Anxiety, Depression Rates Among Patients with Life-Limiting Conditions

A recent study is highlighting the need for psychological assessments and monitoring for anxiety and depression among young people with life-limiting conditions. 



Investigators examining incidence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions found higher prevalence rates of both anxiety and depression among a broad range of life-limiting conditions. 


In order to determine the prevalence and incidence rate of various mental health disorders among patients with life-limiting conditions, investigators conducted a systematic review and meta-analysis of studies that were published between Jan. 2000 and Jan. 2018. Studies were obtained through searches of PubMed, Embase, and PsycInfo. 



For inclusion, studies must have provided primary data of anxiety or depression prevalence or incidence measured using validated tools, participants needed to be between the ages of 5 and 25, participants had to be diagnosed with a life-limiting condition, the study was conducted within a country the Organization for Economic Co-operation and Development, and the study needed to be published in English or subsequently translated.



Investigators excluded case studies, case series, intervention studies, qualitative studies, systematic reviews, and abstracts. Additionally, investigators excluded studies that included non-life-limiting condition diagnoses and did not report data of non-life-limiting conditions and life-limiting conditions subgroups separately and studies of participants successfully treated for cancer.



Investigators screened a total of 14,886 articles from the databases and, after applying criteria and assessing for eligibility, 37 studies were included in the analysis. Of the 37 studies included, 19 reported anxiety prevalence and 36 reported depression prevalence. The mean age of participants from the included studies was 15.6 years. Upon analyses, investigators found that anxiety prevalence generated a pooled prevalence estimate of 19.1% (95% CI, 14.1%-24.6%).

A meta-regression analysis revealed statistically significant differences in anxiety prevalence depending on the assessment tool. Diagnostic interviews were associated with the higher anxiety prevalence (28.5% [95% CI, 13.2%-46.8%]) than self-reported or parent-reported measures (14.9% [95% CI, 10.9%-19.4%]).

The depression meta-analysis revealed a that pooled prevalence estimate of 14.3% (95% CI, 10.5%-18.6%). A meta-regression analysis showed statistically significant differences in depression prevalence by the mean age of the sample (β = 0.02 [95% CI, 0.01-0.03]; P = .001).

In an editorial published in JAMA Pediatrics, Lisa Schwartz, PhD, and Chris Feudtner, MD, PhD, both of the Children’s Hospital of Philadelphia, wrote that the study’s results underscore the need for adequate mental health programs if physicians are to provide necessary services to communities. 



“The bottom line is that commitment and funding are required to assess patients and provide the necessary clinical services,” they wrote. “This requires mental health parity not just in payment, but also in investment by children’s hospitals and other sites of specialty care.”

This study, titled “Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions,” is published in JAMA Pediatrics.