Effectiveness of psychosocial interventions for improving asthma symptoms and parental stress in families of school-age children with asthma: A systematic review and meta-analysis

Background

Asthma is a prevalent chronic disease affecting school-age children, with substantial psychosocial implications for children and their parents.

Objectives

This review aimed to synthesise current evidence on the effects of psychosocial interventions for families of school-age children with asthma and investigate the optimal features of effective interventions.

Methods

Embase, MEDLINE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Google Scholar, CNKI, and Wanfang Data were searched from inception to November 2023. Randomised controlled trials (RCTs) examining psychosocial interventions in children aged six to twelve with asthma on asthma symptoms and parental stress were included. Emergency department visits, hospitalisations, lung function, psychological symptoms and health-related quality of life in both children and parents were secondary outcomes. Data were pooled for short-term (≤ three months), medium-term (> three months and ≤ six months), and long-term (> six months) follow-ups. Risk of bias was appraised using version 2 of the Cochrane risk of bias tool for randomised trials. Meta-analysis was performed using RevMan 5.4.1.

Results

Seven RCTs with 884 parent–child dyads from two countries were included. Meta-analyses found that psychosocial interventions improved asthma control (k = 2, n = 301, standardised mean difference [SMD] 0.35, 95 % confidence interval [CI] 0.12 to 0.58, P = 0.003), sleep problem (k = 2, n = 149, SMD -0.47, 95 % CI -0.79 to − 0.14, P = 0.005), cough (k = 2, n = 149, SMD -0.97, 95 % CI -1.59 to − 0.35, P = 0.002), wheezing (k = 2, n = 149, SMD -0.76, 95 % CI -1.09 to − 0.42, P < 0.0001), and parental stress (k = 6, n = 813, SMD -0.32, 95 % CI -0.61 to − 0.02, P = 0.03), compared to controls in the short term. Subgroup analysis revealed significant effects of psychoeducation, family empowerment interventions, and acceptance and commitment therapy-based interventions on reducing parental stress. No significant intervention effects were observed on parental symptoms of depression at any follow-up. Narrative synthesis indicated that psychosocial interventions may provide benefits in children's health-related quality of life in the short term, parental symptoms of anxiety in the medium term, and activity limitation, cough, and wheezing in the long term. The intervention effects for other reviewed outcomes were inconsistent.

Conclusions

Psychosocial interventions demonstrate possible benefits for families of school-aged children with asthma in asthma symptoms, parental stress, and children's health-related quality of life within three months post-intervention and parental symptoms of anxiety at six months post-intervention. Future research with rigorous design should investigate the optimal duration, frequency, and intervention approaches of psychosocial interventions.

Tweetable abstract: Psychosocial interventions improve asthma symptoms and parental stress within three months post-intervention for families of school-age children with asthma @ConnieChong1.