Effects of eHealth interventions on depression, anxiety, quality of life, and post-traumatic stress symptoms among parents of children with cancer: A meta-analysis of randomized controlled trials
Abstract
Objective To synthesize evidence from randomized controlled trials on the effects of eHealth interventions on depression, anxiety, quality of life, and post-traumatic stress symptoms in parents of children with cancer. Methods PubMed, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Web of Science, CNKI, VIP, and SinoMed were searched from inception to 31 January 2026. Two reviewers independently screened studies, extracted data, assessed risk of bias using RoB 2 and rated certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). For family-randomized trials, standard errors were inflated using a design effect with a primary intraclass correlation coefficient (ICC) of 0.50; sensitivity analyses used ICCs of 0.10, 0.25, and 0.75. Exploratory subgroup analyses, sensitivity analyses, and publication bias assessments were conducted when appropriate. Results Thirteen randomized controlled trials involving 1022 parents were included in the meta-analysis. eHealth interventions significantly reduced depression (standardized mean difference [SMD] = −0.56, 95% confidence interval [CI] −0.76 to −0.36) and anxiety (SMD = −0.66, 95% CI −1.12 to −0.20). The effect on quality of life was not statistically significant (SMD = 0.36, 95% CI −0.06 to 0.78). A significant reduction in post-traumatic stress symptoms was observed (SMD = −0.48, 95% CI −0.84 to −0.11), but this result was not stable in sensitivity analysis. For anxiety, excluding one influential study reduced the pooled effect to −0.45 (95% CI −0.62 to −0.27) and I2 from 80.5% to 28.5%. Effect directions, statistical significance, and certainty ratings were unchanged across ICC assumptions of 0.10–0.75. The certainty of evidence was moderate for depression and very low for anxiety, quality of life and post-traumatic stress symptoms. Conclusions eHealth interventions may help reduce depression in parents of children with cancer. Evidence for anxiety, quality of life and post-traumatic stress symptoms remains limited and should be interpreted with caution. More rigorous randomized controlled trials with clearer intervention reporting, longer follow-up, and better adherence data are needed. Systematic review registration CRD420251236158.