Ethnic Disparities in Mental Health Screening and Outcomes in Youth with Childhood-Onset Systemic Lupus Erythematosus

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Objectives This study examines ethnic differences in mental health (MH) screening and prevalence of elevated symptoms of depression and anxiety among youth with cSLE. Methods We completed a retrospective study of patients with cSLE (diagnosed <18 years of age) followed in the SickKids Lupus clinic from Jan 2022-Dec 2024. Self-reported ethnicity was categorized by Canada census groups. We reviewed electronic medical records for documented MH questionnaire completion, referrals to MH providers, and identified issues at MH visit. Elevated depression and anxiety symptoms were identified by positive screens on the Patient Health Questionnaire 9-item (PHQ-9 score ≥10) and Generalized Anxiety Disorder 7-item (GAD-7 score ≥10). We tested the association between ethnicity and ever completing MH screening and ever screening positive in univariate and multivariable logistic regression models, adjusted for demographic and clinical factors (age, sex, marginalization score, duration of follow-up, neuropsychiatric SLE [NPSLE], lupus nephritis, disease damage) (significance P<0.05). Results Our study included 138 cSLE patients; 85% were female with a median age at SLE diagnosis of 13 years (IQR 10-15). The majority of patients were of East Asian (28%), White/European (24%), and South Asian (20%) ethnicity. A total of 107 (78%) patients completed both the PHQ-9 and GAD-7; 28% screened positive on the PHQ-9 and 27% on the GAD-7. In logistic regression models, there was no significant difference in MH screening between ethnic groups. In adjusted models, Black patients had a significantly lower odds of screening positive on the PHQ-9 (OR = 0.07, CI 0.01-0.57, P = 0.01). Increased marginalization (OR = 4.77, CI 1.26-22.61, P = 0.02) and NPSLE (OR = 5.98, CI 1.12-42.77, P = 0.04) were significantly associated with screening positive on the PHQ-9. No significant associations were found between demographic or clinical factors and GAD-7 outcomes (Table 1). For patients that screened positive on the PHQ-9 and/or GAD-7, 89% were referred to as an MH provider, with the most commonly identified issue at MH visit being low mood (39%). Table 1. Predictors of Ever Screening Positive on PHQ-9 (N=30) and GAD-7 (N=29) Conclusion In this multiethnic cSLE cohort, there was no difference in MH screening between ethnic groups. However, Black patients had significantly lower odds of screening positive on the PHQ-9, after adjusting for marginalization and NPSLE. Patients with cSLE experience many MH issues, especially low mood. This study highlights the need to re-evaluate the performance of MH questionnaires in assessing depression and anxiety between ethnic groups, as well as the importance of addressing MH as part of routine care.

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