title: Identifying Differences in Risk Factors for Depression and Anxiety in Pediatric Chronic Disease: A Matched Cross-Sectional Study of Youth with Lupus/Mixed Connective Tissue Disease and Their Peers with Diabetes.
abstract: OBJECTIVE
  To investigate differences in risk factors for depression and anxiety, such as central nervous system involvement in systemic lupus erythematosus (SLE)/mixed connective tissue disease (MCTD), by comparing youth with SLE/MCTD to peers with type 1 diabetes mellitus (T1D).
  
  
  METHODS
  We conducted a cross-sectional study of 50 outpatient pairs, ages 8 years and above, matching subjects with SLE/MCTD and T1D by sex and age group. We screened for depression, suicidal ideation, and anxiety using the Patient Health Questionnaire-9 and the Screen for Childhood Anxiety Related Emotional Disorders, respectively. We collected parent-reported mental health treatment data. We compared prevalence and treatment rates between subjects with SLE/MCTD and T1D, and identified disease-specific risk factors using logistic regression.
  
  
  RESULTS
  Depression symptoms were present in 23%, suicidal ideation in 15%, and anxiety in 27% of participants. Compared with subjects with T1D, subjects with SLE/MCTD had lower adjusted rates of depression and suicidal ideation, yet poorer rates of mental health treatment (24% vs 53%). Non-White race/ethnicity and longer disease duration were independent risk factors for depression and suicidal ideation. Depression was associated with poor disease control in both groups, and anxiety with insulin pump use in subjects with T1D.
  
  
  CONCLUSIONS
  Depression and anxiety are high and undertreated in youth with SLE/MCTD and T1D. Focusing on risk factors such as race/ethnicity and disease duration may improve their mental health care. Further study of central nervous system and other disease-related factors may identify targets for intervention.
authors: Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; Children's Hospital of Philadelphia PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: knighan@email.chop.edu.
authors: Andrea
authors: A
authors: Knight
authors: Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors: Pamela
authors: P
authors: Weiss
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors: Knashawn
authors: K
authors: Morales
authors: Children's Hospital of Philadelphia PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA; Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Marsha
authors: M
authors: Gerdes
authors: Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Melissa
authors: M
authors: Rearson
authors: Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; Children's Hospital of Philadelphia PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Michelle
authors: M
authors: Vickery
authors: Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Ron
authors: R
authors: Keren
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000523:psychology; D008297:Male; D008603:Mental Health; D008947:Mixed Connective Tissue Disease / Q000150:complications* / Q000523:psychology; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors