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

Conclusions

Despite these limitations, several conclusions can be drawn from the present meta-analysis. From the research perspective, more studies are needed on parental depression pertaining to chronic pediatric conditions that were seldom addressed in the present meta-analysis, such as chronic fatigue syndrome. As concurrent associations do not inform us about the causal direction of associations, we recommend more longitudinal research on predictors of change in depressive symptoms of parents with children with chronic conditions. More research is also recommended on the prevalence of clinical depression and on the processes that cause elevated levels of depressive symptoms and clinical depression in parents of children with a chronic condition, such as related losses, emotional or physical exhaustion, or feelings of guilt. As only a minority of the parents develops clinical depression, we also recommend more research on factors that protect the parents from becoming depressed.

With regard to the policy perspective, our data indicate that efforts are particularly needed for families from less economically developed countries, such as improving medical care of the child and supporting their parents. With regard to conclusions for clinicians, the highest observed rates of parental depressive symptoms within families with a child with neuromuscular disorders, cancer, cerebral palsy, and inherited hematological diseases indicate that these parents should be, in particular, screened for depressive symptoms and receive psychosocial services aimed at reducing these symptoms, if needed. As available theoretical explanations for parental depressive symptoms refer to loss of control (Carpentier et al., 2006), exhaustion by care demands (Lawoko & Soares, 2006), and feelings of guilt (Lazarus et al., 2009), interventions should increase parental control (e.g., through an active role in treatment decision-making), reduce overtaxing caregiving demands (e.g., by use of informal or formal support), and lower feelings of guilt (e.g., by realistically evaluating the possible parental contribution to the child's condition). A meta-analysis by Eccleston, Fisher, Law, Bartlett, and Palermo (2015) found support for positive effects of problem-solving therapy on the mental health of parents of children with chronic physical conditions. In this kind of intervention, specific problem-solving skills are taught in sequential steps such as defining the problem, generating alternative solutions, making decisions, and verifying/implementing solutions. Although average effect sizes on mental health were small, we must be aware that many participating parents probably did not fulfill the criteria of psychological disorders at the start of the intervention, thus leaving less room for improvement. Nonetheless, more intervention research is needed on clinically depressed parents of children with chronic conditions.

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