Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions: A Systematic Review and Meta-analysis

Abstract

Importance: Children, adolescents, and young adults with life-limiting conditions experience various challenges that may make them more vulnerable to mental health problems, such as anxiety and depression. However, the prevalence and incidence of anxiety and depression among this population appears to be unknown.

Objective: To conduct a systematic review and meta-analysis to estimate the prevalence and/or incidence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions.

Data sources: Searches of MEDLINE (PubMed), PsycInfo, and Embase were conducted to identify studies published between January 2000 and January 2018.

Study selection: Studies were eligible for this review if they provided primary data of anxiety or depression prevalence and/or incidence, included participants aged 5 to 25 years with a life-limiting condition, were conducted in an Organisation for Economic Co-operation and Development country, and were available in English.

Data extraction and synthesis: Random-effects meta-analyses were generated to provide anxiety and depression prevalence estimates. Meta-regression was conducted to analyze associations between study characteristics and each prevalence estimate.

Main outcomes and measures: Prevalence of anxiety and depression.

Results: A total of 14 866 nonduplicate articles were screened, of which 37 were included in the review. Of these, 19 studies reported anxiety prevalence, and 36 studies reported depression prevalence. The mean (range) age of participants was 15.4 (6-25) years. The meta-analysis of anxiety prevalence (n = 4547 participants) generated a pooled prevalence estimate of 19.1% (95% CI, 14.1%-24.6%). Meta-regression analysis found statistically significant differences in anxiety prevalence by assessment tool; diagnostic interviews were associated with higher anxiety prevalence (28.5% [95% CI, 13.2%-46.8%]) than self-reported or parent-reported measures (14.9% [95% CI, 10.9%-19.4%]). The depression meta-analysis (n = 5934 participants) found a pooled prevalence estimate of 14.3% (95% CI, 10.5%-18.6%). Meta-regression analysis revealed statistically significant differences in depression prevalence by the mean age of the sample (β = 0.02 [95% CI, 0.01-0.03]; P = .001).

Conclusions and relevance: In this systematic review and meta-analysis, the prevalence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions was high, highlighting the need for increased psychological assessment and monitoring. Further research is required to determine the prevalence and incidence of anxiety and depression in a larger sample of children, adolescents, and young adults with a broader range of life-limiting conditions.

Figure 1.. Flow Diagram

The flow diagram adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard. LLC indicates life-limiting conditions; OECD, Organisation for Economic Co-operation and Development.

Figure 2.. Forest Plot of Pooled Anxiety Prevalence, Grouped by Life-Limiting Condition Diagnostic Group

Forest plot of 19 studies included in the meta-analysis of anxiety prevalence. The pooled anxiety prevalence from the meta-analysis was 19.1% (95% CI, 14.1%-24.6%). ES indicates effect size (prevalence).

Figure 3.. Forest Plot of Pooled Depression Prevalence, Grouped by Life-Limiting Condition Diagnostic Group

Forest plot of the 36 studies included in the meta-analysis of depression prevalence. The pooled depression prevalence from the meta-analysis was 14.3% (95% CI, 10.5%-18.6%). ES indicates effect size (prevalence).