In this blog for people with long-term physical conditions, their families and clinicians, Hiran Thabrew, child psychiatrist and paediatrician at Starship Children’s Hospital, New Zealand discusses two Cochrane Reviews he recently authored about treating anxiety and depression in children with long-term physical conditions. This blog is one of a series on Evidently Cochrane, #YoungMindsMatter.
What is the problem?
More than one in ten children and young people around the world have long‐term physical conditions (chronic illnesses) such as asthma, diabetes, and cancer. Due to the stress of their illness and treatment, they are more likely to develop psychological problems, especially anxiety and depression. Some of these problems are the same as those experienced by children without long-term physical illness, while others are more specific to health. Examples include health-related anxiety, where anxiety is related to concerns about your health, and procedural anxiety, where anxiety is related to concerns about medical procedures and tests you may have as a result of your health condition. Working at a major children’s hospital in New Zealand, I see many such children and young people every week with these problems.
We know that treating anxiety and depression early using talking therapies (psychological therapies) can prevent difficulties with family life, school, and future mental health problems. These can either be delivered face-to-face or using digital technology such as computers and smart phones (e-health interventions). Until recently, it was unclear whether face-to-face talking therapies or e-health interventions designed for children and adolescents without medical issues are also appropriate for use with this group.
What did we do to find out?
In 2018, we searched for all the relevant research that could help us find out whether the treatments we were interested in are helpful for children and adolescents with long-term physical conditions and how they feel about them. We critiqued and summarised what we found and published it in these two Cochrane Reviews:
- Psychological therapies for anxiety and depression in children and adolescents with long‐term physical conditions
- E‐health interventions for anxiety and depression in children and adolescents with long‐term physical conditions
These reviews tried to answer the following questions:
- Are psychological and e-health therapies better than a range of other therapies, or being on a waiting list, in reducing symptoms of anxiety and depression in children and adolescents with long‐term physical conditions?
- Are psychological and e-health therapies acceptable to these children and adolescents?
What did we find?
The first review included 29 studies with 1349 children and adolescents and the second review included 5 studies with 463 children and adolescents. Disappointingly, we rated the available evidence in the first review as being of ‘low to moderate’ quality and the evidence in the second review as being of ‘very low’ quality, meaning that we could not be certain about our findings in either review.
Of the face-to-face talking therapies, we found that those based on the principles of cognitive behavioural therapy (CBT) and those specifically designed to treat depression or anxiety may be more effective than control interventions at reducing mild symptoms of these conditions, but only in the short term. We found limited evidence that such therapies were acceptable to young people and that they could improve other things such as quality of life and symptoms of long‐term physical conditions. We did not find any talking therapies specifically designed to address health‐related anxiety.
Of the online (e-health) talking therapies, we found that none of the three therapies (Breathe Easier Online, Web‐MAP, and multimodal cognitive behavioural therapy) examined in 5 studies were better than a selected range of other therapies or just being on a waiting list at reducing symptoms of anxiety or depression. However, some of them were acceptable to the children and adolescents using them.
So, what does this mean?
There is still a lack of reliable evidence to help people decide which type of face-to-face or online talking therapy might be most effective for treating anxiety and depression in children with long-term physical conditions.
What should happen next?
Given the ongoing need for effective therapies to address anxiety and depression in this group, we suggest that further research is undertaken to develop effective face-to face and online talking therapies for them. We specifically recommend the development of therapies that target health-related anxiety as there do not seem to be any interventions proven to treat this issue commonly faced by children and adolescents with long-term physical conditions.
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Thabrew H, Stasiak K, Hetrick SE, Donkin L, Huss JH, Highlander A, Wong S, Merry SN. Psychological therapies for anxiety and depression in children and adolescents with long‐term physical conditions. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More 2018, Issue 12. Art. No.: CD012488. DOI: 10.1002/14651858.CD012488.pub2.
Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. E‐Health interventions for anxiety and depression in children and adolescents with long‐term physical conditions. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD012489. DOI: 10.1002/14651858.CD012489.pub2.
Declaration of interest: Hiran Thabrew has nothing to disclose.