Identifying the State of Mental Health Care in Canadian Adults with Systemic Lupus Erythematosus.

Abstract

OBJECTIVE To identify barriers to accessing mental health care among adult patients with systemic lupus erythematosus (SLE) in Canada, exploring physician- and patient-reported barriers and evaluating possible interventions. METHODS We surveyed Canadian rheumatologists and adult patients with SLE. Physicians reported current practices, barriers, and interventions for mental health care. Patients reported their mental health experiences, barriers to access, and preferences for interventions. Surveys were distributed through professional networks, clinics, and social media, with analyses conducted using descriptive statistics and Cohen's kappa for agreement. RESULTS A total of 25 rheumatologists and 235 patients participated. Physicians cited limited availability of mental health providers (88%) and insufficient time (84%) as top barriers. Few used standardized screening tools like PHQ-9 (16%) or GAD-7 (12%). Patients reported anxiety (41.7%) and depression (39.9%) as common concerns, with many facing challenges accessing care due to long wait times and affordability. Patients favored integrated mental health services within rheumatology clinics (58.6%), whereas physicians preferred external referrals. Agreement between groups on interventions ranged from moderate (κ=0.64) for primary care screening to low (κ=0.25) for integration of services into the rheumatology clinic. CONCLUSION Mental health care in SLE management remains underdeveloped, hindered by systemic barriers and discordance between patient and provider preferences. Standardized screening, interprofessional collaboration, and alignment of perspectives would likely improve mental health outcomes and overall patient quality of life. These findings highlight opportunities for targeted interventions and guideline development in mental health care for SLE.