Interventions to reduce parenting stress in carers of children with a chronic condition: A systematic review and meta-analysis

Objective: Determine the effectiveness of psychosocial interventions on parenting stress among carers of children with a chronic condition. Secondary objectives of this review were to explore effects via subgroup analyses including intervention type, delivery modality and care recipient age. Methods: This systematic review assessed randomized controlled trials from PsychInfo, PsycArticles, MEDLINE, SCOPUS and INFORMIT published between 2004 and 2018. Dual screening for inclusion and exclusion criteria occurred at each stage of review. A random effects model was implemented to pool results. The standardised mean change was calculated using raw score standardisation (SMCR) to examine mean differences between groups and change over measurement periods as the primary measure of effect. Weighted mean effect sizes were calculated using Hedges' g. Results: The search yielded 4,829 articles. After exclusion, twenty-three studies were included (N=1,824) in the systematic review and twenty-one studies had data available for meta-analyses. For the primary objective, the confidence interval and effect estimate indicate psychosocial interventions have a significant small effect on reducing parenting stress at longest follow-up (g = -0. 29, 95% CI = -0.47 to -0.12; I2 = 75.6 %). However, uncertainty surrounding the findings was introduced by the wide 95% prediction interval (g =-0.29, 95% PI = -0.86 to 0.28) that encompasses an effect of zero. Conclusion: The findings of this review should be interpreted with caution due to the substantial between-study heterogeneity and high ratings of risk of bias. More rigorous trials with larger sample sizes are needed in the field. This would increase the capacity to review studies and draw firmer conclusions regarding the effectiveness of interventions and examine the ways in which benefits of interventions can be both increased and have long lasting effects. Further exploration of effects according to intervention characteristics such as optimal dose (length and timing of delivery), outcome measure utilised and participation (both child and parent or parent only) are warranted. PROSPERO registration: CRD42020152661 Keywords: Carer stress, parenting stress, childhood chronic condition, psychosocial intervention