Case Report,  Int J Ment Health Psychiatry Vol: 11 Issue: 2

Mental health of Adolescents and Young Adults Related to Cancer Patients: A Cross Sectional Comparative Study

Yara Abou Jaoude¹, Grace Wehbe², Pia Maria Obeid³, Tarek Costa⁴, Tatiana Akl³, Georges Al Kari⁴, Adriana Salloum¹, Elie Bterrani⁵, Tarek Wehbe^5*

¹Department of Arts and Sciences, The Lebanese American University, Jbeil, Byblos, Lebanon

²Department of Medicine, The Sabis Educational System, Adma, Lebanon

³Department of Psychiatry, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American, University, Byblos, Lebanon

⁴Department of Medicine, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon

⁵Department of Medicine, University of Balamand, Faculty of Medicine and Notre Dame University Hospital, Jounieh, lebanon

*Corresponding Author: Tarek Wehbe
Department of Medicine, University of Balamand,
Faculty of Medicine and Notre Dame University Hospital, Jounieh, lebanon;
E-mail: Twwehbe4@gmail.com

Received date: 05 Feb, 2025, Manuscript No. IJMHP-25-160928; Editor assigned date: 07 Feb, 2025, PreQC No. IJMHP-25-160928 (PQ); Reviewed date: 21 Feb, 2025, QC No. IJMHP-25-160928; Revised date: 27 Feb, 2025, Manuscript No. IJMHP-25-160928 (R); Published date: 10 Mare, 2025, DOI: 10.4172/2471-4372.1000287.

Citation: Jaoude YB, Wehbe G, Obeid PM, Costa T, Akl T, et al. (2025) Mental health of Adolescents and Young Adults Related to Cancer Patients: A Cross Sectional Comparative Study.11:287.

Abstract

Keywords: Adolescents; Young adults; Generalized anxiety disorders; Depression; Cancer diagnosis

Introduction

A cancer diagnosis often shatters the lives of the affected individual, their family, and friends. The quality of Life, mental health, financial balance and the daily routine of cancer patients and their families especially their caregivers are severely impacted, leading to increased anxiety and depression as well as heightened risk of suicidal thoughts [1,2].

Cancer diagnosis is perceived differently by various individuals and cultures according to their perceptions and perspectives, sometimes perceived as catastrophic and sometimes imposing a turning point that changes everything from family relationships to work and other elements of life. Needless to say, young adults and adolescents are among the most sensitive and vulnerable to those drastic life changes [3,4].

Given the central role of the family and the dependence of children on their parents in most cases. This is especially true in traditional Lebanese culture. It is seemingly likely that adolescents and young adults not only suffer emotionally but also sink into anxiety about their future, their own wellbeing and their financial security which is usually provided by their parents [5].

In this regard, emotional support is essential to minimize the likelihood of depression, anxiety, and post-traumatic stress disorders. Hospital environment becomes routine, at the expense of fun family activities and the sense of normalcy [6-12]. The financial burdens build up and further complicate domestic life, especially in countries like Lebanon with ample financial and security stressors. The impact could reach every aspect of the domestic life including inter-marital relations destabilizing every aspect of the psychological wellbeing [13].

The perception of the dramatic changes is very much dependent on the support system providing assistance to the caregivers and siblings and establishing common understandings, goals and hopefully new positive bonds within the family. The stressors usually stem from the diagnosis, procedures and treatments building up as time goes by due to different complications, side effects and hospital stays [14-20].

Sibling conflicts which are common in normal life may be accentuated as the parents turn their attention to the sick member, and the whole family becomes more anxious under the pressure of the diagnosis. Feud and jealously may become more frequent inciting different feelings leading to altered sibling relationships. The chronicity of stress among siblings may impose an unhealthy environment on adolescents or in some cases bonding and strenghthening of family relationships [21-25].

Methods

This cross-sectional study was performed using an anonymous multiple choice survey, conducted across all areas of Lebanon between August and September 2024. The survey was formatted on Google forms IT assistance and distributed using a snowballing technique to target adolescents and young adults between the ages of 15 and 25.

The questionnaire was designed with questions about age, gender, area of residence, whether the subject has a parent, sibling, cousin, uncle, aunt, or a friend who had cancer. The questions also included 2 sets of standardized, validated surveys namely, the 7 questions which constitute the GAD 7 tool to check for generalized anxiety disorder and 9 questions that represent the PHQ 9 tool to screen for Major Depressive Disorders (MDD). The questions were self-administered in English or Arabic languages.

The GAD 7 tool included the following questions: feeling of nervousness, anxiety or on edge in the past 2 weeks, being unable to stop or control worrying, worrying too much about different things, having trouble relaxing, being so restless that it is hard to sit still, becoming easily annoyed or irritable, and feeling afraid as if something awful might happen. The response options were: none, several days, more than half the days, and almost daily.

The PHQ 9 tool for MDD included questions on: having little interest or pleasure in doing things; feeling down, depressed or hopeless, trouble falling or staying asleep or sleeping too much; feeling tired or having little energy; having poor appetite or overeating; feeling bad about oneself and having trouble concentrating on things such as reading the newspaper or watching television and moving or speaking so slowly that other people could have noticed; or being so fidgety and restless that you have been moving a lot more than usual; or having thoughts that you would be better off dead; or thoughts of hurting yourself in some way. The options included: none, several days, more than half the days, and almost daily.

Statistical analysis

The minimum sample size was calculated using the Epi Info software (CDC, Atlanta, USA) for bivariate analysis based on an alpha of 5%, a beta of 20%, a minimal OR to be demonstrated of 2, and a minimum 20% prevalence of anxiety, the minimal sample size to be targeted was calculated as n=187. We decided to add another 20% to this number for more certainty.

The Statistical Package for Social Sciences Software (SPSS), version 27.0 was used to analyze our data. All variables were represented as numeric or nominal using percentages. Chi-Square test was employed to compare variables. Results with a P value of <0.05 were considered statistically significant.

Results

Two hundred and fifty subjects answered the survey unanimously before recruitment was stopped. There were 142 (56.8%) subjects aged 15-20 and 108 (43.2%) subjects aged 21-25. We had 161 (64.4%) female respondents and 89 (35.6%) males.

Sixty-nine (27.6%) reported no relatives or friends were diagnosed with cancer within a year of this study. 55 (22%) reported a friend was diagnosed. 45 (18%) reported an uncle or aunt were diagnosed with cancer, 18 (7.2%) reported a cousin was diagnosed with cancer. 12 (4.8%) reported a mother was diagnosed, 11 (4.4%) reported a father was, 3 (1.2%) a sister and 3 (1.2%) a brother, 34 (13.6%) reported other relatives were diagnosed with cancer within a year.

GAD 7

1. Feeling of nervousness, anxiety or being on edge: 30 (12%) person reported none, 104 (41.6) several days, 68 (27.2%) more than half the days, and 48 (19.2%) almost daily
2. Not being able to stop or control worrying: 48 (19.2%) subjects reported none, 97 (38.8%) several days, 70 (28%) more than half the days, and 39 (15.6%) almost daily.
3. Worrying too much about different things: 26 (10.4%) person reported none, 89 (35.6%) several days, 90 (36%) more than half the days, and 47 (18.8%) almost daily
4. Having trouble relaxing: 45 (18%) person reported none, 89 (35.6%) several days, 77 (30.8%) more than half the days, and 42 (16.8%) almost daily.
5. Being so restless that it is hard to sit still: 88 individuals reported none, 93 several days, 54 more than half the days, and 20 almost daily.
6. Becoming easily annoyed or irritable: 37 (14.8%) subjects reported none, 98 (39.2%) several days, 79 (31.6%) more than half the days, and 41 (15.2%) almost daily.
7. Feeling afraid as if something awful might happen: 54 (21.6%) subjects reported none, 100 (40%) several days, 62 (24.8%) more than half the days, and 38 (13.5%) almost daily (Table 1).

Table 1: Distribution of responses to GAD-7 items based on frequency of symptoms..

PHQ 9

1. Little interest or pleasure in doing things: 59 subjects reported none, 116 several days, 59 more than half the days, and 16 almost daily
2. Feeling down, depressed or hopeless: 63 person reported none, 122 several days, 47 more than half the days, and 18 almost daily
3. Trouble falling or staying asleep or sleeping too much: 52 individuals reported none, 96 several days, 71 more than half the days, and 31 almost daily
4. Feeling tired or having little energy: 36 person reported none, 100 several days, 82 more than half the days, and 32 almost daily
5. Having poor appetite or overeating: 77 person reported none, 86 several days, 57 more than half the days, and 30 (12%) almost daily
6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down: 109 person reported none, 73 several days, 50 more than half the days, and 18 almost daily
7. Trouble concentrating on things such as reading the newspaper or watching television: 95 subjects reported none, 87 several days, 49 more than half the days, and 19 almost daily
8. Moving or speaking so slowly that other people could have noticed, or so fidgety and restless that you have been moving a lot more than usual: 138 (55.2%) person reported none, 65 (26%) several days, 38 (15.2%) more than half the days, and 9 almost daily
9. Thoughts that you would be better off dead, or thoughts of hurting yourself in some way: 182 (72.8%) individuals reported none, 44 several days, 16 (6.4%) more than half the days, and 8 (3.2%) almost daily (Table 2).

Table 2: Distribution of responses to PHQ-9 items based on symptom frequency.

Variables	Anxiety	Depression
Having a relative with cancer Vs. not	More significant	More significant
Gender	Females have more anxiety then males	Not significant
Age	Not signifiant	Not signifiant
The patient died	Not significant	Not significant

Table 3: Tabulated conclusions.

Moderate to severe depression was significantly found among subjects with a family member having cancer compared to those who did not (45 vs 27%) (P=0.049) (Hazard ratio 1.7 or 70% increased risk).

Moderate to severe anxiety was also more significantly present among subjects with a cancer diagnosed relative (P=0.000) (57.5% vs. 42.3% or HR of 1.36 or 36% increased risk of anxiety).

A subject being a female correlated with a higher likelihood of exhibiting anxiety when someone in the family had cancer compared to males (P=0.000) (56.5 vs. 42.7%) (HR 1.3 or a 30% increased risk). The difference between males and females was not significant when it comes to depression.

Depression and anxiety were not higher in the group of subjects with relatives suffering from cancer regardless whether the patient died or not or between the two age groups.

Discussion

In almost every culture, the cancer diagnosis carries a heavy weight and a life-changing experience not only on the affected person but also on his or her family members and friends. Many studies that examined this effect found an increase in cardiac and cancer diagnosis in the patient entourage. In this study we chose to quantitate this effect by measuring the risk of anxiety and depression using two standardized, validated surveys namely the GAD 7 and the PHQ 9 for generalized anxiety disorder and major depressive disorder respectively.

Teenagers and young adults are among the most vulnerable in the family of the patients with cancer and suffer the most drastic impact on their quality of life. Culturally oriented support groups and methods are essential to handle these issues. Our study demonstrates the gravity of this issue and the need to include it in our discussions with the patients and their families.

There is little literature regarding how adolescents and young adults handle cancer in the family. The emotional effects are governed by the pre-existing relationships among siblings and parents. In fact, sibling and parent conflicts, a common occurrence, has been linked to negative outcomes such as increased levels of depression. A more open relationship would likely help the child adjust better to the impact of cancer diagnosis [28-31].

In contrast to our findings, others studying this question in other communities, reported that a family member with cancer diagnosis did not impact the levels of psychological distress or family functioning among adolescents in Finland. This positive adjustment could be attributed to open communication, emotional involvement, and problem-solving flexibility. The gender of the sick parent and child did not impact the child’s mental health either. Conversely, in other communities, mental distress varied among participants with cancer diagnosis in the family and seems to be aggravated by the lack of communication and involvement among the family members [26-29].

Several aggravating factors may worsen the impact of this diagnosis including financial distress, pre-existent disputes and lack of support for the patient’s care givers. Mitigating factors include the availability of secondary caregivers, alleviating single person burden, and disruption of the work routine correlating with decreased risk of suicidal thoughts. In addition, religious faith and spirituality positively impacted the QOL and mental health of the cancer patient family members and caregivers. It correlated negatively with stress, depression, and suicidal ideations [30-33].

Our study shows the scale of generalized anxiety and depression among adolescents and young adults. Not only is the risk of developing these mental illnesses significantly increased but that increase is so evident in nearly half the subjects affected that professional assistance is a must to facilitate daily life. Males and females are both affected but females seem to be more prone to anxiety while males are more likely to develop depression related symptoms. The cancer diagnosis may weaken sibling bonds in some cases or may promote favorable qualities such as warmth and emotional support, emphasizing the intricate and dynamic nature of family relationships.

It is clear that the mental health and stress responses are directly related to each individual life, its culture and its unique qualities. Social workers, psychologists and psychiatrists have a major role to play in mitigating the impact on the intra-family relationships by promoting open communication and active involvement, facilitating problem solving adjustments and supporting caregivers, adolescents and young adults. Healthy family functioning is positively associated with open communication and affective involvement between family members.

Conclusion

In cultures with strong family and community cohesiveness, distressful situations impinge on individuality. The makeup of the Lebanese culture causes any impact on a family member to be felt vividly by the other family members. Cancer diagnosis exacerbates the financial and emotional burden on the entire family, including adolescents and young adults. Cultural expectations for caregiving and emotional resilience results in suppressed emotions and additional stress, contributing to the high levels of mental health issues found in this study. Females, who might feel a stronger sense of duty to care for sick relatives, may experience heightened anxiety and MDD as well.

Males, on the other hand, might feel societal pressure, leading to internalized emotional distress and higher depression rates. The study highlights the need for psychological support for adolescents and young adults dealing with cancer in their families. It is beneficial in most situations to involve external support systems, such as peer support groups, counselors at schools, and social services, in alleviating the mental health burden.

The relationship between mental health and stress response is significantly influenced by culture, family structure, and the individual qualities. Intra-family relationships play a major role in the mental response to the stress of a cancer diagnosis. Furthermore, caregiver support, along with open communication and active involvement in discussions with adolescents and young adults, fosters adjustment and promotes healthy family relationships.

We found, in this Lebanese cohort, the anxiety and depression risks multiply especially when a tragic event hits a family member. Such effects are particularly harsh on adolescents and young adults. Psychological family support, open discussions and communications, assistance in caregiving, financial assistance and spiritual bonding may help alleviate the burden of the difficult times.

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