title: Parents' psychological adjustment in families of children with spina bifida: a meta-analysis.
abstract: BACKGROUND
  Spina Bifida (SB) is the second most common birth defect worldwide. Since the chances of survival in children with severe SB-forms have increased, medical care has shifted its emphasis from life-saving interventions to fostering the quality of life for these children and their families. Little is known, however, about the impact of SB on family adjustment. Reviewers have struggled to synthesize the few contradictory studies available. In this systematic review a new attempt was made to summarize the findings by using meta-analysis and by delimiting the scope of review to one concept of family adjustment: Parents' psychological adjustment. The questions addressed were: (a) do parents of children with SB have more psychological distress than controls? (b) do mothers and fathers differ? and (c) which factors correlate with variations in psychological adjustment?
  
  
  METHODS
  PsycInfo, Medline, and reference lists were scanned. Thirty-three relevant studies were identified of which 15 were eligible for meta-analysis.
  
  
  RESULTS
  SB had a negative medium-large effect on parents' psychological adjustment. The effect was more heterogeneous for mothers than for fathers. In the reviewed studies child factors (age, conduct problems, emotional problems, and mental retardation), parent factors (SES, hope, appraised stress, coping, and parenting competence), family factors (family income, partner relationship, and family climate), and environmental factors (social support) were found to be associated with variations in parents' psychological adjustment.
  
  
  CONCLUSIONS
  Meta-analysis proved to be helpful in organizing studies. Clinical implications indicate a need to be especially alert to psychological suffering in mothers of children with SB. Future research should increase sample sizes through multi-center collaborations.
authors.affiliation: Institute of Family and Child Care Studies, Radboud University Nijmegen, The Netherlands. i.vermaes@pwo.ru.nl
authors.forename: Ignace P R
authors.initials: IP
authors.lastname: Vermaes
authors.forename: Jan M A M
authors.initials: JM
authors.lastname: Janssens
authors.forename: Anna M T
authors.initials: AM
authors.lastname: Bosman
authors.forename: Jan R M
authors.initials: JR
authors.lastname: Gerris
mesh_terms: D000223:Adaptation, Psychological; D002648:Child; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D012737:Sex Factors; D016135:Spinal Dysraphism / Q000523:psychology*; D013315:Stress, Psychological