The relationship between parental distress and child psychosocial functioning in Juvenile Idiopathic Arthritis: A systematic review and meta-analysis

Juvenile idiopathic arthritis (JIA) is associated with numerous negative outcomes including increased symptoms of anxiety and depression, functional disability and reduced quality of life (QoL). Family factors are shown to influence how children cope with JIA. Parental distress (PD), which refers to a broad group of symptoms relating to negative mood, has been associated with poorer psychosocial and functional outcomes in this population. However, inconsistencies in the literature are present, and previous attempts to meta-analytically synthesize findings are limited due to methodological limitations. The current study aimed to (1) meta-analytically quantify the relationship between PD and psychosocial and functional outcomes (QoL, functional ability, depressive and anxiety symptoms) in children with JIA, (2) examine whether the strength of these relationships vary according to the PD measure utilised and (3) examine several covariates (child age, child sex, parent education and parent SES) as potential explanations for heterogeneity. Using a random effects model, 12 studies were analyzed. PD was moderately associated with QoL, and symptoms of anxiety and depression, in youth with JIA. PD was also weakly associated with child functional ability. None of the examined covariates were significant. Analyses accounting for differences in PD measures were not feasible due to an inadequate number of included trials. Findings provide support for future parent-focused interventions targeting PD to reduce caregiving burden and enhance wellbeing among children with JIA. Findings are discussed in consideration to study limitations, including synthesis of numerous PD measures, assessing different facets of PD and inclusion of low-quality studies. Small number of studies across several analyses also impacted on comprehensive examination of publication bias