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
Abstract
BACKGROUND

The metacognitive model of generalized anxiety disorder identifies three forms of metacognition: Positive metacognitive beliefs about worry (POS), negative metacognitive beliefs about worry (NEG), and meta-worry. Though this model was originally developed relying on adult samples, it has since been applied to children and youth in different studies, and results mostly support its validity for this group. As the roles of POS, meta-worry, and age-effects do not appear to be fully clarified for children and adolescents yet, an integration of studies on children and adolescents and the metacognitive model is both timely and worthwhile.

AIM

To summarize the current research on relationships, age-effects, and measurements for POS, NEG, and meta-worry in childhood and youth.

METHODS

We carried out a literature search 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 were measured. Studies were included for meta-analysis if they reported correlations between these metacognitions and anxiety or worry. Consensus rating for eligibility was done for 20.89% of full-texts with 90.32% agreement. Risk of bias was assessed with the appraisal tool for cross-sectional studies and consensus rating of appraisal tool for cross-sectional studies for 20.83% of included studies attaining agreement of intraclass correlation = 0.898. Overall, correlations between metacognitions, anxiety and worry were calculated 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. PROSPERO-ID: CRD42018078852.

RESULTS

Overall, k = 763 records and k = 78 additional records were identified. Of those, k = 48 studies with 12839 participants were included and of those, k = 24 studies were included for meta-analysis. Most studies showed consistent NEG correlations with worry and anxiety, as well as higher values for clinical than for non-clinical samples. POS findings were less consistent. Meta-analysis revealed large effects for NEG correlating with worry and anxiety, small to medium effects for POS correlating with worry and anxiety, as well as small to medium effects for POS correlating with NEG. Meta-regressions did not reveal mean age as a significant covariate. Meta-worry was assessed in only one study. We identified eight questionnaires and one interview-format that assess metacognition about worry in children and adolescents.

CONCLUSION

POS and NEG are measurable from the age of seven upwards and correlate with anxiety and worry without influences by age. Meta-worry requires further investigation.

Keywords: Metacognition, Anxiety, Child, Adolescent, Measures, Meta-analysis

Core Tip: Systematic review and meta-analysis showed that positive metacognitive beliefs about worry and negative metacognitive beliefs about worry correlate with worry and anxiety, as claimed in the metacognitive model of generalized anxiety disorder. Studies tended not to report significant correlations between age and positive metacognitive beliefs about worry or negative metacognitive beliefs about worry. Mean age was not a significant covariate in meta-regressions. No conclusions about meta-worry’s influence can be drawn. We need an adequate measurement of meta-worry, and measurements applying to young children should undergo further investigation. Studies showed moderate to large heterogeneity, and the power of meta-regression might have been low. As mostly cross-sectional data were collected, no causal conclusions can be drawn.