儿童慢性病患者父母的健康结局：系统评价和荟萃分析。

Health Outcomes of Parents of Children with Chronic Illness: A Systematic Review and Meta-Analysis.

机构信息

Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; The Hebrew University of Jerusalem, Jerusalem, Israel.

Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.

出版信息

J Pediatr. 2020 Mar;218:166-177.e2. doi: 10.1016/j.jpeds.2019.10.068. Epub 2020 Jan 6.

DOI:10.1016/j.jpeds.2019.10.068

PMID:31916997

Abstract

OBJECTIVE

To assess health outcomes of parents caring for children with chronic illnesses compared with parents of healthy children.

STUDY DESIGN

We searched OvidSP MEDLINE, EBM Reviews-Cochrane Central Register of Controlled Trials, EMBASE, and EBSCOHost CINAHL through September 2019. Included were English-language studies reporting health conditions or mortality of parents of affected children compared with healthy controls.

RESULTS

Of 12 181 screened publications, 26 met inclusion criteria. Eight studies reported on anxiety, 23 on depression, 1 on mortality, and 1 on cardiovascular disease. Parents of chronically ill children had greater anxiety (standardized mean difference 0.42; 95% CI 0.24-0.60; P < .001) and depression scores (standardized mean difference 0.35; 95% CI 0.26-0.45; P < .001) than parents of healthy children. Thirty-five percent of parents of affected children met cut-offs for clinical depression, compared with 19% in the control (relative risk 1.75; 95% CI 1.55-1.97). Fifty-seven percent of such parents met cut-offs for anxiety, compared with 38% in the control (relative risk 1.40; 95% CI 1.18-1.67). One study of mothers of children with congenital anomalies reported a greater mortality risk than a comparison (adjusted hazard ratio 1.22; 95% CI 1.15-1.29), and another reported that these mothers experience an increased risk of cardiovascular disease (adjusted hazard ratio 1.15; 95% CI 1.07-1.23).

CONCLUSIONS

Parents of chronically ill children experience poorer mental health (more anxiety and depression), and mothers of those with congenital anomalies may have greater risk of cardiovascular disease and mortality than parents of unaffected children. Our findings suggest a need for targeted interventions to attenuate adverse parental caregiver health outcomes.

PRIOR REGISTRATION

PROSPERO CRD42018094657 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94657).

摘要

目的

评估照顾慢性病患儿的父母与照顾健康儿童的父母的健康结果。

研究设计

我们在 2019 年 9 月前通过 OvidSP MEDLINE、EBM Reviews-Cochrane 中央对照试验注册、EMBASE 和 EBSCOHost CINAHL 检索了英文文献，纳入了比较患病儿童的父母和健康对照的健康状况或死亡率的研究。

结果

在筛选出的 12181 篇文献中，有 26 篇符合纳入标准。8 项研究报告了焦虑，23 项研究报告了抑郁，1 项研究报告了死亡率，1 项研究报告了心血管疾病。慢性病患儿的父母焦虑程度更高（标准化均数差 0.42；95%置信区间 0.24-0.60；P<0.001）和抑郁评分更高（标准化均数差 0.35；95%置信区间 0.26-0.45；P<0.001）比健康儿童的父母。患病儿童的父母中有 35%达到临床抑郁的标准，而对照组中只有 19%（相对风险 1.75；95%置信区间 1.55-1.97）。57%的此类父母达到了焦虑的标准，而对照组中只有 38%（相对风险 1.40；95%置信区间 1.18-1.67）。一项对先天性异常患儿母亲的研究报告说，与对照组相比，她们的死亡率风险更高（调整后的危险比 1.22；95%置信区间 1.15-1.29），另一项研究报告说，这些母亲患心血管疾病的风险增加（调整后的危险比 1.15；95%置信区间 1.07-1.23）。