Prevalence of psychological distress among family caregivers of children with cancer: a systematic review and meta-analysis

Abstract Purpose: This study aimed to systematically review and quantify the prevalence of anxiety and depressive symptoms in family caregivers of children with cancer and to explore potential determinants that may influence these outcomes. Methods: This systematic review and meta-analysis. Searches were conducted across multidisciplinary, health, and psychology databases, supplemented by grey literature sources. Observational studies reporting validated measures of caregiver anxiety or depression were included. Data extraction and risk-of-bias assessments (JBI tool) were performed independently by multiple reviewers. Random-effects single-proportion meta-analyses, subgroup analyses, and meta-regressions were conducted to estimate pooled prevalence rates and explore heterogeneity. Results: Most studies were cross-sectional and conducted in North America or Europe. The pooled prevalence of anxiety symptoms was 25% (95% CI: 16–36%), based on 19 studies (n=2,116), while the pooled prevalence of depressive symptoms was 27% (95% CI: 17–39%), based on 23 studies (n=2,091). High heterogeneity was observed across analyses (I² > 95%). Meta-regressions showed no associations between prevalence rates and caregiver or child age, sex distribution, or leukemia prevalence. Subgroup analyses revealed higher anxiety prevalence in studies conducted in Asia and Europe and in those using combined assessment tools. No significant subgroup differences were found for depression. Risk-of-bias assessments indicated considerable methodological limitations, particularly regarding sampling and reporting. Conclusion: Approximately one in four caregivers of children with cancer experience clinically significant anxiety or depressive symptoms. These results emphasize the importance of care strategies that include family members and address their mental health needs throughout the entire cancer treatment process.