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Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting ConditionsA Systematic Review and Meta-analysis

Educational Objective
To conduct a systematic review and meta-analysis to estimate the prevalence and/or incidence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions.
1 Credit CME
Key Points

Question  What is the prevalence and/or incidence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions?

Findings  In this systematic review and meta-analysis, the pooled prevalence of anxiety in 19 studies was 19.1%, with significant differences in prevalence according to the type of assessment tool used; in a meta-analysis of 36 studies, depression prevalence was 14.3% and was associated with increasing age. No studies included information on incidence of anxiety or depression.

Meaning  The high prevalence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions highlights the need for improved services to address their psychological needs.


Importance  Children, adolescents, and young adults with life-limiting conditions experience various challenges that may make them more vulnerable to mental health problems, such as anxiety and depression. However, the prevalence and incidence of anxiety and depression among this population appears to be unknown.

Objective  To conduct a systematic review and meta-analysis to estimate the prevalence and/or incidence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions.

Data Sources  Searches of MEDLINE (PubMed), PsycInfo, and Embase were conducted to identify studies published between January 2000 and January 2018.

Study Selection  Studies were eligible for this review if they provided primary data of anxiety or depression prevalence and/or incidence, included participants aged 5 to 25 years with a life-limiting condition, were conducted in an Organisation for Economic Co-operation and Development country, and were available in English.

Data Extraction and Synthesis  Random-effects meta-analyses were generated to provide anxiety and depression prevalence estimates. Meta-regression was conducted to analyze associations between study characteristics and each prevalence estimate.

Main Outcomes and Measures  Prevalence of anxiety and depression.

Results  A total of 14 866 nonduplicate articles were screened, of which 37 were included in the review. Of these, 19 studies reported anxiety prevalence, and 36 studies reported depression prevalence. The mean (range) age of participants was 15.4 (6-25) years. The meta-analysis of anxiety prevalence (n = 4547 participants) generated a pooled prevalence estimate of 19.1% (95% CI, 14.1%-24.6%). Meta-regression analysis found statistically significant differences in anxiety prevalence by assessment tool; diagnostic interviews were associated with higher anxiety prevalence (28.5% [95% CI, 13.2%-46.8%]) than self-reported or parent-reported measures (14.9% [95% CI, 10.9%-19.4%]). The depression meta-analysis (n = 5934 participants) found a pooled prevalence estimate of 14.3% (95% CI, 10.5%-18.6%). Meta-regression analysis revealed statistically significant differences in depression prevalence by the mean age of the sample (β = 0.02 [95% CI, 0.01-0.03]; P = .001).

Conclusions and Relevance  In this systematic review and meta-analysis, the prevalence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions was high, highlighting the need for increased psychological assessment and monitoring. Further research is required to determine the prevalence and incidence of anxiety and depression in a larger sample of children, adolescents, and young adults with a broader range of life-limiting conditions.

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Article Information

Accepted for Publication: March 20, 2019.

Corresponding Author: Mary M. Barker, MPH, Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, United Kingdom (mmb529@york.ac.uk).

Published Online: July 8, 2019. doi:10.1001/jamapediatrics.2019.1712

Author Contributions: Dr Barker had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Barker, Beresford, Fraser.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Barker, Beresford, Fraser.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Barker, Bland, Fraser.

Obtained funding: Beresford, Fraser.

Supervision: Beresford, Fraser.

Conflict of Interest Disclosures: Dr Fraser reported grants from Martin House Children’s Hospice during the conduct of the study. No other disclosures were reported.

Funding/Support: This article was undertaken as part of the Martin House Research Centre, which is supported by Martin House Hospice Care for Children and Young People and the University of York.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Liam Robson, BSc, MPH, University of York, conducted a portion of the abstract screening and full text review. Tom Ainscough, PhD, University of York, reviewed sections of the manuscript. They were not compensated for their contributions.

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