PREVALENCE OF CLINICAL AND SELF-REPORTED DIAGNOSES OF DEPRESSION AND ANXIETY IN PATIENTS WITH CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS

PV168 / #462 Poster Topic: AS18 - Pediatric SLE Background/Purpose Symptoms of depression and anxiety are common among patients with childhood-onset systemic lupus erythematosus (cSLE). In recent years, screening for depression and anxiety using validated self-report tools is increasingly part of routine clinical care. Comparing prevalence of mood disorders over time amid evolving perspectives on mental health requires retrospective chart review. However, identifying patients with depression and anxiety by retrospective chart review is challenging and requires consideration of both clinical documentation and patient-reported symptoms. This study aims to investigate the prevalence of clinical and self-reported diagnoses of depression and anxiety among children and adolescents diagnosed and followed for cSLE in the SickKids Lupus Clinic, using retrospective clinical chart review and self-report screening tools. Methods We completed a retrospective study of children and adolescents aged ≤ 18 years seen in a tertiary care Lupus Clinic between January 1, 2000, to December 31, 2023. All patients met ≥4 American College of Rheumatology (ACR) and/or Systemic Lupus International Collaborative Clinics (SLICC) criteria for SLE with data prospectively collected in a dedicated Lupus database. Additional information such as age of SLE diagnosis, sex, ancestry, and disease activity were extracted from the database. Symptoms and diagnoses of depression and/or anxiety and use of psychotropic medication, before and after cSLE diagnosis, were extracted from clinical charts in ChartMaxx and EPIC. We identified patients with depression and/or anxiety as those with medical chart documentation of 1) a diagnosis and 2) persistent depression and/or anxiety symptoms over a course of at least 2 months. Self-reported depression and anxiety were identified by the Children’s Depressive Inventory (CDI, CDI-2) and Multidimensional Anxiety Scale for Children (MASC, MASC-2), completed as clinical screening measures for patients seen by psychiatry. We classified individuals as positive for self-reported depression based on a total score >13 on the CDI and CDI-2, and for self-reported anxiety based on a total score >60 on the MASC and MASC-2, appropriate for referral to mental health services. We included patients who completed at least 1 self-report screen for depression or anxiety and retained the most severe score in analyses. Descriptive statistics were used for cohort demographics and cSLE features. Results We reviewed 491 patient clinical charts and identified 135 patients who completed at least 1 self-report questionnaire. The majority were females (86%) and the median age of cSLE diagnosis was 13 years (IQR 12-15) (Table 1). Most patients were of European (33%) and East Asian (24%) ancestry. The majority of patients completed the CDI (64%) and/or the MASC (25%), followed by MASC-2 (6%) and/or CDI-2 (5%) (Table 2). Of the 93 patients who completed a self-report screen for depression, 41 (44%) screened positive for depression; the majority who screened positive (68%) did not receive a diagnosis of depression (Table 3). Of the 42 patients who completed a self-report screen for anxiety, 18 (43%) screened positive for anxiety; the majority who screened positive (55%) did not receive a diagnosis of anxiety. Psychotropic medication was initiated in 34% of patients after screening positive for depression and/or anxiety. Table 1. Demographic and clinical features of reviewed cSLE cohort (n = 135) Table 2. Number of patients who completed the CDI, CDI-2, MASC, and/or MASC-2 Table 3. Number of patients who screened positive for depression on the CDI or CDI-2, and/or anxiety on the MASC or MASC-2 Conclusions We found self-reported depression and anxiety to be prevalent among youth with cSLE. Future directions include examining scores for the Patient Health Questionnaire-4 (PHQ-4), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item scale (GAD-7). Concordance between clinical diagnosis and self-reported depression and anxiety will be assessed using chi-square statistics for categorical values and Wilcoxon rank-sum test for continuous variables.

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