International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Centre for Global Mental Health, London School of Hygiene & Tropical Medicine and King's Health Partners, London, United Kingdom.
PLoS One. 2019 Jul 30;14(7):e0219888. doi: 10.1371/journal.pone.0219888. eCollection 2019.
Although caring for a child with intellectual and developmental disabilities (IDD) can have positive outcomes, parents may be at a greater risk of depression and anxiety, due to a number of associated stressors, such as increased caregiver demands and financial strain. This systematic review updates previous data, exploring the relationship between parenting a child with IDD and parental depression and anxiety.
Five electronic databases were searched for eligible English-language articles, published between January 2004 and July 2018. All epidemiological study designs were eligible, provided the level of depression and/or anxiety was compared between parents of children (aged <18) with and without IDD. No limit was placed on geographic location. The proportion of positive associations between parenting a child with IDD and depression/anxiety were disaggregated by disability type, geographic region, and sample size. The percentage of parents at risk of moderate depression or anxiety were calculated using recognised clinical cut-off scores for each screening tool. Meta-analyses, in which pooled effect sizes of elevated depression and anxiety symptoms were calculated, were conducted across two IDD conditions, autism and cerebral palsy.
Of the 5,839 unique records screened, 19 studies fulfilled the inclusion criteria. The majority of studies were conducted in high-income (n = 8, 42%) or upper-middle income countries (n = 10, 53%). Of the 19 studies, 69% focused on parents of children with cerebral palsy (n = 7, 37%) or autism (n = 6, 32%). Nearly all studies found a positive association between parenting a child with IDD and depression (n = 18, 95%) and anxiety (n = 9, 90%) symptoms. Factors associated with higher levels of depression symptoms amongst parents of children with IDD included disability severity (n = 8, 78%) and lower household income (n = 4, 80%). Approximately one third (31%) of parents of children with IDD reach the clinical cut-off score for moderate depression, compared with 7% of parents of children without IDD. 31% of parents of children with IDD reach the cut-off score for moderate anxiety, compared with 14% of parents of children without IDD. The meta-analyses demonstrated moderate effect sizes for elevated depression amongst parents of children with autism and cerebral palsy.
Results indicate elevated levels of depressive symptoms amongst parents of children with IDD. Quality concerns amongst the existing literature support the need for further research, especially in low- and middle-income countries.
尽管照顾有智力和发育障碍（IDD）的儿童可能会产生积极的结果，但由于一些相关的压力源，如增加照顾者的需求和经济压力，父母可能面临更大的抑郁和焦虑风险。本系统评价更新了以前的数据，探讨了养育有 IDD 儿童与父母抑郁和焦虑之间的关系。
在 2004 年 1 月至 2018 年 7 月期间，对五个电子数据库进行了检索，以寻找符合条件的英文文章。所有的流行病学研究设计都符合条件，只要比较了有和没有 IDD 的儿童（年龄<18 岁）父母之间的抑郁和/或焦虑水平。不限制地理位置。根据残疾类型、地理区域和样本量，对与养育有 IDD 的儿童有关的抑郁/焦虑的阳性关联比例进行了细分。使用每个筛查工具的公认临床临界值计算有中度抑郁或焦虑风险的父母的百分比。对两种 IDD 疾病（自闭症和脑瘫）的升高的抑郁和焦虑症状的汇总效应大小进行了荟萃分析。
在筛选出的 5839 条独特记录中，有 19 项研究符合纳入标准。大多数研究是在高收入（n = 8，42%）或中上收入国家（n = 10，53%）进行的。在这 19 项研究中，69%的研究重点是脑瘫（n = 7，37%）或自闭症（n = 6，32%）儿童的父母。几乎所有的研究都发现，养育有 IDD 的儿童与抑郁（n = 18，95%）和焦虑（n = 9，90%）症状之间存在正相关。与 IDD 儿童父母中较高水平的抑郁症状相关的因素包括残疾严重程度（n = 8，78%）和较低的家庭收入（n = 4，80%）。与没有 IDD 的儿童的父母相比，约三分之一（31%）的 IDD 儿童的父母达到了中度抑郁的临床临界值，而没有 IDD 的儿童的父母只有 7%。与没有 IDD 的儿童的父母相比，31%的 IDD 儿童的父母达到了中度焦虑的临界值，而没有 IDD 的儿童的父母只有 14%。荟萃分析显示，自闭症和脑瘫儿童的父母中抑郁症状的效应量中等。
研究结果表明，有 IDD 儿童的父母中抑郁症状水平较高。现有文献中的质量问题支持进一步研究的必要性，特别是在低收入和中等收入国家。
