The effect of cognitive behavioral therapy on depressive symptoms in parents of children with special needs: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Objective: This study conducts a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluate the effects of cognitive behavioral therapy (CBT) on depressive symptoms in parents of children with special needs. Additionally, it examines potential moderators of treatment outcomes, including the type of child diagnosis and the dosage of intervention.

Methods: A comprehensive Literature search was performed in PubMed, Web of Science, Scopus, PsycINFO, and the Cochrane Library up to April 15, 2025. Peer-reviewed RCTs published in English that compared at least one structured CBT intervention to an inactive or active control group were included. Hedges' g was utilized to calculate standardized mean differences (SMDs) in depression scores. Random- or fixed-effects models were employed based on heterogeneity (I²). Subgroup analyses and meta-regression were conducted to identify moderators. The risk of bias was assessed using the Cochrane ROB2 tool, and publication bias was evaluated using funnel plots and Egger's test.

Results: A total of 13 RCTs involving 1,441 parents were included. An initial random-effects model showed a slight, non-significant reduction in depressive symptoms (SMD = -0.33, 95% CI [-0.72, 0.07]; I² = 89%). After excluding two outliers, a random-effects analysis indicated a significant effect (SMD = -0.24, 95% CI [-0.47, 0.00], p = 0.046; I² = 75.9%). Subgroup analyses revealed that CBT was most effective for parents of children with neurodevelopmental disorders (NDDs), in trials using waitlist control groups, involving both parents, and when delivered over a short duration (6-8 weeks). Meta-regression demonstrated that child diagnosis type (β = 0.83, p = 0.000) and parental age (β = 0.04, p = 0.053) were significant moderators. The optimal therapeutic effect was achieved at a total intervention dose of 4 h (SMD ≈ -0.5), with parents aged 37.9 years demonstrating the most significant improvement, suggesting the necessity for individualized adjustment of the intervention protocol.

Conclusion: CBT demonstrated a moderate and significant effect in alleviating depressive symptoms among parents of children with special needs, particularly in the context of NDDs. This effect was most pronounced when interventions were implemented with moderate-to-high intensity, in a short-term format, and involved both parents. Furthermore, tailoring interventions according to the child's diagnosis and the total dosage of the intervention proved essential for optimizing outcomes.