ABSTRACT
Background. Juvenile Dermatomyositis (JDM) is a chronic systemic vasculopathy of unknown etiology characterized by symmetrical proximal muscle weakness, raised serum concentration of muscle enzymes and pathognomonic skin rashes. Although JDM is the most common pediatric idiopathic inflammatory myopathy, it is still quite rare with an annual incidence of 3.2 cases per million children in the US. Youth with chronic disease are reported to have a higher prevalence of mental health disorders compared to healthy peers, with some research reporting up to a fourfold increase in risk. The COVID-19 pandemic has raised psychological distress among youth;data from the first year of the pandemic suggests that 1 in 4 youth globally are experiencing clinically elevated depression symptoms. The primary aim of this study is to describe the prevalence of depression in a cohort of patients with JDM to help providers better understand the mental health issues that arise in this population. This is critically important as early intervention for depression in youth with JDM has the potential to improve both medical and psychosocial outcomes. Methods. This was a cohort study measuring depression in youth with JDM at Children's Healthcare of Atlanta (CHOA). Subjects were recruited during routine outpatient visits to CHOA rheumatology clinics from August to December 2020. Subjects had a diagnosis of JDM for at least 3 months, were between 5-20 years old, and had no cognitive deficit precluding questionnaire completion. Parent completed a proxy questionnaire if the child was 5-7 years old. Depression was assessed using the Patient Questionnaire-9 (PHQ-9). Of 15 eligible subjects, all consented to the study. Informed consent/assent was obtained. CHOA Institutional Review Board approved the study. Upon identification of depression, an educational handout was offered, which also included mental health care providers. Identified suicide risk was addressed with immediate direct questioning of suicidal intent, plan or attempt within the prior week;endorsement of any of these prompted enactment of a safety plan and urgent psychiatric evaluation. Statistical comparisons were performed using SAS. Medians and interquartile ranges (IQR), mean and standard deviation and frequencies were calculated for demographic and disease related variables. The presence of depression symptoms were analyzed as binary covariates for positive screens on the PHQ-9. Results. Demographics of the 15 participants included 53% female, median age of 12 years (IQR 10.0, 19.0;range 5-20) with a range of 5-20 years. The sample was heterogeneous with respect to race/ethnicity, with 8 (53.3%) Black, 6 (40%) White and 1 (6.7%) Asian participant. Median disease duration was 4.1 years (IQR 2.2, 6.9). Calcinosis was present in 10 (67%) of patients. Five (33%) participants had active disease at the time of completing PHQ-9, all of whom had mild disease with median Physician Global Score of 0.6 (IQR 0, 0.9). Depression was identified in 6 subjects (40%): 5 subjects (33%) were classified as having mild depression and 1 subject (7%) was classified as having moderate depression. No subjects had severe depression nor endorsed suicidal ideation. There was no significant difference in depression prevalence in patients with active disease versus inactive disease. The prevalence of depression in this small cohort is similar to previously reported rates of depression in patients with JIA and SLE;notably, it is higher than rates of depression in healthy children in the US. Conclusions. This pilot study adds to our understanding of the relationship between JDM diagnosis and psychosocial functioning in children and youth. The COVID-19 pandemic has been associated with a rise in depression in all children. Our findings suggest that regardless of disease status, there is a higher prevalence of depression in JDM patients compared to their healthy peers. Given the small sample size, further studies are needed to assess depression in paediatric rheumatology clinics.