in males. There were no statistically significant hazard ratios when analyzing subgroups of JIA patients with long disease duration or treatment with disease-modifying antirheumatic drugs. Conclusions Individuals with JIA do not have any statistically increased risk of being diagnosed with depression or anxiety compared to matched references.

Anxiety and depression symptoms in adolescents and young adults with juvenile idiopathic arthritis: results of an outpatient screening

“…Consistent with trends in the general population [ 42 ] and those previously reported in JIA [ 14 , 18 , 41 , 54 ], our results showed that females were more likely to have conspicuous screening results and higher symptom severity than males. Moreover, we have shown that the risk for conspicuous depressive and anxiety symptoms increases significantly with age, with older patients more frequently reporting higher symptom severity.…”

“…Few previous studies on internalizing symptoms in JIA have highlighted an increased risk in specific outcomes such as depression and anxiety compared to the general population [ 9 , 39 – 41 ]. Methodological discrepancies, but also sometimes small heterogeneous samples, differences in disease durations/activities, and the high rate of mental health problems in the general population may explain why some previous studies have stated no increased risk of mental health problems in JIA patients compared to general population controls [ 13 , 15 – 18 , 43 ]. As our study did not include a control group, an exact comparison with the general population is not possible.…”

“…While previous studies have shown that growing up with rheumatic conditions can be associated with poorer psychological functioning [ 11 ], studies on depression and anxiety in paediatric patients with JIA and the possible association of these symptoms with disease characteristics are limited and provide conflicting results [ 9 , 12 – 18 ]. In fact, studies on mental health in JIA reported rates of depressive and anxious symptoms ranging from 7 to 36% and 7–64%, respectively, and were often limited by small sample sizes.…”

The Elephant in the Rheum: Time to Address Mental Health as a Priority in Pediatric Rheumatology

“…Although this finding may be subject to type 1 error given the overall low enthesitis count (median was zero) in the small cohort, it is supported by other studies that have shown patients with enthesitis have higher pain, worse function, and worse quality of life. 14 The study therefore adds to the mixed evidence in the literature of the relationship between depression/anxiety symptoms and JIA disease metrics, 9,14 finding inconsistent associations with disease activity, physical function, and disability. Given the potential for subjectivity even in physician-reported disease measures, inclusion of more specific and objective markers of disease inflammation may be helpful in future studies.…”

“…8 In contrast, another longitudinal study of a Swedish JIA cohort (N = 640) found that the incidence of depression and anxiety in JIA were not statistically different than in healthy controls. 9 It is worth noting, however, that even if rates of mental health problems in JIA are similar to peers on a group level, mounting evidence points to the need to address these problems for affected JIA youth to optimize overall health and outcomes. 5,10 The study findings also highlight the importance of identifying and addressing anxiety, particularly in youth with JIA.…”