Uncorrected Proof Iran J Psychiatry Behav Sci. In Press(In Press):e113591. Published online 2022 April 25. doi: 10.5812/ijpbs-113591. Systematic Review Anxiety, Depression, and Quality of Life in Caregivers of Children with Cleft Lip and Palate: A Systematic Review Parastoo Namdar 1, 2 , Mehdi Pourasghar 3 , Farzaneh Lal Alizadeh 4 and Atena Shiva 5, 2, * 1 Department of Orthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran 2 Dental Research Center, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran 3 Psychiatry and Behavioral Sciences, Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran 4 Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 5 Department of Pathology, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran * Corresponding author: Department of Pathology, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran. Email: hosseini.somay@gmail.com Received 2021 February 08; Revised 2021 October 25; Accepted 2022 February 04. Abstract Context: Cleft Lip and Palate (CL/P) is the most common craniofacial malformation in the oral cavity, with a prevalence of “1 to 2in 1,000 live births worldwide. Parents with CL/P children are more prone to experience emotional disorders, especially depression, and have higher child-related stress than the parents of normal children. Due to the effect of the mental status of parents on chil- dren, the assessment of the psychological aspects of this problem and its effects on the patients and their parents is critical. Evidence Acquisition: This systematic review was carried out to determine the quality of life (QoL) and emotional problems, includ- ing anxiety and depression, in the mothers of CL/P children. All the published studies were searched in three electronic databases, including MEDLINE, PubMed, and Web of Science, up to December 30, 2020, using the keywords "Orofacial Clefts” and “Cleft Lip and Palate” in combination with “Anxiety," "Stress," "Depression," and "Quality of Life” in addition to “Parents," "Mothers," "Fathers," and "Caregivers." Results: Finally, 29 articles met the eligibility criteria for this review. Due to the differences in health care and culture, controversial findings were obtained on the QoL of parents with CL/P children. Social support plays a vital role in the prevention, resolution, and treatment of psychological problems of parents with CL/P children. The majority of studies confirmed the higher levels of anxiety and depression in caregivers of children with CL/P than in normal individuals. Conclusions: These findings emphasize the necessity of psychological screening in the first few months following the diagnosis to facilitate providing appropriate psychological support for parents with CL/P children. Keywords: Anxiety, Cleft Lip, Cleft Palate, Depression, Quality of Life 1. Context Orofacial clefts, including cleft lip (CL), cleft palate (CP), or cleft lip and palate (CL/P) together, are the most com- mon heterogeneous craniofacial malformations in the oral cavity characterized by environmental and genetic fac- tors (1). These clefts may be unilateral or bilateral. Max- illary retrognathism, greater anterior facial heights, and retroclined maxillary incisors are the main clinical factors in patients with unilateral CL/P (2, 3). The disease preva- lence is 1 to 2 in 1,000 live births worldwide. The highest and lowest incidences of CL/P are reported among Indian and Afro-Caribbean populations, respectively (4-7). The main aspects that should be considered for these patients are the modification of facial malformation, optimization of the quality of speech, and maintenance or restoration of middle ear function (8). CL/P patients are regarded as less intelligent and social with fewer professional opportunities than normal chil- dren (9-12). In this regard, the most important protective factor for children with CL/P is a healthy family environ- ment. The parents of special children with intellectual dis- abilities are prone to experience emotional disorders, es- pecially depression, and have higher child-related stress than parents of normal children (13, 14). There are some re- ports on the experience of CL/P patients, intellectual and social development of CL/P subjects, and reactions of CL/P cases to their unique environments; however, limited stud- ies have assessed the psychological status of parents with CL/P children. Due to the effect of the mental status of par- ents on children, the assessment of psychological aspects of this problem and associated effects on the patients and Copyright © 2022, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.