The role of illness intrusiveness in thebarriers to care → depressive symptomassociation in youth with juvenile rheumatic diseases (JRDs) was examined. Sixty-six youth completed the Child Depression Inventory and the Illness Intrusiveness Scale-Child; parents completed the Barriers to Care Questionnaire and the Illness Intrusiveness Scale-Parent. Healthcare barriers and parent illness intrusiveness had direct effects on child illness intrusiveness, which was subsequently associated with youth depressive symptoms. Child illness intrusiveness mediated thebarriers to care → depressive symptomassociation, particularly under conditions of low parent illness intrusiveness. Findings suggest that parent appraisals directly influence child illness appraisals related to adjustment outcomes. Healthcare barriers contribute to youth outcomes in the absence of maladaptive parent illness perceptions.