The impact of juvenile idiopathic arthritis on psychosocial outcomes: a systematic review and meta-analysis

OBJECTIVE: In addition to the physical challenges of juvenile idiopathic arthritis (JIA), youth with JIA also experience a range of psychosocial sequalae, which requires further attention. This meta-analysis aimed to compare the psychosocial outcomes of youth with JIA to healthy peers and other illness groups. METHOD: The protocol for this review was registered on PROSPERO (ID CRD42022348012). Seven electronic databases were searched from date of inception to February 20, 2024. Eligible studies reported on the health-related quality of life (HRQoL) or psychological outcomes of youth (<18 years) with JIA and included a comparison group. A modified Downs and Black Checklist was used to evaluate each study's quality. This research was supported by an Australian Government Research Training Program (RTP) Scholarship. RESULTS: Fifty-six studies met inclusion criteria, representing a total of 335,708 participants. Compared to healthy controls, youth with JIA had more internalizing problems (g = 0.35, 95% confidence interval [CI] 0.13-0.57) and psychiatric diagnoses (g = 0.29, 95% CI 0.18-0.41), but did not differ on anxiety and depression symptoms. Relative to other illnesses, those with JIA had less anxiety (g = -0.26, 95% CI -0.42 to -0.10) and depressive symptoms (g = -0.51, 95% CI -0.73 to -0.30), but were similar in internalizing problems and psychiatric diagnoses. HRQoL was impaired relative to healthy peers overall (g = 0.74, 95% CI 0.46-1.02) and specifically in the physical domain (g = -0.89, 95% CI -1.18 to -0.60) and psychosocial domain (g = -0.53, 95% CI -0.68 to -0.37). Compared to other illnesses, youth with JIA had poorer physical (g = 0.79, 95% CI 0.03-1.55) and psychosocial HRQoL (g = 0.53, 95% CI 0.04-1.02). The quality of studies included were moderate but were limited by their poor external validity. CONCLUSIONS: Although youth with JIA had more internalizing problems and psychiatric diagnoses than healthy peers, they also demonstrated psychological resilience for anxiety and depression symptoms. However, they face large disparities in their HRQoL compared to both healthy youth and youth with other health conditions.