Emotional and behavior problems in children and adolescents with chronic physical health conditions: an updated meta-analysis

OBJECTIVE: The study updated a meta-analysis on emotional and behavioral problems among children with chronic physical health conditions (CPHCs) as assessed with the Achenbach System of Empirically Based Assessment. METHOD: A systematic search in electronic databases (PsycInfo, Medline, Web of Science, and PSYNDEX) identified 1,337 studies that were analyzed with multilevel meta-analysis. RESULTS: Young people with CPHCs had, on average, higher levels of internalizing (g = .51 standard mean difference), externalizing (g = .25), and total behavior problems (g = .49) than peers without CPHCs or test norms. Elevations of total problems were larger than in the past meta-analysis. The largest elevations of internalizing problems were found for chronic fatigue syndrome, while the largest elevations of total problems and externalizing problems were observed in the case of thalassemia. Effect sizes tended to be larger when parent reports were used rather than adolescent self-reports. Effect sizes also varied by country and, in part, by duration of the CPHCs, sampling, target of comparison, equivalence of the compared groups, response rate, age, and gender. CONCLUSIONS: The results call for regular screening for psychological distress in children with CPHCs.