In Reply We thank the authors of the letters for their correspondence and interest in our meta-analysis of the prevalence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions (LLCs).1 One of the key issues highlighted in these letters was heterogeneity, both in the overall meta-analysis and the subgroup analyses. Although we agree that the heterogeneity is high, we do not believe that this is a methodologic flaw but is instead an important finding of the review. The objective of the meta-analysis was to pool prevalence data to understand the epidemiology of anxiety and depression in the total population because palliative care services are involved in the care and support of all patients in this population. In addition, previous meta-analyses of prevalence found similarly high heterogeneity, both in their overall analysis2,3 and subgroup analysis.3 We also agree that caution should be taken when interpreting the results of the meta-regression, as with any meta-analysis, because many studies could not be included in this analysis owing to the lack of reporting of key study characteristics. It is noted in the conclusion of our meta-analysis that future studies should report data separately by sex and age band to comprehensively evaluate the effects of these covariates on anxiety and depression prevalence.1
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Barker MM, Bland M, Fraser LK. Anxiety and Depression Prevalence in Children, Adolescents, and Young Adults With Life-Limiting Conditions—Reply. JAMA Pediatr. 2020;174(2):208–209. doi:10.1001/jamapediatrics.2019.4809
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