Children with Arthritis and Adverse Childhood Experiences Have Higher Rates of Depression, Anxiety, and Impairment

Children with juvenile idiopathic arthritis (JIA) have a higher prevalence of adverse childhood experiences, according to new research presented at the annual meeting. In addition, children with JIA who have adverse childhood experiences are more likely to experience depression, anxiety, and physical impairment.

JIA is estimated to affect about 300,000 children in the United States. Researchers from Children’s Hospital at Montefiore in Bronx, N.Y.; the University of Minnesota in Minneapolis; and Northwestern University in Chicago, Ill., explored how JIA combined with adverse childhood experiences might affect health outcomes. For the purposes of the present study, adverse childhood experiences were defined as abuse, neglect, or household dysfunction before the child turned 18 years old (e.g., food/housing insecurity, death of a parent, divorce or separation, incarceration of a parent, witnessing physical abuse in the home or violence in the neighborhood, alcohol or drug abuse at home, racial or ethnic discrimination, and mental illness in the home).

“There is growing literature and increasing appreciation in pediatrics of the relationship between psychosocial stress in childhood and development of disease,” said Tamar Rubinstein, MD, MS, of Children’s Hospital at Montefiore. “In addition, there is some evidence that psychosocial stress may be associated with worse outcomes in rheumatologic diseases. […] This led us to question whether adverse childhood experiences, as a measure of psychosocial stress, might be associated with arthritis and, among children with arthritis, with worse outcomes.”

The researchers examined data on 123 children with JIA from the 2016 National Survey of Children’s Health (NSCH) to assess at the distribution of adverse childhood experiences. They compared the patients’ experiences to the experiences of children with other chronic, acquired physical conditions, as well the experiences of all other children.

Sixty-five percent of the sample had at least one adverse childhood experience, as compared to 40 percent of children without arthritis and 53 percent of children with other chronic conditions. In addition, children who had four or more adverse experiences were more likely to have arthritis than those who did not experience adverse experiences. High exposure to adverse experiences was associated with a higher likelihood of arthritis, as compared with other chronic conditions.

Among children with arthritis, physical impairment and comorbid depression and anxiety were associated with the degree of exposure to adverse childhood experiences. Ninety-five percent of arthritis children with high exposure to adverse childhood experiences had physical impairment and 68 percent had depression/anxiety.

“At this point, we do not know which contributes to which—whether having higher adverse childhood experiences contributes to arthritis, or whether having a child with arthritis contributes to family stress and leads to adverse childhood experiences—or finally, whether there is a third, not-yet-identified factor that ties these two together.” Dr. Rubinstein said. “Either way, […] it is important to understand why these children in particular are so affected, and what we can do in the future to help mitigate those effects.”