Behavior problems in children and adolescents with chronic physical illness: a meta-analysis

J Pediatr Psychol. 2011 Oct;36(9):1003-16. doi: 10.1093/jpepsy/jsr042. Epub 2011 Aug 1.


Objective: To examine the risk of emotional and behavioral problems among children with a chronic physical illness.

Methods: Random-effects meta-analysis was computed to integrate the results of 569 studies that used the Child Behavior Checklist, Youth Self Report, and the Teacher Report Form.

Results: Young people with a chronic physical illness have higher levels of internalizing (g = .47 standard mean difference), externalizing (g = .22) and total behavior problems (g = .42) than healthy peers. The largest differences were found in parental ratings and the weakest differences in adolescent self-ratings. Strongest elevations of internalizing problems were found for chronic fatigue syndrome and strongest elevations of externalizing problems were observed for epilepsy and migraine/tension-type headache. Effects also varied by country and, in part, by age, gender, year of publication, and study design.

Conclusions: The results call for regular screens for psychological distress and referrals for mental health services, when needed.

Publication types

  • Meta-Analysis

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Child
  • Child Behavior / psychology*
  • Child Behavior Disorders / psychology*
  • Chronic Disease / psychology*
  • Emotions*
  • Female
  • Humans
  • Male