Systematic Reviews
Copyright ©The Author(s) 2021.
World J Psychiatr. Sep 19, 2021; 11(9): 635-658
Published online Sep 19, 2021. doi: 10.5498/wjp.v11.i9.635
Table 1 Overview of studies included in the systematic review
Ref.
Sample
n
Female (%)
Age in year (range), mean ± SD
Risk of bias
POS/NEG/meta-worry
Worry
Anxiety
Babaei et al[55]NC200NANAMod (9)MCQ-30-GHQ-scale
Bacow et al[27]Total/C1,2,3,4/NC98/78/20NA/63%/65%(7-17) NA/(NA) 11.9 ± 3.1/(NA) 12.4 ± 3.0Low (14)MCQ-CADIS-C-sectionADIS-C/P
Bacow et al[28]Total/C1,2,3,4/NC98/78/20NA/63%/65%(7-17) NA/(NA) 11.9 ± 3.1/(NA) 12.4 ± 3.0Low (14)MCQ-CPSWQ-C; ADIS-C-sectionADIS-C/P
Benedetto et al[64]NC18453%(11-13) 12.0 ± 0.9Mod (13)MCQ-CPSWQ-CRCMAS-2
Benedetto et al[49], study1NC19149%(13-18) 16.4 ± 1.76aMod (13)MCQ-C-RCMAS-2
Benedetto et al[49], study2C1,5/NCb14/1457%/NA(12-17) 14.9 ± 1.6/NALow (14)MCQ-C-RCMAS-2
Boysan et al[92]NC80549%(11-17) 13.9 ± 1.4Low (14)MCQ-C-STAI-C
Carr and Szabó[72]NC9348%(7-12) 10.0 ± 1.2Low (16)MCQ-CCAWS-
Cartwright-Hatton et al[53]C6/NC(11)/166(64%)/66%NA/(13-17) 15.3 ± NAMod (12)MCQ-A-RCMAS
Donovan et al[80]Total/C1/NC50/25/2560%/NA/NA(7-12) 9.9 ± 1.5/NA/NALow (14)MCQ-CPSWQ-CADIS-C
Donovan et al[65]NC11451%(8-12) 9.9 ± 1.3Low (15)MCQ-CPSWQ-C-
Ellis and Hudson[24]Total/C1,5/NC123/81/42NA/57%/52%(12-17) NA/(NA) 14.1 ± 1.5/(NA) 13.7 ± 1.4Low (15)MCQ-APSWQADIS-C/P; SCAS-C/P
Esbjørn et al[23], study1NC58755%(9-17) 12.5 ± 0.9aMod (12)MCQ-C30PSWQ-CSCARED-R
Esbjørn et al[23], study2Total/C1,4,7,3/NC93/50/43NA/NA/NA(7-12) 9.8 ± 1.6/NA/NAMod (13)MCQ-C30-ADIS-C/P
Esbjørn et al[93]NC11164%(8-12) 10.1 ± 1.4Low (15)MCQ-C30PSWQ-CADIS-C/P; RCADS
Esbjørn et al[66]NC97455%(9-17)Low (15)MCQ-C30PSWQ-CSCARED-R
Esbjørn et al[56]C14450%(7-13) 9.7 ± 1.6Low (15)MCQ-C30PSWQ-CADIS; RCADS
Fergus and Limbers[57]NC (TG)/NC (CG)39/3462%/71%(NA) 13.8 ± 0.5/(NA) 13.8 ± 0.7Low (17)MCQ-C-CTAS
Fisak et al[73]NC17566%(11-18) 13.9 ± 1.5Mod (12)MCQ-C;MWQPSWQ-C-
Francis et al[50]NC31255%(9-15) 11.9 ± 1.2Low (15)MCQ-CPSWQ-CSCAS;MASC
Francis et al[51]NC31255%(9-15) 11.9 ± 1.2Mod (14)MCQ-CPSWQ-C-
Gallagher and Cartwright-Hatton[94]NC16885%(16-18) 17.2 ± 0.9Mod (11)MCQ-30-STAI-T
Gini et al[67]NC116948%(14-17) 15.8 ± 1.1Mod (11)MCQ-30PSWQ-CGAD7
Hearn et al[25]C312660%(8-17) 11.3 ± 2.7Mod (13)MCQ-CPSWQ-C(SF)ADIS;SPAI-10-C/P
Hearn et al[74]Total/C1,3/NC60/40/2070%/NA/NA(8-12) 9.9 ± 1.3/NA/NALow (15)MCQ-CPSWQ-C(SF)ADIS; SCAS
Hearn et al[26]Total/C3(TG)/C3(WL)125/95/3060%/NA/NA(8-17) 11.3 ± 2.7/NA/NALow (17)MCQ-CPSWQ-C(SF)ADIS; SPAI-10
Holmes et al[59]C110%10Low (16)MCQ-CPSWQ-CADIS-C/P;SCAS-C/P
Holmes et al[58]Total/C1(TG)/C1(WL)42/20/2267%/NA/NA(7-12) 9.6 ± 1.4/NA/NALow (17)MCQ-CPSWQ-CADIS-C/P;SCAS-C/P
Irak[78]NC47044%(8-17) 12.2 ± 2.8Mod (12)MCQ-C-STAI-C
Kertz and Woodruff-Borden[75]NC8071%(8-12) 9.6 ± 1.1Mod (12)MCQ-CPSWQ-C(SF)RCMAS
Laugesen et al[71]NC52849%(14-18) 15.6 ± 0.9Low (15)WW-IIPSWQ-CWAQ
Lønfeldt et al[76]NC18866%(7-12) 10.0 ± 1.4Low (14)MCQ-C30-ADIS-P; RCADS
Lønfeldt et al[77]NC106255%(9-17) 12.3 ± 1.7Low (14)MCQ-C30-SCARED-R
Mather and Cartwright-Hatton[95]NC16666%(13-17) 15.1 ± 1.4Mod (12)MCQ-A-RCMAS
Matthews et al[81]NC22356%(13-16) NAMod (13)MCQ-A--
Naumann[68]NC97252%(7-14) 10.6 ± 1.5Low (14)MKF-KPSWQ-CSCAS
Normann et al[60]C1,4,3,74450%(7-12) 9.9 ± 1.6Low (14)MCQ-C30-ADIS-C/P; SCARED-R
Reinholdt-Dunne et al[79]C1,4,3,7/NC169/18253%/55%(7-14) 9.9 ± 1.8/(7-12) 10.0 ± 1.4Low (16)MCQ-C30-RCADS
Sanger and Dorjee[61]NC (TG)/NC (CG)20/2550%/68%(16-18) 16.6 ± 0.6/(16-18) 17.1 ± 0.6Mod (12)MCQ-A--
Simons and Vloet[62]C73100%(14-17) 15.3 ± 1.5Mod (13)MCQ-ASCAS-scaleSCAS
Smith and Hudson[52]Total/C1,3,2,7,4,8/NC83/49/3460%/NA/NA(7-12) 9.2 ± 1.6/NA/NAMod (13)MCQ-C-ADIS-C/P; SCAS
Thorslund et al[63]C1,3,91070%(14-17) 15.2 ± NALow (14)MCQ-CPSWQ-CMINIKid
White and Hudson[30]NC18731%(7-12) 10.6 ± 1.7Low (15)MCQ-CRPSWQ-CSCAS
Wilson et al[82]NC7254%(11-16) 13.2 ± 1.0Mod (13)MCQ-APSWQ-CMASC
Wilson and Hall[69]NC15156%(13-16) 15.1 ± 1.0Mod (12)MCQ-ATCQ-scale-
Wilson and Hughes[70]NC5761%(6-10) NAMod (12)InterviewPSWQ-CMASC
Yavuz et al[96]NC181754%(14-17) 15.4 ± 1.1Mod (12)MCQ-C-NMP-Q
Zimmermann et al[54]NC22155%(13-17) 14.9 ± 1.4Mod (12)MCQ-A-SBB-ANZ
aMean was only reported for subsamples and has been weighted on sample size.
bSubsample from study 1.
Superscript numbers show diagnosis of clinical groups in descending order:
1Generalized Anxiety disorder.
2Obsessive-compulsive-disorder.
3Social Anxiety Disorder.
4Separation Anxiety disorder.
5Other Anxiety disorder.
6Any emotional disorder.
7 Specific Phobia.
8Post-traumatic stress disorder.
9Panic disorder/agora phobia.
NA: Not available; TG: Treatment group; WL: Waiting list; CG: Control group; POS: Positive beliefs about worry; NEG: Negative beliefs about worry; Mod: Moderate; MCQ-30: Metacognitions Questionaire-30-Item Version; MCQ-C: Metacognitions Questionnaire for children; MCQ-A: Metacognitions Questionnaire-Adolescent Version; MKF-K: Metakognitions-Fragebogen für Kinder; MCQ-CR: Revised Metacognitions Questionnaire for Children; MCQ-C30: Metacognitions Questionnaire for Children–30Item Version; MWQ: Meta-Worry Questionnaire; ADIS-C/P: Anxiety Disorders Interview Schedule Child/Parent Versions; PSWQ: Penn State Worry Questionnaire; PSWQ-C: Penn State Worry Questionnaire for Children; WAQ: Worry and Anxiety Questionnaire; RCMAS,RCMAS-2: Revised Children's Manifest Anxiety Scale; STAI-C: State-Trait Anxiety Inventory for Children; CAWS: Child and Adolescent Worry Scale; SCAS: Spence Children's Anxiety Scale; SCARED-R: Revised Version of the Screen for Child Anxiety Related Emotional Disorders; MASC: Multidimensional Anxiety Scale for Children; GHQ: General Health Questionnaire; TCQ: Thought Control Questionnaire; SPAI-10: Social Phobia and Anxiety Inventory for Children; CTAS: Children´s Test Anxiety Scale; MINI Kid: Mini International Neuropsychiatric Interview for Children and Adolescents; GAD7: 7-item Generalized Anxiety Disorder scale; NMP-Q: Nomophobia Questionnaire; SBB-ANZ: Diagnostik-System für Psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche – Selbstbeurteilungsfragebogen Angst- und Zwangsstörungen; SD: Standard deviation.
Table 2 Extracted correlational coefficient on measures of positive beliefs about worry/negative beliefs about worry and worry/anxiety
Ref.Worry
Anxiety
POS
Age
POS
NEG
POS
NEG
NEG
POS
NEG
Babaei et al[55]---0.053-0.303b0.21b--
Bacow et al[27]-----NANA
Bacow et al[28]0.21a0.55b-----
Benedetto et al[64]0.23b0.70b0.29b0.65b0.30b
Benedetto et al[49], study1--0.203,a; 0.014 0.563,b; 0.484,b0.173; 0.314,b--
Benedetto et al[49], study2---0.681,a; 0.382 0.561,a; 0.422 -0.411; 0.692,b --
Boysan et al[92]-------
Carr and Szabó[72]0.35c----0.02 -
Cartwright-Hatton et al[53]--0.32c0.67c---
Donovan et al[80]-------
Donovan et al[65]0.22a0.72b--0.20a--
Ellis and Hudson[24]0.49b0.84b0.46b0.72b-0.16 0.16
Esbjørn et al[23], study1-------
Esbjørn et al[23], study2-------
Esbjørn et al[93]-------
Esbjørn et al[66]0.25c0.31c0.17c0.55c0.25c--
Esbjørn et al[56]-------
Fergus and Limbers[57]-------
Fisak et al[73]-------
Francis et al[50]-------
Francis et al[51]0.39b0.69b--0.31b--
Gallagher and Cartwright-Hatton[94]-----
Gini et al[67]0.32c0.65c0.22c0.60c0.16c--
Hearn et al[25]0.16 0.50b0.02 0.39b0.08--
Hearn et al[74]-------
Hearn et al[26]0.02 0.48b0.01 0.36b---
Holmes et al[59]-------
Holmes et al[58]-------
Irak[78]--0.194c0.412c---
Kertz and Woodruff-Borden[75]0.14 (P) 0.53c (P)-----
Laugesen et al[71]0.37c (P)------
Lønfeldt et al[76]--0.31b0.57b0.30b0.10 0.06
Lønfeldt et al[77]--0.19a0.58a0.23c-0.01 -0.08a
Mather and Cartwright-Hatton[95]-------
Matthews et al[81]----0.47a-0.05 -0.18b
Naumann[68]0.20b0.63b0.20b0.55b0.07--
Normann et al[60]-------
Reinholdt-Dunne et al[79]--0.091; 0.362,b0.621,b; 0.682,b0.051; 0.292,b0.101; -0.10201; 02
Sanger and Dorjee[61]-------
Simons and Vloet[62]-------
Smith and Hudson[52]--0.30b0.47b0.36b--
Thorslund et al[63]-------
White and Hudson[30]0.08 0.65b0.20b0.56b0.27a0.06 0.07
Wilson et al[82]0.35b0.74b0.19 0.51aNA< 0.16 < 0.16
Wilson and Hall[69]0.33c0.51c--0.29c--
Wilson and Hughes[70]-------
Yavuz et al[96]-------
Zimmermann et al[54]--0.22b0.57b-0.16a0.12
1Clinical group.
2Non-clinical group.
3Female subsample.
4Male subsample.
aP < 0.05.
bP < 0.01.
cP < 0.001.
NA: Not available; POS: Positive beliefs about worry; NEG: Negative beliefs about worry; (P): Partial correlation.
Table 3 Summary of results for random effect models for meta-analysis on correlational coefficient on measures of positive beliefs about worry/negative beliefs about worry and worry/anxiety
Overall effectHeterogenity test
Meta-analysis
k
r
95%CI, r
95%PI, r
Fisher‘s z
95%CI, z
Z
Q
I2
T2
POS and worry130.27(0.22, 0.33)(0.08, 0.45)0.28 (0.22, 0.34)9.56, P < 0.00136.14, P < 0.00167 %0.01
NEG and worry120.64(0.55, 0.72)(0.27, 1.25)0.76 (0.62, 0.90)10.49, P < 0.001233.90, P < 0.00195 %0.06
POS and anxiety180.20(0.16, 0.25)(0.00, 0.38)0.20 (0.16, 0.25)8.54, P < 0.00152.11, P < 0.00167 %0.01
NEG and anxiety180.53(0.46, 0.60)(0.19, 0.76)0.59 (0.50, 0.69)12.32, P < 0.001234.07, P < 0.00193 %0.04
POS and NEG170.24(0.18, 0.28)(0.04, 0.41)0.24(0.18, 0.29)8.49, P < 0.00166.44, P < 0.00176 %0.01
k: Number of studies included in meta-analysis; r: Pearson’s product-moment correlation; CI: Confidence interval; PI: Prediction interval; SE: Standard error; POS: Positive beliefs about worry; NEG: Negative beliefs about worry.
Table 4 Results of meta-regressions on correlational coefficient on measures of positive beliefs about worry/negative beliefs about worry and worry/anxiety with mean age as covariate
Meta-regression
B
SEB
95%lower
95% upper
Z
P
POS and Intercept0.50820.356-0.2541.2711.4290.175
Anxiety1Latitude-0.02650.028-0.0860.033-0.9580.354
POS and Intercept-0.09050.195-0.5250.344-0.4640.652
Worry2Latitude0.03020.016-0.0050.0651.9110.085
NEG and Intercept0.44270.1280.1680.7183.4500.004b
Anxiety3Latitude0.00940.010-0.0120.0310.9400.363
NEG and Intercept0.64820.2250.1391.1572.8810.018a
Worry4Latitude0.00040.018-0.0400.0410.0210.984
POS andIntercept0.52560.260-0.0421.0932.0190.066
NEG5Latitude-0.02860.021-0.0740.017-1.3570.200
1Based on k: 16 studies.
k: 2 studies[55,67] were excluded as no mean age was reported;
2Based on k: 12 studies.
k: 1 study[67] was excluded as no mean age was reported;
3Based on k: 16 studies.
k: 2 studies[55,67] were excluded as no mean age was reported;
4Based on k: 11 studies.
k: 1 study[67] was excluded as no mean age was reported;
5Based on k: 14 studies.
k: 3 studies[55,67,81] were excluded as no mean age was reported.
aP < 0.05.
bP < 0.01.
B: Point estimate; SEB: Standard error of point estimate; POS: Positive metacognitive beliefs about worry; NEG: Negative metacognitive beliefs about worry.
Table 5 Measurements of metacognitive beliefs about worry and meta-worry
Measure
Items
Scales
Answer format
Values for reliability
Age
k
MCQ-C 24 4Do not agree (1) to agree very much (4)POS: α = 0.46 - 0.89, rtt = 0.82; NEG: α = 0.60 - 0.95, rtt = 0.76[25-28,49,51,52,57,64,65,72,73,74,78]7-17 22
MCQ-A 30 5Do not agree (1) to agree very much (4)POS: α = 0.80 - 0.90, rtt = 0.66; NEG: α = 0.80 - 0.87, rtt = 0.71[24,53,54,81,82]11-17 9
MCQ-C30305Not at all (1) to completely (4)POS: α = 0.64 - 0.73; NEG: α = 0.71 - 0.79[23,76,93]7-178
MCQ-30 305Do not agree (1) to agree very much (4)POS: α = 0.88; NEG: α = 0.77[67]15-18 3
MCQ-CR 305Not true (1) to Very true (4); I do not understandPOS: α = 0.77; NEG: α = 0.80[30]7-121
MKF-K 304Not at all (1) to completely (4)POS: α = 0.73; NEG: α = 0.70[68]7-141
MWQ72Never (1) to almost always (4)α = 0.80 - 0.82[73]11-181
WW-II255Not at all (0) to incapacitating (4)α = 0.90[71]7-181
Interview22Open questionsκ = 0.61[70]6-101
α: Cronbach’s Alpha; rtt: Test-retest-reliability; κ: Cohen’s kappa; k: Number of included studies which used the measure; MCQ-30: Metacognitions Questionnaire - 30-Item Version; MCQ-A: Metacognitions Questionnaire - Adolescent Version; MCQ-C: Metacognitions Questionnaire for Children; MCQ-CR: Revised Metacognitions Questionnaire for Children; MCQ-C30: Metacognitions Questionnaire for Children - 30 Item version; MKF-K: Metacognition questionnaire for children; MWQ: Meta-Worry Questionnaire; WW-II: Why Worry-II; POS: Positive beliefs about worry; NEG: Negative beliefs about worry.