The effects of universal parental support programs: a systematic review and meta-analysis

There are few current comprehensive meta-analyses and systematic reviews of the literature on universal parental support programs. The aim of this meta-analysis was therefore to examine the effects of universal parental support programs on children's externalizing and internalizing problems, as well as on parental mental health, and to evaluate the possible importance of theoretical frameworks in achieving better outcomes.

The meta-analysis included randomized controlled trials of universal parental support programs for parents to children and adolescents aged 2-17 years. A search in five databases was conducted from inception to December 2020 and updated in April 2024. The abstracts and subsequent full-text articles were independently reviewed by two pairs of authors, resulting in 31 original studies (36 articles) with a total of 7635 participants. To evaluate risk of bias, we used the Cochrane risk-of-bias tool for randomized trials.

Small positive short-term effects were obtained for the included universal parental support programs on parental ratings of children's externalizing (d = 0.18: 95% CI 0.07-0.29) and internalizing problems (d = 0.16: 95% CI 0.03-0.30), parental stress (d = 0.22: 95% CI 0.04-0.40) and parental depression (d = 0.13: 95% CI 0.01-0.25). Subgroup analyses showed that significant effects on primary outcomes were only found when interventions were compared to waitlist, not to an active control group. The long-term between-group effects were positive but small and non-significant. Most of the programs were based on social learning theory, no differences emerged between programs with different theoretical frameworks.

This meta-analysis indicates that universal parental support programs, when compared to waitlist only, may have a small positive impact on children's externalizing and internalizing problems as well as on parental stress and depression in the short time frame.