Abstract / Summary
Abstract Background: Cancer diagnosis in children and adolescents is associated with significant psychological distress. International evidence indicates a high prevalence of anxiety and depression in this population, but evidence from Saudi Arabia and the Gulf region is limited. This study aimed to determine the prevalence and severity of anxiety and depression among children and adolescents with cancer in Saudi Arabia and to examine associations with demographic and clinical variables. Methods: A cross-sectional observational study was conducted; data collection spanned 12 months, from August 2020 to July 2021. Arabic-validated Revised Child Anxiety and Depression Scale-25 (RCADS-25) tool was used to calculate mean scores and severity of anxiety and depression. Associations were examined using the appropriate non-parametric test. Results: A total of 67 children and adolescents (aged 8–18 years) with a confirmed cancer diagnosis at a tertiary oncology centre in Jeddah completed the Arabic-validated Revised Child Anxiety and Depression Scale-25 (RCADS-25). Applying official UCLA T-score conversion tables (n = 56, Grades 3–12), 25.0% (95% CI: 15.5–37.7%) met the clinical threshold for anxiety, 17.9% (10.0–29.8%) for depression, and 23.2% (14.1–35.8%) for the combined score. A sample-internal percentile method (N = 67) yielded higher clinical rates (29.9% across all three outcomes), consistent with systematic elevation of this population above US normative benchmarks. Female sex was significantly associated with higher scores across all outcomes (p < 0.05); older age was associated with higher depression (rho = 0.318, p = 0.009); and participants receiving combined treatment had the highest distress scores (all p < 0.05). Notably, 20.9% (95% CI: 12.9–32.1%) of participants gave a non-standard response to the death-related RCADS-25 item, a rate 418-fold higher than for any other item. Findings were robust in sensitivity analyses excluding brain tumour participants. Conclusions: A substantial burden of psychological distress was identified in this Saudi sample, with adolescent girls, older children, and those receiving combined treatment modalities at highest risk. These findings provide a locally grounded evidence base for integrated psycho-oncology services in Saudi Arabia. Locally derived RCADS-25 normative data for Saudi populations are urgently needed.