Abstract
<title>Abstract</title> <p> <bold>Background</bold> Parents of children with cancer experience substantial psychological distress, yet little is known about distinct longitudinal trajectories of depressive and anxiety symptoms following treatment or how social inequalities contribute to differences in parental mental health outcomes. This study aimed to identify trajectories of parental depressive and anxiety symptoms during pediatric cancer follow-up care and to examine whether sociodemographic and clinical characteristics were associated with trajectory membership. <bold>Methods</bold> This longitudinal study included 256 parents of children, treated for cancer. Participants completed standardized measures of depressive and anxiety symptoms at three follow-up assessments. Social determinants of health, including socioeconomic status, social support, age, gender, and self-efficacy, as well as clinical characteristics (cancer entity, treatment and diagnostic knowledge), were examined as predictors of trajectory membership. Latent growth mixture modeling was estimated to identify distinct symptom trajectories. <bold>Results</bold> Three distinct trajectories were identified for both depressive and anxiety symptoms: (1) a persistently burdened group, (2) an initially burdened but improving group, and (3) a resilient group with consistently low symptom levels. For depressive symptoms, higher social support (β = 0.30, <italic>p</italic> = .02), higher socioeconomic status (β = -0.16, <italic>p</italic> = .03), and gender (β = 1.46, <italic>p</italic> = .01) were associated with membership in more favorable trajectories. For anxiety symptoms, higher self-efficacy predicted membership in more favorable trajectories (β = 0.57, <italic>p</italic> < .001). Clinical characteristics, including cancer entity and diagnostic knowledge, were not significantly associated with trajectory membership. <bold>Conclusions</bold> Social determinants of health, particularly socioeconomic status, social support, and self-efficacy, were associated with differences in parental mental health trajectories, whereas clinical characteristics showed no significant associations. These findings highlight the role of social inequalities in shaping psychological adjustment after childhood cancer and underscore the importance of integrating assessments of social resources and vulnerabilities into pediatric oncology follow-up care. Identifying families experiencing social disadvantage may support the development of targeted psychosocial interventions and contribute to reducing disparities in parental mental health outcomes. </p>