This systematic review seeks to evaluate the QoL of parents of children with disabilities in Saudi Arabia, which is especially important as it may be used to inform evidence-based interventions and policy enhancements. The objectives of this systematic review are structured around the research questions outlined in Table 1.

This review included quantitative studies that met specific inclusion and exclusion criteria. Studies were included if they focused on the QoL of parents or primary caregivers of children with disabilities in Saudi Arabia. Various disability conditions were considered, including attention-deficit/hyperactivity disorder (ADHD), cerebral palsy (CP), autism spectrum disorder (ASD), physical and sensory disabilities, intellectual and developmental disabilities, and Down syndrome (DS).

The age range of parents included in the studies was 23 years to over 57 years, while caregivers ranged from 14 to 57 years. Children included in the studies ranged in age from infancy to 18 years. Only studies that assessed QoL using validated instruments were included. These instruments comprised the WHOQOL-BREF (including its Arabic version), PedsQL 3.0 CP Module, the Beach Center Family QoL Scale, SF-36, and RAND SF-36.

Eligible studies were required to compare parental QoL across different demographic and child-related factors. Such factors included parent gender, employment status, education, housing, and type of disability. Comparisons were also made between mothers and fathers, caregivers of children with CP, ADHD, or ASD, and families with children with or without disabilities. In addition, studies examining income level, coping strategies, marital status, and experiences of discrimination were considered.

Exclusion criteria were applied to ensure the reliability of findings. Studies involving children with comorbid chronic illnesses were excluded, as these conditions could confound QoL outcomes. Intervention-based studies that evaluated the effects of treatments or programs on parental QoL were also excluded. Furthermore, only studies published in English between January 2020 and December 2024 were included to maintain consistency in language and time frame.

An initial search of the Cochrane Database of Systematic Reviews and PROSPERO was conducted in order to identify any existing or registered systematic reviews on the QoL of parents of children with disabilities in Saudi Arabia (17). Following this, a comprehensive literature search was carried out across multiple electronic databases, including PubMed, Scopus, Embase, Web of Science, CINAHL, ERIC, the Cochrane Library, Google Scholar, the Saudi Digital Library, and NARIC. All databases were searched using the same time limits and core eligibility filters, restricting results to studies published between January 2020 and December 2024, written in English, and involving human participants. This systematic approach was applied in order to understand the most recent evidence and to be able to capture all relevant studies within a defined time frame. It has been shown that using multiple databases, as well as being thorough in search methods, increases the likelihood that all eligible studies are identified (18).

A structured search strategy was developed, combining controlled vocabulary such as MeSH terms where applicable and free-text keywords. Boolean operators “AND” and “OR” were applied to combine search terms. The search string focused on parental and caregiver populations, different types of disabilities including autism spectrum disorder, ADHD, cerebral palsy (CP), Down syndrome (DS), and other physical disabilities, QoL outcomes, and Saudi-specific studies. Database-specific filters were applied in order to improve precision. In PubMed, filters for publication date, English language, human participants, and study type (observational and cross-sectional studies) were applied. In Scopus and Web of Science, searches were limited to peer-reviewed journal articles within health, social science, and psychology subject areas published between 2020 and 2024. Embase searches were restricted to human studies, English language, and observational study designs. CINAHL and ERIC were filtered for caregiver or parent populations, quality-of-life outcomes, English language, and the specified publication period. The Cochrane Library was searched in order to confirm the absence of prior Saudi-specific syntheses. Google Scholar was used as a supplementary source, and the first 200 results sorted by relevance were screened. In addition, the Saudi Digital Library and NARIC were searched for peer-reviewed articles matching the same keywords and publication period.

During the screening stage, additional inclusion and exclusion criteria were applied based on parental employment status (full-time, part-time, unemployed), parental and child age, and type of disability, in line with the predefined eligibility criteria. Studies examining the caregiving role and its association with parental QoL across disability types were included to inform caregiver well-being, policy, and practice. Most eligible studies were published between 2020 and 2024, with publications grouped into early (2020–2021), mid (2022–2023), and recent (2024) periods, demonstrating a clear upward trend in research activity. Reference lists were also manually screened to ensure comprehensive study identification.

The methodological quality of the reviewed studies was carefully assessed to ensure that the review findings are reliable and valid. A systematic evaluation process was employed to enhance transparency and maintain methodological rigor. The PRISMA 2020 guidelines (Page et al. 40) informed the assessment, as they provide a clear outline of how to report and assess the possibility of bias, supporting a consistent and reproducible review process. It is the method, which considers the quality of every study and its adherence to general methodological principles, that is used due to the necessity of reliable evidence (40).

The quality of the studies was checked with the help of predefined criteria, which is a systematic process that is currently being employed in order to make the review transparent and credible. These criteria were designed to include study design and methods, sampling strategy and sample size, validity and reliability of QoL measurement tools, appropriate application of data analysis approaches, consideration of potential confounding factors, ethical approval, clear reporting of results, and relevance to parental QoL in Saudi Arabia, allowing for a consistent assessment (19). Studies were rated as Good (high quality), Moderate (with some limitations), or Low (with major weaknesses). To reduce assessment bias, all included studies were evaluated independently by two reviewers, a process aimed at ensuring consistency and reliability. Cohen's Kappa was used to measure agreement between the reviewers, as it helps show how consistent the study quality ratings were beyond chance.

The Figure 2 illustrates the process of selecting studies for the systematic review. Initially, 469 records were identified from multiple databases. Before screening, 240 duplicate or repeated records were removed, leaving 229 records to be screened by title and abstract, of which 169 were excluded for not meeting the inclusion criteria. Next, 60 full-text articles were requested for review, but 7 could not be retrieved. Out of 53 full-text articles assessed for eligibility, 39 were excluded due to reasons such as disabilities caused by chronic illnesses, studies not focused on parents in Saudi Arabia, studies published before 2014, non-English articles, studies not measuring parental QoL, or those involving QoL interventions. Ultimately, 14 studies were included in the systematic review.

The analysis included a total of 1,841 participants, comprising 1,090 mothers (60.18%), 418 fathers (23.08%), and 333 caregivers (18.39%), highlighting the diverse distribution of key demographic groups across the studies (41–54) (see Table 3). The age range for mothers was primarily from their early 20s to over 50 years, with most studies reporting an average age between 30 and 45 years. Similarly, the fathers' ages range from 20 to over 50 years, with most fathers being between 31 and 50 years old. The total number of children with disabilities across these studies is 1460, with common disabilities including ASD, ADHD, CP, and other physical disabilities such as stroke and amputations. The children in these studies generally range from 1 to 18 years old, with the majority falling between 1 and 5 years and 6–10 years. The studies reporting 539 people (46.4%) were employed, while 623 people (53.6%) were unemployed across the studies. Notably, the studies by Zahra et al. (47), Tedla et al. (44), Subke et al. (41), AlAhmari et al. (49), and Alhazmi et al. (54) did not explicitly mention either the employment status of caregivers or support received by families. The QoL measures used across the studies include WHOQOL-BREF, PedsQL 3.0, and RAND SF-36, among others. A variety of support from services was reported, including rehabilitation services, telehealth, special education, and government financial support, although some caregivers faced challenges related to limited access and discrimination. Comorbidities such as learning difficulties, autism, ADHD, and physical impairments were often noted in children with disabilities (see Table 2).

The reviewed studies used different tools to measure QoL across several areas of life. The most common tool was the WHOQOL-BREF, used in 10 studies, which looks at physical, psychological, social, and environmental health. Determinants like employment, education, income, and coping strategies had a big impact on these areas. For instance, Subke et al. (41) and Tedla et al. (43) found that parents who were employed and had higher education reported better QOL, especially in physical and psychological aspects. Another tool, the Beach Center Family QOL Scale, used by Alasiri et al. (46), focused on how the family functions, including family interactions, parenting, and emotional well-being. The PedsQL 3.0 CP Module, applied in Tedla et al. (43), looked specifically at children with cerebral palsy, showing differences in mobility and age-related health outcomes. The SF-36 survey, used by Alenazi et al. (51) and Sulaimani et al. (52), measured physical functioning, role limitations, energy, emotional well-being, and pain, highlighting how caregiving and sociodemographic factors affect parents' lives. Overall, all these tools showed a similar picture: parents' quality of life is strongly influenced by caregiving duties and sociodemographic factors, with physical, psychological, and social areas being the most affected.

As part of the quality appraisal, several quality criteria were applied to systematically evaluate each study, and the results are summarized in Table 4.

The findings below summarize the domain-specific QoL outcomes across the included studies, highlighting both positive and negative effects identified using different validated assessment instruments among caregivers and children with disabilities in Saudi Arabia (Table 5).

WHOQOL-BREF

Used in 10 of the 14 studies, making it the most frequently applied QoL instrument.

A systematic review was conducted to summarize findings on the QoL of caregivers of children with disabilities in Saudi Arabia. It has been observed that caregiver QOL is influenced by sociodemographic factors, such as gender, employment, education, marital status, and income, as well as by the type and severity of the child's disability (see Table 5). For example:

Alhefdhi et al. (42) found lower QOL among single and unemployed mothers. Marital status, occupation, and number of children were significant predictors. The environmental domain was most negatively affected, particularly in mothers facing economic or social challenges (p < 0.05).

This section examines whether QoL outcomes differ between mothers and other caregivers, including fathers and extended family members, based on evidence from the included comparative studies. Overall, most studies indicate that mothers experience poorer QoL outcomes than other caregivers.

Ten studies using the WHOQOL-BREF reported consistent differences in QoL outcomes between mothers and other caregivers, with mothers generally reporting lower scores across multiple domains.

To answer the fourth research question, the results show that QoL affects caregivers in different ways across several areas. Physical health was one of the most challenging areas, especially for caregivers looking after children with severe disabilities or limited mobility. Many caregivers reported feeling physically exhausted and experiencing health problems due to the constant demands of caregiving [Tedla et al. (43), Sulaimani et al. 52]. Psychological well-being was also strongly affected, with caregivers reporting high levels of stress, anxiety, and depression. Mothers and caregivers who relied on poor coping strategies were particularly vulnerable and reported lower psychological QoL [Alenezi et al. (50), Subke et al. 41]. Social relationships were another area of difficulty, as many caregivers felt isolated and disconnected from others. However, those who took part in support groups reported better social QoL because these groups helped them feel more connected and less alone [Alhazmi et al. (54), Al Awaji et al. 53]. Environmental QoL was closely linked to practical factors such as housing, safety, and access to services. Caregivers with better financial stability and access to resources tended to report better outcomes in this area (Alhazmi et al. (54), Zahra et al. (47). Overall, these findings show that caregivers face different challenges across multiple areas of quality of life, rather than in just one single domain (see Table 5).

Social and governmental support systems, such as rehabilitation services and financial aid, significantly enhance the QoL for parents of children with disabilities in Saudi Arabia. Parents who received access to rehabilitation services reported better QoL. For example, Tedla et al. (43) noted that caregivers of children with CP benefited from rehabilitation and special education services, which contributed positively to their QoL. Financial support was shown to significantly alleviate stress. In Tedla et al. (44), 55.7% of caregivers received government financial support, which correlated with improved QoL measures. Alhazmi et al. (54) also highlighted the role of financial stability, often enabled by employment or subsidies, in improving caregivers' QoL across multiple domains. Although the Saudi government provides funds and access to rehabilitation centers [Al Awaji et al. (53)], gaps remain in the accessibility and availability of services, particularly during lockdowns or crises, reducing the potential benefits for caregivers. AlAhmari et al. (49) emphasized limited healthcare access and social integration gaps, negatively impacting caregivers' QoL. Speech and behavioral therapy, as noted by Alasiri et al. (46), were crucial for parents of children with autism, leading to enhanced family satisfaction.

The strengths of this study include its systematic and comprehensive approach, following PRISMA guidelines to synthesize evidence from multiple Saudi-based studies published between 2020 and 2024, which enhances methodological rigor and transparency (40). The inclusion of diverse childhood disabilities and the use of validated QoL instruments allow for meaningful comparisons across different caregiver groups and life domains. Additionally, by focusing specifically on the Saudi context, this review fills an important research gap and provides culturally relevant insights (1, 3, 65), while identifying key vulnerable groups and highlighting the role of support services, making the findings highly relevant for healthcare policy, family support planning, and future research (8, 14, 52).

Despite these strengths, several limitations must be addressed for proper interpretation of the findings. Most importantly, cross-sectional designs were employed in all included studies, which restricts causal relationships between caregiving factors and parental QoL from being inferred (16, 27, 62). It is straightforward that assessment of how caregiver QoL evolves over time or in response to changes in disability severity, service access, or policy interventions is prevented by the lack of longitudinal evidence, which must be addressed in future research (30, 55). When these changes are considered, it becomes evident that causal links cannot be established.

QoL outcomes were predominantly based on self-reported measures, which can be influenced by recall bias, response bias, and social desirability effects (55, 56). Cultural norms within Saudi society may further affect how psychological distress or social challenges are reported by caregivers, which may have led to under- or overestimation of certain QoL domains. This is particularly significant, as uncertainty in the reported outcomes could thereby be increased (59).

A clear gender imbalance was observed, with mothers comprising the majority of participants, which is one challenge in the included studies. While real-world caregiving patterns are reflected, generalizable findings for fathers and other caregivers are not always obtained, thereby restricting deeper gender-comparative analyses (31, 60). Following this, it becomes apparent that gender differences in caregiver QoL should be explored in future research in order to understand the full scope of caregiving experiences and to what extent these experiences vary by caregiver type (23, 28).

Methodological heterogeneity, which included differences in QoL instruments, reporting formats, and domain-level analyses, limited direct comparability and precluded quantitative meta-analysis (27, 30, 40). Convenience sampling from single regions or clinical settings was used in several studies, which reduced national representativeness and limited insights into rural or underserved populations. It was shown that observed patterns of caregiver QoL could thereby be influenced, which must be considered when interpreting the results. Finally, some studies lacked detailed diagnoses or comorbidity data, which may have affected caregiver QoL and should be addressed in future research (16, 43, 44).

The QoL of parents caring for children with disabilities in Saudi Arabia is affected by several ongoing challenges. Services are not evenly distributed, with families in urban areas having better access than those in rural regions, especially for specialized therapies such as speech and language services (23, 66). Financial support often does not fully cover the high cost of care and long-term therapy, which places added stress on families. There is also a shortage of trained professionals and specialized centers, making it harder for families to receive consistent and high-quality support (65, 66). Cultural attitudes toward disability can further increase emotional strain and limit social participation for caregivers. Looking ahead, future efforts should focus on improving access to services across all regions, expanding training programs to build a skilled workforce, and strengthening community-based rehabilitation services to better support families and improve caregiver QoL.