Improving the mental health of children and young people with long term conditions: Linked evidence syntheses

Abstract

Background Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. Objectives To evaluate the effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (Review 1), and explore the factors that may enhance or limit their delivery (Review 2). Data Sources For Review 1, 13 electronic databases were searched, including MEDLINE, Embase, PsycINFO, CENTRAL, CINAHL and Science Citation Index. For Review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. Review Methods The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post-intervention (Cohen’s d). Where appropriate, random-effects meta-analysis produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and wellbeing of CYP with LTCs. Synthesis followed the principles of meta-ethnography. An overarching synthesis integrated the findings from Review 1 and Review 2 using a deductive approach. End-user involvement, including topic experts, CYP with LTCs and their parents, was a feature throughout the project. 3 Results Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies, evaluating 21 types of intervention. Cancer, HIV positive and mixed-LTC samples were most common. Interventions often aimed to improve broader mental health and wellbeing, rather than symptoms of mental health disorder. The meta-ethnography identified five main constructs, described in an explanatory line-of-argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. Limitations Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in Review 1, limiting the applicability of findings. The mental health status of participants in Review 2 was usually unknown, limiting comparability with Review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. Conclusions There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high quality RCTs integrating process evaluations. End-user involvement enriched the project.