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

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.