Anxiety and Depression in Patients Receiving Haematopoietic Stem Cell Transplantation and Their Caregivers: A Dyadic Longitudinal Study

Abstract

Introduction: Haematopoietic stem cell transplantation (HSCT) recipients and their caregivers may experience psychological distress. This study aimed to evaluate anxiety and depression in patients and caregivers throughout the HSCT process. As a secondary objective, we explored the association between anxiety and depression in patient and caregiver over the same period and compared anxiety and depression according to sociodemographic factors and whether HSCT was homebound or hospitalised.

Methodology: Longitudinal descriptive study. Seventy-two HSCT patients and their caregivers were consecutively included at a Spanish hospital between October 2019 and February 2021. The HADS instrument was used to assess anxiety and depression at six time-points, including pre-HSCT, the acute period and one-year follow-up. An adjusted linear mixed model assessed variable changes over time-points and a correlational analysis evaluated the relationship between anxiety and depression. To detect differences between groups over time, a linear mixed model was adjusted.

Results: Participants’ anxiety levels were high at all time-points and consistently higher among caregivers than patients. Patients and caregivers’ depression levels were low pre-HSCT and increased significantly during hospitalisation. Patients’ depression decreased during follow-up but remained stable among caregivers. We observed moderate positive correlations between patient and caregiver anxiety or depression at all time-points except pre-HSCT. Caring for other dependents increased depression in patients and being female increased both anxiety and depression in caregivers. Residing in social housing increased patient anxiety and depression and caregiver depression.

Conclusions: Diverging trajectories for patient and caregiver anxiety and depression were observed. Caregivers showed higher levels of anxiety than patients throughout the HSCT process and higher levels of depression from 3 months after HSCT. Admission was a critical time that increased depression in both. This study supports the need for new intervention approaches in prevention, early detection and treatment of anxiety and depression in patients receiving HSCT and their caregivers.