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

Figures & data

Table 1. Sample characteristics.

	Parents of survivors			Bereaved parents
Parent characteristics	Mean (SD)	n	%	Mean (SD)	n	%
Parents, total		132	78.1		37	21.9
Mothers		68	51.5		20	54.1
Fathers		64	48.5		17	45.9
Age (years), T1	38.9 (6.6)			37.1 (7.5)
<30		12	9.1		5	13.5
33–39		67	50.8		20	54.1
≥40		53	40.2		12	32.4
Age (years), T7^a	45.3 (6.4)			43.3 (7.6)
<30		–	–		1	2.7
33–39		23	18.2		11	29.7
≥40		105	79.5		20	54.1
Marital status, T7
Married/cohabitating		112	84.8		33	89.2
Single		11	3.0		3	8.1
Non-cohabitating partner		9	6.8		1	2.7
Education level, T1
Nine years		16	12.1		4	10.8
Upper secondary		64	48.5		18	48.6
University		50	37.9		14	37.8
Not stated		2	1.5		1	2.7
	Survivors			Deceased children
Child characteristics	Mean (SD)	n	%	Mean (SD)	n	%
Children, total		74	77.0		22	23.0
Girl		35	47.3		10	45.5
Boy		39	52.7		12	54.5
Age (years), T1	7.8 (5.1)
0–3		20	27.0		7	31.8
4–7		23	31.1		5	22.7
8–12		17	23.0		6	27.3
13–18		14	18.9		4	18.2
Age (years), T7^b	14.2 (5.0)			–
4–7		8	10.8		–	–
8–12		25	33.8		–	–
13–18		40	54.0		–	–
Number of siblings, T1
0		6	8.1		2	9.1
1–2		55	74.3		17	77.3
≥ 3		13	17.6		3	13.6
Diagnosis
Leukemia		27	36.5		7	31.8
CNS tumor		6	8.1		5	22.7
Other solid tumor		41	55.4		10	45.5

^aMissing: parents of survivors n = 3, bereaved parents n = 5.

^bMissing: survivors n = 1.

n: number; SD: standard deviation.

Table 2. Psychological distress in parents of survivors or bereaved parents five years after the end of cancer treatment or a child’s death.

	Parents of survivors			Bereaved parents
	Total (n = 132)	Mothers (n = 68)	Fathers (n = 64)	Total (n = 37)	Mothers (n = 20)	Fathers (n = 17)
Anxiety
BAI total score, mean (SD)	4.60 (6.1)	6.2 (6.8)	2.9 (4.8)	6.7 (7.8)	6.8 (5.9)	6.6 (9.7)
BAI, n (%)
No anxiety (≤7)	106 (80.3)	50 (73.5)	56 (87.5)	24 (64.9)	12 (60.0)	12 (70.6)
Anxiety above cutoff (≥8)	26 (19.7)	18 (26.5)	8 (12.5)	13 (35.1)	8 (40.0)	5 (29.4)
Mild	16 (12.1)	10 (14.8)	6 (9.4)	8 (21.6)	5 (25.0)	3 (17.6)
Moderate	8 (6.1)	6 (8.8)	2 (3.1)	4 (10.8)	3 (15.0)	1 (5.9)
Severe	2 (1.5)	2 (2.9)	0 (0.0)	1 (2.7)	0 (0.0)	1 (5.9)
Depression
BDI total score, mean (SD)	6.0 (6.9)	7.3 (7.9)	4.5 (5.2)	9.7 (9.9)	8.7 (7.4)	10.9 (12.3)
BDI, n (%)
No depression (≤13)	113 (85.6)	53 (77.9)	60 (93.8)	26 (70.3)	14 (70.0)	12 (70.6)
Depression above cutoff (≥14)	19 (14.4)	15 (22.1)	4 (6.2)	11 (29.7)	6 (30.0)	5 (29.4)
Mild	11 (8.3)	9 (13.2)	2 (3.1)	4 (10.8)	4 (20.0)	0 (0.0)
Moderate	6 (4.6)	4 (5.9)	2 (3.1)	5 (13.5)	2 (10.0)	3 (17.6)
Severe	2 (1.5)	2 (2.9)	0 (0.0)	2 (5.4)	0 (0.0)	2 (11.8)
Comorbid symptoms
Anxiety/Depression, n (%)	15 (11.4%)	12 (17.6%)	3 (4.7%)	9 (24.3%)	5 (25.0%)	4 (23.5%)
Depression/Partial PTSD, n (%)	9 (6.8%)	8 (11.8%)	1 (1.6%)	5 (13.9%)	2 (10.0%)	3 (18.8%)
Anxiety/Partial PTSD, n (%)	10 (7.6%)	9 (13.2%)	1 (1.6%)	7 (19.4%)	3 (15.0%)	4 (25.0%)
Anxiety/Depression/Partial PTSD, n (%)	9 (6.8%)	8 (11.8%)	1 (1.6%)	5 (13.9%)	2 (10.0%)	3 (18.8%)

BAI: Beck Anxiety Inventory; BDI: Beck Depression Inventory-second edition, n: number, PTSD: posttraumatic stress disorder, SD: standard deviation.

Table 3. Multivariable predictors of symptoms of anxiety five years after end of treatment or a child’s death.

	Model 1		Model 2
	Standardized regressioncoefficient (SE)	p value	Standardized regressioncoefficient (SE)	p value
Parent sex (male/ female)	0.166 (0.081)	.042	0.115 (.054)	.035
Parent age at diagnosis	0.006 (0.107)	.956	0.041 (.072)	.570
Child age at diagnosis	−0.078 (0.104)	.456	−0.035 (.070)	.618
Bereaved (no/ yes)	0.109 (0.077)	.160	−0.039 (.054)	.467
Previous stressful life events (no/yes)	0.162 (0.077)	.038	−0.054 (.058)	.351
R^2	0.085
Current distress in relation to previous stressful life events (no/yes)			0.044 (0.064)	.496
Depression at T7			0.393 (0.077)	<.001
PTSS at T7			0.421 (0.076)	<.001
R^2			0.605

PTSS: posttraumatic stress symptoms; SE: standard error; T7: five years after end of treatment or a child’s death.

Table 4. Multivariable predictors of symptoms of depression five years after end of treatment or a child’s death.

	Model 1		Model 2
	Standardized regressioncoefficient (SE)	p value	Standardized regressioncoefficient (SE)	p value
Parent sex (male/ female)	0.037 (0.079)	.640	−0.061 (0.052)	.240
Parent age at diagnosis	−0.095 (0.105)	.366	−0.091 (0.068)	.184
Child age at diagnosis	−0.018 (0.102)	.861	0.037 (0.066)	.577
Bereaved (no/ yes)	0.159 (0.075)	.036	0.055 (0.051)	.284
Previous stressful life events (no/yes)	0.244 (0.076)	.002	0.017 (0.055)	.757
R^2	0.118
Current distress in relation to previous stressful life events (no/yes)			0.170 (0.060)	.005
Anxiety at T7			0.357 (0.070)	<.001
PTSS at T7			0.387 (0.073)	<.001
R^2			0.641

PTSS: posttraumatic stress symptoms; SE: standard error; T7: five years after end of treatment or a child’s death.