Risk for Use of Antidepressants, Anxiolytics and Hypnotics in Parents of Children Diagnosed with Cancer: A Population-Based Cohort Study

Abstract

Background: Experiencing cancer in a child may be stressful for the whole family. In a population-based cohort study, we investigated the psychological impact in terms of risk of psychotropic medication in the parents. Methods: We examined the risk for first prescription of psychotropic medication (antidepressants, anxiolytics, or hypnotics) among all parents of children with cancer (N=6744) identified in the Danish Cancer Registry between 1998-2014 using matched parents of cancer-free children (N=65 421) as a comparison cohort. In Cox proportional hazard models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for first prescription of psychotropic medication according to cancer status in the child. Further, to identify potential vulnerable sub-groups among parents of children with cancer, we followed all parents of children with cancer identified in the Childhood Cancer Registry between 2003-2015 (N = 3290 parents) and estimated HRs for first prescription of psychotropic medication according to education, income, cancer type, cancer relapse or death of the child. Findings: Three years after diagnosis, parents of children with cancer had a 14% cumulative incidence (95% CI 13·6-15·3) of having a first prescription of any psychotropic medication compared to 10 % in of parents of cancer-free children. The risk was highest in the first year and was particularly high for anxiolytics (HR 2·99 CI 2·54-3·52) and hypnotics (HR 2·64 CI 2·26-3·09). Among parents of children with cancer, the highest risk was seen for hypnotics in parents who experienced the death of a child (HR 6·91 CI, 3·50-13·66) in the first year after diagnosis, but an increased risk was also seen according to relapse, education, and income. Interpretation: Increased use of psychotropic drugs among parents to children with cancer emphasizes the need for psychological support to prevent psychiatric morbidity so severe as to require medical treatment. Funding: Danish Childhood Cancer Foundation. Conflict of Interests: The authors declare no potential conflict of interest. Ethical Approval Statement: The study approved by the Danish Data protection Agency (No. 2014-41-3405). Research based solely on registry data are exempt from ethical approval as well as from informed consent according to Danish law.