Depressive Symptoms in Parents of Children With Chronic Health Conditions

A Meta-analysis

Martin Pinquart, PHD

Disclosures

J Pediatr Psychol. 2019;44(2):139-149. 

In This Article

Abstract and Introduction

Abstract

Objective: Caring for children with chronic health conditions is associated with stressors that may impair mental health. The goal of our meta-analysis was to analyze depressive symptoms among parents who care for a child or adolescent with chronic physical disease and/or sensory disability and/or physical disability compared with parents of healthy children or test norms.

Methods: A systematic search through electronic databases identified 460 relevant studies that were included in a random-effects meta-analysis.

Results: Parents of children with chronic conditions showed small to moderate elevations of depressive symptoms compared with parents of healthy/nondisabled children and test norms (g = .46 SD units). Twelve studies using structured clinical interviews provided a weighted mean depression rate of 20.9%. The highest elevations were found among parents of young people with neuromuscular disorders, cancer, and cerebral palsy. Elevations of depressive symptoms were greater in cases with shorter durations of the chronic condition, in mothers compared with fathers, and in parents from economically less developed countries rather than developed countries.

Conclusions: Parents of children with chronic conditions, particularly parents of children with neuromuscular disorders, cancer, and cerebral palsy, should be screened for depression and receive psychosocial services aimed at reducing these symptoms, if needed.

Introduction

The term chronic health condition covers medically diagnosed diseases and chronic disabilities (Lawn & Schoo, 2010). The present meta-analysis assessed the levels of depressive symptoms and the prevalence of clinical depression among parents of children and adolescents with chronic physical diseases and/or physical/sensory disabilities. In addition, we assessed whether levels of depressive symptoms vary by characteristics of the chronic health condition (e.g., duration), the child (e.g., age), and the parents (e.g., gender), as well as study quality. It is important to understand the extent of depressive symptoms among parents of children with chronic conditions because parental depressive symptoms have been found to be correlated to negative parenting practices (Celano, Bakeman, Gaytan, Smith, Koci, & Henderson, 2008), poor adherence (Eckshtain, Ellis, Kolmodin, & Naar-King, 2010), and an increase in their children's symptoms over time (Otsuki, Eakin, Arceneaux, Rand, Butz, & Riekert, 2010). Knowledge on these questions is also important for identifying parents who should be screened for depression.

Providing care for a child with a chronic health condition may lead to depressive symptoms among mothers and fathers. First, having a child diagnosed with a chronic condition is associated with losses, such as the loss of the healthy/nondisabled child parents thought they had, the loss of confidence in their own parental ability to protect their child from danger, the loss of freedom because of disease- or disability-related restrictions, and the loss of previous sources of positive feelings because of reduced time spent with friends or partaking in hobbies (Lowes & Lyne, 2000). A loss of perceived control is a main risk factor for depressive symptoms and disorders (Abramson, Metalsky, & Alloy, 1989; Carpentier, Mullins, Chaney, & Wagner, 2006). Second, elevated caregiving demands may result in chronic stress and emotional as well as physical exhaustion which could, again, lead to parental depression (Lawoko & Soares, 2006). Third, in some cases, depression may result from feelings of guilt, for example, if the chronic condition resulted from parental behaviors (e.g., in the case of mother-to-child transmission of HIV; Lazarus, Struthers, & Violari, 2009). Finally, when parents face their child's life-threatening condition (where existing treatments may fail) or life-limiting conditions (when the disease cannot be cured and patients will die of the disease; Fraser et al., 2012), a negative mood could also be an aspect of anticipatory grief reactions (Lowes & Lyne, 2000; Olshansky, 1962; Rando, 2000).

Until now, only one meta-analysis has been published on depressive symptoms among parents of children with a chronic health condition. Easter, Sharpe, and Hunt (2015) found a small to moderate elevation of depressive symptoms among caregivers of children with asthma compared with caregivers of healthy children (d = .44 SD units). Narrative reviews indicated that up to 50% of parents of children with congenital heart defects or epilepsy report clinically relevant levels of depression and/or anxiety (Ferro & Speechley, 2009; Woolf-King, Anger, Arnold, Weiss, & Teitel, 2017). Elevated levels of general psychological distress has also been found in meta-analyses on parents of children with cancer (d = .30–.35; Pai, Greenley, Lewandowski, Drotar, Youngstrom, & Peterson, 2007) and spina bifida (d = .54–.76; Vermaes, Janssens, Bosman, & Gerris, 2005). However, the results of these reviews are difficult to compare because of the use of different outcome variables (depression vs. heterogeneous indicators of psychological distress). In addition, most reviews reported considerable variability of the effect sizes (Pai et al., 2007; Vermaes et al., 2005; Woolf-King et al., 2017). Information on the source of heterogeneity is needed for identifying parents who are at the highest risk for depressive symptoms. These points were addressed in the present meta-analysis.

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