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

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


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 (

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adolescent
  • Anxiety / complications
  • Cardiovascular Diseases / complications
  • Caregivers / psychology*
  • Child
  • Child, Preschool
  • Chronic Disease / therapy*
  • Congenital Abnormalities
  • Depression / complications
  • Female
  • Health Status*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mental Health
  • Outcome Assessment, Health Care
  • Parents / psychology*