Editorial: Anxiety in Pediatric Chronic Illness: The Elephant in the Exam Room

Anxiety disorders are the most prevalent psychiatric conditions in childhood, with a rate that increases approximately twofold in youths with a chronic illness.¹ Anxiety in youths with a chronic illness is associated with greater functional impairment than would be expected by either the anxiety disorder or the medical illness alone.² Left untreated, the significant functional impairment associated with anxiety in childhood can persist into adulthood and may compromise medical outcomes across the life span.³ Cobham et al.⁴ conducted a systematic review to evaluate the prevalence of anxiety and the association of anxiety with medical outcomes in studies of children with select chronic medical conditions. The authors reviewed 53 studies meeting inclusion criteria. Clear evidence was found for an increased prevalence of anxiety in children and youths with asthma, type 1 diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis, congenital heart disease, and sickle cell disease, with estimates ranging from 20% to 50%. Evidence for the impact of anxiety on disease outcomes was more limited. This detailed review reveals the following limitations of the current evidence: 1. Variability in anxiety assessment methods, with many studies not following the gold standard of combined parent–child diagnostic interviews or at a minimum both child and parent reports of symptoms; 2. Lack of control groups and limitations in how control populations were verified to not have medical comorbidity; 3. Limitations in chronic illness ascertainment and impact, eg, some by parent or child report only; and 4. A predominance of cross-sectional studies, which do not allow for evaluation of anxiety impact on disease outcomes, including disease activity, adherence, and functional disability.