Perceived Strengths and Difficulties in Children and Adolescents With Chronic Physical Health Conditions

: 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 Direct comparisons of the results of published and unpublished studies on self-rated SDQ found some evidence for a possible publication bias, while results of published and unpublished studies did not vary when parent ratings were used.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. Zusammenfassung: Theoretischer Hintergrund: Der Fragebogen zu St & auml;rken und Schw & auml;chen (SDQ) wird oft zum Screening psychischer Probleme bei chronisch Erkrankten genutzt. Fragestellung: Untersucht wurde ob a) Kinder und Jugendliche mit chronischen k & ouml;rperlichen Erkrankungen erh & ouml;hte psychische Symptome und weniger prosoziales Verhalten als gesunde Gleichaltrige bzw. Testnormen aufweisen, b) welche Erkrankungen mit dem st & auml;rksten Symptomanstieg verbunden sind und c) ob Ergebnisse in Abh & auml;ngigkeit von Studienmerkmalen variieren. Methode: Eine systematische Suche in elektronischen Datenbanken lieferte 605 Studien mit 217440 chronisch Erkrankten. Ergebnisse: Es traten kleine bis moderate Erh & ouml;hungen im Summenwert der Schw & auml;chen und in den Problemskalen auf, w & auml;hrend sich das prosoziale Verhaltens nur gering von der Vergleichsgruppe unterschied. Kinder mit Zerebralparese, Chronischem Ersch & ouml;pfungssyndrom und Epilepsie wiesen die st & auml;rksten psychischen Symptome auf. Gr & ouml;ss ere Effektst & auml;rken wurden in Elternberichten als in den Selbstberichten der Erkrankten gefunden, bei & auml;lteren Teilnehmenden und bei sp & auml;terem Erkrankungsbeginn. Diskussion und Schlussfolgerung: Bei der Interpretation muss die & Uuml;berlappung von Symptomen der k & ouml;rperlichen Erkrankung mit im SDQ erfassten emotionalen Symptomen beachtet werden.