Health-related quality of life, service utilisation and costs for anxiety disorders in children and young people: A systematic review and meta-analysis

Abstract

Background

Anxiety disorders (ADs) are common mental health issues in children and young people (CYP). The literature on its overall economic burden regarding health-related quality of life (HRQoL), service use and costs is limited. This study synthesises the literature on how ADs are associated with these outcomes in CYP (0–24 years) and caregivers.

Method

A systematic search was undertaken across six databases from January 2013 to the end of December 2024. Grey literature was also searched. Dual-independent screening and quality assessment were conducted. An adapted version of the Effective Public Health Practice Project tool was used for quality assessment. Narrative synthesis and meta-analysis were conducted.

Results

Of 41,166 studies identified, 24 studies were included. Most were cross-sectional; only four were longitudinal, with 1.5- to 6-year follow-up periods. Studies found poorer HRQoL in CYP with ADs compared to those without ADs or healthy peers. The meta-analysis found a strong effect on the psychological/emotional and social functioning of HRQoL. Comorbid ADs were also associated with poor overall HRQoL, with a particularly very large effect on emotional functioning. Limited studies show that childhood ADs were associated with increased health service use and costs, with mixed findings on caregivers’ HRQoL.

Conclusion

ADs in CYP were associated with lower HRQoL for CYP and their caregivers, and with increased health service use and costs. This review highlights the need for future research to examine the burden on caregivers and the long-term impact on CYP's HRQoL, service use and costs.