Assessing Emotional and Behavioral Problems in Children and Adolescents with β-Thalassemia Major Using the CBCL: Associations with Serum Ferritin and Transfusion Frequency
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Objective: Children and adolescents with β-thalassemia major are at increased risk for emotional and behavioral problems. This study assessed internalizing/externalizing problems using the Child Behavior Checklist (CBCL) and examined associations with serum ferritin level and blood transfusion frequency in two age groups.
Methods and Materials: In this descriptive–analytical cross-sectional study (2022–2023), patients with β-thalassemia major attending Seyyed al-Shohada Hospital, Isfahan, Iran were assessed using the parent-report CBCL. Participants were categorized into children (4–11 years) and adolescents (12–18 years). Data were analyzed with SPSS (significance set at p<0.05) using t-test/chi-square and Pearson correlation.
Findings: Total psychological problem scores differed significantly between children and adolescents (p=0.011). Several CBCL subscales showed different distributions across age groups, including withdrawal, somatic complaints, anxious/depressed mood, thought problems, attention problems, and behavioral domains. Serum ferritin level was inversely correlated with total CBCL score (r=−0.24). Higher problem scores co-occurred with greater blood transfusion frequency.
Conclusion: A considerable proportion of patients with β-thalassemia major exhibited clinically relevant emotional/behavioral problems, highlighting the need for routine psychosocial screening and long-term supportive interventions alongside medical care. Future studies should include representative socio-economic strata and both genders to improve generalizability.
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