A Pandemic of Psychological Distress Is Upon Us

Why Us?

For those questioning whether addressing mental health should fall within the realm of adult and pediatric rheumatologists, there are three things to consider. 

First, we have more access to our patients. Rheumatologists follow their patients more closely than primary care physicians. The difference in access to patients may be exaggerated during the pandemic. When patients with increased concerns of becoming infected are limiting their activities to what is perceived as the most urgent and essential, primary care visits are being deferred. This means, with the proper tools, rheumatologists are more likely to pick up mental health problems and more likely to find them earlier, when treatment can prevent suffering and downstream health effects. 

Second, downstream health effects likely include effects on rheumatologic diseases, physical functioning, pain processing and other aspects of health we spend so much time and effort trying to improve.

Third, and most importantly, our patients demand it. Much of the behind-the-scenes efforts to understand and improve mental health for individuals with rheumatologic diseases is patient driven. Patients and families have been advocating long and hard for us to partner with them to help them overcome the mental health problems that so often come along with their diseases. This makes sense, considering how many view their rheumatology clinics as their medical homes, perhaps more so than their primary care clinics—a theme that permeates qualitative work done around mental health in pediatric rheumatology.

Do We Hear Them?

While the patient community is loud and clear, the question remains: Are rheumatologists listening? As rheumatologists, we have always faced depression and anxiety in our patients. The increased burden of mental health in the COVID era demands that we—collectively as a society and personally as healthcare providers—consider how we can address our patients’ mental health more effectively. 

Continuing our current practices will risk patients’ lives and well-being.

Tamar Rubinstein, MD, MS, MD, MS, is an assistant professor of pediatric rheumatology at Children’s Hospital at Montefiore, The Bronx, N.Y. Her research focuses on improving mental health and SLE disease outcomes in youth. She is a co-leader of the CARRA Mental Health Workgroup.

Natoshia R. Cunningham, PhD, is a tenure-track assistant professor in the Department of Family Medicine at Michigan State University and a licensed clinical psychologist. She is leading a multi-site study funded by CARRA and the Arthritis Foundation to test a telehealth application of a tailored cognitive behavioral intervention for adolescents and young adults diagnosed with childhood-onset lupus to manage fatigue, mood and pain symptoms. Dr. Cunningham serves as the co-chair of CARRA’s Mental Health Workgroup.