Use of Mental Health Services Low in Patients with Systemic Sclerosis

Karima Becetti, MD

Data from a large international scleroderma cohort found that only 18% of participants affected by the disease received mental health services in a 3-month period, most of which was issued by a general practitioner.

According to the Canadian Scleroderma Research Group Registroy, an estimated 23% of patients affected by scleroderma experience lifetime major depressive disorder, which is undoubtedly related to the significant morbidity and high mortality rates associated with the disease.

Likewise, limitations in the availability and efficacy of pharmacotherapies have contributed to the myriad of psychological and emotional implications of scleroderma. As such, addressing the psychosocial concerns of those effected by the rare disease has been a prominent concern among patients and providers, especially given the limited data regarding the frequency of mental health services in this population.

With this study, investigators led by Karima Becetti, MD, of Weill Cornell Medicine-Qatar, sought to determine the number of participants enrolled in the Scleroderma Patient-Centered Intervention Network (SPIN) Cohort who utilized mental health services in a 3-month period while also interpreting the demographic, psychological, and disease-specific factors associated with the use of these services.

Determining Mental Health Service Use

The SPIN cohort featured participants from more than 45 centers across the United States, Canada, UK, France, Spain, Mexico, and Australia. Eligibility for the study required all participants 18 years or older to meet the 2013 American College of Rheumatology/European League Against Rheumatism classification for scleroderma. Questionnaires were then issued in several languages.

The current study was comprised of participants who completed the appropriate questionnaires from January 2014 to May 2020.

Following the questionnaires and the collection of demographic information, participants were asked “In the last 3 months, have you seen any of the following health professionals to address a mental health concern?”, before checking a box for any answers that applied to them, including psychiatrist, psychologist, general practitioner or family doctor, or “other”. Participants were also asked how many times they used these services in the 3-month period.

From there, participants completed questionnaires that evaluated symptoms of depression, anxiety, and body image stress, including the 8-item Patient Health Questionnaire (PHQ-8), Patient-Reported Outcomes Measurement Information system-29 (PROMIS-29v2), and theSatisfaction with Appearance (SWAP) scale.

The Self-Efficacy for Managing Chronic Disease (SEMCD) scale was also utilized to determine the confidence participants had regarding self-managing scleroderma despite fatigue, physical discomfort, and emotional distress.

A total of 2319 participants from the SPIN Cohort were included in the study, a majority of whom (36%) originated from the United States. A majority of the participants in the cohort were women (88%) and White (81%), and the mean age was 54 years.

Among these participants,only 18% (417) had utilized mental health services in the 3 months prior to enrollment, with 37% (153) having received these services from more than 1 type of provider.

General practitioners were the most common mental health service providers (59%), followed by psychologists (25%) and psychiatrists (19%).

Following a multivariable analysis, mental health service use was independently associated with higher education (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.11), smoking (OR 1.06), being retired (OR 0.60), having limited scleroderma (OR 1.39), and having higher anxiety symptom scores (OR 1.04) and lower self-efficacy scores (OR 0.90, 95% CI 0.83-0.97).

Investigators suggested that additional studies could explore the factors determined in their study, in addition to the rate of mental health services use in patients with scleroderma and a clinical diagnosis of major depressive disorder or other mental health disorders.

"The effects of these services in this unique patient population are also important to explore in future research," the team wrote.

The study, "Mental Health Care Use and Associated Factors in Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study," was published online in ACR Open Rheumatology.