Sex Differences in PROMIS Pediatric Depressive Symptoms, Anxiety, and Psychological Stress Among Children and Adolescents Living With Pediatric Rheumatic Diseases

OBJECTIVE: Children and adolescents living with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematosus (cSLE) frequently experience mental health comorbidities. This study evaluated sex differences in symptoms of depression, anxiety, and psychological stress in JIA and cSLE. METHODS: This multicenter, prospective cohort study recruited children and adolescents from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Disease activity and Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric self-report measures of Depressive Symptoms and Anxiety were collected at 3 timepoints over 12 months, and Psychological Stress was collected at baseline. Differences by sex were tested using chi-square and Wilcoxon rank-sum tests. Linear mixed effect models (LMMs) were created for each PROMIS measure to evaluate differences by sex. The prespecified α was 0.05. RESULTS: Among 393 children/adolescents with JIA and 58 children/adolescents with cSLE, Depressive Symptoms, Anxiety, and Psychological Stress scores were higher (indicating poorer mental health symptoms) for girls than boys. At baseline, approximately 1 in 3 girls with JIA and 1 in 2 girls with cSLE had moderate-to-severe Depressive Symptoms and Psychological Stress, compared to approximately 1 in 6 boys with JIA or cSLE. LMMs showed significantly higher scores (indicating poorer symptoms) for girls than boys, generally exceeding the minimally important difference threshold. CONCLUSION: Girls self-reported worse symptoms of depression, anxiety, and psychological stress compared to boys. Significant sex differences persisted after adjusting for rheumatic disease activity, time, and other pertinent variables. Mental health screening, management, and interventions may need to be tailored by sex.