Anxiety and Depression in Children and Young People with Life-Limiting Conditions

Children and young people with life-limiting conditions experience various challenges, which may make them more vulnerable to anxiety and depression. This thesis investigates the prevalence, incidence and associated factors of anxiety and depression in children and young people with life-limiting conditions.
Two systematic reviews were conducted; a meta-analysis of the prevalence and incidence of anxiety and depression in children and young people with life-limiting conditions, and a best evidence synthesis of the factors associated with anxiety and depression in this population. These reviews informed a comparative cohort study, which used data from the Clinical Practice Research Datalink (CPRD) and linked datasets to investigate the incidence of and risk factors for anxiety and depression in 5,527 with life-limiting conditions, 6,729 with chronic conditions and 13,057 with no long-term conditions.
The meta-analysis reported a higher pooled prevalence of anxiety and depression in children and young people with life-limiting conditions compared to prevalence estimates found in the general population. No relevant studies of anxiety or depression incidence were found. The best evidence synthesis identified conflicting evidence for associations between most of the sociodemographic factors investigated and anxiety/depressive symptoms, as well as limited evidence for the protective role of coping style.
Findings from the CPRD analysis indicated that the incidence of anxiety and depression was highest among children and young people with chronic conditions, followed by those with life-limiting conditions, with the lowest incidence observed among those with no long-term conditions. In all three condition groups, the incidence of anxiety and depression was associated with female sex, older age, ethnicity, and maternal mental health conditions. These findings have important implications for the provision and targeting of psychological support for these children and young people in order to improve their mental health.