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

Research Questions

Absolute levels of depressive symptoms cannot be aggregated across studies if different measures were used. Therefore, depression scores of the individual studies must be standardized before aggregation (Lipsey & Wilson, 2001). This is achieved when computing the difference between depressive symptoms in parents of a child with a chronic health condition and members of a control group (who have been assessed with the same depression scale but who do not have a child with a chronic condition), and dividing the difference by the pooled SD. The standardized score indicates elevations of depressive symptoms in parents of a child with a chronic condition that can be attributed to the condition. Thus, the present meta-analysis analyzed elevations of depressive symptoms in parents of children with a chronic condition when compared with parents of healthy children and test norms. The first research question asked whether parents of children and adolescents with a chronic condition show higher levels of depressive symptoms and a higher rate of clinical depression than parents of healthy/nondisabled children or test norms.

The second question asked whether elevations of parental depressive symptoms vary by study characteristics. The selection of moderator variables was mainly based on family stress models. These models indicate that the amount of psychological distress of family members depends on the amount of stressors and the availability of coping resources (Frishman et al., 2017). With regard to stressors, the strongest elevations of parental depressive symptoms were expected among cases of life-threatening and life-limiting conditions, such as cancer, cystic fibrosis, HIV infection/AIDS, and progressive neuromuscular disorders (Fraser et al., 2012) because depressive symptoms often result from losses (Lowes & Lyne, 2000) and anticipatory grief (Rando, 2000). In addition, mothers of young people with chronic conditions were expected to show stronger elevations of depressive symptoms than fathers because of being, on average, more involved in the childcare (Pinquart, 2018), showing stronger emotional responses to stressors than men as well as less effective ways of coping with stressors (Hyde, Mezulis, & Abramson, 2008). Furthermore, stronger elevations of parental depressive symptoms were expected when caring for younger children (because of higher caregiver demands; Naar-King et al., 2009) and in the case of shorter duration of the chronic condition (because of having less time to adapt; Murray et al., 2008).

With regard to resources, married parents of children with chronic health conditions were expected to show weaker elevations of depressive symptoms than unmarried parents because married parents tend to share caregiving responsibilities and because being married increases the availability of emotional support (Frishman et al., 2017; Mullins et al., 2011). In addition, we expected weaker elevations of depressive symptoms in parents from developed countries with advanced economies (International Monetary Fund [IMF], 2018) because of better access to high-quality medical treatments (World Health Organization, 2018) and psychosocial services for the affected families (Telfer, 2009; Witbooi, 2013).

Because moderator effects of the study quality are a central topic of high-quality meta-analyses (Higgins & Green, 2009; Lipsey & Wilson, 2001), we also tested whether effect sizes vary by study quality and publication status.

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