Figure 4 Effects of IVR-based interventions on anxiety (Exclusion of 2 studies).
3.2.2 | Depression meta-analysis
Three studies16-18 respectively, exemplified the effect of IVR on depression in breast cancer patients, and the results showed that IVR-based interventions were effective in alleviating depressive symptoms [SMD = -2.31, 95% CI = (-4.39,0.23)](Figure 5) compared to the control group, with a statistically significant difference (p < 0.05), but with a high degree of heterogeneity (I2 = 97%). After excluding the Chirico et al.18 ’s study, the combined effect size was statistically significant and heterogeneity decreased significantly [I2 =35%, SMD=-0.68, 95% CI=(-1.09,-0.27), p=0.001](Figure 6). Heterogeneity may be related to treatment duration and intervention period.