Prevalence of depression, anxiety and stress symptoms in caregivers of children with cancer at the National Cancer Institute Sri Lanka (NCISL)


Session type:

Senali Yasara Seneviratne, Nilanga Gamage, Sanjeeva Gunasekera



The psychological wellbeing of caregivers of children with cancer in Sri Lanka has not been previously studied. The objectives of our study were to establish the prevalence of depression, anxiety and stress symptoms amongst Sri Lankan caregivers and identify any psychosocial factors associated with more severe symptoms.


The study population for this cross-sectional study included primary caregivers (>18 years) of a child (≤18 years) with cancer. Caregivers were recruited from inpatient wards and outpatient clinics at NCISL, a tertiary paediatric oncology centre. Caregivers with any past psychiatric history were excluded. Validated Sinhala and Tamil versions of the self-administered Depression, Anxiety and Stress Scale (DASS-21) tool were used.


300 caregivers were recruited (Inpatient caregivers (ICs), n=133, Outpatient caregivers (OCs), n=167). Mean age of cohort was 39.3 years. Significantly more ICs reported severe or extremely severe depression (29.3% vs 16.2% p<0.001), anxiety (45.8% vs 24.6%, p<0.001) and stress (33.8% vs 17.4%, p<0.001) symptoms than OCs. Amongst both ICs and OCs, depression (p=0.028, p<0.001 respectively), anxiety (p=0.002, p<0.001) and stress (p=0.002, p<0.001) symptoms showed significant negative correlations with time since diagnosis.

In our multivariate ordinal logistic regression analysis, ICs of children within 30 days of diagnosis (OR 6.09, 95% CI 1.76-21.1) and children with relapsed disease (OR 6.11, 95% CI 1.64-22.7) had significantly more severe stress symptoms than other ICs. Increasing IC age was associated with less severe symptoms of stress (OR 0.92, 95% CI 0.87-0.98). Amongst OCs, those with children in disease remission (OR 0.28, 95% CI 0.12-0.66) and those continuing to work (OR 0.15, 95% CI 0.06-0.43) had significantly less severe anxiety symptoms than other OCs.


Depression, anxiety and stress symptoms are highly prevalent amongst ICs and OCs and are most prevalent soon after diagnosis. Prevalence rates of depression and anxiety are more than ten-fold higher than general population statistics in Sri Lanka. These findings should be validated in a prospective study however, we believe all caregivers at NCISL should receive routine screening for depression, anxiety and stress symptoms.

Impact statement

Depression, anxiety and stress symptoms are highly prevalent amongst Sri Lankan caregivers of children with cancer and should be screened for routinely.