The Prevalence of Anxiety in Patients With Beta-Thalassaemia Major: A Systematic Review and Meta-Analysis
AI Summary
Pooled prevalence of anxiety in beta-thalassaemia major estimated at 33%, but should be interpreted with substantial caution due to extreme heterogeneity (I2 ≈ 98%).
Prevalence varied by assessment tool and region; DASS-21 reported higher estimates (56%), Middle East 38%, Europe 31%, United States 21%.
Recommend routine anxiety screening with validated tools and integration of mental health and culturally sensitive psychosocial support into thalassaemia care pathways.
AIM: Beta-thalassaemia major (BTM) is a chronic hemoglobinopathy associated with a substantial psychosocial burden. Reported rates of anxiety in BTM vary widely, hindering service planning and intervention design. We performed a systematic review and meta-analysis to estimate the pooled prevalence of anxiety in patients with BTM.
DESIGN: A comprehensive search of PubMed/MEDLINE, Scopus and Web of Science (studies from 2005 to 30 April 2025) identified observational studies reporting anxiety prevalence in BTM. Pooled prevalence and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis (Stata v16), with heterogeneity quantified by I2.
RESULTS: From 726 records, 10 studies met inclusion criteria (total N ≈ 11,385). The pooled prevalence of anxiety symptoms in BTM was 33.0% (95% CI: 22.0-44.0); however, given extreme between-study heterogeneity (I2 ≈ 98%), this estimate should be interpreted with substantial caution. Prevalence varied by instrument (DASS-21: 56.0%, higher than other tools), and by region (Middle East 38.0% vs. Europe 31.0% and United States 21.0%). By severity, pooled estimates were: mild 18.0%, moderate 11.0% and severe 11.0%.
CONCLUSION: Elevated anxiety symptoms, detected predominantly via screening instruments rather than formal clinical diagnosis, were identified in an estimated one-third of BTM patients; this figure should be interpreted cautiously given extreme between-study heterogeneity. Given this substantial burden, routine psychological screening and integration of mental-health interventions into thalassaemia care pathways are recommended.
IMPLICATIONS FOR NURSING PRACTICE: Nurses should incorporate routine anxiety screening with validated tools (e.g., HADS, DASS-21) into thalassaemia and transfusion care, assess body image and stigma concerns, provide culturally sensitive family education and refer patients exceeding clinical thresholds to mental health professionals. Embedding structured psychosocial support within thalassaemia services is essential for holistic BTM care.
NO PATIENT OR PUBLIC CONTRIBUTION: As this study was a review of previously published literature, there was no involvement from patients or the public in the design, conduct, reporting or dissemination of research.
TRIAL REGISTRATION: The protocol of this study is registered in PROSPERO with ID: CRD420251238275.
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