Anxiety in children and adolescents with chronic physical health conditions: an updated meta-analysis

The present meta-analysis aimed to test whether young people with chronic physical health conditions (CPHC) show elevated anxiety levels.

Studies were included if they (a) compared levels of anxiety symptoms or the prevalence of anxiety disorders between young people with CPHC and their peers without such conditions or test norms, or they provided sufficient information for comparison with test norms or a control group from that country with a similar mean age, (b) assessed children or adolescents (≤18 years), and (c) were published or made available by September 2024. Risk for bias was evaluated using the Mixed Methods Appraisal Tool. A systematic search in the electronic databases, PsycInfo, MEDLINE, Google Scholar, and PSYNDEX, and cross-referencing identified 1,251 papers for inclusion in the multi-level meta-analysis.

On average, children with CPHC had higher anxiety symptoms compared to controls (g = 0.31), with the highest effect sizes observed in young people with thalassemia (g = 0.80), chronic headache (g = 0.60), chronic fatigue syndrome (g = 0.54), and hearing impairment (g = 0.51). Higher between-group differences were observed in observer-ratings compared to self-ratings, in studies comparing participants with peers rather than test norms, in samples with higher proportions of female participants and ethnic minorities, and in studies from developing countries. Results also varied depending on which anxiety measure was used and certain indicators of study quality.

Efforts are needed to screen young people with CPHC for anxiety symptoms and implement measures to prevent or reduce elevated symptoms.