A meta-analysis of nearly 13,000 children with long-term physical conditions found substantially higher levels of emotional, anxiety and somatic problems than among healthy peers, strengthening calls for routine psychological screening in paediatric care.
A large new meta-analysis suggests that children and teenagers living with chronic physical health conditions face markedly higher levels of emotional and body-related distress than their healthy peers, reinforcing calls for more routine mental health screening in paediatric care. The review, published in Frontiers in Psychology and led by researchers at Marburg University, pooled 115 studies involving 12,958 young people with long-term physical illnesses and 24,638 comparison participants. It found elevated scores across every psychological scale examined, with the biggest gaps in somatic complaints, such as aches and nausea, and affective problems linked to low mood.
The analysis used six DSM-oriented scales from the Achenbach System of Empirically Based Assessment, a widely used set of behaviour checklists completed by parents, teachers or young people themselves. Those scales cover affective problems, anxiety problems, somatic problems, attention deficit hyperactivity problems, oppositional defiant problems and conduct problems. Most of the data came from parents completing the Child Behaviour Checklist, and the average age across the samples was about 10, with just under half of participants being girls. Among the most frequently studied conditions were epilepsy, eczema and other atopic disorders, heart disease, cancer, HIV, obesity, traumatic brain injury and chronic pain.
According to the paper, the strongest elevations were seen for somatic problems, with an effect size of 0.66 standard deviations, and affective problems, at 0.61. Anxiety problems were also notably higher, at 0.50, while increases in attention, oppositional and conduct problems were smaller but still statistically clear. Between about 8.6% and 14.3% of children with chronic illness scored in the clinical range on these scales, compared with roughly 2% in the general population. The authors said the pattern points to a need for regular psychosocial screening in paediatric settings, especially for children with conditions affecting the brain or nervous system.
The review also found that the size of the gap varied depending on who filled in the checklist. Parents tended to report larger problems than adolescents did themselves, particularly for mood and anxiety. Illnesses involving the nervous system were associated with stronger elevations on most measures, while shorter duration of illness and older age were linked with larger differences on several scales. By contrast, whether a condition was visible and the child’s gender made little difference.
The findings fit with earlier research showing that children with chronic medical problems are at greater risk of depressive symptoms, anxiety and broader emotional and behavioural difficulties, although not all are clinically unwell. Previous meta-analyses have also found that internalising problems, such as anxiety and low mood, tend to rise more sharply than externalising behaviours. The new review adds weight to that picture, while also highlighting an important caution: high screening scores do not amount to a diagnosis, and somatic complaints can overlap with symptoms of the underlying illness or its treatment.
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