Stamp Out Stigma
In Southern California, the Loma Linda University Medical Center’s rheumatology clinic gives all patients a standard mental health questionnaire, says Vaneet Kaur Sandhu, MD, an associate program director. Positive results alert the rheumatologist to ask more questions and refer to a mental health provider if indicated.
“[Although] these tools are certainly helpful, I find really just interacting with patients to be most effective,” says Dr. Sandhu. “I set goals for each patient appointment to include a meaningful interaction, one in which I feel I have connected somehow with the patient. In establishing a relationship with patients, I feel an added benefit, so that if something is missed during our mental health screening, perhaps we can address [it] during the clinic visit.”
Mental health issues are not being adequately addressed in rheumatology or anywhere else in healthcare, she says.
“The first and most important barrier to mental healthcare is the social stigma that must be stamped down,” says Dr. Sandhu. “I’m often frustrated that a patient of mine cannot see a psychiatrist because their insurance will not cover it, or that it will be months before the patient can be seen. This is not acceptable. We need more resources, at the very least, to triage patients and act as a bridge to established mental healthcare.”
Rheumatology clinics should try to screen patients for depression as early in the care continuum as possible, according to Dr. Rathbun. “The gravity of this task,” he says, “is immensely challenging, but at the end of the day, [it] may be reliant on regular communications between patients and providers, such as brief, candid and routine inquiry, and discussion of patients’ mental health status during clinical encounters.”
Susan Bernstein is a freelance journalist based in Atlanta.
References
- Rathbun AM, Schuler MS, Stuart EA, et al. Depression subtypes in persons with or at risk for symptomatic knee osteoarthritis. Arthritis Care Res (Hoboken). 2019 Apr 5.
- Stubbs B, Aluko Y, Myint PK, et al. Prevalence of depressive symptoms and anxiety in osteoarthritis: A systematic review and meta-analysis. Age Ageing. 2016 Mar;45(2):228–235.
- Sugai K, Takeda-Imai F, Michikawa T, et al. Association between knee pain, impaired function and development of depressive symptoms. J Am Geriatri Soc. 2018 Mar;66(3):570–576.
- Rathbun AM, Yau MS, Shardell M, et al. Depressive symptoms and structural disease progression in knee osteoarthritis: Data from the Osteoarthritis Initiative. Clin Rheumatol. 2017 Jan;36(1):155–163.
- Rathbun AM, Stuart EA, Shardell M, et al. Dynamic effects of depressive symptoms on osteoarthritis knee pain. Arthritis Care Res (Hoboken). 2018 Jan;70(1):80–88.
- Matcham F, Rayner L, Steer S, et al. The prevalence of depression in rheumatoid arthritis: A systematic review and meta-analysis. Rheumatology (Oxford). 2013 Dec;52(12):2136–2148.
- Aguglia A, Salvi V, Maina G, et al. Fibromyalgia syndrome and depressive symptoms: Comorbidity and clinical correlates. J Affect Disord. 2011 Feb;128(3):262–266.
- Figueiredo-Braga M, Cornaby C, Cortez A, et al. Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical and psychosocial factors. Medicine (Baltimore). 2018 Jul;97(28):e11376.
- Sleath B, Chewning B, de Vellis BM, et al. Communication about depression during rheumatoid arthritis patient visits. Arthritis Rheum. 2008 Feb 15;59(2):186–191.
