A U.K. study involving national focus groups of young people with JIA highlighted the need to consider social aspects of the young person's life alongside their physical and psychological needs (1). Young people reported an overwhelming need to meet similar others with JIA and the need for health professionals to pay increased attention to issues such as bullying, social isolation, and the loss of valued social activities. In a health care setting discussion of such topics can help develop rapport and build trusting relationships. In addition the development of interventions to address these issues may prove invaluable. Developing a supportive client-centered relationship that is seen as responsive and motivating may improve adherence, as has been demonstrated in young people with diabetes, comparing a client-centered approach with doctors who were "expert" decision makers who adopted a traditional medical model (10). Health care workers may therefore need training to ensure that their consultations are adolescent friendly and not dominated by disease monitoring tasks (see Chapters 4 and 17).
The development of psychosocial interventions is also important as social groups are a useful mechanism for sharing feelings they would not normally disclose to others (11). Social groups may therefore be an important tool for screening for mental health issues. Mood has also been shown to play an important role in the reporting of disease symptoms, including pain and fatigue, and that mood enhancing activities could have a positive effect on such symptoms (12). It could therefore be inferred that social isolation and the lack of peer support could have an effect on mood and the subsequent reporting of symptoms in clinic. Health professionals therefore need to be cognisant of the benefits of psychosocial interventions when managing physical symptoms as well as the more traditional medical treatments for symptom relief.
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