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Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study

BMC Cancer volume 24, Article number: 518 (2024) Cite this article

Abstract

Background

Children and adolescents diagnosed with cancer often experience psychological distress, encompassing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aimed to evaluate the prevalence of these conditions among Omani children and adolescents diagnosed with cancer, alongside identifying contributing factors.

Methods

A prospective cross-sectional study was conducted from October 2021 to June 2023 among a cohort of Omani children and adolescents (6–18 years old) diagnosed with cancer at three primary cancer referral centres in Oman. Validated Arabic-language versions of the Screen for Child Anxiety Related Disorders, the Center for Epidemiologic Studies Depression Scale for Children, and the Impact of Event Scale-Revised instruments were used to assess symptoms of anxiety, depression, and PTSD, respectively. An initial assessment (T1) was undertaken within the first 3 months of diagnosis, followed by a second assessment (T2) 3–6 months later.

Results

Of 113 eligible participants, 101 agreed to participate in the study (response rate: 95.6%), with 92 (91.0%) completing both assessments and included in the final analysis. Prevalence rates of anxiety, depression, and PTSD decreased from 43.5%, 56.5%, and 32.6%, respectively, at T1, to 38.0%, 35.9%, and 23.9% at T2. All average scores were below diagnostic cut-off points, except for the depression score at T1. Anxiety and depression scores decreased significantly (p = 0.043 and 0.001, respectively) between T1 and T2, as did the overall prevalence of depression (p = 0.004). At T1, linear regression analysis showed significant correlations between anxiety scores and the child’s age and PTSD score (p < 0.05); these variables were also correlated with depression scores (p ≤ 0.001). At T2, significant correlations were observed between anxiety scores and the child’s age and PTSD scores (p < 0.001). At both T1 and T2, anxiety, depression, and PTSD scores remained significantly correlated (p < 0.001).

Conclusions

Omani children and adolescents recently diagnosed with cancer exhibit a high prevalence of anxiety, depression, and PTSD over time. Age-appropriate communication, ongoing support, and mental health services are recommended to help this patient group cope with their diagnosis and manage their emotional wellbeing. There is a need for future research to determine the effectiveness of specific psychological interventions in reducing the frequency of these disorders.

Peer Review reports

Background

Cancer in childhood and adolescence ranked as the sixth leading contributor to the total global cancer burden in 2019 [1]. An estimated 429,000 individuals under 19 years of age are diagnosed with cancer every year, with 141–185 cases per million reported worldwide [2, 3]. Approximately 100,000 children and adolescents die annually from cancer, with the vast majority of deaths (90%) occurring in low- and middle-income countries (LMICs) [1]. Furthermore, those diagnosed with cancer in LMICs have a low five-year survival rate of 30%, in stark contrast to high-income countries where survival rates exceed 80% due to significant advances in cancer treatment [2, 3].

In Arab countries, over 18,000 children below the age of 15 years are diagnosed with cancer every year, with annual incidence rates ranging from 7.5 to 12.8 cases per 100,000 children, although variations may be due to differences in registration accuracy [4]. In Oman, approximately 31% of the total population is under 19 years of age [5]. In 2019, a total of 2,307 patients were diagnosed with cancer, of which 2,089 patients (91.5%) were of Omani nationality and 124 (5.9%) comprised children aged 0 to 14 years [6]. However, the anticipated total number of annual cancer diagnoses is projected to rise to 8,549 by the year 2040 [7].

Anxiety, depression, and post-traumatic stress disorder (PTSD) are frequent in children and adolescents with cancer, with pooled prevalence rates of 13.92%, 20.43%, and 20.90%, respectively [8]. Recent research underscores a higher incidence of anxiety and depression in paediatric cancer patients and the heightened vulnerability of this demographic to post-traumatic stress symptoms, emphasising the need for a nuanced understanding of emotional challenges throughout the cancer diagnosis, treatment, recovery, and survivorship journey [9,10,11,12]. In itself, a diagnosis of cancer, along with accompanying physical symptoms and treatment side-effects, can lead to excessive tension, discomfort, and fear of death [8, 13]. Symptoms of depression, including low mood, despair, guilt, and loss of interest in usual activities, may also challenge patients’ ability to function and adhere to treatment [14].

As Oman continues to make significant improvements in healthcare delivery and medical treatment, cancer survival rates among children and adolescents have improved. However, the emotional toll of a cancer diagnosis cannot be underestimated, and an understanding of these psychological repercussions is crucial as an essential indicator of patients’ well-being to ensure the provision of comprehensive oncologic care [8]. Indeed, it has been found that that the activity of making jewelry from beads was effective in reducing the state and trait anxiety levels of children with cancer [15]. Our study therefore aimed to identify the prevalence of anxiety, depression, and PTSD among Omani children and adolescents diagnosed with cancer and their associated factors, and to describe changes occurring over time.

Methods

Study design and setting

A cross-sectional study was conducted targeting all Omani children and adolescents aged six to 19 years diagnosed with any type of cancer between 1st October 2021 and 30th June 2023. The study was conducted at the National Oncology Centre (NOC) of the Royal Hospital, the Paediatric Haematology Unit of the Sultan Qaboos University Hospital (SQUH), and the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC). These centres, located in Muscat, the capital city of Oman, serve as the primary referral cancer centres providing integrated care for cancer patients throughout Oman.

Recruitment of participants

Participants were recruited during their visits to either the outpatient clinics of the three referral centres or upon admission to the oncology/haematology wards. Children and adolescents who were non-Omani or had cognitive and behavioural disorders (as documented in their medical records) were excluded from the study.

Data collection

An Arabic version of the Screen for Child Anxiety Related Disorders (SCARED) tool was used to screen for anxiety symptoms over the past three months [16, 17]. It consists of various questions or items related to anxiety symptoms, and individuals are typically asked to respond based on their experiences which is valuable for understanding the child’s mental health status over a recent period [16]. This child self-report instrument includes 41 items scored on a 3-point scale (from 0 to 2), yielding five factors matching classifications outlined in the Diagnostic and Statistical Manual of Mental Disorder, fifth edition (DSM-IV) [16]. Overall, a total SCARED score of ≥ 25 may indicate the presence of an anxiety disorder, while scores of > 30 are more specific to anxiety. According to a validation study, internal consistency (Cronbach’s α) for the translated tool is 0.91, ranging between 0.65 and 0.89 for individual subscales [16].

Depressive symptoms were assessed using an Arabic version of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) [18, 19]. It consists of a series of questions that ask about various feelings and behaviours associated with depression, such as sadness, irritability, changes in appetite or sleep patterns, and feelings of worthlessness [19]. Respondents rate how often they have experienced each symptom over a specific period, typically within the past week [19]. This self-report scale consists of 20 items scored on a 4-point scale (from 0 to 3), for a total score ranging from 0 to 60, with higher scores more indicative of depression [18]. The cut-off CES-DC score is 15, with scores of 15–60 considered indicative of significant symptoms of depression. The Arabic version of the CES-DC has previously demonstrated high internal consistency (Cronbach’s α = 0.90) [18].

An Arabic version of the Impact of Event Scale-Revised (IES-R) was used to measure symptoms of post-traumatic stress [20, 21]. The IES-R is a self-report scale designed to assess current subjective distress for any major life event in children, adolescents, and adults, assessing the core symptom cluster of avoidance, intrusion, and hyperarousal [20, 21]. The tool has been also used to evaluate the extent of distress experienced by individuals who have been exposed to a traumatic event such as accidents, natural disasters, combat, or other life-threatening situations [21]. The scale helps clinicians and researchers understand the psychological impact of these events on individuals [20]. The tool consists of 22 items scored on a 5-point scale (from 0 to 4), of which 14 items correspond directly to symptom criteria outlined in the DSM-IV. Total scores range from 0 to 88, with a cut-off IES-R score of 33 and above indicative of a probable diagnosis of PTSD [20, 21]. According to previous research, the Arabic version of the self-report IES-R scale has demonstrated acceptable internal consistency (Cronbach’s α = 0.94) [20].

Arabic versions of the SCARED, CES-DC, and IES-R instruments were administered twice to assess for symptoms of anxiety, depression, and PTSD, respectively. The first assessment (T1) was conducted at any time within the first 3 months of diagnosis, while the second assessment (T2) was conducted 3 to 6 months after T1. Research assistants administered the questionnaire to participants aged 6 to 12 years, while the instruments were self-administered by participants aged 12 years or older. In both cases, a research assistant remained available to clarify any questions that the participants might have had during completion. Additional sociodemographic and clinical information was recorded by the researchers based on data gathered from the participants’ medical records or elicited from the children’s parents or primary caregivers at T1. Cancer risk was estimated based on the participant’s age at diagnosis, disease stage, tumour histology, MYCN status (amplified versus nonamplified), and tumour cell ploidy status [22].

Statistical analysis

Statistical analysis was performed using SPSS Statistics Software for Windows, version 23 (IBM Corp., Armonk, NY). Descriptive statistics, including percentages, frequencies, means, and standard deviations, were used to delineate the participants’ sociodemographic and clinical characteristics, as well as their average anxiety, depression, and PTSD scores. Paired t-tests and McNemar’s tests were utilised to assess differences in average anxiety, depression, and PTSD scores between the two time points. Analysis of variance and independent sample t-tests were employed to assess variations between the dependent variable (average anxiety, depression, or PTSD scores) and independent variables (sociodemographic and clinical characteristics). Pearson’s Chi-squared test was applied to explore associations between psychological outcomes and sociodemographic and clinical characteristics. Linear regression models were used to investigate correlations between sociodemographic and clinical characteristics and average anxiety, depression, and PTSD scores. The researchers adhered to a significance level of 5% throughout the analysis.

Results

Characteristics of the participants

Out of the 113 Omani children and adolescents diagnosed with cancer during the study period, 101 agreed to participate, yielding a response rate of 95.6%. However, only 92 participants (91.0%) completed both T1 and T2 assessments and were included in the final analysis. Of these, 83 (90.2%) received a new diagnosis of cancer, while nine (9.8%) had suffered relapses. The mean age was 11.4 ± 3.6 years, with a median of 11.0 years. Most participants (n = 62; 67.4%) were children (aged 6–12 years). Males (n = 52; 56.5%) outnumbered females (n = 40; 43.5%). Leukaemia was the most frequent diagnosis (n = 38; 41.3%), with most participants receiving chemotherapy as the sole form of treatment (n = 56; 60.9%). Most participants were assessed within the first month of diagnosis (n = 66; 71.7%), with their cancer diagnosis not being disclosed to them (n = 65; 70.7%) [see Table 1].

Table 1 Baseline sociodemographic and clinical characteristics of Omani children and adolescents diagnosed with cancer (N = 92)
Full size table

Prevalence of anxiety, depression, and PTSD

Overall, 40 (43.5%) and 35 (38.0%) participants exhibited anxiety symptoms at T1 and T2, respectively, while 52 (56.5%) and 33 (35.9%) reported depressive symptoms and 30 (32.6%) and 22 (23.9%) had probable diagnoses of PTSD. There was a significant reduction in the prevalence of depression between T1 and T2 (p = 0.004). Similarly, average scores decreased significantly for both anxiety (23.7 ± 10.6 vs. 21.7 ± 11.0; p = 0.043) and depression (17.67 ± 10.7 vs. 13.6 ± 8.9; p = 0.001) during this interval [see Table 2].

Table 2 Prevalence of anxiety, depression, and post-traumatic stress disorder* over time among Omani children and adolescents diagnosed with cancer (N = 92)
Full size table

Factors associated with anxiety, depression, and PTSD

At T1, the univariate analysis revealed a statistically significant increase in average scores for anxiety (p = 0.005), depression (p < 0.001), and PTSD (p < 0.001) as the child’s age advanced. Adolescents (aged 13–18 years) demonstrated significantly increased anxiety (p = 0.041), depression (p = 0.012), and PTSD (p = 0.001) scores compared to children (aged 6–12 years). Participants identified as having a high risk of cancer exhibited significantly increased PTSD scores (p = 0.001), while those aware of their cancer diagnosis showed significant increases in both anxiety (p = 0.003) and PTSD (p = 0.004) scores. Increased anxiety scores correlated with significant increases in both depression (p < 0.001) and PTSD (p < 0.001) scores; similarly, increased depression scores were associated with higher anxiety (p < 0.001) and PTSD (p < 0.001) scores, while elevated PTSD scores were associated with significant increases in both anxiety (p < 0.001) and depression (p < 0.001) scores [see Table 3].

Table 3 Associations between selected sociodemographic, clinical, and psychological factors and mean anxiety, depression, and post-traumatic stress disorder scores* at first investigation (T1) among Omani children and adolescents diagnosed with cancer (N = 92)
Full size table

At T2, the univariate analysis similarly showed significant increases in anxiety (p = 0.001), depression (p < 0.001), and PTSD (p < 0.001) scores as age increased, with adolescents exhibiting greater (p = 0.006), depression (p = 0.001), and PTSD (p = 0.002) scores compared to children. Participants with a high risk of cancer had significantly higher anxiety (p = 0.007) and depression (p = 0.007) scores, while those aware of their diagnosis demonstrated significantly higher scores for anxiety (p = 0.007), depression (p = 0.003), and PTSD (p = 0.005). Increased anxiety scores correlated with increased depression (p < 0.001) and PTSD (p < 0.001) scores, while increased depression scores correlated with increased anxiety (p < 0.001) and PTSD (p < 0.001) scores. Finally, increased PTSD scores were associated with significant increases in both anxiety (p < 0.001) and depression (p < 0.001) scores [see Table 4].

Table 4 Associations between selected sociodemographic, clinical, and psychological factors and mean anxiety, depression, and post-traumatic stress disorder scores* at second investigation (T2) among Omani children and adolescents diagnosed with cancer (N = 92)
Full size table

A linear regression analysis was conducted to establish links between anxiety, depression, and PTSD scores and various sociodemographic, clinical, and psychological factors. At T1, significant correlations were observed between anxiety scores and age (β = 0.762; p < 0.001), age group (adolescents vs. children; β = -0.217; p = 0.001), and PTSD scores (β = 0.209; p = 0.025), with an adjusted R2 value of 0.861. Depression scores demonstrated significant correlations with age (β = 0.460; p = 0.001) and PTSD scores (β = 0.488; p < 0.001), with an adjusted R2 value of 0.849. Finally, PTSD scores were significantly correlated with cancer risk (β = 0.147; p = 0.025), anxiety scores (β = 0.287; p = 0.016), and depression scores (β = 0.604; p < 0.001), with an adjusted R2 value of 0.827 [see Table 5].

Table 5 Linear regression (enter) analysis of factors influencing anxiety, depression, and post-traumatic stress disorder scores* over time in Omani children and adolescents diagnosed with cancer (N = 92)
Full size table

At T2, anxiety scores were found to be significantly correlated with age (β = 0.553; p < 0.001), age group (adolescents vs. children; β = -0.134; p = 0.014), and PTSD scores (β = 0.400; p < 0.001), with an adjusted R2 value of 0.896. Depression scores were significantly correlated with age (β = 0.297; p = 0.018) and PTSD scores (β = 0.431; p < 0.001), with an adjusted R2 value of 0.837. Finally, PTSD scores showed significant correlations with both anxiety (β = 0.622; p < 0.001) and depression (β = 0.426; p < 0.001) scores, with an adjusted R2 value of 0.839 [see Table 5].

Discussion

To our knowledge, this is the first study conducted in Oman to identify the prevalence of anxiety, depression, and PTSD among Omani children and adolescents diagnosed with cancer, associated factors, and to describe changes occurring over time. Our findings revealed that a high number of children and adolescents with cancer in Oman exhibit symptoms of anxiety (43.5%), depression (56.5%), and PTSD (32.6%) within the first three months of diagnosis. Prevalence rates of these psychological disorders, especially anxiety and depression, were notably higher compared to the pooled rates reported in a recent systematic review and meta-analysis of previous literature (13.92%, 20.43%, and 20.90%, respectively) [8]. However, these differences might be attributed to variations in the measurement and screening tools used across different studies.

Alternatively, another explanation for the high prevalence rates of anxiety, depression, and PTSD symptoms observed in our study could be linked to the lack of specialized or psychosocial supportive care for cancer patients in Oman, particularly at the time of diagnosis [23]. This is likely exacerbated by the fact that, in certain Arab cultures, including in Oman, there remains considerable stigma surrounding mental health issues, posing a challenge for individuals to actively seek or obtain psychological support [24, 25]. Moreover, limitations in healthcare resources, such as a shortage of mental health professionals, may further hinder access to psychological support services for cancer patients [24]. Finally, a lack of widespread awareness regarding the significance of psychological support for cancer patients, particularly children and adolescents, could contribute to a shortage of available programs and services [26].

We also found that symptoms of anxiety, depression, and PTSD among children and adolescents diagnosed with cancer decreased over time; these findings are supported by other longitudinal studies [27,28,29]. Other research has shown that a healthy family environment is a strong protective factor against the development of these disorders, as well as improving the quality of life of children and adolescents diagnosed with cancer [30, 31]. In Oman, support extended by family members and friends to cancer patients has been observed to significantly reduce mental distress and alleviate the adverse side-effects associated with cancer treatment [23]. Moreover, cancer patients in Oman have been shown to develop various coping mechanisms and adaptive strategies to deal with the emotional impacts of a cancer diagnosis, including denial, optimism, withdrawal, and a strong reliance on Islamic beliefs and practices [32]. These factors likely play a role in decreasing psychological distress over time.

The results of our study indicated that the child’s age had a significant impact on their anxiety, depression, and PTSD scores, with adolescents exhibiting a higher likelihood of experiencing these conditions compared to children. Other studies have also highlighted a notable increase in major depressive episodes during the transition to adolescence [33, 34]. This finding aligns with the understanding that adolescence is marked by hormonal changes and an enhanced ability to comprehend emotions [35]. Moreover, adolescents with cancer may face substantial disruptions to their education, potentially missing school due to the demands of treatment and recovery [36]. Repercussions may extend beyond academic skills, encompassing a range of missed opportunities, such as participation in sports, group activities, excursions, and award ceremonies, as well as the absence of daily structure and routine provided in the scholastic environment [37]. Prolonged absences from school and limited peer interaction can contribute to the development of emotional, behavioural, and psychological challenges [37, 38].

We also found that children and adolescents who were informed of their diagnosis exhibited significantly higher anxiety, depression, and PTSD scores compared to those who remained unaware of their condition. The relationship between disclosure of a cancer diagnosis and mental health outcomes is complex, and individual reactions can vary widely. Some children and adolescents may benefit from being informed, as this allows them to be more actively involved in their own care and treatment decision-making, while others may find comfort in not knowing the full extent of their illness [39]. Fundamentally, awareness of a cancer diagnosis results in a deeper cognitive understanding of illness severity, the side-effects of treatment, social stigma, and health uncertainties, all of which can increase anxiety and stress [40]. However, in Omani culture, it is routine for some parents and family members to try to protect their loved ones or keep their hopes up by choosing to withhold knowledge of their diagnosis [23].

Our findings showed that high-risk patients had significantly higher PTSD scores during the first three months of diagnosis. Patients with more aggressive types of cancer often require more intensive and invasive treatment regimens, such as surgery and radiation, resulting in long periods of hospitalization, all of which may contribute to increased stress, anxiety, and trauma [41]. Furthermore, the aggressive nature of the cancer and its associated treatment can create a sense of uncertainty about the future, including treatment outcomes and the potential for relapse [42]. Indeed, the physical and emotional toll of aggressive cancer can be overwhelming as a result of the side-effects of treatment, including changes in physical appearance and disruptions to daily life, factors which can contribute to symptoms of depression [43].

The results of our study should be considered in the light of certain limitations. Firstly, the study involved a prospective, cross-sectional design in which Omani children and adolescents were screened for symptoms of anxiety, depression and PTSD at two separate time intervals following diagnosis. The length of time between these intervals might not have been adequate to track dynamic changes in anxiety and PTSD over time, thereby limiting our understanding of the long-term psychological effects of cancer diagnoses. An extended study period with more frequent assessments could have potentially enabled a more in-depth exploration of the psychological challenges faced by children and adolescents at different points in their cancer experiences.

Secondly, the information regarding anxiety, depression, and PTSD symptoms was self-assessed by the participants; such self-reporting is susceptible to various biases, including memory recall influenced by the passage of time, emotional states, and individual differences in cognitive processing. Thus, the participants may have unintentionally provided inaccurate or incomplete information regarding their psychological experiences, leading to potential discrepancies between reported and actual symptoms. Finally, we cannot rule out the effect of the confounding variables such as socioeconomic status that are associated with both the independent variable (the factor of interest) and the dependent variable (mental health outcome).

Conclusions

To our knowledge, this is the first study conducted in Oman to identify the prevalence of anxiety, depression, and PTSD symptoms, along with their associated factors, among Omani children and adolescents diagnosed with cancer. The findings indicated that children and adolescents in Oman exhibited high levels of anxiety, depression, and PTSD within the first three months of a cancer diagnosis. Implementing routine screening protocols for psychological symptoms among children and adolescents diagnosed with cancer, particularly within the first three months of diagnosis, is imperative. The early identification of mental health challenges can facilitate timely intervention and support, particularly for adolescents, as they are more likely to suffer from psychological and emotional distress.

Furthermore, integrating mental health services into standard care protocols for paediatric and adolescent cancer patients in Oman could significantly enhance outcomes and support the delivery of holistic care. An urgent need exists for the provision of additional resources and specialised training for healthcare professionals in Oman, enabling them to recognize and address the psychological needs of children and adolescents with cancer. To advance the field, future research should consider employing longitudinal interventional designs, extending assessment durations, and incorporating a more comprehensive set of psychological variables. This approach will bolster the robustness and applicability of findings concerning mental health in the context of cancer. Additionally, longitudinal designs will enable the observation of changes in self-reported symptoms over time, offering a more nuanced understanding of the evolving psychological state of individuals navigating cancer.

Data availability

The datasets supporting the conclusions of this article are available from the corresponding author upon reasonable request.

Abbreviations

CES-DC:

Center for Epidemiologic Studies Depression Scale for Children

DSM-IV:

Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition

IES-R:

Impact of Event Scale-Revised

LMICs:

Low and Middle-Income Countries

MYCN:

V-Myc Avian Myelocytomatosis Viral Oncogene Neuroblastoma-Derived Homolog

NOC:

National Oncology Centre

PTSD:

Post-Traumatic Stress Disorder

SCARED:

Screen for Child Anxiety Related Disorders

SPSS:

Statistical Package for the Social Sciences

SQCCCRC:

Sultan Qaboos Comprehensive Cancer Care and Research Centre

SQUH:

Sultan Qaboos University Hospital

References

  1. Force LM, Abdollahpour I, Advani SM, Agius D, Ahmadian E, Alahdab F, et al. The global burden of childhood and adolescent cancer in 2017: an analysis of the global burden of disease study 2017. Lancet Oncol. 2019;20(9):1211–25. https://doi.org/10.1016/S1470-2045(19)30339-0

    Article  Google Scholar 

  2. Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017;18(6):719–31. https://doi.org/10.1016/S1470-2045(17)30186-9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science. 2019;363(6432):1182–6. https://doi.org/10.1126/science.aaw4892

    Article  CAS  PubMed  Google Scholar 

  4. Zandki D, Sultan I. Pediatric oncology in the Arab world. 2021. In: Al-Shamsi HO, Abu-Gheida IH, Iqbal F, Al-Awadhi A, editors. Cancer in the Arab world. Singapore: Springer; 2022. pp. 409– 25. https://doi.org/10.1007/978-981-16-7945-2_26

  5. National Center for Statistics and Information. Census of population, housing, and establishments. 2023. https://portal.ecensus.gov.om/ecen-portal/. Accessed 14 Dec 2023.

  6. Ministry of Health. Cancer incidence in Oman 2019 report. 2019. https://www.moh.gov.om/ar/web/general-directorate-of-primary-health-care/cancer-report. Accessed 14 Dec 2023.

  7. Mehdi I, Al Farsi AA, Al Bahrani B, Al-Raisi SS. General oncology care in Oman. In: Al-Shamsi HO, Abu-Gheida IH, Iqbal F, Al-Awadhi A, editors. Cancer in the arab world. Singapore: Springer; 2022. pp. 175–93. https://doi.org/10.1007/978-981-16-7945-2_12

    Chapter  Google Scholar 

  8. Al-Saadi LS, Chan MF, Al-Azri M. Prevalence of anxiety, depression, and post-traumatic stress disorder among children and adolescents with cancer: a systematic review and meta-analysis. J Pediatr Hematol Nurs. 2022;39(2):1140–31. https://doi.org/10.1177/27527530211056001

    Article  Google Scholar 

  9. Rahmani A, Azadi A, Pakpour V, Faghani S, Afsari EA. Anxiety and depression: a cross-sectional survey among parents of children with cancer. Indian J Palliat Care. 2018;24(1):82–5. https://doi.org/10.4103/IJPC.IJPC_141_17

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kazak AE, Alderfer M, Rourke MT, Simms S, Streisand R, Grossman JR. Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors. J Pediatr Psychol. 2004;29(3):211–9. https://doi.org/10.1093/jpepsy/jsh022

    Article  PubMed  Google Scholar 

  11. D’Urso A, Mastroyannopoulou K, Kirby A, Meiser-Stedman R. Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample. J Psychosoc Oncol. 2018;36(6):768–83. https://doi.org/10.1080/07347332.2018.1494664

    Article  PubMed  Google Scholar 

  12. van Warmerdam J, Zabih V, Kurdyak P, Sutradhar R, Nathan PC, Gupta S. Prevalence of anxiety, depression, and posttraumatic stress disorder in parents of children with cancer: a meta-analysis. Pediatr Blood Cancer. 2019;66(6):e27677. https://doi.org/10.1002/pbc.27677

    Article  PubMed  Google Scholar 

  13. McDonnell G, Baily C, Schuler T, Verdeli H. Anxiety among adolescent survivors of pediatric cancer: a missing link in the survivorship literature. Palliat Support Care. 2015;13(2):345–9. https://doi.org/10.1017/S1478951514000297

    Article  PubMed  Google Scholar 

  14. Smith HR. Depression in cancer patients: pathogenesis, implications and treatment (review). Oncol Lett. 2015;9(4):1509–14. https://doi.org/10.3892/ol.2015.2944

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Günay U, Sarman A, Salman U, Yılmaz AS. The effects of the activity of making jewelry from beads on the anxiety levels of children with cancer: a randomised controlled study. J Pediatr Hematol Oncol Nurs. 2022;39(5):317–25. https://doi.org/10.1177/27527530221068760

    Article  PubMed  Google Scholar 

  16. Hariz N, Bawab S, Atwi M, Tavitian L, Zeinoun P, Khani M, et al. Reliability and validity of the Arabic screen for child anxiety related emotional disorders (SCARED) in a clinical sample. Psychiatry Res. 2013;209(2):222–8. https://doi.org/10.1016/j.psychres.2012.12.002

    Article  PubMed  Google Scholar 

  17. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the screen for child anxiety related Emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999;38(10):1230–6. https://doi.org/10.1097/00004583-199910000-00011

    Article  CAS  PubMed  Google Scholar 

  18. Ayyash-Abdo HA, Nohra J, Okawa S, Sasagawa S. Depressive symptoms among adolescents in Lebanon: a confirmatory factor analytic study of the center for epidemiological studies depression for children. Acta Psychopathol. 2016;02(6):46. https://doi.org/10.4172/2469-6676.100072

    Article  Google Scholar 

  19. Weissman MM, Orvaschel H, Padian N. Children’s symptoms and social functioning self-report scales: comparison of mothers’ and children’s reports. J Nerv Ment Dis. 1980;168(12):736–40. https://doi.org/10.1097/00005053-198012000-00005

    Article  CAS  PubMed  Google Scholar 

  20. Davey C, Heard R, Lennings C. Development of the Arabic versions of the impact of events scale-revised and the posttraumatic growth inventory to assess trauma and growth in Middle Eastern refugees in Australia. Clin Psychol. 2015;19(3):131–9. https://doi.org/10.1111/cp.12043

    Article  Google Scholar 

  21. Weiss DS. The impact of event scale-revised. In: Wilson JP, Tang CS, editors. Cross-cultural assessment of psychological trauma and PTSD. New York: Springer; 2007. pp. 219–38. https://doi.org/10.1097/01.naj.0000339101.39986.85

    Chapter  Google Scholar 

  22. Sokol E, Desai AV. The evolution of risk classification for neuroblastoma. Child (Basel). 2019;6(2):27. https://doi.org/10.3390/children6020027

    Article  Google Scholar 

  23. Al Balushi A. Psychosocial care needs of children with cancer and their families: perceptions and experiences of Omani oncologists and nurses. University of Maryland, Baltimore ProQuest Dissertations Publishing. 2019. https://www.proquest.com/openview/a2861f33f5ab326624a3e3fd249e1590/1?pq-origsite=gscholar&cbl=18750&diss=y. Accessed 22 Jan 2024.

  24. Al-Adawi S. Mental health services in Oman: the need for more cultural relevance. Oman Med J. 2017;32(2):83–5. https://doi.org/10.5001/omj.2017.17

    Article  PubMed  PubMed Central  Google Scholar 

  25. El Khatib H, Alyafei A, Shaikh M. Understanding experiences of mental health help-seeking in arab populations around the world: a systematic review and narrative synthesis. BMC Psychiatry. 2023;23(1):324. https://doi.org/10.1186/s12888-023-04827-4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lewandowska A, Zych B, Papp K, Zrubcová D, Kadučáková H, Šupínová M, et al. Problems, stressors and needs of children and adolescents with cancer. Child (Basel). 2021;8(12):1173. https://doi.org/10.3390/children8121173

    Article  Google Scholar 

  27. Myers RM, Balsamo L, Lu X, Devidas M, Hunger SP, Carroll WL, et al. A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia: a report from the children’s oncology group. Cancer. 2014;120(9):1417–25. https://doi.org/10.1002/cncr.28578

    Article  PubMed  Google Scholar 

  28. Hockenberry MJ, Hooke MC, Rodgers C, Taylor O, Koerner KM, Mitby P, et al. Symptom trajectories in children receiving treatment for leukemia: a latent class growth analysis with multitrajectory modeling. J Pain Symptom Manage. 2017;54(1):1–8. https://doi.org/10.1016/j.jpainsymman.2017.03.002

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dupuis LL, Lu X, Mitchell HR, Sung L, Devidas M, Mattano LA Jr, et al. Anxiety, pain, and nausea during the treatment of standard-risk childhood acute lymphoblastic leukemia: a prospective, longitudinal study from the children’s oncology group. Cancer. 2016;122(7):1116–25. https://doi.org/10.1002/cncr.29876

    Article  PubMed  Google Scholar 

  30. Kunin-Batson AS, Lu X, Balsamo L, Graber K, Devidas M, Hunger SP, et al. Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: a prospective longitudinal study. Cancer. 2016;122(10):1608–17. https://doi.org/10.1002/cncr.29946

    Article  PubMed  Google Scholar 

  31. Bin Lee ARY, Yau CE, Low CE, Li J, Ho RCM, Ho CSH. Severity and longitudinal course of depression, anxiety and post-traumatic stress in paediatric and young adult cancer patients: a systematic review and meta-analysis. J Clin Med. 2023;12(5):1784. https://doi.org/10.3390/jcm12051784

    Article  Google Scholar 

  32. Al-Azri MH, Al-Awisi H, Al-Rasbi S, Al-Moundhri M. Coping with a diagnosis of breast cancer among Omani women. J Health Psychol. 2014;19(7):836–46. https://doi.org/10.1177/1359105313479813

    Article  PubMed  Google Scholar 

  33. Farhangi H, Badiei Z, Moharreri F. Prevalence of psychiatric symptoms in ALL patients during maintenance therapy. Iran J Pediatr Hematol Oncol. 2015;5(2):77–82.

    CAS  Google Scholar 

  34. Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN. Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med. 2004;158(8):760–5. https://doi.org/10.1001/archpedi.158.8.760

    Article  PubMed  Google Scholar 

  35. Akimana B, Abbo C, Balagadde-Kambugu J, Nakimuli-Mpungu E. Prevalence and factors associated with major depressive disorder in children and adolescents at the Uganda cancer institute. BMC Cancer. 2019;19(1):466. https://doi.org/10.1186/s12885-019-5635-z

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sisk BA, Fasciano K, Block SD, Mack JW. Impact of cancer on school, work, and financial independence among adolescents and young adults. Cancer. 2020;126(19):4400–6. https://doi.org/10.1002/cncr.33081

    Article  PubMed  Google Scholar 

  37. Donnan BM, Webster T, Wakefield CE, Dalla-Pozza L, Alvaro F, Lavoipierre J, et al. What about school? Educational challenges for children and adolescents with cancer. Educ Develop Psychol. 2015;32(1):23–40. https://doi.org/10.1017/edp.2015.9

    Article  Google Scholar 

  38. Wakefield CE, McLoone J, Goodenough B, Lenthen K, Cairns DR, Cohn RJ. The psychosocial impact of completing childhood cancer treatment: a systematic review of the literature. J Pediatr Psychol. 2010;35(3):262–74. https://doi.org/10.1093/jpepsy/jsp056

    Article  PubMed  Google Scholar 

  39. Harrison C. Canadian paediatric society. Treatment decisions regarding infants, children and adolescents. Paediatr Child Health. 2004;9(2):99–114. https://doi.org/10.1093/pch/9.2.99

    Article  Google Scholar 

  40. Fainsilber Katz L, Fladeboe K, King K, Gurtovenko K, Kawamura J, Friedman D, et al. Trajectories of child and caregiver psychological adjustment in families of children with cancer. Health Psychol. 2018;37(8):725–35. https://doi.org/10.1037/hea0000619

    Article  Google Scholar 

  41. Unseld M, Krammer K, Lubowitzki S, Jachs M, Baumann L, Vyssoki B, et al. Screening for post-traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress. Psychooncology. 2019;28(12):2382–8. https://doi.org/10.1002/pon.5239

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wang Y, Feng W. Cancer-related psychosocial challenges. Gen Psychiatr. 2022;35(5):e100871. https://doi.org/10.1136/gpsych-2022-100871

    Article  PubMed  PubMed Central  Google Scholar 

  43. Al-Azri M, Al-Awisi H, Al-Rasbi S, El-Shafie K, Al-Hinai M, Al-Habsi H, et al. Psychosocial impact of breast cancer diagnosis among Omani women. Oman Med J. 2014;29(6):437–44. https://doi.org/10.5001/omj.2014.115

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank the parents and guardians of the participants for allowing their children to take part in the study. The authors also extend their gratitude to the respective authorities of the NOC, SQUH, and SQCCCRC for permitting this study to be conducted.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman

    Laila S. Al-Saadi, Moon Fai Chan, Hana Al Sumri & Mohammed Al-Azri

  2. National Oncology Centre, Royal Hospital, Bawshar, Muscat, Oman

    Amal Al Sabahi & Jalila Alkendi

  3. Department of Child Health, Sultan Qaboos University Hospital, Al Khoud, Muscat, Oman

    Nawal Al-Mashaikhi

  4. Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Al Khoud, Muscat, Oman

    Amal Al-Fahdi

Authors
  1. Laila S. Al-Saadi
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  2. Moon Fai Chan
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  3. Amal Al Sabahi
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  4. Jalila Alkendi
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  5. Nawal Al-Mashaikhi
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  6. Hana Al Sumri
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  7. Amal Al-Fahdi
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  8. Mohammed Al-Azri
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Contributions

LA, MFC, AA, JA, NA, AF, and MA contributed to the study conception and design. Data collection was performed by LAS. Data analysis was performed by LA, MFC, and HA. The first draft of the manuscript was written by LAS and MA. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohammed Al-Azri.

Ethics declarations

Ethical approval and consent to participate

The study protocol was approved by the respective local research ethics committees of the NOC, SQUH, and SQCCCRC. All procedures performed in this study were in accordance with the principles of the Declaration of Helsinki and good clinical practice. Written informed consent was obtained from the parents and guardians of the participating children and adolescents. Information requiring participation requirements and the right to refuse was delivered to all participants.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Al-Saadi, L.S., Chan, M.F., Al Sabahi, A. et al. Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study. BMC Cancer 24, 518 (2024). https://doi.org/10.1186/s12885-024-12272-z

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Keywords

BMC Cancer

ISSN: 1471-2407

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