American College of Rheumatology Guidance Statements for Addressing Mental Health Concerns in Youth With Pediatric Rheumatologic Diseases
Bibliographic record
Abstract
OBJECTIVE: Pediatric rheumatologic diseases (PRDs) are characterized by high rates of anxiety and depression known to impact health-related outcomes. We present guidance statements to assess and manage mental health concerns for youth with PRDs in pediatric rheumatology practice. METHODS: Development of the guidance statements was initiated in 2019 and concluded in November 2023. It included (1) the formation of a task force (including pediatric rheumatologists, pediatric behavioral health providers, patients, and parents) led by two licensed pediatric psychologists and two board-certified pediatric rheumatologists, (2) iterative drafting of statements and rating of evidence based on the Oxford Centre for Evidence-Based Medicine levels of evidence, (3) an open comment period followed by revision of statements, (4) a Delphi panel process to attain consensus on the statements, and (5) review by the American College of Rheumatology (ACR) Committee on Quality of Care and refinement of statements to an identified list of those with the strongest empiric evidence for endorsement by the ACR. RESULTS: The task force drafted 34 statements for addressing mental health concerns in pediatric rheumatology, including identification, management, and clinic environment/education considerations. After two rounds of Delphi panel voting by a random sample of 76 members of the Childhood Arthritis and Rheumatology Research Alliance, 31 statements attained at least 80% consensus. Eleven of those statements had high empirical support and endorsement and were thus selected as the final guidance statements, including recommendations for depression and anxiety screening in youth aged 12 years and older, management of identified symptoms, and education of patients about mental health. CONCLUSION: It is a goal that these recommendations be used to empower pediatric rheumatology teams to consider how they may better address mental health concerns in their setting and help improve both mental health- and health-related outcomes for youth with rheumatologic diseases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.121 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.010 | 0.008 |
| Insufficient payload (model declined to judge) | 0.008 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".