A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia

Abstract

Background We prospectively assessed anxiety, depression, and behavior in children with standard risk acute lymphoblastic leukemia (SR-ALL) during the first year of therapy and identified associated risk factors. Methods Cohort study of 159 children (age 2–9.99 years) with SR-ALL enrolled on Children’s Oncology Group protocol AALL0331 at 31 sites. Parents completed the Behavior Assessment System for Children, the Family Assessment Device-GF, and the Coping Health Inventory for Parents at ~1, 6 and 12 months after diagnosis. Results Overall, mean scores for anxiety, depression, aggression and hyperactivity were similar to population norms. However, more children scored in the at risk/clinical range for depression than the expected 15% at one month (21.7%, p=0.022), six months (28.6%, p<0.001), and twelve months (21.1%, p=0.032). For anxiety, more scored in the at risk/clinical range at one month (25.2% vs. 15%, p=0.001), but then reverted to expected levels. In adjusted analysis, unhealthy family functioning predicted anxiety (OR=2.24, p=0.033) and depression (OR=2.40, p=0.008). Hispanic ethnicity was associated with anxiety (OR=3.35, p=0.009). Worse physical functioning (p=0.049), unmarried parents (p=0.017), and less reliance on social support (p=0.004) were associated with depression. Emotional distress at one month predicted anxiety (OR=7.11, p=0.002) and depression (OR=3.31, p=0.023) at twelve months. Conclusion Anxiety is a significant problem in a subpopulation of SR-ALL patients immediately after diagnosis, while depression remains a significant problem for at least one year. Children of Hispanic ethnicity or with unhealthy family functioning may be particularly vulnerable. These data suggest that clinicians should screen for anxiety and depression throughout the first year of therapy.

Treatment of Anxiety and Depression in Adolescents and Young Adults With Cancer

“…Another recent study showed the frequency of children exhibiting symptoms that were consistent with both depression and anxiety. The same study showed that anxiety and depression scores at 1 month after diagnosis significantly predicted persistence of symptoms throughout the first year of therapy (Myers et al, 2014).…”

Systematic Review: Associations Between Family Functioning and Child Adjustment After Pediatric Cancer Diagnosis: A Meta-Analysis

“…Indeed, when faced with childhood cancer, families need to deal with intense emotions, communicate effectively and renegotiate roles and responsibilities to accommodate the demands of treatment (Kazak et al, 2004;Marcus, 2012). While most families are resilient to these challenges (Van Schoors et al, 2015), children in poorly functioning families who struggle with these demands may be at greater risk for adjustment problems (e.g., Long, Marsland & Alderfer, 2013;Myers et al, 2014). This key principle is embedded within various family-systems models often applied to chronic illness populations.…”

Are We Aware of Anxiety and Depression in Patients with Newly Diagnosed Acute Leukemia?

“…Depression was distinctively more common than anxiety in overall subject group and there was a positive correlation between depression and anxiety. Depression indicates deep impact of diseases in the patients' mood and necessitates a professional support to recover their psychological damage [19][20][21].…”