Harper Lauren, Ardoin Stacy P, Leever Alana, Driest Kyla, Sivaraman Vidya, Taxter Alysha J
Department of Pediatric Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States.
Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States.
Front Pediatr. 2024 Oct 8;12:1427543. doi: 10.3389/fped.2024.1427543. eCollection 2024.
Patients with childhood-onset systemic lupus erythematosus (c-SLE) have higher rates of depression than their peers, which has been associated with worse medical outcomes. Therefore, it is imperative that their mental health be addressed. We utilized quality improvement (QI) methodology to automate mental health screening for patients with lupus within a pediatric rheumatology clinic. The retrospective cohort study aims to evaluate the association between mental health screening outcomes and demographics, medications, and disease activity measures in patients with childhood lupus.
The mental health QI team at a quaternary pediatric rheumatology center implemented an automated process for mental health screening in patients with c-SLE. Patients seen between 2017 and June 2023 with a diagnosis of c-SLE were identified using International Classification of Disease -Clinical Modification (ICD-CM) codes. Disease activity was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K). Medications were identified on outpatient and inpatient orders for conventional synthetic and biologic disease-modifying anti-rheumatic drugs, hydroxychloroquine, corticosteroids, and aspirin. Mental health screening was accomplished with the Patient Health Questionnaire (PHQ). Descriptive statistics, univariate and multivariate linear regression were used.
Between January 2017 and June 2023, 117 patients with c-SLE (41% with lupus nephritis) completed 534 total screenings. Each patient completed PHQ screenings, a median of 5 [interquartile range 2, 6] times. Screening increased when the screening process was automated. Those who were Black, female, or prescribed leflunomide, mycophenolate, and corticosteroids had higher PHQ scores.
Mental health support is essential for patients with chronic rheumatologic diseases such as SLE. Sustainable processes for quickly identifying depression are needed for optimal care of patients with SLE. Our process of automated, streamlined mental health screening successfully increased the screening of patients with SLE at every visit and led to timely interventions for positive PHQ scores. Higher PHQ scores were correlated with patients on leflunomide, mycophenolate, and corticosteroids. Future research should identify modifiable risk factors for high PHQ scores that the medical team can target.
儿童期起病的系统性红斑狼疮（c-SLE）患者的抑郁发生率高于同龄人，这与较差的医疗结局相关。因此，解决他们的心理健康问题势在必行。我们采用质量改进（QI）方法，在儿科风湿病诊所实现了对狼疮患者心理健康筛查的自动化。这项回顾性队列研究旨在评估儿童狼疮患者心理健康筛查结果与人口统计学、药物治疗及疾病活动指标之间的关联。
一家四级儿科风湿病中心的心理健康QI团队为c-SLE患者实施了心理健康筛查的自动化流程。使用国际疾病分类-临床修订版（ICD-CM）编码确定2017年至2023年6月期间确诊为c-SLE的患者。采用系统性红斑狼疮疾病活动指数2000（SLEDAI 2K）评估疾病活动度。通过门诊和住院医嘱确定常规合成和生物性改善病情抗风湿药物、羟氯喹、皮质类固醇和阿司匹林的用药情况。使用患者健康问卷（PHQ）进行心理健康筛查。采用描述性统计、单因素和多因素线性回归分析。
2017年1月至2023年6月期间，117例c-SLE患者（41%患有狼疮性肾炎）共完成534次筛查。每位患者均完成了PHQ筛查，中位数为5次[四分位间距2，6]。当筛查流程自动化后，筛查次数增加。黑人、女性或使用来氟米特、霉酚酸酯和皮质类固醇的患者PHQ评分较高。
心理健康支持对SLE等慢性风湿性疾病患者至关重要。为了对SLE患者进行最佳护理，需要有可持续的流程来快速识别抑郁症。我们的自动化、简化的心理健康筛查流程成功增加了每次就诊时对SLE患者的筛查，并导致对PHQ评分呈阳性的患者及时进行干预。较高的PHQ评分与使用来氟米特、霉酚酸酯和皮质类固醇的患者相关。未来的研究应确定医疗团队可以针对的、导致高PHQ评分的可改变风险因素。
