Modifications of the Effect of Juvenile Idiopathic Arthritis (JIA) on Anxiety and Depression in Children and Adolescents: A Pseudo-longitudinal Study of 192,019 Children in the United States.

Introduction: Juvenile Idiopathic Arthritis (JIA), among children and adolescents, is a heterogeneous condition and is a prevalent chronic rheumatological disease. Non-medical (e.g., self-efficacy, social support, parental distress, and coping with pain), medical factors (e.g., permanent damage to joints), and psychological factors (e.g., depression and anxiety) can significantly impact the quality of life for individuals with JIA. Methods: This study aimed to investigate the effect modifiers of the associations of anxiety and depression in children with JIA. The National Survey of Children's Health database (2016-2021) was used for the current study. A total of 192,019 children were included in the analyses. An augmented backward elimination model selection method was used to identify predictors for depression and anxiety. Results: The period prevalence of JIA was 2.723 per 1,000. Sex was an effect modifier. Among boys, those who had JIA were 2.96 times (p<0.0001) more likely to have depression compared to non-JIA boys. On the other hand, the effects of JIA on anxiety were different across the insurance types. Among children with public insurance, children with JIA were 6.28 times (p <0.0001) more likely to have anxiety than those without JIA. Among children with JIA, those with public insurance were 5.23 times (p = 0.0005) more likely to have anxiety than those with private insurance. Discussion: This population-based study found that typical sex differences in depression were not observed in the JIA group and that children with JIA had higher rates of anxiety, particularly those with public insurance. These findings highlight the need for integrated care that addresses both physical and mental health.Collaborative models involving rheumatologists and mental health professionals may aid in early intervention. Limitations include the study's cross-sectional design, which did not establish a causal association, and a lack of analysis by the JIA subtype, which could have varying impacts on mental health outcomes. Conclusion: The findings highlight the importance of conducting comprehensive mental health assessments and developing personalized interventions tailored to the needs of JIA patients. The observed sex differences and the impact of insurance type on anxiety further emphasize the necessity of individualized care approaches.