Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 19, 2021; 11(9): 635-658
Published online Sep 19, 2021. doi: 10.5498/wjp.v11.i9.635
Thinking about worry: A systematic review and meta-analysis on the assessment of metacognitions in children and adolescents
Laura M Köcher, Kai Schneider, Hanna Christiansen
Laura M Köcher, Hanna Christiansen, Department of Psychology, University of Marburg, Marburg 35037, Germany
Kai Schneider, Department of Clinical Child and Adolescent Psychology, University of Landau, Landau 76829, Germany
Author contributions: Köcher LM and Christiansen H designed the research; Köcher LM performed the research; Köcher LM and Schneider K analyzed the data; Köcher LM wrote the paper; Christiansen H and Schneider K supervised the paper; All authors read and approved the final manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Laura M Köcher, MSc, Research Associate, Department of Psychology, University of Marburg, Frankfurter Straße 35, Marburg 35037, Germany. laura.koecher@uni-marburg.de
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 21, 2021
Revised: May 4, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 19, 2021
Processing time: 202 Days and 1.8 Hours
ARTICLE HIGHLIGHTS
Research background

The metacognitive model of generalized anxiety disorder has been applied to children and youth in different studies. Results mostly support its validity, but the roles of positive metacognitive beliefs about worry (POS), meta-worry, and age-effects do not appear to be fully clarified yet.

Research motivation

Summarizing the current research on relationships, age-effects, and measurements for POS, negative metacognitive beliefs about worry (NEG) and meta-worry in childhood and youth are both timely and worthwhile.

Research objectives

Relationships between POS, NEG, and meta-worry with each other, worry, and anxiety, and possible age-effects for these relationships were analyzed. Assessment methods POS, NEG and meta-worry for children and adolescents were examined.

Research methods

A literature search was carried out in the electronic databases PsycINFO, PubMed, PSYNDEX, and ERIC in 2017 and updated in 2020. Empirical research in German or English language on metacognition was included with child and adolescent samples diagnosed with anxiety disorders or healthy controls if POS, NEG, or meta-worry was measured. Meta-analysis for reported correlations between these metacognitions and anxiety or worry was carried out with RevMan 5.4.1, assuming random-effects models. Meta-regressions with mean age as the covariate were performed via the online tool MetaMar 2.7.0.

Research results

Overall, we included k = 48 studies in this systematic literature review and of those, k = 24 studies fulfilled our inclusion criteria for meta-analysis. Systematic review and meta-analysis showed that POS and NEG correlate with worry and anxiety. Mean age was not a significant covariate in meta-regressions. Only one study measured meta-worry. We identified eight questionnaires and one interview approach for assessment of metacognitive beliefs.

Research conclusions

Our overall results support the applicability of the metacognitive model of generalized anxiety disorder in childhood and youth. NEG play an especially relevant role in worry and anxiety in children and adolescents, while conclusions about meta-worry’s influence cannot be drawn. Most included studies used a cross-sectional design and thus preclude causal conclusions. Metacognitive beliefs do not seem to vary with age and appear to be measurable in children from 7 years upwards.

Research perspectives

Longitudinal studies and research on the impact and measurement of meta-worry would be beneficial. Measurements applying to young children should undergo further investigation.