The psychosocial effects of cleft lip and palate: a systematic review

This systematic review examined the published scientific research on the psychosocial impact of cleft lip and palate (CLP) among children and adults. The primary objective of the review was to determine whether having CLIP places an individual at greater risk of psychosocial problems. Studies that examined the psychosocial functioning of children and adults with repaired non-syndromal CLP were suitable for inclusion. The following sources were searched: Medline (January 1966-December 2003), CINAHL (January 1982-December 2003), Web of Science (January 1981-December 2003), PsycINFO (January 1887-December 2003), the reference section of relevant articles, and hand searches of relevant journals. There were 652 abstracts initially identified through database and other searches. On closer examination of these, only 117 appeared to meet the inclusion criteria. The full text of these papers was examined, with only 64 articles finally identified as suitable for inclusion in the review. Thirty of the 64 studies included a control group. The studies were longitudinal, cross-sectional, or retrospective in nature. Overall, the majority of children and adults with CLP do not appear to experience major psychosocial problems, although some specific problems may arise. For example, difficulties have been reported in relation to behavioural problems, satisfaction with facial appearance, depression, and anxiety. A few differences between cleft types have been found in relation to self-concept, satisfaction with facial appearance, depression, attachment, learning problems, and interpersonal relationships. With a few exceptions, the age of the individual with CLP does not appear to influence the occurrence or severity of psychosocial problems. However, the studies lack the uniformity and consistency required to adequately summarize the psychosocial problems resulting from CLP.