Beyond survival: anxiety, depression, and non-response to a death-related item among children and adolescents with cancer in Saudi Arabia

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. 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 an Arabic translation of the Revised Child Anxiety and Depression Scale-25 (RCADS-25). Using the official RCADS-25 T-score tables (Grades 3–12), 18.2% (95% CI: 10.2–30.3%) scored in the clinical range for anxiety, 26.8% (17.0–39.6%) for depression, and 21.8% (12.9–34.4%) for the total score. In exploratory analyses with false discovery rate correction, steroid use was associated with lower scores on all three outcomes (q ≤ 0.022). Older age was associated with higher depression scores (rho = 0.32, p = 0.009, q = 0.084). Girls scored higher than boys, but this difference did not remain after adjustment for steroid use. Fourteen participants (20.9%, 95% CI: 12.9–32.1%) showed item-specific non-response to the item ''I think about death'' (crossing out, refusing, or leaving only this item blank). Across the other 24 items, 0.75% of responses were blank. Findings were similar in sensitivity analyses. Conclusions About one in five children and adolescents with cancer in this Saudi sample scored in the clinical range for anxiety, and about one in four for depression. Item-specific non-response to the item about death was common and deserves attention in clinical assessment. Larger multi-centre studies with diagnostic interviews and Saudi normative data for the RCADS-25 are needed.