Prevalence and predictors of symptoms of anxiety and depression, and comorbid symptoms of distress in parents of childhood cancer survivors and bereaved parents five years after end of treatment or a child’s death

Abstract

Background: Symptoms of anxiety and depression and their comorbidity in parents of children diagnosed with cancer, particularly later in the cancer trajectory, need further study. The aim was to investigate the prevalence and predictors of symptoms of anxiety and depression in parents of childhood cancer survivors and bereaved parents, five years after end of treatment or a child’s death and to investigate comorbidity between symptoms of anxiety, depression and posttraumatic stress.

Material and methods: Participants were 132 parents (68 mothers, 64 fathers) of survivors and 37 bereaved parents (20 mothers, 17 fathers). Chi-square test and t-test were used to explore differences in symptoms of anxiety and depression. Comorbidity was explored using Pearson’s correlations and Chi-square test. Multivariable hierarchical linear regressions were used to identify predictors of symptoms of anxiety and depression.

Results: In parents of survivors, 20% reported anxiety and 14% reported depression. Corresponding figures among bereaved parents were 30% and 35%. Among parents of survivors reporting clinically relevant anxiety and depression, a larger proportion were mothers than fathers. No such difference was found among bereaved parents. Symptoms of anxiety, depression and posttraumatic stress were highly correlated (all r ≥ 0.65, p < .001). Comorbid symptoms were reported by 7–11% of parents of survivors and 14–24% of bereaved parents. In multivariable analyses, more severe symptoms of depression were associated with anxiety, posttraumatic stress and distress related to previous stressful life events. Being a mother, symptoms of depression and posttraumatic stress were associated with more severe symptoms of anxiety.

Conclusion: A subset of parents report clinically elevated symptoms of anxiety and depression, comorbid anxiety, depression and posttraumatic stress. Experiencing distress related to previous stressful life events as well as concurrent comorbidity were associated with more severe psychological distress at five years after end of treatment/a child’s death. These results deserve further attention in research and clinical care.

Acknowledgments

We would like to thank all study participants, the coordinating nurses at the pediatric oncology centers and Susanne Lorenz and Ulrika Pöder for important contributions to this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work has been supported by grants to PI Louise von Essen from the Swedish Research Council (grant numbers K2008-70X-20836-01-3, K2011-70X-20836-04-4, K2015-99X-20836-08-4), the Swedish Cancer Society (grant numbers 2007/1015, 2010/726, 2013/580, 2014/613), and the Swedish Childhood Cancer Foundation (grant number PROJ08/010).