Prevalence and factors associated with depression among children and adolescents aged 7-17 years treated for cancer at Kamuzu Central Hospital, Lilongwe, Malawi

Abstract

Background: Depression affects 121 million people worldwide and is among the leading causes of disability worldwide. Depression negatively affects quality of life, adherence to treatment and overall survival in paediatric cancer. Depression is not routinely screened among children and adolescents with cancer, and therefore the prevalence and associated factors are unknown in Malawi. Objectives: The study aimed to determine the prevalence and factors associated with depression among children and adolescents aged 7-17 years treated for cancer at Kamuzu Central Hospital, Lilongwe, Malawi. Methodology: This was a descriptive cross-sectional study carried out among children and adolescents with cancer attending the Kamuzu Central Hospital, Paediatric Haematology and Oncology outpatient clinic in Lilongwe. Depression was assessed using the Children’s Depression Inventory. Associated factors were assessed using a standardized child and caregiver questionnaire, which included questions from a life events checklist, and the coping inventory. Simple and multivariate logistic regression models were used to assess factors associated with depression in children and adolescents with cancer. Results: Between October 2020 and March 2021, 133 children were enrolled, of which 68 (51.1%) were male with a mean age of 11.9 (SD 2.6) years. The prevalence of depression was 28 (21.1%). Using self-distraction as a coping mechanism (OR 0.03 [95% CI, 0.01-012]; p < 0.001) was protective of depression, while being an adolescent (OR 17.63 [95% CI, 1.79-172.70]; p =0.014); being an orphan (OR 6.76 [95% CI, 1.28-35.8]; p =0.025) and not being in school (OR 9.01 [95% CI,1.34-60.5]; p =0.024) were associated with depression. Conclusion: One in five children and adolescents with cancer had depression. This highlights the need to intergrate depression screening tools into routine oncology care and targeted interventions to treat and prevent progression to depression.