Milatz et al.

Pediatric Rheumatology (2024) 22:10 Pediatric Rheumatology

https://doi.org/10.1186/s12969-023-00948-y

SHORT REPORT Open Access

Mental comorbidities in adolescents

and young adults with juvenile idiopathic
arthritis: an analysis of German nationwide
health insurance data
Florian Milatz1* , Katinka Albrecht1, Kirsten Minden1,2, Ursula Marschall3, Jens Klotsche1,4 and
Johanna Callhoff1,4

Abstract
Background Studies on prevalence rates of mental comorbidities in patients with juvenile idiopathic arthritis
(JIA) have reported varying results and provided limited information on related drugs. The purpose of this study
was to determine the prevalence of selected mental health diagnoses and the range of associated drug prescriptions
among adolescents and young adults (AYA) with JIA compared with general population controls.
Findings Nationwide statutory health insurance data of the years 2020 and 2021 were used. Individuals aged 12
to 20 years with an ICD-10-GM diagnosis of JIA in ≥ 2quarters, treated with disease-modifying antirheumatic drugs
and/or glucocorticoids were included. The frequency of selected mental health diagnoses (depression, anxiety,
emotional and adjustment disorders) was determined and compared with age- and sex-matched controls. Antirheu-
matic, psychopharmacologic, psychiatric, and psychotherapeutic therapies were identified by Anatomical Therapeu-
tic Chemical (ATC) codes and specialty numbers. Based on data from 628 AYA with JIA and 6270 controls, 15.3% vs.
8.2% had a diagnosed mental health condition, with 68% vs. 65% receiving related drugs and/or psychotherapy. In
both groups, depression diagnosis became more common in older teenagers, whereas emotional disorders declined.
Females with and without JIA were more likely to have a mental health diagnosis than males. Among AYA with any
psychiatric diagnosis, 5.2% (JIA) vs. 7.0% (controls) received psycholeptics, and 25% vs. 27.3% psychoanaleptics.
Conclusions Selected mental health conditions among 12-20-year-old JIA patients are diagnosed more frequently
compared to general population. They tend to occur more frequently among females and later in childhood. They are
treated similarly among AYA regardless of the presence of JIA.
Keywords Depression, Anxiety, Mental comorbidities, Adolescents, Health insurance data, Juvenile idiopathic
arthritis

*Correspondence:
Florian Milatz
[email protected]
Full list of author information is available at the end of the article

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Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 2 of 8

Background systemic glucocorticoid therapy in order to increase the

Juvenile idiopathic arthritis (JIA) is the most common reliability of diagnosis.
chronic rheumatic disease in pediatrics describing a het- JIA was categorized into the following categories: pol-
erogeneous group of inflammatory rheumatic diseases of yarthritis, adult type (M08.0), enthesitis-related arthritis/
unknown origin [1]. Affected individuals typically suffer juvenile spondyloarthritis (M08.1), systemic JIA (M08.2),
from acute pain and swelling, but also from joint damage RF- polyarthritis (M08.3), oligoarthritis (M08.4), psori-
and comorbid conditions that might develop during the atic arthritis (M09.0) and undifferentiated JIA (M08.8,
course of their disease [2]. Resulting limitations in daily M08.9). When conflicting diagnoses were recorded in the
life, time-consuming physical therapies, and medication same individual, only one diagnosis was assigned using
side effects can fuel dissatisfaction and psychological dis- the following hierarchy: M08.0, M08.1, M08.2, M08.3,
tress, which in turn detoriates disease self-management M09.0, M08.4, M08.8/M08.9. If e.g. someone had an
and treatment adherence [3–5]. Typical issues faced by ICD-10-GM diagnosis of both M08.1 and M08.8 in their
adolescents are therefore compounded by the challenge data, they were assigned to the enthesitis-related arthri-
of managing their chronic disease [6]. tis/juvenile spondyloarthritis (M08.1) group.
Previous studies among adolescents with JIA have For each AYA with JIA we matched 10 controls with
found an increased risk for mental health impairments; the same sex and age. Controls were randomly selected in
however, rates of symptoms and diagnoses have varied the population without any condition of JIA in the com-
widely [3, 7–10]. Most of the existing studies focused on plete years 2020 or 2021 as defined in the inclusion crite-
mental health issues using self-report questionnaires and ria. Controls were eligible independent of how often they
from a quality of life perspective. Their statements were visited a doctor’s office in 2020 or 2021 (it was possible
partly limited by small sample sizes, lack of controls or that controls had no visits).
missing information on related drug prescriptions [3].
In this study, we aimed to use health insurance data to (Anti)rheumatic therapies and care
determine the prevalence of diagnosed selected mental Antirheumatic therapies were identified using Anatomi-
health conditions and their medication and psychothera- cal Therapeutic Chemical (ATC) codes and included
peutic treatment in AYA with JIA compared to a control conventional synthetic (cs)DMARDs (azathioprine,
group from the general population. cyclophosphamide, chloroquine, hydroxychloroquine,
leflunomide, methotrexate, mycophenolate, sulfasala-
zine), biologic (b)DMARDs (abatacept, adalimumab,
Findings anakinra, canakinumab, certolizumab, etanercept, goli-
Methods mumab, infliximab, rituximab, sarilumab, secukinumab,
Cross-sectional BARMER claims data collected in the tocilizumab), targeted synthetic (ts)DMARDs (barici-
years 2020 and 2021 were used. The BARMER statutory tinib, tofacitinib), nonsteroidal antirheumatic drugs
health insurance fund is one of the largest health insur- (NSAIDs) and systemic glucocorticoids (GCs). Rheuma-
ance companies in Germany and covers around 660,000 tology care was identified by specific billing codes for
adolescents aged 12-20 years, corresponding to around juvenile and adult rheumatology and by a specialist phy-
11% of all juvenile inhabitants of this age group with sician number for adult internal rheumatology.
a statutory health insurance [11]. Germany has health
care coverage for all permanent residents, allowing them Diagnoses and therapy of psychological morbidities
to have access to the statutory health insurance system. The following diagnoses were identified by ICD-10-GM
There is no co-payment for treatment for people under codes: depression (F32, F33, F34, F38), anxiety disorders
18 years of age and low co-payment rate for adults (e.g. (F40,41), emotional disorders (F92, F93) and adjustment
up to 10 euros for a prescription for medication). disorders (F43). Prescribed drugs related to psychologi-
Inclusion criteria were as follows: 1) age between 12 to cal disorders include psycholeptics (N05), such as antip-
20 years, 2) continuous insurance in 2020 and 2021, 3) at sychotics (N05A), anxiolytics (N05B), sedatives (N05C)
least one International Statistical Classification of Dis- as well as homeopathic psycholeptics (N05H), and psy-
eases German Modification (ICD-10-GM) code for JIA in choanaleptics (N06), such as antidepressants (N06A),
at least two quarters of 2020 or 2021, 4) at least one of non-selective monoamine reuptake inhibitors (N06AA)
the following ICD-10-GM codes present before the age and selective serotonin reuptake inhibitors (N06AB).
of 16 years: Juvenile arthritis (M08.X, M09.0 and L40.5†) All drugs prescribed at least once in 2020 or 2021 are
and/or M45.0, M46.0, M46.8, M46.9, M07.0-3/L40.5, reported. Psychological/psychiatric therapy was iden-
M05.X, M06.0, M06.1), and 5) at least one prescription tified by physician specialist numbers. The Defined
for a disease-modifying antirheumatic drug (DMARD) or Daily Doses (DDDs) dispensed are reported, providing
Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 3 of 8

information on the assumed average maintenance dose 41%), while males were more frequently prescribed
per day for a drug used for its main indication [12]. All bDMARDs (f 54% vs. m 63%). Systemic glucocorti-
ICD-10-GM, ATC-codes, physician specialist numbers coids and bDMARDs were increasingly used with
and billing codes are reported in Suppl. Table S1. higher ages, while methotrexate was more often used in
younger adolescents. bDMARD therapy was most fre-
Statistical analysis quent in systemic JIA and polyarthritis. More informa-
Results are provided for AYA with JIA and controls, tion on the characteristics and antirheumatic therapy is
stratified by sex and age groups: 12-14, 15-17, and 18-20 presented in Table 1.
years. In order to exclude accidental identifiability or
inferences to individuals, no data is presented in groups Psychological disorders and related drug prescription
with a case number <30. The frequencies among groups Among 628 AYA with JIA, 15.3% (n=96) had any of the
were compared using a Chi-square-Test as appropri- selected psychological diagnoses. In comparison, 8.2%
ate. As part of a sensitivity analysis, we also determined (n=513) of controls were found to have a psychological
the frequency of psychological disorders based on data diagnosis. In 2019, 16.0% of 506 patients and 7.3% of 5050
from 2019. The short report was written in accordance controls had one of these diagnoses. As shown in Fig. 2
with the REporting of studies Conducted using Obser- adjustment disorders were diagnosed most frequently
vational Routinely-collected health Data (RECORD) (JIA vs. controls: 8.0% vs. 2.8%, p(Chi-square) <0.001)
Statement [13]. followed by depression (5.1% vs. 3.5%, p(Chi-square)
=0.04), emotional disorders (3.5% vs. 1.7%, p(Chi-square)
Results =0.02), and anxiety disorders (3.2% vs. 2.5%, p(Chi-
In total, 628 AYA with JIA and 6,270 age- and sex- square) =0.29).
matched controls were included in the study. One of Depression and anxiety were most common among
the AYA with JIA is of “diverse” gender, for this person individuals aged 18 to 20 year old among both JIA and
we did not find matched controls. A flow diagram is pre- control groups, whereas emotional disorders were diag-
sented in Fig. 1. nosed primarily among 12- to 14-year-olds (Fig. 3).
Of the 88% of AYA with JIA receiving DMARD Female patients were more likely to have depression than
therapy, about 48% received a TNF-inhibitor and 50% males. A psychiatric diagnosis was found more frequently
methotrexate. Female adolescents more often had in patients with oligoarthritis, enthesitis-related arthritis,
csDMARDs (f 54% vs. m 45%) and NSAIDs (49% vs. or psoriatic arthritis than in patients with systemic JIA

Fig. 1 Flow Diagram of selected adolescents and young adults

Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 4 of 8

Table 1 Characteristics of adolescents and young adults with JIA

Variable JIA

total 12-14 years 15-17 years 18-20 years

(n=628) (n=182) (n=234) (n=212)

Sociodemographic data
Age, years, mean (SD) 16.1 (2.5) 13.0 (0.8) 15.9 (0.8) 19.0 (0.9)
Female, no. (%) 446 (71) 130 (71) 160 (68) 156 (74)
JIA category, no. (%)
Polyarthritis, adult type 97 (15) 21 (11) 26 (11) 50 (24)
Polyarthritis, RF-negative 195 (31) 68 (37) 71 (30) 56 (26)
Systemic JIA 67 (11) 16 (8.8) 29 (12) 22 (10)
Oligoarthritis 94 (15) 37 (20) 36 (15) 21 (9.9)
Psoriatic arthritis 21 (3) 5 (2.7) 8 (3.4) 8 (3.8)
Enthesitis-related arthritis/juvenile spon- 57 (9) 8 (4.4) 29 (12) 20 (9.4)
dyloarthritis
Other JIA 97 (15) 27 (15) 35 (15) 35 (16)
Antirheumatic therapy, no. (%)
Any b/cs/tsDMARD 554 (88) 165 (91) 197 (84) 192 (91)
Any bDMARD 371 (59) 99 (54) 129 (55) 143 (67)
Any csDMARD 321 (51) 111 (61) 122 (52) 88 (41)
Any tsDMARD 9 (1.4) 3 (1.6) 4 (1.7) 2 (0.9)
Any NSAID 294 (47) 79 (43) 118 (50) 97 (46)
Systemic GCs 190 (30) 41 (22) 79 (34) 70 (33)
GCs monotherapy 74 (12) 17 (9) 37 (16) 20 (9.4)
Rheumatology care, no (%)
Total 416 (66) 119 (65) 142 (61) 155 (73)
Pediatric 297 (47) 118 (65) 133 (57) 46 (22)
Adult 172 (27) 8 (4.4) 30 (13) 134 (63)
JIA Juvenile idiopathic Arthritis, RF- Rheumatoid factor-negative, DMARD Disease-modifying antirheumatic drug, bDMARD Biological DMARD, csDMARD Conventional
synthetic DMARD, tsDMARD Targeted synthetic DMARD, NSAIDs Non-steroidal anti-inflammatory drugs, GCs Glucocorticoids, SD Standard deviation

Fig. 2 Prevalence of selected psychological disorders among females and males with and without JIA
Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 5 of 8

Fig. 3 Prevalence of selected psychological diagnoses among individuals with (12-14 y, n=182; 15-17 y, n=234; 18-20 y, n=212) and without (12-14
y, n=1820; 15-17 y, n=2340; 18-20 y, n=2110) JIA by age group

Fig. 4 Proportion within each JIA category diagnosed with psychological disorder

or polyarthritis (Fig. 4). More details on characteristics JIA had been diagnosed with depression or were tak-
of AYA with and without a psychological diagnosis are ing an antidepressant.Among AYA with JIA diagnosed
shown in Table 2. with any psychological disorder (n=96), 68% received
Taking into account all persons who either had a diag- related drugs and/or psychotherapy. This was also the
nosed mental disorder or were being treated with related case for a comparable proportion of controls diagnosed
drugs or psychotherapy, 16.7% of AYA with JIA and with any psychological disorder (65%). Psychotherapy,
8.8% of controls were affected. About 7% of AYA with psychoanaleptics, and psycholeptics were documented
Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 6 of 8

Table 2 Characteristics of individuals with and without JIA stratified by presence of any psychological disorder
Variable JIA Controls
Total (n=628) any no any no
psychological psychological psychological psychological
disorders disorders disorders disorders
(n=96) (n=532) (n=513) (n=5,757)

Sociodemographic data
Age, years, mean (SD) 16.1 (2.5) 16.3 (2.6) 16.1 (2.5) 16.5 (2.5) 16.1 (2.5)
Female, no. (%) 446 (71) 74 (77.1) 372 (69.9) 414 (81) 4046 (70)
JIA category, no. (%)
Polyarthritis, adult type 97 (15) 12 (12) 85 (16) - -
Polyarthritis, RF-negative 195 (31) 24 (25) 171 (32) - -
Systemic JIA 67 (11) 8 (8.3) 59 (11) - -
Oligoarthritis 94 (15) 19 (20) 75 (14) - -
Psoriatic arthritis 21 (3.3) 4 (4.2) 17 (3.2) - -
Enthesitis-related arthritis/juvenile spondyloarthritis 57 (9.1) 13 (13) 44 (8.3) - -
Other juvenile arthritis 97 (15) 16 (16) 81 (15) - -
Antirheumatic therapy, no. (%)
Any bDMARD 371 (59) 62 (65) 309 (58) 1 (0.2) 6 (0.1)
Any csDMARD 321 (51) 45 (47) 276 (52) 1 (0.2) 1 (0.0)
Any tsDMARD 9 (1.4) 0 (0) 9 (1.9) 1 (0.2) 0 (0.0)
Any NSAID 294 (47) 55 (57) 239 (45) 92 (18) 712 (12)
Systemic GCs 190 (30) 36 (37) 154 (29) 12 (2.3) 111 (1.9)
GCs monotherapy 74 (11.8) 10 (10) 64 (12) 12 (2.3) 110 (1.9)
Therapy related to psych. disorder, no. (%)
Psycholeptics (N05) 9 (1.4) 5 (5.2) 4 (0.8) 36 (7.0) 33 (0.6)
  Antipsychotics (N05A) 2 (0.3) 2 (2.1) 0 (0) 28 (5.5) 20 (0.3)
  Anxiolytics (N05B) 0 (0) 0 (0) 0 (0) 4 (0.8) 9 (0.2)
  Sedatives (N05C) 7 (1.1) 3 (3.1) 4 (0.8) 16 (3.1) 6 (0.1)
   Homeopathic psycholeptics (N05H) 0 (0) 0 (0) 1 (0.2) 0 (0.0)
Psychoanaleptics (N06) 40 (6.4) 24 (25) 16 (3.0) 140 (27) 118 (2.0)
  Antidepressants (N06A) 25 (3.9) 20 (21) 5 (0.9) 106 (21) 40 (0.7)
   Non-selective monoamine reuptake inhibitors (N06AA) 9 (1.4) 6 (6.3) 3 (0.5) 14 (2.7) 16 (0.3)
   Selective serotonin reuptake inhibitors (N06AB) 15 (2.4) 13 (13) 2 (0.2) 83 (16) 18 (0.3)
Pediatric psychotherapy 71 (11) 49 (51) 22 (4.1) 241 (47) 96 (1.7)
Pediatric psychiatry 37 (5.9) 18 (19) 19 (3.6) 158 (31) 160 (2.8)
Drugs (N05/N06) or psychotherapy 105 (17) 65 (68) 40 (7.5) 331 (64) 220 (3.8)
JIA Juvenile idiopathic Arthritis, RF- Rheumatoid factor-negative, RF+ Rheumatoid factor-positive, DMARD Disease modifying antirheumatic drug, bDMARD Biological
DMARD, csDMARD Conventional synthetic DMARD, tsDMARD targeted synthetic DMARD, NSAIDs Non-steroidal antiinflammatory drugs, GCs Glucocorticoids, SD
Standard deviation

with comparable frequency in the JIA and control group, Discussion

whereas controls were more likely to have a prescrip- To our knowledge, this study on mental comorbidities
tion for psychiatric therapy (Table 2). Psychoanalep- in pediatric JIA patients and controls is based on one of
tics, especially antidepressants, and psycholeptics were the largest samples analyzing a wide range of prescribed
only prescribed from the age of 15 and most frequently medications related to mental health problems using
used in those aged 18 to 20 years. While mean DDDs health insurance data. We found that AYA with JIA had a
for NSAIDs were similar in AYA with (101) and without higher risk of a mental health diagnosis than the control
(101) any psychological disorder, mean DDDs for GCs population.
were lower (80) in AYA with than in AYA without any A few previous studies on psychiatric morbidity in
psychological disorder (106). JIA have also highlighted an increased risk in specific
Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 7 of 8

outcomes compared with controls [7, 14–17]. Although carried out, which, however, came to comparable results
our findings are in line with these results, comparabil- based on data from the pre-corona period. The study was
ity is mostly limited due to methodological discrepancy. not designed to address drug-related associations with
Small heterogeneous samples as well as differences in depression or other mental disorders.
case assessment (symptoms vs. diagnoses) and/or dis- Despite these limitations, our data cover a broad
ease durations/activities may explain why few previous nationwide DMARD/glucocorticoid-treated JIA cohort,
studies have stated no increased risk of mental health representing about 4.5% of the estimated JIA popula-
issues in JIA patients compared to general population tion in Germany [24]. Strengths of claims data include
controls [18–20]. In our study, the prevalence rate of the possibility to identify sex- and age matched controls
psychological diagnoses seemed to be higher among without arthritis diagnoses. A main advantage of the data
females than among males, both in AYA with and with- source is the complete coverage of all prescribed drugs.
out JIA. These results are consistent with trends in the
general population [21] and those previously reported Conclusion
in JIA [14, 17, 20, 22]. We have shown that prevalence Selected psychological disorders among 12- to 20-year-
rates of selected mental disorders vary with age, with olds with JIA are diagnosed more frequently than in
depression and anxiety diagnoses becoming increas- controls without JIA. They are diagnosed with varying
ingly common. Thus, our findings confirm previous frequency across the age range and JIA categories, and
studies on the relationship between age and mental are more common in females than males. Mental health
health in JIA [19, 22, 23]. In our study, individuals with issues are treated proportionally equally in adolescents
oligoarthritis more frequently had mental health diag- with JIA compared to controls.
noses than individuals with polyarthritis. Conversely
to our findings, previous studies showing that patients
Abbreviations
with a polyarticular course are at higher risk for mental AYA​ Adolescents and young adults
health impairments than patients from other categories JIA Juvenile idiopathic Arthritis
[3, 22]. However, since factors such as JIA onset, disease DMARDs Disease-modifying antirheumatic drugs
ICD-10 International Statistical Classification of Diseases
duration, sex, and age can influence the frequency and ICD-10-GM German modification of the ICD-10
type of mental disorders [14], comparability with previ- ATC​ Anatomical Therapeutic Chemical
ous studies is limited. We found that about two thirds NSAIDs Non-steroidal anti-inflammatory drugs
GCs Glucocorticoids
of individuals with JIA and diagnosed mental disorder DDDs Defined Daily Doses
were undergoing psychotherapeutic or psychophar-
macological treatment. The similar proportion of con- Supplementary Information
trols with psychological disorders receiving treatment The online version contains supplementary material available at https://​doi.​
shows that JIA patients seem to have the same chance org/​10.​1186/​s12969-​023-​00948-y.
to receive treatment for diagnosed mental health issues
than controls. Additional file 1.

Limitations and strengths Acknowledgements

The authors thank the BARMER for providing access to data via their data
Our study had several limitations, including not clinically
warehouse for this study. We thank the research partners Peter Böhm, Andrea-
validated diagnoses of JIA and mental disorders. There- Dagmar Quiring and Julius Wiegand in the TARISMA project for dedicating
fore, prescriptions of DMARDS and/or GC were included their time to add the patient perspective to this project. They have accompa-
nied our research from application to implementation.
to increase diagnostic reliability of JIA. Specialist contact
may be underestimated as specialists working in general Authors’ contributions
practitioners’ offices or in outpatient settings within uni- FM, JK, KA, KM and JC conceived the idea for the article. UM and JC were
involved in data acquisition. FM, KA, JK, KM and JC designed the study,
versity hospitals are not identifiable as rheumatologists
planned analyses and interpreted the results. JC extracted the data and
in the data. The higher prevalence of mental disorders in performed the analyses. FM and KA wrote the first draft of the manuscript. All
patients compared to controls could also be due to the authors critically reviewed the manuscript and agreed with the submission.
JC had full access to all the data in the study and takes responsibility for the
fact that patients have regular medical encounters, can
integrity of the data and the accuracy of the data analysis.
express mental problems and have easier access to psy-
chological/psychiatric care. This may also have been the Funding
Open Access funding enabled and organized by Projekt DEAL. The study
case during the corona pandemic (when patients still had
was supported by the Federal Ministry of Education and Research within the
regular medical encounters). In addition, the pandemic research network TARISMA [01EC1902A].
itself as remarkable stressor may also have played a role.
Availability of data and materials
In order to rule out the latter, a sensitivity analysis was
No additional data are available.
Milatz et al. Pediatric Rheumatology (2024) 22:10 Page 8 of 8

Declarations 12. World Health Organization. ATC/DDD Toolkit. https://​www.​who.​int/​tools/​

atc-​ddd-​toolk​it/​about. Accessed 13 Aug 2023.
Ethics approval and consent to participate 13. Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Con-
The study protocol was approved by the ethics committee of the Charité - ducted using Observational Routinely-collected health Data (RECORD)
Universitätsmedizin Berlin (EA2/233/22). statement. PLoS Med. 2015;12:e1001885.
14. Kyllönen MS, Ebeling H, Kautiainen H, Puolakka K, Vähäsalo P. Psychiatric
Consent for publication disorders in incident patients with juvenile idiopathic arthritis - a case-
Not required. control cohort study. Pediatr Rheumatol Online J. 2021;19:105.
15. Bomba M, Meini A, Molinaro A, Cattalini M, Oggiano S, Fazzi E, et al. Body
Competing interests experiences, emotional competence, and psychosocial functioning in
JC received speaker fees from Janssen-Cilag GmbH. FM, KA, KM, JK, UM have juvenile idiopathic arthritis. Rheumatol Int. 2013;33:2045–52.
no conflicts of interest. UM is an employee of the BARMER. There were no 16. Memari AH, Chamanara E, Ziaee V, Kordi R, Raeeskarami SR. Behavioral
financial and personal relationships with other people or organizations that problems in juvenile idiopathic arthritis: a controlled study to examine
could inappropriately influence (bias) this work. the risk of psychopathology in a chronic pediatric disorder. Int J Chronic
Dis. 2016;2016:5726236.
Author details 17. Oommen PT, Klotsche J, Dressler F, Foeldvari I, Foell D, Horneff G, et al.
1
Programme area Epidemiology and Health Services Research, Deutsches Frequency of depressive and anxious symptoms in patients with juvenile
Rheuma-Forschungszentrum, a Leibniz Institute, Charitéplatz 1, 10117 Ber- idiopathic arthritis (JIA) – Data from the Inception Cohort of Newly diag-
lin, Germany. 2 Department of Pediatric Respiratory Medicine, Immunology nosed patients with JIA (ICON). Ann Rheum Dis. 2022;81:143.
and Critical Care Medicine, Charité – Universitätsmedizin Berlin, corporate 18. Tarakci E, Yeldan I, Kaya Mutlu E, Baydogan SN, Kasapcopur O. The
member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, relationship between physical activity level, anxiety, depression, and
Germany. 3 Department Medicine and Health Services Research, BARMER functional ability in children and adolescents with juvenile idiopathic
Institute for Health System Research, Wuppertal, Germany. 4 Institute for Social arthritis. Clin Rheumatol. 2011;30:1415–20.
Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin 19. Fair DC, Nocton JJ, Panepinto JA, Yan K, Zhang J, Rodriguez M, et al.
Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität Anxiety and depressive symptoms in juvenile idiopathic arthritis
zu Berlin, all Germany, Berlin, Germany. correlate with pain and stress using PROMIS measures. J Rheumatol.
2022;49:74–80.
Received: 2 November 2023 Accepted: 17 December 2023 20. Berthold E, Dahlberg A, Jöud A, Tydén H, Månsson B, Kahn F, et al. The risk
of depression and anxiety is not increased in individuals with juvenile
idiopathic arthritis – results from the south-Swedish juvenile idiopathic
arthritis cohort. Pediatr Rheumatol Online J. 2022;20:114.
21. Sauer K, Barkmann C, Klasen F, Bullinger M, Glaeske G, Ravens-Sieberer
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