# Psychosocial Problems in the Siblings of Multitransfused Thalassemia Patients

## TL;DR

Siblings of thalassemia patients experience moderate psychological stress, with anxiety and depression being common, especially among females.

## Contribution

This study provides new insights into the psychosocial stress levels and symptom profiles of siblings of thalassemia patients using two validated psychological scales.

## Key findings

- Over half of the siblings reported moderate stress levels, with internalizing symptoms being the most common.
- A two-class model identified high- and low-symptom groups among siblings, with the high-symptom group showing elevated concerns across all domains.
- Female siblings showed higher rates of anxiety and depression compared to male siblings.

## Abstract

Background: Thalassemia significantly affects the psychosocial health of patients, their families, and siblings. Recognizing and addressing psychosocial challenges within the family system and among siblings is crucial to enhance their well-being and the overall family functioning.

Objectives: To assess the psychosocial stress in siblings of multiple-transfused thalassemia patients, utilizing two distinct scales specifically designed to evaluate psychological distress in children.

Methodology: In this cross-sectional observational study, siblings aged 2-18 years accompanying beta-thalassemia patients attending the Pediatrics Department of Gandhi Medical College, Bhopal, for blood transfusions or outpatient department visits were enrolled. Psychosocial stress was assessed using the Pediatric Symptom Checklist-17 (PSC-17) for the participants aged 4-17 years and the Perceived Stress Scale - Children (PSS-C) for the participants aged 5-18 years. Regression, latent class, and mediation analyses explored sociodemographic associations, symptom profiles, and PSS-C as a mediator of PSC-17 outcomes.

Results: Of 95 participants, 71 completed the PSS-C, with 38 (53.5%) reporting moderate stress and 33 (46.5%) low stress. On PSC-17 screening, 30 (31.6%) screened positive for internalising symptoms, and 9 (9.5%) each for attention and externalizing problems. Older age was associated with higher odds of internalizing concerns, and male gender with lower odds of attention deficit hyperactivity disorder (ADHD) and externalizing symptoms. On latent class analysis, a 2-class model demonstrated the best fit based on the lowest Bayesian information criterion (249.51). Class 1 represented a high-symptom group, characterized by a high probability of screening positive across all three domains, whereas Class 2 represented a low-symptom group showing low probabilities of concern. Mediation analyses revealed no significant indirect effects of perceived stress (PSS-C score) on the relationship between demographic characteristics and psychosocial symptoms across all PSC-17 domains.

Conclusion: We found that siblings of thalassemia patients experience mild to moderate levels of psychological stress. Anxiety and depression emerged as the most prevalent disorders, with a higher incidence observed in females than in males. It advocates for a more inclusive, holistic approach that considers both the patient and the psychosocial well-being of siblings within the broader family context.