Review Perceived Strengths and Difficulties in Children and Adolescents With Chronic Physical Health Conditions A Meta-Analysis, 2024, Pinquart

https://econtent.hogrefe.com/doi/full/10.1026/0942-5403/a000456

Open Access
Review Article
Perceived Strengths and Difficulties in Children and Adolescents With Chronic Physical Health Conditions
A Meta-Analysis
Martin Pinquart
Published Online: September 25, 2024https://doi.org/10.1026/0942-5403/a000456




Abstract
Abstract:

Theoretical Background:

The Strengths and Difficulties Questionnaire (SDQ) is often used for screening of psychological problems in children with chronic physical health conditions (CPHC).

Objective:

The present meta-analysis tested
(a) whether the SDQ scores of young people with CPHC show elevated psychological symptoms and lower prosocial behavior compared with healthy peers or test norms,
(b) which conditions are associated with the strongest increase in symptoms,
and
(c) whether results vary by sample and study characteristics.

Method:

Studies that compared SDQ scores between young people with CPHC and healthy peers or test norms or that provided sufficient information for a comparison with established normative data or sociodemographically equivalent healthy groups from that country, and if studies were published or made available online before July, 2023, were included in the meta-analysis. Study quality was evaluated with the Mixed Methods Appraisal Tool. A systematic search in the electronic databases Medline, PsycINFO, PSYNDEX, Web of Science, and the SDQ database resulted in 605 studies of 217,440 children and adolescents with CPHC that were included in random-effects meta-analyses.

Results:

There were, on average, small-to-moderate elevations in total difficulties (parent/self-report: g = .52/.31) and the four problem scales as well as slight reductions in parent reports on prosocial behavior (g = -.17). Elevations in parent- and self-reports on emotional symptoms (g = .48/.31) and peer problems (g = .43/.26) were significantly stronger than elevations in conduct problems (g = .30/.10) and hyperactivity–inattention (g = .33/.13). In addition, children with cerebral palsy (parent/self-report of total problems: g = .82/.66), chronic fatigue syndrome (g = .82/.66), and epilepsy (g = .95/.40) showed above-average elevations in psychological symptoms. Stronger effect sizes were found, among others, in older children and in the case of a later age at onset. Direct comparisons of the results of published and unpublished studies on self-rated SDQ found some evidence for a possible publication bias, while results of published and unpublished studies did not vary when parent ratings were used. With regard to limitations, only few studies were available on teacher ratings and from non-Western countries. Illness-specific analyses were impossible for rarely assessed conditions, such as cystic fibrosis and spina bifida.

Discussion and Conclusion:

It is concluded that children with epilepsy, cerebral palsy, chronic fatigue syndrome, and other conditions affecting the brain should be, in particular, screened for psychological problems. Symptom overlap of some CPHC with the Emotional Symptoms scale has to be considered when interpreting the data.

Wahrgenommene Stärken und Schwächen bei Kindern und Jugendlichen mit chronischen körperlichen Erkrankungen. Eine Meta-Analyse
Zusammenfassung:Theoretischer Hintergrund: Der Fragebogen zu Stärken und Schwächen (SDQ) wird oft zum Screening psychischer Probleme bei chronisch Erkrankten genutzt. Fragestellung: Untersucht wurde ob a) Kinder und Jugendliche mit chronischen körperlichen Erkrankungen erhöhte psychische Symptome und weniger prosoziales Verhalten als gesunde Gleichaltrige bzw. Testnormen aufweisen, b) welche Erkrankungen mit dem stärksten Symptomanstieg verbunden sind und c) ob Ergebnisse in Abhängigkeit von Studienmerkmalen variieren. Methode: Eine systematische Suche in elektronischen Datenbanken lieferte 605 Studien mit 217440 chronisch Erkrankten. Ergebnisse: Es traten kleine bis moderate Erhöhungen im Summenwert der Schwächen und in den Problemskalen auf, während sich das prosoziale Verhaltens nur gering von der Vergleichsgruppe unterschied. Kinder mit Zerebralparese, Chronischem Erschöpfungssyndrom und Epilepsie wiesen die stärksten psychischen Symptome auf. Größere Effektstärken wurden in Elternberichten als in den Selbstberichten der Erkrankten gefunden, bei älteren Teilnehmenden und bei späterem Erkrankungsbeginn. Diskussion und Schlussfolgerung: Bei der Interpretation muss die Überlappung von Symptomen der körperlichen Erkrankung mit im SDQ erfassten emotionalen Symptomen beachtet werden.


Perceived Strengths and Difficulties in Children and Adolescents With Chronic Physical Health Conditions
Martin Pinquart
Kindheit und Entwicklung 2024 33:3, 145-154

 

This is such a mess. They keep talking about screening for psychological symptoms as if this is a thing that can be done reliably even in normal circumstances, let alone when there are huge, deliberate, overlaps in the questions that just make the entire process an exercise in excessive arbitrariness.

I would bet that 90%+ of this effect is found in that overlap, with the rest being mostly noise. What we have for the most part is a bunch of problems that derive from one cause, where if that cause were removed all those problems would disappear. It's not as if anyone can do much here, almost all the rest is a matter of how severe the illness is, with the balance being almost all socioeconomic.

Mental health care is such a dismal clusterfuck that a complete reset of all knowledge and data would still be the best case scenario. Just starting fresh without all the biases, sunk cost and egomania in the way.