title: Children and adolescents adjustment to parental multiple sclerosis: a systematic review.
abstract: BACKGROUND
  Families are the primary source of support and care for most children. In Western societies, 4 to 12% of children live in households where a parent has a chronic illness. Exposure to early-life stressors, including parenting stress, parental depression and parental chronic disease could lead to harmful changes in children's social, emotional or behavioural functioning. Little is known about the child living with a parent who has Multiple Sclerosis (MS). We systematically reviewed the literature regarding possible effects of having a parent with MS on the child's or adolescent's psychosocial adjustment.
  
  
  METHODS
  The following databases: MEDLINE, PsychInfo, CINAHL, EMBASE, Web of Knowledge, ERIC, and ProQuest Digital Dissertations were searched (from 1806 to December 2012). References from relevant articles were also manually searched. Selected studies were evaluated using the Graphic Appraisal Tool for Epidemiology (GATE).
  
  
  RESULTS
  The search yielded 3133 titles; 70 articles were selected for full text review. Eighteen studies met inclusion criteria. Fourteen studies employed quantitative techniques, of which 13 were cross-sectional and one was longitudinal. Four studies were both qualitative and cross-sectional in design. Only 2 of 18 studies were rated as having high methodological quality. Overall, eight studies reported that children of MS patients exhibited negative psychosocial traits compared with children of "healthy" parents. Specifically for adolescents, greater family responsibilities were linked to lower social relationships and higher distress. Three studies indicated that parental MS was associated with positive adjustment in children and adolescents, such as higher personal competence, while four found no statistically significant differences.
  
  
  CONCLUSIONS
  Although having a parent with MS was often reported to have negative psychosocial effects on children and adolescents, there was a lack of consensus and some positive aspects were also found. However, few high quality studies were identified which makes it difficult to draw evidence-based conclusions at this point. There are potentially important, long-term impacts of early life stressors, such as having a parent with a chronic disease, on subsequent life chances and health, and thus more extensive and higher quality research in this area is greatly needed.
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada. neda.razaz@gmail.com.
authors.forename: Neda
authors.initials: N
authors.lastname: Razaz
authors.forename: Reza
authors.initials: R
authors.lastname: Nourian
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Boyce
authors.forename: Helen
authors.initials: H
authors.lastname: Tremlett
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D055815:Young Adult