Depression, Anxiety, and Stress among Mothers of Children with thalassemia in Bangladesh
Authors: Islam Farhin , Seemanta Senjuti , Rezina Sonia , Mehrab Afsana , Raheem Enayetur , Hossain Mohammad Sorowar 
Published: February 2024

Abstract
Background
Despite Bangladesh being one of the major hotspots of thalassemia in the world, this preventable inherited blood disorder is neglected in research and policy level. Mothers are the primary caregivers of children in South Asian countries with limited resources. Caring for a child with thalassemia can be an emotionally challenging experience for mothers in low and middle-income countries including Bangladesh. This study aimed to explore the levels of depression, anxiety, and stress of the mothers of thalassemic patients in Bangladesh and to correlate with sociodemographic and thalassemia-related factors.
Methods
This cross-sectional study was a continuation of a previous investigation conducted at Bangladesh Thalassaemia Samity Hospital (BTSH) regarding the parental perspective of thalassemia in Bangladesh. A validated Bengali version of the DASS-21 questionnaire was employed to assess the depression, anxiety, and stress levels of mothers with thalassemic children. Descriptive statistics were used to examine sociodemographic characteristics, thalassemia concerns in the family, effects on social and professional life, and DASS-21 scores. The depression, anxiety, and stress levels were predicted using a multiple-regression model.
Results
We found that most mothers of thalassemia children experienced stress (~ 62%), anxiety (~ 58%), or depression (~ 63%) to some extent. Mental health concerns were significantly associated with education level (p < 0.01 for depression and stress and p < 0.05 for anxiety), spouse’s education level (p < 0.01 for depression, anxiety and stress), monthly family income (p < 0.01 for depression and stress and p < 0.05 for anxiety), mortality from thalassemia in the extended family (p < 0.01 for depression and p < 0.05 for anxiety and stress), years of suffering (p < 0.10 for depression and anxiety), frequency of transfusions (p < 0.10 for depression and p < 0.05 for anxiety), social life (p < 0.01 for depression, anxiety and stress), and worry about the child’s future (p < 0.05 for depression and p < 0.01 for stress). Depression and anxiety were significantly influenced by the frequency of transfusions as well as monthly cost of treatment. Multiple linear regression analysis showed that the likelihood of lower level of depression among mothers was associated with higher family income (95% CI [-0.48, -4.67]) and children who had more than a 30-day gap between two transfusions. On the other hand, the likelihood of a higher level of depression was associated with a higher monthly treatment cost (95% CI [-0.48, -4.67], p = 0.037).
Conclusions
Mothers of thalassemic patients in Bangladesh experience complex mental health challenges, including stress, anxiety, and depression. The chronic nature of the condition, combined with associated financial, social, and physical burdens, can lead to heightened levels of these mental health issues. This study provides insights for social organizations and policymakers to adopt a holistic approach in improving the overall mental well-being of mothers with thalassemic children in Bangladesh.