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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 238-243

Anxiety and depression among caregivers of the children with thalassemia, attending at Thalassemia Control Unit of a Rural Tertiary Care Medical College, Darjeeling, West Bengal


1 Department of Community Medicine, North Bengal Medical College & Hospital, Darjeeling, West Bengal, India
2 Department of Dentistry, North Bengal Medical College & Hospital, Darjeeling, West Bengal, India

Date of Submission24-Jan-2022
Date of Acceptance08-Feb-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Tushar Kanti Saha
Department of Community Medicine, North Bengal Medical College & Hospital, C/O- Dr. Kallol Bhandari, Southern Breeze, Block-III, Flat-B, 1st floor, 1266 Upen Banerjee Road, PO+PS- Parnasree, Near Behala Flying Club, Kolkata 700060, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_16_22

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  Abstract 

Background of Study: Caregivers of the children with thalassemia often experienced a life with varied degree of anxiety and depression due the chronic illness like of their children. Mothers as the main caregivers for most of the thalassemic children suffers with different forms of psychological problems. Objectives: The aim of this study was to assess the levels of anxiety and depression of the caregivers of children with Thalassemia and also to find out sociodemographic factors associated with their anxiety and depression. Materials and Methods: Descriptive cross-sectional study conducted in Thalassemia Control Unit (TCU) of North Bengal Medical College (NBMC) from December 2018 to April 2019. Complete enumeration method was used to include 136 caregivers of children (≤12 years) with thalassemia. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) was used to assess the levels of anxiety and depression. Collected data were entered into MS-Excel and analyzed by using SPSS software program, version 22.0. Results: Mean age of caregivers was 34.3 (SD ± 1.4 years). Most of caregivers were female (89%) and had educational qualification up to primary school (45.6%). Majority (70.6%) of the caregivers were the mothers of the children. Most of the study participants (54.4%) had moderate depression followed by 30.1% with mild mood disturbances. Majority (69.9%) of the study participants had mild anxiety and 30.1% moderate anxiety. The median (IQR) of BDI score was 21(23–18) and median (IQR) of BAI score was 20(22–18). Conclusions: Early counseling, psychotherapy, appropriate treatment should be prioritized. Social support, community involvement with their full participation should be emphasized.

Keywords: Anxiety, caregivers, children, depression, Thalassemia


How to cite this article:
Bhandari K, Gazi E, Mandal BC, Saha TK. Anxiety and depression among caregivers of the children with thalassemia, attending at Thalassemia Control Unit of a Rural Tertiary Care Medical College, Darjeeling, West Bengal. Med J Babylon 2022;19:238-43

How to cite this URL:
Bhandari K, Gazi E, Mandal BC, Saha TK. Anxiety and depression among caregivers of the children with thalassemia, attending at Thalassemia Control Unit of a Rural Tertiary Care Medical College, Darjeeling, West Bengal. Med J Babylon [serial online] 2022 [cited 2022 Aug 13];19:238-43. Available from: https://www.medjbabylon.org/text.asp?2022/19/2/238/349473




  Introduction Top


Thalassemia is very much prevalent in Northern part of West Bengal among the ethnic group (Rajbanshi families). In this region of West Bengal among those with abnormal hemoglobin, 66% belonged to the Rajbanshis. There was statistically significant association (P < 0.05) between HbE syndrome and the Rajbanshi families.[1]

The prevalence of thalassemia ranges between 2 and 25% Worldwide.[2] For every 100,000 live births, approximately 4.4 children are affected by thalassemia globally.[3]

The carrier rate for b -thalassemia varies from 1% to 17% with 10,000 children (one-tenth of the world) with b -thalassemia major is born every year in India.[4],[5] Every 10th person is a thalassemia carrier with more prevalent among scheduled caste, scheduled tribe and Muslim populations in West Bengal.[6]

Therefore, understanding the levels of anxiety and depression of the caregivers of children with Thalassemia is necessary which will help us to take appropriate measures to reduce their anxiety and depression and also to give them a better mental health.

Usually, caregivers of the children with Thalassemia often experienced a life with varied degree of anxiety and depression due the chronic illness like Thalassemia, of their children. Mothers as the main caregivers for most of the thalassemic children suffers with different forms of psychological problems.


  Materials and Methods Top


Study design and setting

A descriptive, observational, cross-sectional study was conducted in the Thalassemia Control Unit (TCU) of North Bengal Medical College (NBMC) from December 2018 to April 2019.

Study population

All the caregivers of the children (≤12 years) suffering from Thalassemia who were attended Thalassemia Clinic of North Bengal Medical College (NBMC), were included as study participants. Participants with repeat visit, unwilling and the children who were more than 12 years were excluded.

Sample size and sampling technique

After applying exclusion and inclusion criteria, Complete enumeration technique was used and a total of 136 participants (n = 136) were included.

Data collection tools

Data were collected using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) to assess the levels of anxiety and depression among the study participants. BAI is a self-reported questionnaire with 21 items with good reliability (Cronbach α = 0.92 with test–retest reliability (1 week) is 0.75.[7] BDI is self-scored questionnaire with 21 items with high 1-week test–retest reliability (r = 0.93) and Cronbach α = 0.91. Lowest possible score is zero and highest possible score is 63.[8]

The BAI and BDI was translated into Bengali from English and retranslated into English. The translated versions of the questionnaire were validated by different experts. Pretesting of the questionnaire was done for necessary modifications. The Bengali version of BAI and BDI was used for collection of data.

Data collection procedure

Prior intimation was given to the In-charge of Thalassemia Control Unit (TCU) of North Bengal Medical College (NBMC). Diagnosed thalassemic children attending to Thalassemia Clinic, were identified. Their caregivers were approached and informed about the purpose of this study. Only the willing study participants were included. Participants with repeat visit and children of age > 12 years were excluded. Full assurance was given to the participants about the confidentiality about their identity. Participants who were illiterate or faced any problems during filling were assisted to fill out the questionnaire. Both self-administration and interview technique were used for collection of information. Demographic information was also collected. At the end all the participants were acknowledged for their kind cooperation.

Statistical analyses

Collected data entered into Microsoft-Excel software, double checked and analyzed using IBM SPSS software program, version 22.0. Frequencies, proportions, mean with SD, median with intra quartile range (IQR) were used for descriptive statistics.

In socioeconomic status (SES) class, as the percentage of SES class I and V were negligible, SES class I and II were clubbed into a single SES class (upper class) and SES class IV and V were clubbed into a single class (lower class). SES class III was considered as middle SES class for better interpretation of study results.

Ethical consideration

Approval was taken from the Institutional Ethics Committee of North Bengal Medical College, Darjeeling.


  Results Top


Mean age of caregivers was 34.3 (SD ± 1.4 years) [Table 1]. Most of caregivers were female (89%) and had educational qualification up to primary school (45.6%). Majority (70.6%) of the caregivers were the mothers of the children. Approximately 70.6% of the study participants were homemaker by occupation. Majority (50.7%) belonged to lower socioeconomic class.
Table 1: Sociodemographic characteristics of the study ­participants (n = 136)

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Majority (69.9%) of the study participants had mild anxiety and 30.1% moderate anxiety [Table 2]. Most of them (54.4%) had moderate depression followed by 30.1% with mild mood disturbances. The median (IQR) of BDI score was 21(23–18) and median (IQR) of BAI score was 20(22–18).
Table 2: Distribution of the study participants according to their levels of anxiety and depression (n = 136)

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Box and Whisker plots showing the differences in median BDI Score among different sexes, socioeconomic classes, educational status of the study participants. Upper SES class were more depressed than lower SES Class [Figure 1]. Illiterate caregivers were less depressed than the caregivers who had the educational qualification of high school and above.
Figure 1: Box and Whisker plots showing the differences in median BDI score among different sexes, socioeconomic classes and educational status of the study participants

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No statistically significant association was found in between sociodemographic characteristics of the study participants with level of anxiety [Table 3].
Table 3: Association of anxiety with sociodemographic characteristics of the study participants (n = 136)

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Sex, educational status, relationship with the child were found to be significantly associated with the level of depression and the association was statistically significant (P < 0.05) [Table 4].
Table 4: Association of depression with sociodemographic characteristics of the study participants (n = 136)

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  Discussion Top


It is well known fact that mothers are the main caregivers to the children. In this study also we had found that majority (70.6%) of the caregivers were the mothers of the children.

It is well-established fact that the caregivers of children suffering from Thalassemia will invariably suffer from varied degrees of anxiety and depression. This is due to long term treatment, increased out of pocket expenditure, chronicity of the disease which reduces the life span of the children. This study showed that majority (69.9%) of the study participants had mild anxiety and 30.1% moderate-to-severe anxiety. Among those who had moderate-to-severe anxiety, 29.8% were female and 33.3% were male. In a study by Yengil et al.[9] found that, majority of the caregivers (63.6%) with moderate or severe anxiety symptoms were mothers, rate of anxiety was 25% among all mothers and 10.3% among all fathers. Therefore, this study results were different from the study done by Yengil et al.[9]

In this study we had found that, most of the caregivers (54.4%) had moderate depression followed by 30.1% with mild mood disturbances. In a study by Shargi et al.[10] reported the frequency of depression as 51%. Another study by Aziz et al.[11] reported that the rate of depression as 71%. In our study, depression symptoms were detected in 28.6% of the caregivers of thalassemia patients. Both the studies had almost similar results like our studies.

This study showed that, among the caregivers with moderate depression 56.2% were female and 40% were male. So depression were more common among female caregivers compared to male caregivers. Among the caregivers with moderate-to-severe anxiety 29.8% were female and 33.3% were male. In a study by Yengil et al.[9] found that the caregivers with depression symptoms, 61.1% were mothers, whereas 27.8% were fathers. Depression was present in 39.3% of all mothers, whereas in 17.2% of all fathers. Our results were close to the results found by Yengil et al.[9]

In this study it was found that caregivers belonged to higher SES Class and with higher educational status were more depressed than lower SES Class and illiterate. This finding may be due to the facts that caregivers belonged to lower SES class are usually less educated than the higher SES class. So they had little knowledge and less concerned about thalassemia. Caregivers belonging to higher SES class and higher educational status had better knowledge about thalassemia. They were more concern about the chronicity and fate of the disease. Therefore, they were more depressed. A study conducted by Shaligram,[12] which shows different result from this study. They had shown lower educational status had poorer impact on psychiatric problems.

This study also revealed that there were statistically significant association between caregiver’s sex, educational status, relationship with the child and the level of depression.

Limitations

The other possible factors which might be responsible for anxiety and depression of the caregivers should be properly explored. It is always better to perform a case-control study to find out the responsible factors for anxiety and depression among the caregivers of thalassemic children.


  Conclusion Top


Most of caregivers were female with educational qualification of the most of them were up to primary school. Most of the caregivers were homemakers by occupation and most of them belonged to lower middle class.

Counseling and psychotherapy for family members of the patients with thalassemia can be provided by health care personnel. The need of social support and community involvement should be emphasized to reduce stigma.

Acknowledgement

The authors would like to express their gratitude to the caregivers who had participated and co-operated for this research. We would like to thank Professor (Dr.) Bidyut Goswami, HOD, Department of Pathology and In-charge of Thalassemia Control Unit, North Bengal Medical College & Hospital for his kind permission for collection of data. We were also thankful to Mrs. Maitreyee Sen, councilor of Thalassemia Control Unit, North Bengal Medical College & Hospital for her kind help for data collection. We were grateful to HOD and other faculty members of Department of Community Medicine North Bengal Medical College & Hospital for their kind cooperation for this research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghosh N, Chakrabarti I, Chakraborty M, Goswami BK A community-based pilot study on prevalence of hemoglobinopathies among the antenatal women in a rural area of Darjeeling district, West Bengal. Int J Med Public Health 2013;3:13-6.  Back to cited text no. 1
    
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Weatherall DJ, Clegg JB Inherited haemoglobin disorders: An increasing global health problem. Bull World Health Organ 2001;79:704-12.  Back to cited text no. 2
    
3.
Aljeesh YI Quality of life among thalassemia children patients in the Gaza strip. Am J Nursing Sci 2016;5:77-80.  Back to cited text no. 3
    
4.
World Health Organization. Management of haemoglobin disorders: Report of a joint WHO-TIF meeting, Nicosia, Cyprus, 16–18 November 2007; 2008. Available from: http://apps.​who.int/iris/bitstream/10665/43969/1/9789241597128_eng.pdf. [Last accessed on 2021 Mar 18].  Back to cited text no. 4
    
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Bremner J, Frost A, Haub C, Mather M, Ringheim K, Zuehlke E World population highlights: Key findings from PRB’s 2010 world population data sheet. Population Bull 2010;65:1-2.  Back to cited text no. 5
    
6.
Mondal SK, Mandal S Prevalence of thalassemia and hemoglobinopathy in Eastern India: A 10-year high-performance liquid chromatography study of 119,336 cases. Asian J Transfus Sci 2016;10:105-10.  Back to cited text no. 6
    
7.
Beck AT, Epstein N, Brown G, Steer RA An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol 1988;56:893-7.  Back to cited text no. 7
    
8.
Beck AT, Steer RA Internal consistencies of the original and revised Beck Depression Inventory. J Clin Psychol 1984;40:1365-7.  Back to cited text no. 8
    
9.
Yengil E, Acipayam C, Kokacya MH, Kurhan F, Oktay G, Ozer C Anxiety, depression and quality of life in patients with beta thalassemia major and their caregivers. Int J Clin Exp Med 2014;7:2165-72.  Back to cited text no. 9
    
10.
Sharghi A, Karbakhsh M, Nabaei B, Meysamie A, Farrokhi A Depression in mothers of children with thalassemia or blood malignancies: A study from Iran. Clin Pract Epidemiol Ment Health 2006;2:27.  Back to cited text no. 10
    
11.
Aziz K, Sadaf B, Kanwal S Psychosocial problems of Pakistani parents of thalassemic children: A cross sectional study done in Bahawalpur, Pakistan. Biopsychosoc Med 2012;6:15.  Back to cited text no. 11
    
12.
Shaligram D, Girimaji SC, Chaturvedi SK Quality of life issues in caregivers of youngsters with thalassemia. Indian J Pediatr 2007;74:275-8.  Back to cited text no. 12
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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