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Systematic review

Psychological interventions for children and youth with serious somatic illness in primary care

This overview of systematic reviews presents findings from systematic reviews of high quality, which summarizes the results on the efficacy of psychological interventions provided in primary care for children with severe somatic illness.

This overview of systematic reviews presents findings from systematic reviews of high quality, which summarizes the results on the efficacy of psychological interventions provided in primary care for children with severe somatic illness.


Key message

The prognosis for children with serious somatic illness is better today than a decade ago and more children are living with chronic disease.

However, studies have shown that children with serious somatic illness have a two or three times greater risk of developing mental, social or family problems than healthy children. It is important to identify interventions that may improve mental health in children with severe somatic illness.

This overview of systematic reviews presents findings from systematic reviews of high quality, which summarizes the results on the efficacy of psychological interventions provided in primary care for children with severe somatic illness. We included ten systematic reviews presenting results from 21 primary studies relevant to our problem. The studies primarily dealt with psychological interventions for children with asthma and diabetes. The documentation shows that:


• Conclusions could not be drawn about the effect of psychological interventions provided by professionals in primary care on mental health conditions such as anxiety, depression, quality of life, coping and psychosocial function for children with serious somatic illness.


• A meta-analysis of four studies of children with type 1-diabetes showed that psychological interventions such as cognitive behavioral therapy, support and counseling by psychologist and family systems therapy might possibly contribute to better mental health.

In general, the results from the included studies did not show any statistically significant difference between the differing interventions. One should however, not assume that no documentation of difference equates to documenting that there is no difference. Most of the studies had few participants and large variations.

Summary

Background

Children with serious somatic illness have better prognosis today than a decade ago and more children are living with chronic disease. However, studies have shown that children with serious somatic illness have a two or three times greater risk of developing mental, social or family problems than healthy children. With further medical progress, we can also assume that the number of children living with chronic disease will continue to increase. It is important to identify interventions that may improve mental health in children with severe somatic illness

Objective

The objective was to synthesise research about the effectiveness of psychological interventions provided in primary care for children with serious somatic illness.  

 

Method

We searched for systematic reviews in the following databases: Cochrane library, CRD databases, Medline, Embase, Cinahl, SveMed + Idunn and PsycInfo in August 2013.

The inclusion criteria were:

Study design : Systematic reviews of high quality
Population : Children and adolescents ( <18 years) with severe somatic diseases such as: cancer, diabetes, rheumatic disorders, neurological diseases, cardiovascular diseases, severe asthma , birth defects, defects  following birth and physical trauma.

Intervention : Psychological interventions provided by primary care providers aimed at both families and children, as well as advice to and training of other professionals with a relationship to the child, such as teachers.
We have divided the measures into the following subgroups:
• Defined therapies: behavioral therapy , cognitive therapy, cognitive behavioral therapy, short-term psychotherapy, short-term psychodynamic therapy,  motivational interviewing.
• Stress management and relaxation techniques (in addition psychological treatment) such as autogenic training, relaxation, biofeedback, hypnosis and mindfulness
•Psychological counseling, education and counseling
• Support interventions and environmental interventions (such as a support person)
• Art and expressive therapy
Comparison : Standard measures (treatment as usual) not psychological, or other psychological interventions.
Outcomes : Anxiety, depression, sorrow, stress, quality of life, coping and psychosocial functioning. The outcome measures had to be measured with valid measurement tools.
Languages : All, but the summaries must be in English or one of the Scandinavian languages.

We excluded studies of children with mental illness and mental retardation, and interventions in specialist services.

 

Three authors independently assessed the reviews for inclusion, and two assessed the methodological quality by using a checklist for methodological quality of systematic reviews.  The quality of the evidence was assessed using the Grades of Recommendations Assessment, Development and Evaluation (GRADE).

 

Results

We identified 3079 citations in the search for systematic reviews. We reviewed titles, abstracts, articles in full text and assessed the methodological quality. We included ten systematic reviews of high quality.

 

The systematic reviews presented 21 primary studies relevant to our research question. The studies dealt primarily with psychological interventions for children with asthma and diabetes. The documentation shows that:


• Conclusions could not be drawn about the effect of psychological interventions provided by professionals in primary care on mental health such as anxiety, depression, quality of life, coping and psychosocial function for children with serious somatic illness.


• A meta-analysis of four studies involving children with type 1-diabetes showed that psychological interventions such as cognitive behavioral therapy, support and counseling by psychologist and family systems therapy might possibly contribute to better mental health.

 

Discussion

The quality of the evidence is graded to low or very low, indicating that we have little trust to the results. We cannot draw conclusions about the effect of psychological interventions provided by professionals in primary care on mental health, such as anxiety, depression, quality of life, coping and psychosocial function for children with serious somatic illness. However, a meta-analysis of four studies concluded that psychological interventions such as cognitive behavioral therapy, support and counseling by psychologist and family systems therapy might reduce psychological distress in children with type 1 diabetes.

However one should, be cautious of making the assumption that no documentation of difference equates to documenting that there is no difference. Most of the studies had few participants and large variations.


Several of the included interventions were provided at hospitals and some of these interventions may have been conducted in primary care. We may have overlooked studies because the setting was not clearly described.

Children in need of support can receive psychological treatment by both primary care and other services.  It is possible that needs related to the acute illness and diagnosis and training for major life changes should be handled by specialist expertise in hospital. More lasting challenges common for various types of chronic somatic illness can be handled in primary care by staff with relevant expertise.

 

Conclusion

We have included ten systematic reviews, which presented the findings from 21 studies that were relevant to our research question. The quality of the evidence was insufficient, and we cannot draw conclusions about the effect of psychological interventions provided in primary care on mental health conditions such as anxiety, depression, quality of life, coping and psychosocial function for children with asthma, diabetes, blood disorders and CFS/ME. However, a meta-analysis of four studies concluded that psychological interventions such as cognitive behavioral therapy, support and counseling psychologist and family systems therapy might reduce psychological distress in children with type 1 diabetes.

 

There is a need for more comparative studies examining the effects of psychological interventions for the children with severe somatic illness, such as studies evaluating the effectiveness of interventions for children with congenital heart disease or cancer.

 

About this publication

  • Year: 2014
  • Authors Dahm KT, Smedslund G, Håvelsrud K, Hafstad E, Reinar LM.
  • ISSN (digital): 1890-1298
  • ISBN (digital): 978-82-8121-862-8