A Systematic Review of Approaches to Manage Mental Health Symptoms Among Children and Youth with Juvenile Idiopathic Arthritis to Inform the JIA Option Map

Objectives Children and youth with juvenile idiopathic arthritis (JIA) often experience mental health symptoms such as anxiety, stress, depression, and low self-esteem, which can significantly affect their daily lives. These symptoms are frequently underrecognized. In this systematic review (SR), we aimed to identify evidence on approaches to manage mental health symptoms in JIA to inform updates of our team’s web-based patient decision aid (JIA Option Map).

Methods We searched MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL from inception to September 2024. We included randomized controlled trials (RCTs), systematic reviews (SRs) and clinical practice guidelines (CPGs) evaluating approaches to manage mental health symptoms compared to any control group in children and youth 0-21 years with JIA. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2.0 (RCTs), AMSTAR 2 (SRs with meta-analyses) and AGREE II (CPGs). Certainty of evidence was appraised using GRADE. Findings were summarized descriptively, and standardized mean differences or risk ratios were calculated where applicable. Reporting followed PRISMA guidelines.

Results We included 11 RCTs, 1 SR and 2 CPGs. The RCTs evaluated educational and self-management programs, cognitive behavioral therapy, exercises, massage and relaxation. One SR on eHealth and mHealth interventions reported on the RCTs already included without conducting a meta-analysis. One CPG recommended Pilates, and another recommended early psychological care. Overall, RCTs were rated as having moderate to high risk of bias, resulting in low to moderate certainty of evidence. Most studies did not show statistically significant effects on mental health outcomes, except for 4 RCTs that showed positive results. One showed, with moderate certainty, that Pilates improved psychosocial health-related quality of life compared with conventional exercises. Another showed, with moderate certainty, that healthy sleep improved youth mood compared with restricted sleep. Another showed, with low certainty, that a web-based self-management program for parents reduced parent stress and improved child self-esteem compared with usual care. The last showed, with low certainty, that parent-delivered massage reduced youth and parent anxiety and youth stress compared with relaxation. No adverse events were reported in these trials.

Conclusion Few studies have evaluated approaches to managing mental health symptoms in JIA. Pilates, healthy sleep, parent web-based self-management programs and massage may be beneficial, but the certainty of evidence is limited, and adverse events were often not reported. These findings may assist patients’ and providers’ decision making and will inform updates to the JIA Option Map. Supported by a CIORA grant