{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T14:10:11Z","timestamp":1752156611210,"version":"3.41.2"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study aimed to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) in alleviating depressive symptoms among parents of children with special needs. Additionally, it examined the moderating effects of geographic and cultural contexts, intervention parameters, and types of children\u2019s diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search was conducted in PubMed, Web of Science, and the Cochrane Library. Inclusion criteria were: (1) peer-reviewed studies published in English, (2) randomized controlled trials (RCTs), (3) ACT as the core intervention, (4) participation by parents of children with special needs, and (5) reporting of standardized effect sizes for depressive symptoms. A total of 12 studies (<jats:italic>n<\/jats:italic>\u202f=\u202f746) met the eligibility criteria. A fixed-effects model was employed for the meta-analysis, and subgroup analyses were conducted based on geographic distribution, intervention duration, intervention parameters, and types of children\u2019s diseases (neurodevelopmental disorders, chronic illnesses, or severe conditions).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ACT significantly reduced depressive symptoms (SMD\u202f=\u202f\u22120.36, 95% CI [\u22120.51, \u22120.22], <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.0001). Subgroup analyses indicated that the parents of children with neurodevelopmental disorders or chronic illnesses, the national context, and the frequency of intervention were key sources of heterogeneity in treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The synthesized evidence suggests that ACT is particularly beneficial for parents of children with neurodevelopmental disorders and chronic illnesses. A recommended intervention duration of 4\u20138\u202fweeks (\u226535\u202fmin per session, 1\u20132 sessions per week) is optimal, and the effect may be the most significant in areas with a well-developed welfare system. Future studies should prioritize the development of culturally adapted intervention modules and explore digital health platforms to enhance accessibility.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2025.1590489","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:43:56Z","timestamp":1752126236000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of acceptance and commitment therapy on depression in parents of children with special needs: a meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Wei","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haoran","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"260","DOI":"10.4103\/jehp.jehp_1720_23","article-title":"Compare the effectiveness of two treatments, behavioral activation and acceptance and commitment therapy, on depression and mental rumination in mothers of children with cerebral palsy in Ilam city","volume":"13","author":"Alirahmi","year":"2024","journal-title":"J. Educ. Health Promotion"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"105","DOI":"10.58192\/insdun.v3i1.1791","article-title":"Sarana Dan Prasarana (Fasilitas) Pendidikan Bagi Anak-Anak Berkebutuhan Khusus","volume":"3","author":"Andriani","year":"2024","journal-title":"Inspirasi Dunia: J. Riset Pendidikan Dan Bahasa"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12888-020-03020-1","article-title":"One year follow-up and mediation in cognitive behavioral therapy and acceptance and commitment therapy for adult depression","volume":"21","author":"A-Tjak","year":"2021","journal-title":"BMC Psychiatry"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/j.pedhc.2023.06.003","article-title":"Mothers of children with special health care needs: exploring caregiver burden, quality of life, and resiliency","volume":"37","author":"Bamber","year":"2023","journal-title":"J. Pediatr. Health Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1017\/gmh.2016.21","article-title":"The potential of low-intensity and online interventions for depression in low-and middle-income countries","volume":"3","author":"Bockting","year":"2016","journal-title":"Glob. Ment. Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1177\/15346501221082616","article-title":"A blended cognitive\u2013behavioral intervention for the treatment of postpartum depression: a case study","volume":"21","author":"Branquinho","year":"2022","journal-title":"Clin. Case Stud."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1017\/S0033291720000410","article-title":"A mechanistic model for individualised treatment of anxiety disorders based on predictive neural biomarkers","volume":"50","author":"Brehl","year":"2020","journal-title":"Psychol. Med."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1111\/jcpp.12227","article-title":"Improving child and parenting outcomes following paediatric acquired brain injury: A randomised controlled trial of stepping stones triple P plus acceptance and commitment therapy","volume":"55","author":"Brown","year":"2014","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e20181723","DOI":"10.1542\/peds.2018-1723","article-title":"Acceptance and commitment therapy for parental Management of Childhood Asthma: an RCT","volume":"143","author":"Chong","year":"2019","journal-title":"Pediatrics"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101688","DOI":"10.1016\/j.dhjo.2024.101688","article-title":"Utilization of special services among children and youth with special healthcare needs: A time-to-event analysis of the national survey of children\u2019s health data, 2016\u20132022","volume":"18","author":"Chowdhury","year":"2025","journal-title":"Disabil. Health J."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"19429","DOI":"10.1007\/s12144-022-03760-1","article-title":"Effects of acceptance and commitment therapy-based interventions on the mental states of parents with special needs children: randomized controlled trial","volume":"42","author":"\u00c7i\u00e7ek G\u00fcm\u00fc\u015f","year":"2023","journal-title":"Curr. Psychol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1037\/a0039053","article-title":"Efficacy and moderators of a family group cognitive\u2013behavioral preventive intervention for children of parents with depression","volume":"83","author":"Compas","year":"2015","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1093\/jpepsy\/jsaa102","article-title":"Online psychosocial group intervention for parents: positive effects on anxiety and depression","volume":"46","author":"Douma","year":"2021","journal-title":"J. Pediatr. Psychol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e29328","DOI":"10.1002\/pbc.29328","article-title":"A systematic review and meta-analytic evaluation of psychosocial interventions in parents of children with cancer with an exploratory focus on minority outcomes","volume":"68","author":"Eche","year":"2021","journal-title":"Pediatr. Blood Cancer"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.1026\/03045-000","volume-title":"Akzeptanz- und Commitment-Therapie (ACT)","author":"Eifert","year":"2022"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"104825","DOI":"10.1016\/j.ridd.2024.104825","article-title":"\u201cOf course you crash\u201d parenting a young child with neurodevelopmental difficulties","volume":"153","author":"F\u00e4ldt","year":"2024","journal-title":"Res. Dev. Disabil."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"10","DOI":"10.62792\/ut.education.v6.i11-12.p2631","article-title":"Challenges faced by families of children with autism spectrum disorder","volume":"6","author":"Filipova","year":"2024","journal-title":"J. Educ. Res."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1093\/geroni\/igad104.1230","article-title":"Acceptance and commitment therapy intervention for parent caregivers: a strength-based approach","volume":"7","author":"Frederick","year":"2023","journal-title":"Innov. Aging"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1891\/0889-8391.25.4.240","article-title":"Cognitive behavioral parent programs for the treatment of child disruptive behavior","volume":"25","author":"Gavi\u0163a","year":"2011","journal-title":"J. Cogn. Psychother."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"116","DOI":"10.18502\/avr.v28i2.866","article-title":"Effects of acceptance and commitment therapy on decreasing anxiety and depression symptoms in mothers of hearing-impaired or deaf children","volume":"28","author":"Gharashi","year":"2019","journal-title":"Auditory Vestibular Res."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1002\/14651858.CD007146.pub3","article-title":"Interventions for preventing falls in older people living in the community","volume":"9","author":"Gillespie","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.jcbs.2018.03.002","article-title":"Randomized controlled trial of a brief acceptance and commitment training for parents of individuals diagnosed with autism spectrum disorders","volume":"12","author":"Hahs","year":"2018","journal-title":"J. Context. Behav. Sci."},{"volume-title":"Statistical methods for meta-analysis","year":"2014","author":"Hedges","key":"ref23"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref25","article-title":"A regression-based method for detecting publication bias in multivariate meta-analysis (No. arXiv:2002.04775)","volume-title":"arXiv","author":"Hong","year":"2020"},{"key":"ref26","first-page":"4","article-title":"Effectiveness of acceptance and commitment therapy in the support of parents of children with high-functioning","volume":"2","author":"Joekar","year":"2016","journal-title":"Autism"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e6284","DOI":"10.1002\/pon.6284","article-title":"Efficacy of Op Koers online, an online group intervention for parents of children with cancer: results of a randomized controlled trial","volume":"33","author":"Joosten","year":"2024","journal-title":"Psycho-Oncology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"920744","DOI":"10.3389\/fped.2022.920744","article-title":"Factors influencing the mental health of caregivers of children with cerebral palsy","volume":"10","author":"Kouther","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07317107.2023.2233949","article-title":"Online and self-help acceptance and commitment therapy for parents of children with chronic conditions and developmental disabilities: what happens after the intervention?","volume":"46","author":"Lappalainen","year":"2024","journal-title":"Child Fam. Behav. Ther."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"100382","DOI":"10.1016\/j.invent.2021.100382","article-title":"Supporting parents of children with chronic conditions: A randomized controlled trial of web-based and self-help ACT interventions","volume":"24","author":"Lappalainen","year":"2021","journal-title":"Internet Interv."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"820","DOI":"10.7326\/0003-4819-127-9-199711010-00008","article-title":"Quantitative synthesis in systematic reviews","volume":"127","author":"Lau","year":"1997","journal-title":"Ann. Intern. Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"152426","DOI":"10.1016\/j.comppsych.2023.152426","article-title":"Effectiveness of acceptance and commitment therapy-based interventions for improving the psychological health of parents of children with special health care needs: a systematic review and meta-analysis","volume":"127","author":"Li","year":"2023","journal-title":"Compr. Psychiatry"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"102389","DOI":"10.1016\/j.rasd.2024.102389","article-title":"Effectiveness of parent-focused interventions for improving the mental health of parents and their children with autism spectrum disorder: a systematic review and meta-analysis","volume":"114","author":"Li","year":"2024","journal-title":"Res. Autism Spectr. Disord."},{"key":"ref34","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4018\/978-1-7998-3254-6.ch019","article-title":"Special yoga for children and young people with special needs","volume-title":"Handbook of research on evidence-based perspectives on the psychophysiology of yoga and its applications","author":"Manuel","year":"2021"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1177\/13623613231172241","article-title":"Parent, child, and family outcomes following acceptance and commitment therapy for parents of autistic children: A randomized controlled trial","volume":"28","author":"Maughan","year":"2024","journal-title":"Autism"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"28","DOI":"10.5042\/jmhtep.2010.0217","article-title":"A cognitive behavioural approach for carers of significant others with depression: a pilot study","volume":"5","author":"McIlrae","year":"2010","journal-title":"J. Ment. Health Train. Educ. Pract."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"571","DOI":"10.3758\/s13415-016-0440-5","article-title":"Changing views of emotion regulation and neurobiological models of the mechanism of action of psychotherapy","volume":"16","author":"Messina","year":"2016","journal-title":"Cogn. Affect. Behav. Neurosci."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s13643-016-0204-x","article-title":"What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products","volume":"5","author":"Miake-Lye","year":"2016","journal-title":"Syst. Rev."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1111\/j.1469-185X.2007.00027.x","article-title":"Effect size, confidence interval and statistical significance: A practical guide for biologists","volume":"82","author":"Nakagawa","year":"2007","journal-title":"Biol. Rev."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"393","DOI":"10.32832\/hearty.v12i2.16379","article-title":"Mental health resilience of mothers children with special needs","volume":"12","author":"Nursanti","year":"2024","journal-title":"Heart"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1007\/s40501-024-00335-8","article-title":"Acceptance and commitment therapy for adolescent anxiety","volume":"11","author":"Petersen","year":"2024","journal-title":"Curr. Treat. Options Psychiatry"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1590\/0047-2085000000425","article-title":"Prevalence of anxiety and depression in parents of children with autism spectrum disorder during the first wave of the COVID-19 pandemic on Northeast Brazil","volume":"72","author":"Pond\u00e9","year":"2023","journal-title":"J. Bras. Psiquiatr."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12888-016-0841-6","article-title":"How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms","volume":"16","author":"Pots","year":"2016","journal-title":"BMC Psychiatry"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"156","DOI":"10.24425\/ppb.2023.146587","article-title":"Effectiveness of on-line and off-line acceptance and commitment therapy in developing psychological flexibility, self-compassion and ego-resiliency in parents of children with autism spectrum disorder","volume":"2023","author":"Pyszkowska","year":"2023","journal-title":"Pol. Psychol. Bull."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"76","DOI":"10.30491\/ijbs.2024.440698.2076","article-title":"The effect of acceptance and commitment therapy on sense of guilt self-blame and depression in mothers of individuals with autism spectrum disorders","volume":"18","author":"RashidiFard","year":"2024","journal-title":"Int. J. Behav. Sci."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jcbs.2019.07.004","article-title":"Effectiveness of a web-based acceptance and commitment therapy intervention for wellbeing of parents whose children have chronic conditions: a randomized controlled trial","volume":"13","author":"Sairanen","year":"2019","journal-title":"J. Context. Behav. Sci."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1080\/03630242.2024.2392137","article-title":"Mental health in mothers of children with autism spectrum disorder: a cross-sectional study","volume":"64","author":"Santiago","year":"2024","journal-title":"Women Health"},{"key":"ref49","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/B978-0-323-85757-4.00009-2","article-title":"Cognitive behavior therapy for children with depression: application, practical considerations, and challenges","volume-title":"Handbook of lifespan cognitive behavioral therapy","author":"Singh","year":"2023"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1007\/s00787-010-0135-3","article-title":"Preventive interventions in families with parental depression: children\u2019s psychosocial symptoms and prosocial behaviour","volume":"19","author":"Solantaus","year":"2010","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1017\/S1355617723008068","article-title":"31 outcomes of an ACT-based group protocol on neuropsychological late effects in survivors of childhood cancer","volume":"29","author":"Stuart","year":"2023","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jcbs.2015.02.001","article-title":"Acceptance and commitment therapy for children: a systematic review of intervention studies","volume":"4","author":"Swain","year":"2015","journal-title":"J. Context. Behav. Sci."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"S86","DOI":"10.1192\/j.eurpsy.2024.221","article-title":"Working mechanisms of cognitive behavioral therapy and acceptance and commitment therapy: a dynamic network approach","volume":"67","author":"Van Eeden","year":"2024","journal-title":"Eur. Psychiatry"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1002\/sim.1040","article-title":"Advanced methods in meta-analysis: multivariate approach and meta-regression","volume":"21","author":"Van Houwelingen","year":"2002","journal-title":"Stat. Med."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.30574\/wjarr.2023.19.2.1612","article-title":"The psychological aspects of parents who take care of children with chronic illnesses: a review of the literature","volume":"19","author":"Ververidou","year":"2023","journal-title":"World J. Adv. Res. Rev."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1002\/jrsm.11","article-title":"Outlier and influence diagnostics for meta-analysis","volume":"1","author":"Viechtbauer","year":"2010","journal-title":"Res. Synth. Methods"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"498","DOI":"10.35631\/IJEPC.746037","article-title":"Psychological distress among parents of children with special needs","volume":"7","author":"Wahab","year":"2022","journal-title":"Int. J. Educ. Psychol. Counsel."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/jpepsy\/jsv118","article-title":"Parenting intervention combined with acceptance and commitment therapy: A trial with families of children with cerebral palsy","volume":"41","author":"Whittingham","year":"2016","journal-title":"J. Pediatr. Psychol."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"104129","DOI":"10.1016\/j.brat.2022.104129","article-title":"Parenting acceptance and commitment therapy: an RCT of an online course with families of children with CP","volume":"155","author":"Whittingham","year":"2022","journal-title":"Behav. Res. Ther."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"3046","DOI":"10.1080\/09638288.2022.2117865","article-title":"An intervention to improve the self-efficacy of key workers to support parental wellbeing at an early childhood intervention service in Australia: A stepped wedged randomized cluster trial","volume":"45","author":"Young","year":"2023","journal-title":"Disabil. Rehabil."},{"key":"ref61","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13052-015-0114-x","article-title":"Continuity of care in children with special healthcare needs: A qualitative study of family\u2019s perspectives","volume":"41","author":"Zanello","year":"2015","journal-title":"Ital. J. Pediatr."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/978-3-031-24926-6_8","article-title":"Parental stress in raising a child with mental health and behavior problems","volume":"11","author":"Zeng","year":"2023","journal-title":"Handb. Clin. Child Psychol. Integr. Theory Res. Pract."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12991-023-00462-1","article-title":"Effect of acceptance and commitment therapy for depressive disorders: A meta-analysis","volume":"22","author":"Zhao","year":"2023","journal-title":"Ann. General Psychiatry"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2025.1590489\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T13:39:18Z","timestamp":1752154758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2025.1590489\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":63,"alternative-id":["10.3389\/fpsyg.2025.1590489"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2025.1590489","relation":{},"ISSN":["1664-1078"],"issn-type":[{"type":"electronic","value":"1664-1078"}],"subject":[],"published":{"date-parts":[[2025,7,9]]},"article-number":"1590489"}}