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

To evaluate the effectiveness of ACT-based interventions on improving the mental health of parents of children with SHCN compared to active/inactive controls and to investigate the characteristics/components of the effective interventions in the included studies. Eight databases were searched from inception to 14 February 2023. We included all randomized controlled trials (RCTs) of ACT-based interventions for parents of children with SHCN published in English or Chinese journals and dissertations reporting at least one parental mental health outcome postintervention. Fourteen RCTs were included. The results indicated significant improvements of ACT-based interventions in the stress (Hedges' g = −0.36), depressive symptoms (g = −0.32), anxiety (g = −0.29), distress (g = −0.29), psychological flexibility (g = 0.51), mindful awareness/mindfulness abilities (g = 0.41), and confidence/self-efficacy (g = 0.30) of parents, as well as in the emotional and behavioural problems (EBP; g = −0.39) of their children with SHCN postintervention, with moderate to high certainty of evidence. Furthermore, the optimal components of ACT-based interventions, including the intervention approaches (ACT combined with another parenting technique/program), active participants (only involving parents), delivery mode (in-person) and format (group-based format), and desirable number of sessions (4–8 sessions), were identified to inform the design of future interventions/studies. This review highlights the positive effects of ACT-based interventions on mental health, psychological flexibility, mindful awareness/mindfulness abilities, and confidence/self-efficacy in parents and EBP in children with SHCN. Since group-based ACT combined with a parenting technique/program was identified as the optimal effective strategy, its effects could be further examined in larger-scale RCTs with parents and children with SHCN with diverse ethnic and sociodemographic characteristics. •ACT may increase mental health, psychological flexibility, and mindful awareness in parents of children with SHCN post-intervention and during the three-month follow-up.•ACT may indirectly help children's emotional and behavioural problems.•ACT plus another therapeutic component better addressed SHCN parents' demands than ACT alone.•For parents of children with SHCN, ACT with group-based or 4–8 sessions were the most desirable intervention characteristics.•Parent-only ACT was favourable than parent-child dyads for parents