Psychological therapy for parents of children and adolescents with a longstanding or life-threatening physical illness

Eccleston C, Fisher E, Law E, Bartlett J, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD009660. DOI:10.1002/14651858.CD009660.pub3.

Background

This is an update of a previously published review published in 2012 investigating the efficacy of psychological therapies for parents of children with a longstanding or life-threatening physical illness. This review updates includes studies that have been conducted in the previous two years to give an up-to-date review of the evidence.

Parenting a child with a longstanding or life-threatening illness is very difficult, and can have a negative impact on many aspects of the parents’ life. Parents of these children often have difficulty balancing caring for their child with other responsibilities and demands. As a result, parents may experience more stress, worries, mood disturbance, family arguments, and their children may show troubling or problematic behaviour. Parents also have a major influence on their child’s well-being and adjustment, and play an important role in how their child adapts to living with an illness. Treatments for parents of children with a longstanding illness aim to improve parent distress, parenting behaviours, family conflict, child distress, child disability and the child’s medical symptoms.

Review question

To evaluate the effectiveness of psychological therapies for 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. Psychological therapies will be compared to active, treatment as usual, or wait-list controls. There were two primary outcomes of interest: parent mental health and parenting behaviour. We included five secondary outcomes; child behaviour/disability, child mental health, child symptoms, family functioning, and adverse events.

Study characteristics

The search was completed in July 2014. Forty-seven studies were found in the search including 3778 participants. The average age of the children was 14.6 years. We found studies that focused on six chronic illnesses (painful conditions, cancer, diabetes, asthma, traumatic brain injury and eczema) and evaluated four types of psychological therapies (cognitive behavioural therapy, family therapy, problem solving therapy, multisystemic therapy). Outcomes were extracted from the time point immediately after the treatment and at the first available follow-up. We analysed the data in two ways: first we grouped the studies by each individual illness (across all therapies) and then we grouped the studies by each individual psychological therapy (across all chronic illnesses).

Key Results

Psychological therapies improved parenting behaviour of parents of children with cancer immediately following treatment. Parent distress also improved for parents of children with cancer. Children with painful conditions and those with symptoms of diabetes showed benefit immediately following treatment, and for diabetes the reduction in symptoms was maintained at follow-up. When analysing different psychological therapies, we found cognitive behavioural therapy can improve the child’s medical symptoms. Problem-solving therapy can improve a parent’s distress and their ability to solve problems, with the reduction in parental distress continuing long-term. Five studies reported that there were no adverse events during the study period. The remaining studies failed to report or discuss adverse events. Risk of bias assessments of included studies were predominantly unclear due to poor reporting.

Conclusion

There is evidence that psychological therapies including parent interventions can benefit parents of children with a chronic illness, particularly for parents of children with cancer. However, due to the small number of studies in this review, future studies are likely to change the findings in this review.