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Cited by 216Family Support in IllnessFamily and Disability Support ResearchChild and Adolescent Psychosocial and Emotional Development

Psychological interventions for parents of children and adolescents with chronic illness

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Eccleston, Christopher, Fisher, Emma, Law, Emily, Bartlett, Jess, Palermo, Tonya M·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009660.pub3PMC PMC4838404
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Abstract

BACKGROUND: Psychological therapies have been developed for parents of children and adolescents with a chronic illness. Such therapies include interventions directed at the parent only or at parent and child/adolescent, and are designed to improve parent, child, and family outcomes. This is an updated version of the original Cochrane review published in Issue 8, 2012, (Psychological interventions for parents of children and adolescents with chronic illness). OBJECTIVES: To evaluate the efficacy of psychological therapies that include parents of children and adolescents with chronic illnesses including painful conditions, cancer, diabetes mellitus, asthma, traumatic brain injury (TBI), inflammatory bowel diseases (IBD), skin diseases, or gynaecological disorders. We also aimed to evaluate the adverse events related to implementation of psychological therapies for this population. Secondly, we aimed to evaluate the risk of bias of included studies and the quality of outcomes using the GRADE assessment. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO for randomised controlled trials (RCTs) of psychological interventions that included parents of children and adolescents with a chronic illness. Databases were searched to July 2014. SELECTION CRITERIA: Included studies were RCTs of psychological interventions that delivered treatment to parents of children and adolescents with a chronic illness compared to an active control, waiting list, or treatment as usual control group. DATA COLLECTION AND ANALYSIS: Study characteristics and outcomes were extracted from included studies. We analysed data using two categories. First, we analysed data by each individual medical condition collapsing across all treatment classes at two time points. Second, we analysed data by each individual treatment class; cognitive behavioural therapy (CBT), family therapy (FT), problem solving therapy (PST) and multisystemic therapy (MST) collapsing across all medical conditions. For both sets of analyses we looked immediately post-treatment and at the first available follow-up. We assessed treatment effectiveness for two primary outcomes: parent behaviour and parent mental health. Five secondary outcomes were extracted; child behaviour/disability, child mental health, child symptoms, family functioning, and adverse events. Risk of bias and quality of evidence were assessed. MAIN RESULTS: Thirteen studies were added in this update, giving a total of 47 RCTs. The total number of participants included in the data analyses was 2985, 804 of whom were added to the analyses in the update. The mean age of the children was 14.6 years. Of the 47 RCTs, the studies focused on the following paediatric conditions: n = 14 painful conditions, n = 13 diabetes, n =10 cancer, n = 5 asthma, n = 4 TBI, and n = 1 atopic eczema. We did not identify any studies treating parents of children with gynaecological disorders or IBD. Risk of bias assessments of included studies were predominantly unclear. Evidence quality, assessed using the GRADE criteria, was judged to be of low or very low quality.Analyses of separate medical conditions, across all treatment types, revealed two beneficial effects of psychological therapies for our primary outcomes. First, psychological therapies led to improved adaptive parenting behaviour in parents of children with cancer post-treatment (standardised mean difference (SMD) -0.20, 95% confidence interval (CI) -0.36 to -0.04, Z = 2.44, p = 0.01). In addition, therapies also improved parent mental health at follow-up in this group (SMD = -0.18, 95% CI -0.32 to -0.04, Z = 2.58, p = 0.01). We did not find any effect of therapies for parent behaviour for parents of children with a painful condition post-treatment or at follow-up, or for parent mental health for parents of children with cancer, diabetes, asthma, or TBI post-treatment. For all other primary outcomes, no analysis could be conducted due to lack of data.Across all medical conditions, three effects were found for the primary outcomes of psychological therapies. PST had a beneficial effect on parent adaptive behaviour (SMD = -0.25, 95% CI -0.39 to -0.11, Z = 3.59, p < 0.01) and parent mental health (SMD= -0.24, 95% CI -0.42 to -0.05, Z = 2.50, p = 0.01) immediately post-treatment and this effect was maintained at follow-up for parent mental health (SMD= -0.19, 95% CI -0.34 to -0.04, Z = 2.55, p = 0.01). The remaining analysis for PST on parent behaviour found no effect. No effects were found for CBT post-treatment or at follow-up for either parent outcome. For FT, only one analysis could be run on parent mental health and no effect was found. Due to lack of data, the remaining analyses of primary outcomes could not be run. For MST, no parent outcomes could be analysed due to lack of data.Secondary outcome analyses are presented in the Results section. Five studies reported that there were no adverse events dur

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  • Findings from a systematic review of parent-child interventions, including cognitive-behavioral and family-focused treatments, found these interventions could be beneficial in improving parent behaviors, e.g., reducing attention to pain symptoms and encouraging functioning despite pain.

    “Findings from a systematic review of parent–child interventions, including cognitive-behavioral and family-focused treatments, found that these interventions could be beneficial in improving parent behaviors, e.g., reducing attention to pain symptoms, encourage functioning despite pain [36].”

    From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [36]

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  • Self-management interventions have been found to be effective for CA with other chronic diseases such as asthma and diabetes.

    “Self-management interventions have been found to be effective for adults with IBD 4 and also for CA with other chronic diseases 16 such as asthma 17, 18 and diabetes 19 .”

    From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [18]

    The Results section (Individual conditions across all psychological therapies; page unavailable) reports a small reduction in diabetes-related symptoms after psychological interventions for children with diabetes. But this is a review of parent-focused psychological interventions, not self-management interventions generally, and its asthma analyses found no benefit. The source therefore supports a narrower claim than the one attributed to it. (LLM, conf=0.85)

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  • Studies evaluating the effects of parental support programs on parent behaviors and distress are scarce.

    “Furthermore, despite the evident relationship between pediatric chronic pain and family functioning, studies evaluating the effects of parental support programs on parent behaviors and distress are scarce [16].”

    From A clinical pilot study of individual and group treatment for adolescents with chronic pain and their parents: Effects of acceptance and commitment therapy on functioning (2016) · cites this paper as [16]

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Research works printed but not linked: 5

  1. Committee on Publication Ethics Code of conduct and best practice guidelines for journal editors publicationethics.org/ (accessed 22 March 2012)
  2. Palermo TM Wilson AC Peters M Lewandowski A Somhegyi H Randomized controlled trial of an internet delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain Pain 2009 146 1–2 205 13 10.1016/j.pain.2009.07.034 19695776 PMC2760656 · DOI · Paper page
  3. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan) 5.3 Copenhagen The Nordic Cochrane Centre, The Cochrane Collaboration 2014
  4. Skinner BF Chapter 5: Operant behavior Science and Human Behaviour Toronto The Macmillan Company 1953
  5. Wysocki T Harris MA Greco P Bubb J Danda CE Harvey LM Randomized, controlled trial of behavior therapy for families of adolescents with insulin-dependent diabetes mellitus Journal of Pediatric Psychology 2000 25 1 23 33 10826241

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Authors
Eccleston, C., Fisher, E., Law, E., Bartlett, J., & Palermo, T. M.
Affiliations
  • University of Bath (GB)
  • University of Washington (US)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-04-15
Issue
4
Pages
CD009660-CD009660
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009660.pub3
PMC
PMC4838404
OpenAlex
W4360894050
Cited by
216
References
202
Citations by year
2026: 8 · 2025: 12 · 2024: 18 · 2023: 20 · 2022: 19 · 2021: 19 · 2020: 20 · 2019: 26 · 2018: 34 · 2017: 26 · 2016: 10 · 2015: 4
FWCI
10.02
Type
journal article
Language
en
Update notices
new_version (2019-03-18)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute for Health and Care Research (13/89/29)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD065180, K24HD060068)
Topics
  • Social Sciences › Sociology and Political Science › Family Support in Illness
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
psychological intervention, parents of children with chronic illness, adolescents with chronic illness, parental mental health, child mental health, family functioning, cognitive behavioral therapy, family therapy, problem-solving therapy, multisystemic therapy, adverse events, childhood cancer, diabetes mellitus, asthma, traumatic brain injury, inflammatory bowel disease, skin diseases, gynecological diseases, chronic pain
MeSH terms
Adolescent, Child, Chronic Disease, Family Therapy, Humans, Parents, Problem Solving, Psychotherapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Parenting

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