Prevalence of Psychological Distress Among Family Caregivers of Children with Cancer: A Systematic Review and Meta-Analysis

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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. Neoplasms Caregivers Emotional Stress Mental Health Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Family caregivers of children undergoing oncological treatment frequently experience substantial psychological distress, including fear, worry, and sadness related to the child’s diagnosis, prognosis, and treatment trajectory [ 1 ]. Maintaining optimism, coping with adversity, and preserving daily functioning are frequently described as significant challenges [ 2 ]. As treatment progresses, caregivers accompany children through hospitalizations, medical procedures, treatment side effects, and disruptions in routine [ 3 ], which often contribute to elevated symptoms of anxiety and depression [ 4 ]. Psychological distress among caregivers has been extensively documented in oncology [ 5 ], [ 6 ] with systematic reviews consistently reporting ~ 25% to 45% of anxiety and depression among caregivers of adult cancer patients[ 7 ], [ 8 ]. These high prevalence rates reflect substantial emotional burden across the different types of cancer and contexts, highlighting the necessity of psychosocial support and intervention in adult oncology populations. Nevertheless, the lack of synthesis specifically focusing on the prevalence of psychological distress among pediatric samples represent a major gap in caregiving literature. Given the unique demands of caring for a child with cancer, such as prolonged treatment, uncertainty regarding prognosis and greater dependency of the child, the psychological distress experienced by caregivers in pediatric oncology may differ. Two previous reviews attempted to summarize psychological outcomes in this population [ 9 ], [ 10 ]. For example, the systematic review by Shokri et al. [ 9 ] described a range of psychological difficulties, including burden, stress, anxiety and depression including studies from 2000 and 2019. In addition, the systematic review by Sultan et al. [ 10 ] explored the predictors of psychological distress, indicating that caregiver sex, cancer type and treatment duration were among the factors explaining parental distress. However, these reviews present significant limitations, including lack of the most recent literature, reliance on heterogeneous measurement tools and lack of statistical analysis on the prevalence of psychological distress and its potential influencing factors. Exploring the prevalence of psychological distress and its determinants, such as caregiver age and sex, children’s clinical characteristics, cancer type, geographic region, and the instruments used to assess symptoms, is essential for interpreting variability across studies. Given the lack of such information in caregivers literature, 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. Such evidence is crucial to inform clinical practice in pediatric oncology, support multidisciplinary teams, and guide the development of interventions aimed at improving caregivers’ mental health. METHODS This systematic review with meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 11 ]. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251102489. Eligibility criteria The search for evidence and eligibility process followed the CoCoPop strategy [ 12 ]. Studies were included if they met the following criteria: Condition (Co): caregivers presenting psychological distress (anxiety and/or depressive symptoms); Context (Co): children undergoing cancer treatment; and Population (Pop): family members of children with cancer (e.g., parents, grandparents). Exclusion criteria were: [ 1 ] lack of information on caregivers’ psychological distress; [ 2 ] population not consisting of family members of children with cancer; [ 3 ] bereaved caregivers (e.g., children deceased); [ 4 ] non-observational designs, including intervention studies (e.g., clinical trials) and reviews (e.g., systematic or scoping); [ 5 ] protocols, instrument validation studies, abstracts, letters, or books; [ 6 ] absence of numerical data (percentages) on psychological distress and/or exclusively qualitative data (e.g., interviews); [ 7 ] absence of validated instruments to assess psychological distress. (Supplementary Material – Tab: excluded studies). Search strategy A systematic search was conducted on August 11, 2025, by two authors (EEDJ, MC) in multidisciplinary databases [Scopus (Elsevier), Web of Science (Clarivate Analytics)], health-related databases [Embase (Elsevier), PubMed/MEDLINE, LILACS], and psychology databases [IndexPsi, PsycINFO (APA)]. Additional searches were conducted in Google Scholar and ProQuest to identify other relevant studies, including those not indexed or considered as grey literature. Search terms were applied to titles, abstracts, and keywords, in English only, using Boolean operators (AND / OR). No language restrictions were imposed. Search terms were defined based on DeCS and with technical assistance from an academic librarian. Three main clusters were used: [ 1 ] Psychological distress: [(“psychological distress” OR “emotional distress” OR depression OR “depressive symptom” OR “depressive symptoms” OR anxiety OR anxiousness) AND]; [ 2 ] Pediatric cancer treatment: [(“pediatric cancer treatment” OR “childhood cancer treatment” OR “children undergoing cancer treatment” OR “child undergoing cancer treatment” OR “pediatric oncology” OR “childhood oncology” OR “childhood cancer survivors” OR “child cancer survivors” OR child cancer survivor”) AND]; [ 3 ] Family caregivers: [(family OR families OR father* OR mother* OR parent* OR grandparent* OR relative*)]. For grey literature searches, equivalent English terms were applied: “psychological distress”, “emotional distress”, “depressive symptom”, “anxiety”, “pediatric oncology treatment”, “childhood cancer treatment”, “family”, “relatives”, “family members”, “relative”. Study selection process Screening and selection were independently conducted by two researchers (EEDJ, MC) using the Rayyan tool. After duplicate removal, titles and abstracts were screened against eligibility criteria. Full texts of potentially relevant studies were then assessed. Any disagreements were resolved by a third reviewer (CRF). Data extraction process Only observational studies (cross-sectional, longitudinal, case–control) with quantitative data on caregivers’ psychological distress (anxiety and depression) were included. Studies had to report absolute numbers and percentages (n and %) Mixed - methods (quantitative-qualitative) design were considered for the children’s clinical information and family caregivers’ sociodemographic information. Data extraction was performed by three authors (EEDJ, MC, JBMS) and verified by a fourth (CRF). Extracted variables included: author, year of publication, study design, country, language, anxiety outcomes (classification, cases, prevalence, mean, standard deviation), depression outcomes (classification, cases, prevalence, mean, standard deviation), measurement instruments, sample size (family and child), caregiver and child age, female prevalence, family education, household income, marital status, occupation, child’s cancer type, treatment duration, and treatment modality (Supplementary Material – Tab: Data Extraction). Risk of bias assessment (study quality) The Joanna Briggs Institute (JBI) Critical Appraisal Tool for prevalence studies was used to assess methodological quality (Table 2). Two researchers (JBMS, MC) independently appraised the studies, with disagreements resolved by a third reviewer (EEDJ). The instrument includes nine methodological domains (D1–D9), which examine aspects such as the adequacy of the sampling frame, sampling method, sample size, description of participants and setting, data coverage, validity of diagnostic methods, measurement reliability, statistical analysis, and response rate. Each domain was rated as Yes (Y — low risk of bias), No (N — high risk of bias), or Unclear (U — insufficient information) according to standardized JBI criteria. Individual domain ratings for each study are presented in Supplementary Material (Table 2). Data analysis Analyses were performed using R Studio (version 4.4.1, 2024). A single-proportion meta-analysis was conducted to estimate the pooled prevalence rates of anxiety and depression. The Freeman–Tukey double arcsine transformation was applied to stabilize variance, and a random-effects model using the Restricted Maximum Likelihood (REML) estimator was fitted to account for between-study variability. Heterogeneity was assessed using Cochran’s Q test and quantified by the I² statistic. Individual and pooled prevalence estimates with 95% confidence intervals (CIs) were summarized in tables and forest plots. Confidence intervals for individual studies were calculated using the Clopper–Pearson method. Publication bias was visually evaluated using a funnel plot (see Supplementary Material – Tab: Meta-analysis 1 and 2). To explore potential sources of heterogeneity, subgroup and meta-regression analyses were performed. Meta-regression analyses were undertaken using continuous determinants (mean age of family members and children, percentage of females, and percentage of leukemia cases), while subgroup analyses were conducted for categorical variables such as continent, assessment instrument, and symptom classification. RESULTS Study selection A total of 2,089 records were identified across databases. After removing duplicates, 1,193 records remained. Following title and abstract screening, 194 studies were selected for full-text assessment. Of the 220 full-text articles evaluated, 190 were excluded due to specific reasons (Fig. 1). An additional 149 records were identified through other sources; after removing six duplicates and excluding 118 that did not meet the eligibility criteria, 26 proceeded to full-text review. As a result, 30 studies were deemed eligible for inclusion. The selection process is summarized in Fig. 1 . Most studies were conducted in North American (US, Canada; 36.7%), Europe (Belgium, England, France, Germany, Greece, Poland, Russia, Sweden, Switzerland; 30.0%), Asia (China, India, Pakistan, Turkey; 16.7%), Oceania (Australia; 10%) and South America (Brazil; 3.3%) (Fig. 2). Characteristics of studies, family caregivers and children Most studies were cross-sectional (66.6%), followed by prospective cohorts and case-control designs (16.7%, respectively). A total of 3,788 family caregivers and 2,345 children with cancer were included across the studies. Most caregivers were women (60.8%), and the median age was 38.9 (IQR 35.5–40.7) years. Only 20.4% of participants were reported to have completed a higher education degree, 42.7% were married, and 23.5% were engaged in part- or full-time employment ( Table 1 ). In regard to the children, leukemia was the most common cancer type (29.4%), followed by brain tumours (4.8%), lymphoma (2.2%), haematological (1.5%) and sarcoma (1.3%). The median age at diagnosis was 8.3 (IQR 7.5–10.4) years, and female represented 41.6% of the sample. Only nine studies (30.0%) reported treatment regimens, with most studies reporting chemotherapy [ 13 ], [ 14 ], [ 15 ], [ 16 ]. Treatment duration ranged from two weeks to two years [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]. Of the selected studies, 50% (n = 15) used a combined instrument (collecting both sentiments) and 50% (n = 30) used specific instruments (collecting sentiments separately). Of these instruments, the Hospital Anxiety and Depression Scale (HADS) was the most frequently used (23.3%, n = 7), followed by the Depression, Anxiety and Stress Scale − 21 items (DASS-21; 20%, n = 6). ( Table 2 ). Risk of bias Despite the low risk of bias with all studies meeting the criteria in domain 6 ( Were valid methods used for the identification of the condition? ), most studies had high risk of bias in domain 2 (87%; Were study participants sampled in an appropriate way? ) and domain 3 (80%; Was the sample size adequate? ). Unclear or high risk of bias were also observed in most studies in domain 1 (70%; Was the sample frame appropriate to address the target population? ), domain 4 (80%; Were the study subjects and the setting described in detail? ), domain 5 (83.3%; Was the data analysis conducted with sufficient coverage of the identified sample? ), domain 7 (53.3%; Was the condition measured in a standard, reliable way for all participants? ), domain 8 (76.7%; Was there appropriate statistical analysis? ) and domain 9 (53.3%; Was the response rate adequate, and if not, was the low response rate managed appropriately? ). Individual assessments are provided in Supplementary Material – Tab: Risk of Bias ( Table 2 ). Single-effect proportions on family members' anxiety symptoms Based on 19 studies including 2,116 caregivers (Fig. 3) , the meta-analysis indicated a pooled prevalence rate of 25% (95% CI: 16–36%) of anxiety symptoms among family members of children with cancer. Heterogeneity I 2 was 95.3% (p < 0.001). Visual inspection of the funnel plot and Egger’s regression test did not indicate evidence of publication bias (t = 0.86, p = 0.401). (Supplementary Material – Tab: funnel plot). In the meta-regression, age of caregivers (p = 0.263) or children (p = 0.431), proportion of female caregivers (p = 0.786) or patients (p = 0.218) and proportion of patients with leukemia (p = 0.457) were not associated with higher prevalences of anxiety among family members (Table 3). Subgroup meta-analysis indicated statistical differences between regions (χ 2 = 9.8, p = 0.021). Studies conducted in Asia (37%, 95% CI: 19%–56%) and Europe (34%, 95% CI: 13%–59%) reported higher pooled prevalence rates of anxiety than studies in North America (12%, 95% CI: 6%–19%) and Oceania (20%, 95% CI: 7%–38%) (Table 4) . Differences were also observed based on the focus of the instruments (χ 2 = 6.0, p = 0.014), with studies assessing both anxiety and depression (32%, 95% CI: 20%–45%) displaying higher pooled prevalence rates than studies specifically assessing anxiety (25%, 95% CI: 16%–36%) (Table 4) . Otherwise, similar pooled prevalence rates were observed between the classification of anxiety (χ 2 = 0.5, p = 0.474) (Table 4) . Single-effect proportions on family members’ depression symptoms Based on 23 studies including 2,091 caregivers (Fig. 4) , the meta-analysis indicated a pooled prevalence rate of 27% (95% CI: 17–39%) of depressive symptoms among family members of children with cancer. Heterogeneity I 2 was 97.0% (p < 0.001). Visual inspection of the funnel plot and Egger’s regression test did not indicate publication bias (t = 0.89, p = 0.384). (Supplementary Material – Tab: funnel plot). In the meta-regression, caregiver age (p = 0.545) or child age (p = 0.432), the proportion of female caregivers (p = 0.187) or patients (p = 0.167), and the proportion of patients with leukemia (p = 0.892) were not associated with higher prevalences of depressive symptoms among family members (Table 5). Subgroup meta-analysis indicated no differences among regions (χ² = 6.8, p = 0.082), although studies conducted in Asia (52%, 95% CI: 29–75%) exhibited higher pooled prevalence rates of depressive symptoms than those conducted in North America (19%, 95% IC: 7–35%) and Oceania (18%, 95% CI: 8–31%) (Table 6). Similarly, subgroup differences were not observed regarding the type of instrument used (χ² = 0.70, p = 0.401) or between studies classifying depression as severe versus those including any depressive symptoms (χ² = 0.16, p = 0.686) (Table 6). DISCUSSION This study aimed to systematically review and analyze the prevalence of psychological distress, specifically depressive and anxiety symptoms, among family caregivers of children undergoing cancer treatment. The findings indicated pooled prevalence estimates of ~ 26% for both anxiety and depression, suggesting that about one in four family members experienced clinically relevant distress during the child’s illness and treatment. This finding underscores the substantial psychological burden and the need for targeted screening, early identification, and appropriate psychological support to counteract long-term adverse outcomes for families. The pooled prevalence of anxiety and depressive symptoms in the present review was 25% and 27%, respectively. Our finding aligns with existing literature [ 8 ], [ 14 ] demonstrating the significant psychological burden experienced by caregivers of children with cancer. This burden may be resulted from the unique challenges associated with pediatric cancer, including its life-threatening nature, its unpredictable prognosis, and the complexity and intensity of treatment regimens [ 22 ]. Potential explanations include the prolonged treatment duration [ 14 ], severe treatment-related side effects [ 23 ] and concerns about long-term health risks further exacerbating the need for sustained supportive and demanding care, consequently heightening caregivers’ levels of anxiety and depression [ 22 ]. From the child perspective, disruptions to daily routines, such as changes in sleep, meals, and schooling, can negatively affect emotional well-being [ 24 ]. Importantly, caregivers’ psychological distress can influence children’s emotional adjustment [ 10 ], emphasizing the need for continuous psychosocial support for families coping with childhood cancer. This relationship is likely bidirectional. As children exhibit emotional distress in response to their illness and treatment, anxiety, behavioral changes or mood disturbances, caregivers may experience increased worry, fatigue, and psychological strain [ 25 ]. In turn, this elevated distress can diminish caregiver’s emotional availability and coping capacity to further develop the child’s sense of security and overall adjustment. This interaction underscores the importance of family-centered approaches designed to support both children and their caregivers during the disease course [ 26 ]. Interestingly, prior studies have shown that the psychological burden experienced by caregivers of children with cancer is even greater than that observed among caregivers of children with other chronic conditions. For example, Thomas et al. [ 27 ] investigated 194 caregivers of children with congenital heart disease (50%), diabetes (26%), asthma (4%), and cancer (20%). Overall, a significant proportion of caregivers presented moderate to severe symptoms of depression (26%) and anxiety (38%), with higher rates of depression (n = 16, 41% severe) and anxiety (n = 18, 46% severe) observed in caregivers of children with cancer compared to those caring for children with other illnesses. Moreover, the prevalence of psychological distress observed in caregivers of children with cancer appears comparable to that observed among caregivers of adults with cancer. In the meta-analysis by Pan and Lin [ 8 ], the pooled prevalence of depression was estimated at 25% (95% CI: 21%-29%) based on 85 studies conducted across 25 countries (n = ~ 23,000). Among smaller meta-analyses, including 15–30 studies, the prevalence estimate ranged from 42% to 49% [ 7 ], [ 28 ]. Despite methodological differences, the observed prevalence of psychological distress among caregivers is consistently high across studies, which reinforces the need for systematic screening and targeted psychosocial interventions. The heterogeneity observed was considerably high across the studies included, and methodological factors appeared to contribute meaningfully to this variability. First, 13 different assessment instruments were used across the included studies, most of which measured anxiety and depression concurrently. This approach is conceptually reasonable given the comorbidity of symptoms in caregiving contexts [ 9 ], but may inflate prevalence estimates as observed in our results. In the subgroup meta-analysis, instrument type emerged as a significant moderator, with broader psychological screening tools producing higher estimates compared to anxiety-specific instruments. Likewise, Pan and Lin [ 8 ] reported significant heterogeneity (I² = 97.4%) which was partially attributable to methodological differences such as the use of clinical interviews or self-report tools. These findings highlight that variability in measurement methods should be considered when comparing results across studies, consequently affecting the prevalence of psychological distress in caregivers of children with cancer. Differences in study populations may further contribute to heterogeneity. Most studies included caregivers with higher education levels, employed, and with sufficient income, predominantly from studies conducted in the Americas (43.3%) and Europe (30%). No study was identified from the African continent, suggesting a significant gap in global representation. Although we could not further explore the effect of demographical aspects, higher education and income may facilitate access to information, support, and treatment navigation [ 14 ], whereas poor education may be associated with challenges in understanding medical procedures and decision-making [ 2 ], [ 4 ]. Additionally, marital status and employment may influence emotional burden, with single caregivers and those who change or leave employment facing additional challenges [ 29 ]. These demographic and contextual differences likely contribute to variability in psychological outcomes and should be acknowledged when interpreting pooled estimates. The reviewed evidence indicates that psychological distress among caregivers is common, suggesting a need for more structured emotional support in hospital settings. Although these findings do not reflect the direct results of this review, they highlight recommendations from the included literature, such as considering systematic screening for anxiety and depressive symptoms, and implementing educational and psychosocial programs to assist caregivers during treatment [ 14 ], [ 22 ], [ 23 ], [ 30 ], [ 31 ]. Strategies including psychological counseling, support groups, and physical activity programs have shown potential benefits for stress management and emotional well-being, particularly when delivered in multidisciplinary contexts [ 32 ], [ 33 ], [ 34 ]. Overall, the literature suggests that caregiver-focused interventions may contribute to reducing emotional burden and improving family adjustment during pediatric cancer treatment. Strengths and limitations of the study This is the first systematic review and meta-analysis focusing on the prevalence of psychological distress among caregivers of children with cancer. The strength of this review is the inclusion of 30 studies and > 2,000 caregivers using meta-analysis, subgroup and meta-regression. These provided a comprehensive overview of the psychological distress experienced by families, underscoring the need for targeted psychological support in pediatric oncology settings. However, there are a few limitations. Despite the clinically relevant prevalence rates, heterogeneity across studies was extremely high, which may reduce the certainty of this finding. This variability may be associated with cultural differences, treatment stages (e.g., early diagnosis vs. long-term care), or treatment modalities. In addition, the inability to perform meta-regression analyses using sociodemographic variables and child clinical information (including treatment duration) was another limitation, precluding us to explore the role of education levels and socioeconomic factors on the prevalence of psychological distress in this population. Clinical implications Early identification of caregiver distress enables timely referral to psychosocial support, reducing the risk of long-term mental health problems. Implementing structured interventions, such as counseling, support groups and physical activity programs, may improve caregivers’ emotional resilience and enhance their capacity to support the child throughout treatment. Family-centered care models that address the well-being of both caregivers and children can further strengthen overall treatment outcomes. CONCLUSION This systematic review and meta-analysis identified a high global prevalence of anxiety and depressive symptoms among family caregivers of children undergoing cancer treatment. Despite heterogeneity across studies and methodological limitations, the pooled findings highlight a consistent psychological burden in this population. These results emphasize the importance of implementing comprehensive, multidisciplinary care strategies that extend beyond the pediatric patient to include family members, addressing their mental health needs throughout the cancer treatment trajectory. Declarations Authors' contribution Eduarda Eugenia Dias de Jesus and Pedro Lopez contributed to the conception and design of the study. The database search, article selection, and data extraction were performed by Eduarda Eugenia Dias de Jesus, Micheli Carminatti, and Joana Bastos Matos Schlichting, under the supervision of Pedro Lopez and Cintia de la Rocha Freitas. Statistical analysis and meta-analysis were conducted by Eduarda Eugenia Dias de Jesus and Pedro Lopez. Risk of bias assessment was performed by Eduarda Eugenia Dias de Jesus, Micheli Carminatti, and Joana Bastos Matos Schlichting. The first draft of the manuscript was written by Eduarda Eugenia Dias de Jesus. Micheli Carminatti and Pedro Lopez assisted in the preparation of tables and manuscript review. Pedro Lopez, Rodrigo Sudatti Delevatti, and Cintia de la Rocha Freitas were responsible for the overall supervision of the project and performed a critical review of the manuscript. All authors reviewed and approved the final manuscript for submission. Acknowledgments The authors have no acknowledgments to declare. Funding No funding was received to assist in the preparation of the manuscript. Ethical approval Given that this is a systematic review and meta-analysis of previously published and publicly available data, ethical approval and informed consent were not required for this study. Conflict of Interest Statement The authors declare that there is no conflict of interest. References Mess E, Misiąg W, Klaszczyk T, Kryś K. Depressive and Anxiety Disorders of Parents of Children with Cancer. J Clin Med. 2022;11(19):5670. Dąbrowska A, Malicka I. 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Psychooncology. 2019;28(5):960–9. Tables Table 1 . Sociodemographic characteristics of family caregivers and measuring instruments used to verify the psychological suffering of family members. Author (year) Education Family income Marital status Occupation Anxiety symptoms Depression symptoms Yılancıoğlu (2024) elementary education (mother 52% and father 63%) - - - HADS Terrasson et al. (2023) 40% higher education - 93% married 80% exercise professional activity HADS Hsu et al. (2021) 40% higher education - 87% married 67% part-time PROMIS Wikman et al. (2018) 48% high school - - - BAI BDI-II Neu et al. (2014) 27% higher education - 85% married 46% part-time and full-time HADS Haegen et al. (2018) 45% higher education - 53% married/partnered - HADS Hannah Kurz et al. (2025) 50.4% > 10 years 46.1% average status 77.2% married 77.8% paid employee GAD-7 PHQ-9 Quast et al. (2021) 52% higher education 34% between $75,000–$124,999 - - PROMIS - Lewandowska et al. (2024) 57% higher education 55% financial situation "good" 62% married - HADS * BDI Jayaganapathy et al. (2020) - - - - DASS-21 Christen et al. (2022) 48.5% higher education 55% medium/high (≥6,000 CHF) - 53% employed WAQ - Meeske et al. (2013) 33% elementary education** 41% between 10–35 thousand 69% married - - CES-D Koyu et al. (2020) 34.9% elementary education 65% revenue equals expense - 83% unemployed STAI BDI Burns et al. (2020) 52% with a school degree - 90% single average of 3.20 hours of paid work DASS-21 McCarthy et al. (2021) 29% higher education - 83% married 34% part-time DASS-21 McLoone et al. (2013) 57% without a school degree - 92% partner average of 2.10 hours of paid work DASS-21 Elkin et al. (2007) - - 56% partner - - BDI-II Peterson et al. (2018) - - - - BSI Burns et al. (2018) 46% higher education 47% income above $49,999 100% married 69% full time BSI Vernon et al. (2016) 75% higher education** - 45% married** - DASS-21 Vitorino et al. (2018) - 53.2% financial problems - 81% employed/retired - BDI Zhao et al. (2023) 34% high school - - - HADS Wilford (2018) 64% higher education - 86% married - PROMIS Ghufran et al. (2014) 55% higher education 65% above 50,000 - 95% housewife - HAM-D I.Vlachos et al. (2023) 48% elementary education - 92% partner - HADS Bemis et al. (2015) Average of 13.9 years of education 26.8% between $25,001–50,000 72% married/partnered - - BDI-II Katz et al. (2018) - - 78.3% married - DASS-21 * CES-D Allen et al. (1997) - - - - STAI BDI Santo et al. (2011) 59.4% elementary education** - 75% married 65.6% of the home - BDI Greening et al. (2007) - - 60% married - STAI BDI-II * The instrument chosen for the study was used only to detect symptoms of anxiety; the study opted not to present data on symptoms of depression. Table 2. Risk of bias assessment of included studies. Author (year) D1 D2 D3 D4 D5 D6 D7 D8 D9 Yılancıoğlu (2024) U N N U N Y N Y N Terrasson et al. (2023) Y N N U N Y N U Y Hsu et al. (2021) U N N U N Y U U N Wikman et al. (2018) Y N N Y N Y Y Y N Neu et al. (2014) Y Y Y U Y Y Y U Y Haegen et al. (2018) N N N N N Y Y U Y Hannah Kurz et al. (2025) Y N N Y U Y Y N Y Quast et al. (2021) N N Y N U Y U U Y Lewandowska et al. (2024) N N N N N Y Y N N Jayaganapathy et al. (2020) Y N N Y N Y U Y N Christen et al. (2022) U U N U N Y U U Y Meeske et al. (2013) U N N U N Y U N Y Koyu et al. (2020) U N Y U N Y Y U Y Burns et al. (2020) U N Y U Y Y U U N McCarthy et al. (2021) U N N U U Y U U Y McLoone et al. (2013) U U N U U Y U U U Elkin et al. (2007) N N N N U Y N U N Peterson et al. (2018) N N N N U Y U U N Burns et al. (2018) Y N N Y U Y U U U Vernon et al. (2016) U N N U Y Y Y N Y Vitorino et al. (2018) U N Y U Y Y Y Y Y Zhao et al. (2023) Y N N Y N Y Y Y N Wilford (2018) U N N U U Y N U U Ghufran et al. (2014) Y N Y U Y Y Y Y N I.Vlachos et al. (2023) N N N N U Y Y U Y Bemis et al. (2015) Y N N Y N Y Y U N Katz et al. (2018) N N N N N Y Y N U Allen et al. (1997) N N N N U Y U U Y Santo et al. (2011) U Y N U U Y Y U U Greening et al. (2007) U N N U N Y U Y Y Legend: Y = Yes (low risk of bias); N = No (high risk of bias); I = Unclear (insufficient information); D1: Was the sample frame appropriate to address the target population?; D2: Were study participants sampled in an appropriate way?; D3: Was the sample size adequate?; D4: Were the study subjects and the setting described in detail?; D5: Was the data analysis conducted with sufficient coverage of the identified sample?; D6: Were valid methods used for the identification of the condition?; D7: Was the condition measured in a standard, reliable way for all participants?; D8: Was there appropriate statistical analysis?; D9: Was the response rate adequate, and if not, was the low response rate managed appropriately? Table 3 . Meta-regression for anxiety symptom information. Variable β ± SE p Age of caregivers, years 0.018 ± 0.016 0.263 Age of children, years 0.034 ± 0.043 0.431 Female caregivers, % −0.000 ± 0.003 0.785 Female children, % −0.011 ± 0.009 0.218 Leukemia, % 0.002 ± 0.003 0.457 Table 4. Meta-analysis analyzed by subgroup in relation to continents, instrument type, and anxiety symptoms. Analysis Descriptive Random-effect meta-analysis Heterogeneity Test for subgroup difference Studies (n) Sample (n) Estimate (%) 95% CI I 2 t² p-value χ² p-value Overall 19 2116 25% 16 to 36% 95.3% 0.060 <0.001 - - Region Asia 4 337 37% 19 to 56% 90.6% 0.033 <0.001 9.75 0.020 Europe 7 914 34% 13 to 59% 97.1% 0.109 <0.001 North America 6 736 12% 06 to 19% 84.2% 0.011 <0.001 Oceania 2 129 20% 07 to 38% 79.2% 0.015 0.029 Instrument Combined 14 1000 32% 20 to 45% 93.9% 0.055 <0.001 6.04 0.014 Specific 5 1116 11% 03 to 23% 97.3% 0.033 <0.001 Classification of anxiety Serious 10 806 22% 09 to 37% 93.2% 0.066 <0.001 0.51 0.474 With symptoms 9 1310 29% 16 to 45% 96.3% 0.057 <0.001 Table 5. Meta-regression for depression symptom information. Variable β ± SE p Age of caregivers, years 0.010 ± 0.017 0.545 Age of children, years −0.024 ± 0.031 0.432 Female caregivers, % 0.004 ± 0.003 0.187 Female children, % −0.010 ± 0.007 0.167 Leukemia, % −0.000 ± 0.004 0.892 Table 6. Meta-analysis analyzed by subgroup in relation to continents, instrument type, and depression symptoms. Analysis Descriptive Random-effect meta-analysis Heterogeneity Test for subgroup difference Studies (n) Sample (n) Estimate 95% CI I 2 t² p-value χ² p-value Overall 23 2091 27% 17 to 39% 97.0% 0.085 <0.001 - - Region Asia 5 437 52% 28 to 75% 96.3% 0.073 <0.001 6.70 0.082 Europe 6 398 27% 08 to 51% 96.6% 0.089 <0.001 America 10 1127 19% 07 to 35% 97.4% 0.079 <0.001 Oceania 2 129 18% 08 to 31% 66.0% 0.007 0.086 Instrument Combined 14 1000 31% 17 to 47% 96.6% 0.087 <0.001 0.70 0.401 Specific 9 1091 22% 08 to 40% 97.6% 0.085 <0.001 Classification of depression Serious 10 759 30% 12 to 52% 97.4% 0.117 <0.001 0.16 0.686 With symptoms 13 1332 25% 14 to 39% 96.8% 0.068 <0.001 Additional Declarations No competing interests reported. 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2","display":"","copyAsset":false,"role":"figure","size":574785,"visible":true,"origin":"","legend":"\u003cp\u003eGeographic distribution of included studies.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8369169/v1/3d397ca165d8e2bf254c7157.png"},{"id":101204632,"identity":"12a97087-9788-486f-a4cd-48bd0f5f0dc9","added_by":"auto","created_at":"2026-01-27 09:43:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":268616,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the prevalence of anxiety symptoms among caregivers.\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8369169/v1/3141c52eacc30f1e823a9524.png"},{"id":101019669,"identity":"a5768d84-c8cc-40da-bc44-22090042dd91","added_by":"auto","created_at":"2026-01-24 00:40:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":307242,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis of the prevalence of depressive symptoms among caregivers.\u003c/p\u003e","description":"","filename":"figura4.png","url":"https://assets-eu.researchsquare.com/files/rs-8369169/v1/97af632adfa738f99191696e.png"},{"id":103410686,"identity":"c4ebd437-715b-4ec6-a8cd-dfb15a9d24d7","added_by":"auto","created_at":"2026-02-25 10:57:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2673546,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8369169/v1/fc29e18e-ef4e-4d7c-ade2-f622922ee69a.pdf"},{"id":101019667,"identity":"4790157c-4fa8-49db-ac64-cce9ff6cc020","added_by":"auto","created_at":"2026-01-24 00:40:06","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":57805,"visible":true,"origin":"","legend":"","description":"","filename":"metaregreoficial.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8369169/v1/91b3d56219a95c67730d84f3.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Psychological Distress Among Family Caregivers of Children with Cancer: A Systematic Review and Meta-Analysis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eFamily caregivers of children undergoing oncological treatment frequently experience substantial psychological distress, including fear, worry, and sadness related to the child\u0026rsquo;s diagnosis, prognosis, and treatment trajectory [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Maintaining optimism, coping with adversity, and preserving daily functioning are frequently described as significant challenges [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As treatment progresses, caregivers accompany children through hospitalizations, medical procedures, treatment side effects, and disruptions in routine [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which often contribute to elevated symptoms of anxiety and depression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePsychological distress among caregivers has been extensively documented in oncology [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] with systematic reviews consistently reporting\u0026thinsp;~\u0026thinsp;25% to 45% of anxiety and depression among caregivers of adult cancer patients[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These high prevalence rates reflect substantial emotional burden across the different types of cancer and contexts, highlighting the necessity of psychosocial support and intervention in adult oncology populations. Nevertheless, the lack of synthesis specifically focusing on the prevalence of psychological distress among pediatric samples represent a major gap in caregiving literature.\u003c/p\u003e \u003cp\u003eGiven the unique demands of caring for a child with cancer, such as prolonged treatment, uncertainty regarding prognosis and greater dependency of the child, the psychological distress experienced by caregivers in pediatric oncology may differ. Two previous reviews attempted to summarize psychological outcomes in this population [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For example, the systematic review by Shokri et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] described a range of psychological difficulties, including burden, stress, anxiety and depression including studies from 2000 and 2019. In addition, the systematic review by Sultan et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] explored the predictors of psychological distress, indicating that caregiver sex, cancer type and treatment duration were among the factors explaining parental distress. However, these reviews present significant limitations, including lack of the most recent literature, reliance on heterogeneous measurement tools and lack of statistical analysis on the prevalence of psychological distress and its potential influencing factors.\u003c/p\u003e \u003cp\u003eExploring the prevalence of psychological distress and its determinants, such as caregiver age and sex, children\u0026rsquo;s clinical characteristics, cancer type, geographic region, and the instruments used to assess symptoms, is essential for interpreting variability across studies. Given the lack of such information in caregivers literature, 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. Such evidence is crucial to inform clinical practice in pediatric oncology, support multidisciplinary teams, and guide the development of interventions aimed at improving caregivers\u0026rsquo; mental health.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis systematic review with meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251102489.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria\u003c/h2\u003e \u003cp\u003eThe search for evidence and eligibility process followed the CoCoPop strategy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Studies were included if they met the following criteria: Condition (Co): caregivers presenting psychological distress (anxiety and/or depressive symptoms); Context (Co): children undergoing cancer treatment; and Population (Pop): family members of children with cancer (e.g., parents, grandparents). Exclusion criteria were: [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] lack of information on caregivers\u0026rsquo; psychological distress; [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] population not consisting of family members of children with cancer; [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] bereaved caregivers (e.g., children deceased); [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] non-observational designs, including intervention studies (e.g., clinical trials) and reviews (e.g., systematic or scoping); [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] protocols, instrument validation studies, abstracts, letters, or books; [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] absence of numerical data (percentages) on psychological distress and/or exclusively qualitative data (e.g., interviews); [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] absence of validated instruments to assess psychological distress. (Supplementary Material \u0026ndash; Tab: excluded studies).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eA systematic search was conducted on August 11, 2025, by two authors (EEDJ, MC) in multidisciplinary databases [Scopus (Elsevier), Web of Science (Clarivate Analytics)], health-related databases [Embase (Elsevier), PubMed/MEDLINE, LILACS], and psychology databases [IndexPsi, PsycINFO (APA)]. Additional searches were conducted in Google Scholar and ProQuest to identify other relevant studies, including those not indexed or considered as grey literature.\u003c/p\u003e \u003cp\u003eSearch terms were applied to titles, abstracts, and keywords, in English only, using Boolean operators (AND / OR). No language restrictions were imposed. Search terms were defined based on DeCS and with technical assistance from an academic librarian. Three main clusters were used: [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Psychological distress: [(\u0026ldquo;psychological distress\u0026rdquo; OR \u0026ldquo;emotional distress\u0026rdquo; OR depression OR \u0026ldquo;depressive symptom\u0026rdquo; OR \u0026ldquo;depressive symptoms\u0026rdquo; OR anxiety OR anxiousness) AND]; [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Pediatric cancer treatment: [(\u0026ldquo;pediatric cancer treatment\u0026rdquo; OR \u0026ldquo;childhood cancer treatment\u0026rdquo; OR \u0026ldquo;children undergoing cancer treatment\u0026rdquo; OR \u0026ldquo;child undergoing cancer treatment\u0026rdquo; OR \u0026ldquo;pediatric oncology\u0026rdquo; OR \u0026ldquo;childhood oncology\u0026rdquo; OR \u0026ldquo;childhood cancer survivors\u0026rdquo; OR \u0026ldquo;child cancer survivors\u0026rdquo; OR child cancer survivor\u0026rdquo;) AND]; [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Family caregivers: [(family OR families OR father* OR mother* OR parent* OR grandparent* OR relative*)]. For grey literature searches, equivalent English terms were applied: \u0026ldquo;psychological distress\u0026rdquo;, \u0026ldquo;emotional distress\u0026rdquo;, \u0026ldquo;depressive symptom\u0026rdquo;, \u0026ldquo;anxiety\u0026rdquo;, \u0026ldquo;pediatric oncology treatment\u0026rdquo;, \u0026ldquo;childhood cancer treatment\u0026rdquo;, \u0026ldquo;family\u0026rdquo;, \u0026ldquo;relatives\u0026rdquo;, \u0026ldquo;family members\u0026rdquo;, \u0026ldquo;relative\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003eStudy selection process\u003c/h3\u003e\n\u003cp\u003eScreening and selection were independently conducted by two researchers (EEDJ, MC) using the Rayyan tool. After duplicate removal, titles and abstracts were screened against eligibility criteria. Full texts of potentially relevant studies were then assessed. Any disagreements were resolved by a third reviewer (CRF).\u003c/p\u003e\n\u003ch3\u003eData extraction process\u003c/h3\u003e\n\u003cp\u003eOnly observational studies (cross-sectional, longitudinal, case\u0026ndash;control) with quantitative data on caregivers\u0026rsquo; psychological distress (anxiety and depression) were included. Studies had to report absolute numbers and percentages (n and %) Mixed - methods (quantitative-qualitative) design were considered for the children\u0026rsquo;s clinical information and family caregivers\u0026rsquo; sociodemographic information.\u003c/p\u003e \u003cp\u003eData extraction was performed by three authors (EEDJ, MC, JBMS) and verified by a fourth (CRF). Extracted variables included: author, year of publication, study design, country, language, anxiety outcomes (classification, cases, prevalence, mean, standard deviation), depression outcomes (classification, cases, prevalence, mean, standard deviation), measurement instruments, sample size (family and child), caregiver and child age, female prevalence, family education, household income, marital status, occupation, child\u0026rsquo;s cancer type, treatment duration, and treatment modality (Supplementary Material \u0026ndash; Tab: Data Extraction).\u003c/p\u003e\n\u003ch3\u003eRisk of bias assessment (study quality)\u003c/h3\u003e\n\u003cp\u003eThe Joanna Briggs Institute (JBI) Critical Appraisal Tool for prevalence studies was used to assess methodological quality \u003cb\u003e(Table\u0026nbsp;2).\u003c/b\u003e Two researchers (JBMS, MC) independently appraised the studies, with disagreements resolved by a third reviewer (EEDJ). The instrument includes nine methodological domains (D1\u0026ndash;D9), which examine aspects such as the adequacy of the sampling frame, sampling method, sample size, description of participants and setting, data coverage, validity of diagnostic methods, measurement reliability, statistical analysis, and response rate. Each domain was rated as Yes (Y \u0026mdash; low risk of bias), No (N \u0026mdash; high risk of bias), or Unclear (U \u0026mdash; insufficient information) according to standardized JBI criteria. Individual domain ratings for each study are presented in Supplementary Material \u003cb\u003e(Table\u0026nbsp;2).\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAnalyses were performed using R Studio (version 4.4.1, 2024). A single-proportion meta-analysis was conducted to estimate the pooled prevalence rates of anxiety and depression. The Freeman\u0026ndash;Tukey double arcsine transformation was applied to stabilize variance, and a random-effects model using the Restricted Maximum Likelihood (REML) estimator was fitted to account for between-study variability. Heterogeneity was assessed using Cochran\u0026rsquo;s Q test and quantified by the I\u0026sup2; statistic. Individual and pooled prevalence estimates with 95% confidence intervals (CIs) were summarized in tables and forest plots. Confidence intervals for individual studies were calculated using the Clopper\u0026ndash;Pearson method. Publication bias was visually evaluated using a funnel plot (see Supplementary Material \u0026ndash; Tab: Meta-analysis 1 and 2). To explore potential sources of heterogeneity, subgroup and meta-regression analyses were performed. Meta-regression analyses were undertaken using continuous determinants (mean age of family members and children, percentage of females, and percentage of leukemia cases), while subgroup analyses were conducted for categorical variables such as continent, assessment instrument, and symptom classification.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStudy selection\u003c/h2\u003e \u003cp\u003eA total of 2,089 records were identified across databases. After removing duplicates, 1,193 records remained. Following title and abstract screening, 194 studies were selected for full-text assessment. Of the 220 full-text articles evaluated, 190 were excluded due to specific reasons (Fig.\u0026nbsp;1). An additional 149 records were identified through other sources; after removing six duplicates and excluding 118 that did not meet the eligibility criteria, 26 proceeded to full-text review. As a result, 30 studies were deemed eligible for inclusion. The selection process is summarized in \u003cb\u003eFig.\u0026nbsp;1\u003c/b\u003e. Most studies were conducted in North American (US, Canada; 36.7%), Europe (Belgium, England, France, Germany, Greece, Poland, Russia, Sweden, Switzerland; 30.0%), Asia (China, India, Pakistan, Turkey; 16.7%), Oceania (Australia; 10%) and South America (Brazil; 3.3%) (Fig.\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of studies, family caregivers and children\u003c/h2\u003e \u003cp\u003e Most studies were cross-sectional (66.6%), followed by prospective cohorts and case-control designs (16.7%, respectively). A total of 3,788 family caregivers and 2,345 children with cancer were included across the studies. Most caregivers were women (60.8%), and the median age was 38.9 (IQR 35.5\u0026ndash;40.7) years. Only 20.4% of participants were reported to have completed a higher education degree, 42.7% were married, and 23.5% were engaged in part- or full-time employment (\u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eIn regard to the children, leukemia was the most common cancer type (29.4%), followed by brain tumours (4.8%), lymphoma (2.2%), haematological (1.5%) and sarcoma (1.3%). The median age at diagnosis was 8.3 (IQR 7.5\u0026ndash;10.4) years, and female represented 41.6% of the sample. Only nine studies (30.0%) reported treatment regimens, with most studies reporting chemotherapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Treatment duration ranged from two weeks to two years [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Of the selected studies, 50% (n\u0026thinsp;=\u0026thinsp;15) used a combined instrument (collecting both sentiments) and 50% (n\u0026thinsp;=\u0026thinsp;30) used specific instruments (collecting sentiments separately). Of these instruments, the Hospital Anxiety and Depression Scale (HADS) was the most frequently used (23.3%, n\u0026thinsp;=\u0026thinsp;7), followed by the Depression, Anxiety and Stress Scale \u0026minus;\u0026thinsp;21 items (DASS-21; 20%, n\u0026thinsp;=\u0026thinsp;6). (\u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRisk of bias\u003c/h2\u003e \u003cp\u003eDespite the low risk of bias with all studies meeting the criteria in domain 6 (\u003cem\u003eWere valid methods used for the identification of the condition?\u003c/em\u003e), most studies had high risk of bias in domain 2 (87%; \u003cem\u003eWere study participants sampled in an appropriate way?\u003c/em\u003e) and domain 3 (80%; \u003cem\u003eWas the sample size adequate?\u003c/em\u003e). Unclear or high risk of bias were also observed in most studies in domain 1 (70%; \u003cem\u003eWas the sample frame appropriate to address the target population?\u003c/em\u003e), domain 4 (80%; \u003cem\u003eWere the study subjects and the setting described in detail?\u003c/em\u003e), domain 5 (83.3%; \u003cem\u003eWas the data analysis conducted with sufficient coverage of the identified sample?\u003c/em\u003e), domain 7 (53.3%; \u003cem\u003eWas the condition measured in a standard, reliable way for all participants?\u003c/em\u003e), domain 8 (76.7%; \u003cem\u003eWas there appropriate statistical analysis?\u003c/em\u003e) and domain 9 (53.3%; \u003cem\u003eWas the response rate adequate, and if not, was the low response rate managed appropriately?\u003c/em\u003e). Individual assessments are provided in Supplementary Material \u0026ndash; Tab: Risk of Bias (\u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSingle-effect proportions on family members' anxiety symptoms\u003c/h2\u003e \u003cp\u003eBased on 19 studies including 2,116 caregivers \u003cb\u003e(Fig.\u0026nbsp;3)\u003c/b\u003e, the meta-analysis indicated a pooled prevalence rate of 25% (95% CI: 16\u0026ndash;36%) of anxiety symptoms among family members of children with cancer. Heterogeneity I\u003csup\u003e2\u003c/sup\u003e was 95.3% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Visual inspection of the funnel plot and Egger\u0026rsquo;s regression test did not indicate evidence of publication bias (t\u0026thinsp;=\u0026thinsp;0.86, p\u0026thinsp;=\u0026thinsp;0.401). (Supplementary Material \u0026ndash; Tab: funnel plot).\u003c/p\u003e \u003cp\u003eIn the meta-regression, age of caregivers (p\u0026thinsp;=\u0026thinsp;0.263) or children (p\u0026thinsp;=\u0026thinsp;0.431), proportion of female caregivers (p\u0026thinsp;=\u0026thinsp;0.786) or patients (p\u0026thinsp;=\u0026thinsp;0.218) and proportion of patients with leukemia (p\u0026thinsp;=\u0026thinsp;0.457) were not associated with higher prevalences of anxiety among family members \u003cb\u003e(Table\u0026nbsp;3).\u003c/b\u003e Subgroup meta-analysis indicated statistical differences between regions (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.8, p\u0026thinsp;=\u0026thinsp;0.021). Studies conducted in Asia (37%, 95% CI: 19%\u0026ndash;56%) and Europe (34%, 95% CI: 13%\u0026ndash;59%) reported higher pooled prevalence rates of anxiety than studies in North America (12%, 95% CI: 6%\u0026ndash;19%) and Oceania (20%, 95% CI: 7%\u0026ndash;38%) \u003cb\u003e(Table\u0026nbsp;4)\u003c/b\u003e. Differences were also observed based on the focus of the instruments (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.0, p\u0026thinsp;=\u0026thinsp;0.014), with studies assessing both anxiety and depression (32%, 95% CI: 20%\u0026ndash;45%) displaying higher pooled prevalence rates than studies specifically assessing anxiety (25%, 95% CI: 16%\u0026ndash;36%) \u003cb\u003e(Table\u0026nbsp;4)\u003c/b\u003e. Otherwise, similar pooled prevalence rates were observed between the classification of anxiety (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.5, p\u0026thinsp;=\u0026thinsp;0.474) \u003cb\u003e(Table\u0026nbsp;4)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSingle-effect proportions on family members\u0026rsquo; depression symptoms\u003c/h2\u003e \u003cp\u003eBased on 23 studies including 2,091 caregivers \u003cb\u003e(Fig.\u0026nbsp;4)\u003c/b\u003e, the meta-analysis indicated a pooled prevalence rate of 27% (95% CI: 17\u0026ndash;39%) of depressive symptoms among family members of children with cancer. Heterogeneity I\u003csup\u003e2\u003c/sup\u003e was 97.0% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Visual inspection of the funnel plot and Egger\u0026rsquo;s regression test did not indicate publication bias (t\u0026thinsp;=\u0026thinsp;0.89, p\u0026thinsp;=\u0026thinsp;0.384). (Supplementary Material \u0026ndash; Tab: funnel plot).\u003c/p\u003e \u003cp\u003eIn the meta-regression, caregiver age (p\u0026thinsp;=\u0026thinsp;0.545) or child age (p\u0026thinsp;=\u0026thinsp;0.432), the proportion of female caregivers (p\u0026thinsp;=\u0026thinsp;0.187) or patients (p\u0026thinsp;=\u0026thinsp;0.167), and the proportion of patients with leukemia (p\u0026thinsp;=\u0026thinsp;0.892) were not associated with higher prevalences of depressive symptoms among family members \u003cb\u003e(Table\u0026nbsp;5).\u003c/b\u003e Subgroup meta-analysis indicated no differences among regions (χ\u0026sup2; = 6.8, p\u0026thinsp;=\u0026thinsp;0.082), although studies conducted in Asia (52%, 95% CI: 29\u0026ndash;75%) exhibited higher pooled prevalence rates of depressive symptoms than those conducted in North America (19%, 95% IC: 7\u0026ndash;35%) and Oceania (18%, 95% CI: 8\u0026ndash;31%) \u003cb\u003e(Table\u0026nbsp;6).\u003c/b\u003e Similarly, subgroup differences were not observed regarding the type of instrument used (χ\u0026sup2; = 0.70, p\u0026thinsp;=\u0026thinsp;0.401) or between studies classifying depression as severe versus those including any depressive symptoms (χ\u0026sup2; = 0.16, p\u0026thinsp;=\u0026thinsp;0.686) \u003cb\u003e(Table\u0026nbsp;6).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to systematically review and analyze the prevalence of psychological distress, specifically depressive and anxiety symptoms, among family caregivers of children undergoing cancer treatment. The findings indicated pooled prevalence estimates of ~\u0026thinsp;26% for both anxiety and depression, suggesting that about one in four family members experienced clinically relevant distress during the child\u0026rsquo;s illness and treatment. This finding underscores the substantial psychological burden and the need for targeted screening, early identification, and appropriate psychological support to counteract long-term adverse outcomes for families.\u003c/p\u003e \u003cp\u003eThe pooled prevalence of anxiety and depressive symptoms in the present review was 25% and 27%, respectively. Our finding aligns with existing literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] demonstrating the significant psychological burden experienced by caregivers of children with cancer. This burden may be resulted from the unique challenges associated with pediatric cancer, including its life-threatening nature, its unpredictable prognosis, and the complexity and intensity of treatment regimens [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Potential explanations include the prolonged treatment duration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], severe treatment-related side effects [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and concerns about long-term health risks further exacerbating the need for sustained supportive and demanding care, consequently heightening caregivers\u0026rsquo; levels of anxiety and depression [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom the child perspective, disruptions to daily routines, such as changes in sleep, meals, and schooling, can negatively affect emotional well-being [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Importantly, caregivers\u0026rsquo; psychological distress can influence children\u0026rsquo;s emotional adjustment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], emphasizing the need for continuous psychosocial support for families coping with childhood cancer. This relationship is likely bidirectional. As children exhibit emotional distress in response to their illness and treatment, anxiety, behavioral changes or mood disturbances, caregivers may experience increased worry, fatigue, and psychological strain [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In turn, this elevated distress can diminish caregiver\u0026rsquo;s emotional availability and coping capacity to further develop the child\u0026rsquo;s sense of security and overall adjustment. This interaction underscores the importance of family-centered approaches designed to support both children and their caregivers during the disease course [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, prior studies have shown that the psychological burden experienced by caregivers of children with cancer is even greater than that observed among caregivers of children with other chronic conditions. For example, Thomas et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] investigated 194 caregivers of children with congenital heart disease (50%), diabetes (26%), asthma (4%), and cancer (20%). Overall, a significant proportion of caregivers presented moderate to severe symptoms of depression (26%) and anxiety (38%), with higher rates of depression (n\u0026thinsp;=\u0026thinsp;16, 41% severe) and anxiety (n\u0026thinsp;=\u0026thinsp;18, 46% severe) observed in caregivers of children with cancer compared to those caring for children with other illnesses.\u003c/p\u003e \u003cp\u003eMoreover, the prevalence of psychological distress observed in caregivers of children with cancer appears comparable to that observed among caregivers of adults with cancer. In the meta-analysis by Pan and Lin [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the pooled prevalence of depression was estimated at 25% (95% CI: 21%-29%) based on 85 studies conducted across 25 countries (n\u0026thinsp;=\u0026thinsp;~\u0026thinsp;23,000). Among smaller meta-analyses, including 15\u0026ndash;30 studies, the prevalence estimate ranged from 42% to 49% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Despite methodological differences, the observed prevalence of psychological distress among caregivers is consistently high across studies, which reinforces the need for systematic screening and targeted psychosocial interventions.\u003c/p\u003e \u003cp\u003eThe heterogeneity observed was considerably high across the studies included, and methodological factors appeared to contribute meaningfully to this variability. First, 13 different assessment instruments were used across the included studies, most of which measured anxiety and depression concurrently. This approach is conceptually reasonable given the comorbidity of symptoms in caregiving contexts [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], but may inflate prevalence estimates as observed in our results. In the subgroup meta-analysis, instrument type emerged as a significant moderator, with broader psychological screening tools producing higher estimates compared to anxiety-specific instruments. Likewise, Pan and Lin [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] reported significant heterogeneity (I\u0026sup2; = 97.4%) which was partially attributable to methodological differences such as the use of clinical interviews or self-report tools. These findings highlight that variability in measurement methods should be considered when comparing results across studies, consequently affecting the prevalence of psychological distress in caregivers of children with cancer.\u003c/p\u003e \u003cp\u003eDifferences in study populations may further contribute to heterogeneity. Most studies included caregivers with higher education levels, employed, and with sufficient income, predominantly from studies conducted in the Americas (43.3%) and Europe (30%). No study was identified from the African continent, suggesting a significant gap in global representation. Although we could not further explore the effect of demographical aspects, higher education and income may facilitate access to information, support, and treatment navigation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], whereas poor education may be associated with challenges in understanding medical procedures and decision-making [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, marital status and employment may influence emotional burden, with single caregivers and those who change or leave employment facing additional challenges [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These demographic and contextual differences likely contribute to variability in psychological outcomes and should be acknowledged when interpreting pooled estimates.\u003c/p\u003e \u003cp\u003eThe reviewed evidence indicates that psychological distress among caregivers is common, suggesting a need for more structured emotional support in hospital settings. Although these findings do not reflect the direct results of this review, they highlight recommendations from the included literature, such as considering systematic screening for anxiety and depressive symptoms, and implementing educational and psychosocial programs to assist caregivers during treatment [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Strategies including psychological counseling, support groups, and physical activity programs have shown potential benefits for stress management and emotional well-being, particularly when delivered in multidisciplinary contexts [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Overall, the literature suggests that caregiver-focused interventions may contribute to reducing emotional burden and improving family adjustment during pediatric cancer treatment.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e \u003cp\u003e This is the first systematic review and meta-analysis focusing on the prevalence of psychological distress among caregivers of children with cancer. The strength of this review is the inclusion of 30 studies and \u0026gt;\u0026thinsp;2,000 caregivers using meta-analysis, subgroup and meta-regression. These provided a comprehensive overview of the psychological distress experienced by families, underscoring the need for targeted psychological support in pediatric oncology settings.\u003c/p\u003e \u003cp\u003eHowever, there are a few limitations. Despite the clinically relevant prevalence rates, heterogeneity across studies was extremely high, which may reduce the certainty of this finding. This variability may be associated with cultural differences, treatment stages (e.g., early diagnosis vs. long-term care), or treatment modalities. In addition, the inability to perform meta-regression analyses using sociodemographic variables and child clinical information (including treatment duration) was another limitation, precluding us to explore the role of education levels and socioeconomic factors on the prevalence of psychological distress in this population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical implications\u003c/h2\u003e \u003cp\u003eEarly identification of caregiver distress enables timely referral to psychosocial support, reducing the risk of long-term mental health problems. Implementing structured interventions, such as counseling, support groups and physical activity programs, may improve caregivers\u0026rsquo; emotional resilience and enhance their capacity to support the child throughout treatment. Family-centered care models that address the well-being of both caregivers and children can further strengthen overall treatment outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis systematic review and meta-analysis identified a high global prevalence of anxiety and depressive symptoms among family caregivers of children undergoing cancer treatment. Despite heterogeneity across studies and methodological limitations, the pooled findings highlight a consistent psychological burden in this population. These results emphasize the importance of implementing comprehensive, multidisciplinary care strategies that extend beyond the pediatric patient to include family members, addressing their mental health needs throughout the cancer treatment trajectory.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEduarda Eugenia Dias de Jesus and Pedro Lopez contributed to the conception and design of the study. The database search, article selection, and data extraction were performed by Eduarda Eugenia Dias de Jesus, Micheli Carminatti, and Joana Bastos Matos Schlichting, under the supervision of Pedro Lopez and Cintia de la Rocha Freitas. Statistical analysis and meta-analysis were conducted by Eduarda Eugenia Dias de Jesus and Pedro Lopez. Risk of bias assessment was performed by Eduarda Eugenia Dias de Jesus, Micheli Carminatti, and Joana Bastos Matos Schlichting. The first draft of the manuscript was written by Eduarda Eugenia Dias de Jesus. Micheli Carminatti and Pedro Lopez assisted in the preparation of tables and manuscript review. Pedro Lopez, Rodrigo Sudatti Delevatti, and Cintia de la Rocha Freitas were responsible for the overall supervision of the project and performed a critical review of the manuscript. All authors reviewed and approved the final manuscript for submission.\u003cbr\u003e \u003cstrong\u003eAcknowledgments\u003cbr\u003e\u003c/strong\u003eThe authors have no acknowledgments to declare.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist in the preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven that this is a systematic review and meta-analysis of previously published and publicly available data, ethical approval and informed consent were not required for this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflict of Interest Statement\u003cbr\u003e\u003c/strong\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMess E, Misiąg W, Klaszczyk T, Kryś K. 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J Pediatr Hematol Oncol. 2025;47(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePara\u0026iacute;zo JLM do, Ferreira JAR, Camilo LV, Souza AFA, S\u0026aacute; RMB de, Viana JVM, et al. Assist\u0026ecirc;ncia multidisciplinar a pacientes oncol\u0026oacute;gicos: Impacto do cuidado integrado. Journal of Medical and Biosciences Research. 2025;2(2):360\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeychenne M, White RL, Richards J, Schuch FB, Rosenbaum S, Bennie JA. Do we need physical activity guidelines for mental health: What does the evidence tell us? Ment Health Phys Act. 2020;18:100315.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAraujo RHO, Werneck AO, de Jesus GM, Silva DRP. Is it possible to run after positive affective experiences instead of health benefits without tackling social inequalities? J Sport Health Sci. 2024;13(6):756\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026aacute;nchez-Egea R, Rubio‐Aparicio M, S\u0026aacute;nchez‐Meca J, Rosa‐Alc\u0026aacute;zar AI. Psychological treatment for family members of children with cancer: A systematic review and meta‐analysis. Psychooncology. 2019;28(5):960\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Sociodemographic characteristics of family caregivers and measuring instruments used to verify the psychological suffering of family members.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"755\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eYılancıoğlu (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eelementary education (mother 52% and father 63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eTerrasson et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e40% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e93% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e80% exercise professional activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eHsu et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e40% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e87% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e67% part-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003ePROMIS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eWikman et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e48% high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eBAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eNeu et al. (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e27% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e85% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e46% part-time and full-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eHaegen et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e45% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e53% married/partnered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eHannah Kurz et al. (2025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e50.4% \u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e46.1% average status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e77.2% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e77.8% paid employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eGAD-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eQuast et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e52% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e34% between $75,000\u0026ndash;$124,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003ePROMIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eLewandowska et al. (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e57% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e55% financial situation \u0026quot;good\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e62% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eHADS *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eJayaganapathy et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eDASS-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eChristen et al. (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e48.5% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e55% medium/high (\u0026ge;6,000 CHF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e53% employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eWAQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMeeske et al. (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e33% elementary education**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e41% between 10\u0026ndash;35 thousand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e69% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eCES-D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eKoyu et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e34.9% elementary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e65% revenue equals expense\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e83% unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eSTAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eBurns et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e52% with a school degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e90% single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eaverage of 3.20 hours of paid work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eDASS-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMcCarthy et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e29% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e83% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e34% part-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eDASS-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMcLoone et al. (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e57% without a school degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e92% partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eaverage of 2.10 hours of paid work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eDASS-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eElkin et al. (2007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e56% partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003ePeterson et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eBSI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eBurns et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e46% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e47% income above $49,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e100% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e69% full time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eBSI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eVernon et al. (2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e75% higher education**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e45% married**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eDASS-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eVitorino et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e53.2% financial problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e81% employed/retired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eZhao et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e34% high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eWilford (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e64% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e86% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003ePROMIS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eGhufran et al. (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e55% higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e65% above 50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e95% housewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eHAM-D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eI.Vlachos et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e48% elementary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e92% partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eBemis et al. (2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAverage of 13.9 years of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e26.8% between $25,001\u0026ndash;50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e72% married/partnered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eKatz et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e78.3% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eDASS-21 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eCES-D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eAllen et al. (1997)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eSTAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eSanto et al. (2011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e59.4% elementary education**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e75% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e65.6% of the home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eGreening et al. (2007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e60% married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eSTAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eBDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* The instrument chosen for the study was used only to detect symptoms of anxiety; the study opted not to present data on symptoms of depression.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Risk of bias assessment of included studies.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"447\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eYılancıoğlu (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eTerrasson et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eHsu et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eWikman et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eNeu et al. (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eHaegen et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eHannah Kurz et al. (2025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eQuast et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eLewandowska et al. (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eJayaganapathy et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eChristen et al. (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eMeeske et al. (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eKoyu et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eBurns et al. (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eMcCarthy et al. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eMcLoone et al. (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eElkin et al. (2007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003ePeterson et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eBurns et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eVernon et al. (2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eVitorino et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eZhao et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eWilford (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eGhufran et al. (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eI.Vlachos et al. (2023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eBemis et al. (2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eKatz et al. (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eAllen et al. (1997)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eSanto et al. (2011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.1622%;\"\u003e\n \u003cp\u003eGreening et al. (2007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.98198%;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eLegend: Y = Yes (low risk of bias); N = No (high risk of bias); I = Unclear (insufficient information);\u0026nbsp;D1: Was the sample frame appropriate to address the target population?; D2: Were study participants sampled in an appropriate way?; D3: Was the sample size adequate?; D4: Were the study subjects and the setting described in detail?; D5: Was the data analysis conducted with sufficient coverage of the identified sample?; D6: Were valid methods used for the identification of the condition?; D7: Was the condition measured in a standard, reliable way for all participants?; D8: Was there appropriate statistical analysis?; D9: Was the response rate adequate, and if not, was the low response rate managed appropriately?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Meta-regression for anxiety symptom information.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"271\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.9705%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta; \u0026plusmn; SE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4982%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.9705%;\"\u003e\n \u003cp\u003eAge of caregivers, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5314%;\"\u003e\n \u003cp\u003e0.018 \u0026plusmn; 0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4982%;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.9705%;\"\u003e\n \u003cp\u003eAge of children, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5314%;\"\u003e\n \u003cp\u003e0.034 \u0026plusmn; 0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4982%;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.9705%;\"\u003e\n \u003cp\u003eFemale caregivers, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5314%;\"\u003e\n \u003cp\u003e\u0026minus;0.000 \u0026plusmn; 0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4982%;\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.9705%;\"\u003e\n \u003cp\u003eFemale children, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5314%;\"\u003e\n \u003cp\u003e\u0026minus;0.011 \u0026plusmn; 0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4982%;\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47.9705%;\"\u003e\n \u003cp\u003eLeukemia, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5314%;\"\u003e\n \u003cp\u003e0.002 \u0026plusmn; 0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4982%;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Meta-analysis analyzed by subgroup in relation to continents, instrument type, and anxiety symptoms.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"707\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescriptive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRandom-effect meta-analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeterogeneity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest for subgroup difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudies (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e16 to 36%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e95.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eAsia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e19 to 56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e90.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 36px;\"\u003e\n \u003cp\u003e9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eEurope\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e13 to 59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e97.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eNorth America\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e06 to 19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e84.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eOceania\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e07 to 38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e79.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstrument\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eCombined\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e20 to 45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e93.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 36px;\"\u003e\n \u003cp\u003e6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eSpecific\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e1116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e03 to 23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e97.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClassification of anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eSerious\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e09 to 37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e93.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cem\u003eWith symptoms\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e1310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e16 to 45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e96.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 5.\u003c/strong\u003e Meta-regression for depression symptom information.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"389\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta; \u0026plusmn; SE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eAge of caregivers, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0.010 \u0026plusmn; 0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eAge of children, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;0.024 \u0026plusmn; 0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale caregivers, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0.004 \u0026plusmn; 0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale children, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;0.010 \u0026plusmn; 0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eLeukemia, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;0.000 \u0026plusmn; 0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 6.\u003c/strong\u003e Meta-analysis analyzed by subgroup in relation to continents, instrument type, and depression symptoms.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"692\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescriptive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRandom-effect meta-analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeterogeneity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest for subgroup difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudies (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e17 to 39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e97.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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44px;\"\u003e\n \u003cp\u003e97.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cem\u003eOceania\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e08 to 31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e66.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstrument\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n 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style=\"width: 45px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cem\u003eSpecific\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e1091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e08 to 40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e97.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n 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\u003c/tbody\u003e\n \u003c/table\u003e\u0026nbsp;\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neoplasms, Caregivers, Emotional Stress, Mental Health","lastPublishedDoi":"10.21203/rs.3.rs-8369169/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8369169/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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 \u0026gt; 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eApproximately 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.\u003c/p\u003e","manuscriptTitle":"Prevalence of Psychological Distress Among Family Caregivers of Children with Cancer: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-24 00:39:56","doi":"10.21203/rs.3.rs-8369169/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38bc2956-fe84-427d-8799-ab0f599f7ce7","owner":[],"postedDate":"January 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T10:56:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-24 00:39:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8369169","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8369169","identity":"rs-8369169","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}