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CBT 'may' benefit mental health of children with chronic conditions

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The mental health of children and young people with some long-term physical conditions could benefit from cognitive behavioural therapy, according to UK researchers.

A systematic review, carried out by the University of Exeter Medical School, identified some evidence of the benefits of CBT in inflammatory bowel disease, chronic pain and epilepsy.

“The mental health of children and young people is important and offering the best response is vital”

Michael Nunns

The researchers said they found a lack of good quality evidence available on the subject for them to review but highlighted that their analysis provided a “roadmap for what to do next”.

In England, 23% of secondary school age pupils reported that they had a long-term medical illness or disability in a recent survey, noted the study authors.

They said children and young people with long-term conditions were four times more likely to experience feelings of depression, anxiety and other mental health issues than other children.

Their review ablaysed evidence from 25 trials that evaluated 11 types of intervention and involving 12 different long-term conditions.

“Tentative evidence” from seven studies suggested that CBT interventions could improve the mental health of children and young people with “certain” long-term conditions, said the researchers.

There were some positive effects for the strategies tested on both mental health and other outcomes, but, because the studies were often small, exact effects were uncertain, they said.

“The exciting thing about this project is that it provides researchers with a roadmap2

Stuart Logan

The researchers, from Devon, also looked at a further 57 studies that explored experiences of interventions. Their analysis suggested that it was important that strategies involve building good relationships and are delivered in what feels like a safe space.

Study participants tended to like interventions that gave social support and helped them feel better about living with a condition. Successful interventions were viewed as “accessible and engaging”.

The researchers also found some benefit from parenting programmes to reduce behavioural problems in children with acquired brain injury and/or cerebral palsy.

Further studies showed that children and young people valued treatments that considered a range of needs rather than just focussing on their mental health.

The opportunity to build a supportive relationship with those managing their condition was also seen to help some young people by giving them a sense of hope for the future and the opportunity to learn skills to manage both their physical and mental health.

Study author Dr Liz Shaw, said: “As well as looking at whether treatments worked for these children, we also included studies that explored the experiences of people giving and receiving the treatments.

“These studies highlighted the benefits of building good relationships and providing treatments in what feels like a ‘safe space’,” she said.

Study author Dr Michael Nunns said: “The mental health of children and young people is important and offering the best response is vital.

“When we set out to do this research we were hoping to make recommendations about what works to support children and young people with long term conditions, who are also having difficulties with their mental health,” he said.

“However, we were disappointed in the lack of good quality evidence available to guide treatment decisions for these children,” he added.

“We also included studies that explored the experiences of people giving and receiving the treatments”

Liz Shaw

Throughout the study, the team worked with a group of children and young people who provided a real-world perspective on the issues they faced.

They were particularly disappointed in the lack of available research and urged researchers to do something about it, said the authors of the review.

Another one of the researchers, Professor Stuart Logan, said: “The exciting thing about this project is that it provides researchers with a roadmap for what to do next.

“We need to work sensibly with parents and children to carefully design treatments and test them in a way that helps us understand whether they actually work,” he said.

The systematic review was funded by the National Institute for Health Research (NIHR) and the findings have been published in Health Technology Assessment.

It was also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC).

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