Cancer as a chronic disease is one of the most common causes of death in children worldwide. This disease accounts for 4% of deaths in children under 5 years and 13% of deaths in children aged 5-15 years in the Iranian population. In cancer, due to its chronic nature, children and their parents face a lot of stress. Cancer in children affects the quality of life, mental and physical health, daily life activities, family dynamism, and the role of each family member. Caring for a child with cancer is very stressful for parents. Depending on the stage of cancer development, the child can be influenced by the anxiety and stress of parents. Since the caregivers of these children have a major role in caring, supporting and following up on their treatment and, on the other hand, the mental health of caregivers affects the quality of care provided by them to children, providing and promoting the mental health of caregivers in order to maintain the care for children with cancer is absolutely essential. Due to the strong presence of religious and spiritual beliefs in Iran, this study aims to evaluate the effect of spiritual group therapy intervention on depression, anxiety and stress of caregivers of children with cancer.

The present study is a quasi-experimental study with a pre-test/post-test design conducted on mothers of 24 children with cancer in Ardabil, Iran, divided into two intervention and control groups. The intervention group participated in 8 sessions of spiritual group therapy. The tools used in this study to collect data were a demographic form surveying age, gender and education as well as the 42-item Depression Anxiety And Stress Scale (DASS-42) developed by Lovibond in 1995. The control group did not receive any spiritual intervention. Finally, collected data were analyzed in SPSS v. 25 software using descriptive statistics (mean and standard deviation for quantitative variables, and frequency and percentage for qualitative variables) and inferential statistics including Chi-square test, independent and paired t-test in case of normal data distribution and Mann-Whitney U and Wilcoxon tests in case of abnormal distribution. The normality of data distribution was examined using Kolmogorov-Smirnov test (Figure 1). 


 

The Mean±SD age of mothers as caregivers was 39.08±8.59 years (ranged 28-55 years). The results of independent t-test showed no significant difference between the intervention and control groups in terms of age (P= 0.854). Moreover, 58.33% of participants were at educational level lower than high school. The results of Chi-square test showed no significant difference between the two groups in terms of educational level (P= 0.9). Depression (P= 0.001), stress (P= 0.001) and anxiety (P= 0.001) of mothers of children with cancer in the intervention group were significantly lower compared to the control group (Table 1). 


 

Findings of the present study showed that spiritual group therapy had a significant effect on reducing depression, anxiety, and stress in mothers of children with cancer since the mean scores in the intervention group decreased significantly after the therapy. Spirituality-based interventions, by improving effective coping mechanisms in individuals, can help patients and caregivers to deal with and deal with the stress of disease and its consequences in a positive and effective way. According to the results of studies that indicate the prevalence of anxiety and depression in mothers of children with cancer, the development of spirituality-based programs with the aim of alleviating psychological problems in this group is recommended to help improve the quality of care provided by them to the children and, thus, improve the quality of life of the patient and other family members. Due to the strong presence of spiritual-religious culture in Iranian society, it is suggested that the concept of spirituality as an important dimension in mental health, receive more attention from health policy makers, specialists, members of the health care teams, and psychologists.
One of the limitations of the present study was the limited sampling to the children’s cancer Association. This was because the researchers wanted let the acute period of the disease pass and the families be in a stable condition. Therefore, further studies in other medical centers and samples, as well as caregivers of patients with other chronic disorders are recommended. Another limitation of this study was the lack of access to samples in the long run and lack of follow-up period; therefore, more studies to evaluate the long-term effects of spiritual group therapy are recommended.

This study has an ethical approval obtained from Ardabil University of Medical Sciences (Code: IR.ARUMS.REC.1398.01). 

Ardabil University of Medical Sciences supported this study.

All authors equally contributed to preparing this article.

The authors declare no conflict of interest.

The authors would like to than the Vice Chancellor for Research of Ardabil University of Medical Sciences, as well as all the staff of the children’s cancer association in Ardabil and the families who were members of this association for their support and cooperation.

 

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