Peer rejection, social behavior, and psychological adjustment in children with juvenile rheumatic disease.

Objective: To examine the associations among disease status, social competence, and depressive symptoms in children with juvenile rheumatic disease (JRD) and to test the hypothesis that individual differences in children’s social competence account for a significant proportion of variance in depressive symptoms after controlling for disease status variables.

Methods: Thirty-six children with JRD completed standardized instruments to assess pain, health status, and depressive symptoms. The rheumatologist completed a disease severity measure, and teachers provided ratings of peer rejection and social behavior.

Results: Pain, peer rejection, and problematic social behavior were all positively associated with depressive symptoms. Social variables remained significantly associated with depressive symptoms after controlling for level of pain. In addition, peer rejection moderated the association between pain and depressive symptoms, such that children with high levels of pain and high levels of peer rejection reported the highest frequency of depressive symptoms.

Conclusion: Health care providers should assess the social functioning of children with JRD in order to identify socially vulnerable children who may be at increased risk for internalizing problems.