Parent Psychological Distress Moderates the Association Between Child Psychopathology and Disease Activity in Children with Juvenile Idiopathic Arthritis

Objectives Parents of children with juvenile idiopathic arthritis (JIA) commonly experience mental health problems that negatively affect their well-being and quality of life. Among parents of children with JIA, both their child’s mental health and disease activity have been linked to higher levels of parent burden and stress.[1] Despite this, whether parent distress relates to children’s disease outcomes remains unknown. We investigated whether parent psychological distress moderates the association between child mental health and disease activity in children with JIA.

Methods Parents and their children (10-16 years) with JIA were recruited from clinics at McMaster and Alberta Children’s Hospitals. At enrollment, we measured child mental health using the parent-reported Emotional Behavioral Scales (EBS), and the child-reported EBS (CEBS). Parent psychological distress was measured using the Kessler 6 (K6), and Parent Stress Scale (PSS). Disease activity was measured by self-perceived impact of JIA based on a single question within the Patient Global Assessment (PtGA). Descriptive statistics were determined for all variables of interest. Multiple regression analyses using product-term interactions estimated whether parent psychological distress moderated the association between child mental health, categorized as internalizing and externalizing psychopathology and disease activity. Covariates included parent and child age and sex, household income, and parent education.

Results Baseline characteristics for parent-youth dyads (n=132) are shown (Table 1). There were significant (p<.05) moderating effects of both measures of parent psychological distress (PSS and K6 modeled independently) on the association between disease activity and internalizing psychopathology. Significant interaction effects were observed for child-reported internalizing × PSS (β=−.248, p=.005) and × K6 (β=−.753, p<.05), as well as parent-reported internalizing × PSS (β=−.218, p=.005), and × K6 (β=−.671, p<.05). No moderating effects were found for the association between externalizing psychopathology and disease activity.

Conclusion Overall, parent stress/distress was a significant moderator of the relationship between child mental health and disease activity, with more distress associated with worse disease activity. This study will continue to assess child mental health outcomes for up to 18 months. Findings will inform early prevention of parental stress and subsequent mental health problems in children with JIA. Understanding the psychosocial impact of JIA will support the development of individualized mental health services and support.

References [1.] Gowda N. Clin Rheumatol 2024;43:2009-19.