Self-perceived depression, anxiety and stress among caregivers of cancer patients in Institut Kanser Negara, Putrajaya during COVID-19 pandemic

Background: Cancer incidence continues to rise in Malaysia, and the effect of cancer is profound on the caregivers’ physical, emotional and practical aspects. In addition, the rapid rise of COVID-19 disease has caused many challenges for caregivers as they need to provide immense care with little or no support from healthcare providers nor home care services. As a result, caregivers are likely to exacerbate the symptoms of poor mental health. Objectives: This study aims to determine the prevalence and associated factors of depression, anxiety and stress among caregivers of cancer patients in Institut Kanser Negara (IKN), Putrajaya, during the COVID-19 pandemic. Methodology: A cross-sectional study design using a random sampling method was adopted involving a total of 437 caregivers attending the Radiotherapy and Oncology Department and Palliative Department, IKN. The psychological manifestations were measured using Depression Anxiety Stress Scales and 21 specific items (DASS-21) questionnaires, previously translated and verified. Simple logistic regression and multiple logistic regression analyses were used to address the research question. Results: The most common psychological manifestation among caregivers is anxiety 178 (41.4%), followed by depression 125 (29.1%) and stress 116 (27.0%). The multivariable model indicated that the prevalence of anxiety among caregivers was associated with being female, adjusted odds ratio (Adj OR) = 1.69 (95% CI : 1.13, 2.54; p-value <0.05) while caregivers of the older patients were less likely to be depressed, Adj OR = 0.97 (95% CI : 0.96, 0.99; p-value <0.05). Spousal caregivers were a protective factor for stress, Adj OR = 0.54 (95% CI : 0.32, 0.93; p-value <0.05). Additionally, non-Malay ethnicity were more likely to experience depression, Adj OR = 2.20 (95% CI : 1.34, 3.63; p-value <0.05) and anxiety, Adj OR = 1.82 (95% CI : 1.16, 2.87; p-value <0.05) compared to Malay ethnicity. Finally, caring for patients with poor functional status were more likely to placed them in a considerable poor psychological health outcome of depression, Adj OR = 2.24 (95% CI : 1.10, 4.56; p-value <0.05), anxiety, Adj OR = 3.97 (95% CI : 1.87, 8.42; p-value <0.001) and stress, Adj OR = 3.91 (95% CI : 1.94, 7.90; p-value