Depressive Symptoms in Children and Adolescents with Chronic Physical Illness: An Updated Meta-Analysis

Objective To integrate results of available studies that compared levels of depressive symptoms of children and adolescents with chronic physical illness to healthy peers or test norms. Methods Random-effects meta-analysis was computed with 340 studies and 450 subsamples. Results Children and adolescents with chronic illness have, on average, higher levels of depressive symptoms than their healthy peers (d = .19 SD units). Differences are strongest for chronic fatigue syndrome (d = .94), fibromyalgia (d = .59), cleft lip and palate (d = .54), migraine/tension head ache (d = .51), and epilepsy (d = .39). Larger effect sizes were found in studies with higher proportion of girls, with a healthy control group, from developing countries, published before 1990, and that used parent rating or clinician ratings rather than child ratings. Conclusions Pediatricians and others working with children with chronic illnesses should screen children with chronic physical illness for symptoms of psychological distress and make appropriate referrals for mental health services, when needed.