Indexed on: 05 Nov '19Published on: 05 Nov '19Published in: Journal of the American Academy of Child and Adolescent Psychiatry
Youth with chronic medical conditions (CMCs) have been reported to be at increased risk of developing anxiety disorders. Importantly, suffering from anxiety may also impact their disease-related outcomes. This study set out to systematically review the literature on anxiety and seven CMCs among youth (asthma, congenital heart disease, diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis and sickle cell disease). A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were conducted across PubMed, PsycNET, Embase, and reference lists of the included studies (1990-2018). Three independent reviewers screened titles and abstracts and conducted full-text assessment. Studies were included if they reported the prevalence of anxiety or the association of anxiety on disease-related outcomes in children and/or adolescents with the focal CMCs. Fifty-three studies met the predetermined inclusion criteria. Across the CMCs, the prevalence of anxiety disorder was increased in youth with CMCs compared to the general population. Evidence for a relationship between anxiety and adverse disease-related outcomes was limited. For asthma, inflammatory bowel disease and sickle cell disease, there was some evidence indicating that anxiety was associated with adverse outcomes; supported by two longitudinal studies, one in asthma and one in inflammatory bowel disease. For diabetes, results were inconsistent; with some studies indicating that anxiety was associated with worse and others with better treatment adherence. The prevalence of anxiety disorders in youth with CMCs is higher than that of the general population. Anxiety may also be associated with adverse disease-related outcomes for youth, but it is not possible to draw definitive conclusions. Longitudinal studies making use of parent/youth composite anxiety measures and a combination of parent/youth reported and objective measures of disease-related outcomes are needed. Given the burden of disease of anxiety disorders; regardless of the impact on the disease outcomes, screening for and treatment of anxiety is recommended in youth with CMCs. Copyright © 2019. Published by Elsevier Inc.