E0 ConsensusModerate confidencePEM not requiredMeta-AnalysisPeer-reviewedReviewed
Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis.
Pinquart, Martin, Shen, Yuhui · Acta paediatrica (Oslo, Norway : 1992) · 2011 · DOI
Quick Summary
This large review combined results from 332 studies to compare anxiety levels in children with chronic illnesses versus healthy children. Children with chronic illnesses, including ME/CFS, showed higher levels of anxiety than their healthy peers. ME/CFS was among the conditions most strongly linked to anxiety in children.
Why It Matters
This study demonstrates that anxiety is a significant comorbidity in children and adolescents with ME/CFS, not merely a secondary consequence but a recognized clinical feature requiring attention. Recognizing anxiety as particularly elevated in ME/CFS may help clinicians implement earlier screening and support, potentially improving quality of life and treatment outcomes in this vulnerable population.
Observed Findings
- Children with chronic illnesses overall showed elevated anxiety levels compared to healthy peers (d=0.18 SD units)
- ME/CFS was identified as one of the chronic conditions with the strongest anxiety elevations
- Migraine/tension headache, sensory impairment, and epilepsy also showed pronounced anxiety elevations
- 332 studies were integrated in the analysis
- Pediatricians identified the need for anxiety screening in children with chronic illnesses
Inferred Conclusions
- Anxiety is a significant psychological comorbidity in pediatric chronic illness, with ME/CFS among the most affected populations
- Routine screening for anxiety symptoms is warranted in children with ME/CFS and other high-risk chronic conditions
- Clinic-based interventions for anxiety may improve overall outcomes in this population
Remaining Questions
- What are the specific effect sizes for anxiety elevation in ME/CFS compared to other chronic conditions?
- Does anxiety precede ME/CFS onset, develop secondary to illness, or reflect shared pathophysiology?
- Which psychological or pharmacological interventions most effectively reduce anxiety in children with ME/CFS?
What This Study Does Not Prove
This meta-analysis establishes association between chronic illness and anxiety but does not establish causation—anxiety may precede illness onset, result from illness burden, or reflect shared biological pathways. The study does not provide individual patient-level data, condition-specific intervention efficacy, or mechanisms underlying the anxiety elevation. Effect sizes by specific condition are not detailed in the abstract, limiting condition-specific inferences.
Tags
Symptom:Fatigue
Phenotype:Pediatric
Method Flag:Weak Case DefinitionMixed Cohort
Metadata
- DOI
- 10.1111/j.1651-2227.2011.02223.x
- PMID
- 21332786
- Review status
- Editor reviewed
- Evidence level
- Higher-level evidence type — systematic reviews, meta-analyses, guidelines, or major syntheses (study type, not a quality guarantee)
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Contribute
Private, reviewed by a human. Not a public comment thread.