Abstract
OBJECTIVES: To assess the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) and their associated factors among the caregivers of children diagnosed with cancer in Oman and explore the changes in psychological outcomes over time. DESIGN: A multicentre, prospective, cohort study. SETTING: The National Oncology Centre of the Royal Hospital, the Sultan Qaboos University Hospital and the Sultan Qaboos Comprehensive Cancer Care and Research Centre in Muscat, Oman. PARTICIPANTS: Caregivers of Omani children and adolescents diagnosed with cancer at the three primary cancer referral centres in Oman. OUTCOME MEASURES: Validated Arabic versions of the State-Trait Anxiety Inventory, the Centre for Epidemiologic Studies Depression Scale and the Impact of Event Scale-Revised were used to screen for symptoms of anxiety, depression and PTSD, respectively. The first assessment (T1) was conducted any time within the first 3 months of the child's diagnosis, while the second assessment (T2) was conducted 3-6 months after T1. Multivariate linear regression models were used to investigate the association between socio-demographic and clinical characteristics and average anxiety, depression and PTSD scores. RESULTS: Of the 92 caregivers of Omani children and adolescents diagnosed with cancer, 45.7%, 53.3%, 45.7% and 68.5% exhibited state anxiety, trait anxiety, depression and PTSD at T1. Subsequently, prevalence rates of these conditions decreased to 32.6%, 42.4%, 33.7% and 55.4%, respectively, at T2. Between T1 and T2, the prevalence of state anxiety decreased significantly, as did average state anxiety and PTSD scores (p<0.05). According to the univariate analysis, the child's age and awareness of their diagnosis correlated with caregiver depression scores (p<0.05). Moreover, the child's gender was associated with both caregiver anxiety and depression scores (p<0.05). Mothers reported significantly higher depression scores compared with other caregivers (p=0.029). At T2, the type of cancer treatment received by the child was associated with caregiver anxiety and depression scores (p<0.05). At T2, a linear regression analysis showed significant positive associations between state anxiety scores and caregiver education level (β=0.196; p<0.001) and between trait anxiety scores and caregiver gender (β=0.096; p=0.029). Depression scores were significantly negatively affected by the child's age at T1 (β=-0.572; p=0.001) and the child's gender at T2 (β=-0.119; p=0.018). Family income was negatively associated with caregiver PTSD scores at T2 (β=-0.094; p=0.049). CONCLUSIONS: Caregivers of Omani children and adolescents with cancer, especially mothers, are likely to suffer from anxiety, depression or PTSD. Offering additional psychological support, such as counselling services, to the caregivers of children and adolescents diagnosed with cancer is recommended to reduce psychological distress and address potential mental health challenges in a timely manner.