Evidence
Alert

Psychological therapies may improve parenting skills in parents of children with chronic illness

Psychological therapies appear to show promise in helping improve self-reported parenting behaviour of parents of children and adolescents with cancer, chronic pain, diabetes or traumatic brain injury.

Cognitive behavioural therapy (CBT) and problem-solving therapy (PST) appear particularly valuable in supporting this. Psychological therapies also seemed beneficial in improving the mental health of parents who have children with cancer and chronic pain, but not in studies of children with diabetes.

Parenting a child with a chronic illness can pose challenges to family life, causing emotional strain for both the parents and children concerned. Skills for adapting to this can help improve parenting behaviour and the mental health and well-being outcomes for families of children with chronic illness.

This Cochrane systematic review analysed 44 trials of varying quality, which included over 4,600 parents. The results may help support healthcare practitioners working with families where children have chronic illness.

 

Why was this study needed?

Chronic medical conditions such as asthma, diabetes mellitus and chronic pain in childhood and adolescence can impact poorly on quality of life and be potentially life-threatening. Parents and families play a critical role in helping their children adapt to chronic illness, and this can be stressful. All aspects of daily life for both the parents and child can be negatively affected.

Parents of children with chronic medical conditions are more likely to experience emotional distress such as anxiety and depression, unsuitably adapted parenting responses and poor family functioning. This has been linked to poorer social and educational outcomes for the child.

Worldwide, chronic medical conditions in childhood and adolescence are expected to increase over time. A better understanding is needed of what psychological treatments can help support parents and children to cope more effectively with chronic illness.

 

What did this study do?

This updated Cochrane review found 44 randomised controlled trials that compared psychological and non-psychological therapies given to parents of children with common chronic illnesses. The largest number of studies came from parents of children with diabetes and chronic pain. The review included 4,697 parents and other primary caregivers of children and adolescents aged three months to 19 years with chronic medical conditions lasting beyond three months.

Studies included the use of psychotherapeutic treatments focussed on improving the behaviours and mental health of parents measured by self-reporting on various outcome scales. Studies were chosen that compared psychological therapies such as CBT, PST, motivational interviewing and family therapy delivered face-to-face with any other treatment or no treatment. It was unclear whether participants had a current psychological diagnosis.

Most studies were of low quality apart from those measuring parental mental health.

 

What did it find?

  • Cognitive behavioural therapy (CBT) and problem-solving therapy (PST) showed the most promise for improving reported parenting behaviour for parents of children with cancer, chronic pain, diabetes and traumatic brain injury.
  • Psychological therapies appeared to sustainably improve parenting behaviour for children with cancer (mean difference at three months follow-up -0.21, 95% confidence interval [CI] -0.37 to -0.05; 625 parents) and children with chronic pain (mean difference at three to 12 months follow-up -0.35, 95% CI -0.50 to -0.20; 678 parents).
  • Psychological therapies appeared to improve parenting behaviour after the therapy ended for children with diabetes (mean difference -1.39, 95% CI -2.41 to -0.38; 338 parents) and traumatic brain injury (mean difference -0.74, 95% CI -1.25 to -0.22; 254 parents).
  • The mental health of parents of children with cancer appeared to be sustainably improved by psychological therapies (mean difference -0.23, 95% CI -0.39 to -0.08; 667 parents) and of children with chronic pain (mean difference -0.20, 95% CI -0.38 to -0.02; 482 parents).
  • Child mental health symptoms post-treatment were improved after their parents received psychological therapy (mean difference -0.08, 95% CI -0.19 to 0.03; 1,786 parents).

 

What does current guidance say on this issue?

National guidelines from NICE for most of the chronic illnesses considered in this study do not make detailed recommendations about psychological treatments in terms of parental support.

Most focus on the clinical management of the condition and make broad recommendations on accessing charitable organisations and other local and national support and information services. Guideline development is currently in progress or identified as needed in other areas.

 

What are the implications?

This review indicates that in some areas, psychological therapies have beneficial effects in improving parenting skills and mental health in parents of children with chronic illness. Family functioning and parent and child well-being may be aided by this, leading to better overall adaptation to coping with illness.

Current clinical guidelines place little emphasis on psychological therapies and in many cases refer service users to charitable organisations and national support services. These options, alongside strong social support, are likely to be helpful. Where there is less opportunity to access this type of support, CBT and PST may present viable alternative options. The costs and cost-effectiveness of these options did not form part of this review.

 

Citation and Funding

Law E, Fisher E, Eccleston C and Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev. 2019;3:CD009660.

Cochrane UK and the Pain, Palliative and Supportive Care Review Group (PaPaS) Cochrane Review Group are supported by NIHR infrastructure funding.

 

Bibliography

Cousino MK and Hazen RA. Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol. 2013;38(8):809‐28.

Leeman J, Crandell JL, Lee A et al. Family functioning and the well‐being of children with chronic conditions: a meta‐analysis. Res Nurs Health. 2016; 39:229‐43.

Liu L, Oza S, Hogan D et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post‐2015 priorities: an updated systematic analysis. Lancet, 2015; 385:430‐40.

NICE. Cancer services for children and young people. QS55. London: National Institute for Health and Care Excellence; 2014.

NICE. Asthma: diagnosis, monitoring and chronic asthma management. NG80. London: National Institute for Health and Care Excellence; 2017.

NICE. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. NG18. London: National Institute for Health and Care Excellence; 2016.

NICE. Head Injury. QS74. London: National Institute for Health and Care Excellence; 2014.

Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre

 

Commentaries

Expert commentary

This is a highly competent review, but it is difficult to draw clinical conclusions. Most parents of chronically ill children are able to manage the stress involved using their own personal and social resources. They are therefore unlikely to require specialised interventions such as reviewed here. In addition, the stress varies according to type of disorder, illness stage and severity.

The review would have been more informative for clinicians had it addressed more clinically homogeneous populations and focused on interventions for parents who do develop unhelpful, persistent styles of parenting, or for those with significant mental health problems. 

Elena Garralda, Emeritus Professor of Child and Adolescent Psychiatry, Imperial College London

The commentator declares no conflicting interests