Based on that screening, 24.4% of the cohort met the threshold for elevated anxiety symptoms and 19.0% met the threshold for elevated depressive symptoms. Its purpose was to examine the relative associations of two groups of factors: conventional clinicopathological characteristics and patient-reported somatic symptoms and lifestyle factors. Seven predefined somatic symptoms and lifestyle factors were evaluated systematically.

Multivariable logistic regression was then used to identify factors associated with anxiety and depression after accounting for other variables included in the respective models. This design allowed the researchers to compare whether conventional clinical and pathological information or patients’ own reports of symptoms and routines had stronger statistical associations with the two distress outcomes. Fatigue, palpitations and irregular meals were each independently associated with both elevated anxiety and depressive symptoms.

Their adjusted odds ratios ranged from 1.63 to 2.14, and all reported P values were below 0.01. These estimates mean that the odds of screening above the relevant HADS threshold were higher among patients reporting these features than among those who did not, conditional on the other variables in the models. They do not establish that the symptoms or meal patterns caused anxiety or depression.

Three other factors were associated with elevated anxiety symptoms: musculoskeletal pain, cold or heat intolerance, and sleep duration below seven hours. Their adjusted odds ratios ranged from 1.42 to 1.79, with all reported P values below 0.05. By contrast, none of the conventional clinicopathological characteristics examined showed a significant association with either anxiety or depression.

The authors’ conclusion was that preoperative psychological distress in papillary thyroid carcinoma showed stronger associations with patient-reported somatic symptoms and lifestyle factors than with conventional clinicopathological characteristics. That comparison is a conclusion of the study rather than a finding that the measured factors directly predict future distress. The cross-sectional design captured relationships at one point in time and cannot determine whether distress contributed to symptoms and routines, whether these factors contributed to distress, or whether other processes influenced both.

For the anxiety outcome, the investigators developed a nomogram intended to estimate the probability of elevated anxiety symptoms and validated it internally. The model achieved a C-index of 0.720, with a 95% confidence interval of 0.686–0.755, which the researchers described as moderate discrimination, and it showed good calibration. Overall, the analysis identified patient-reported fatigue, palpitations, irregular meals, musculoskeletal pain, temperature intolerance and short sleep as statistically associated with aspects of preoperative psychological distress in this cohort.

It also suggests that symptom and lifestyle assessment may provide information not captured by the conventional clinicopathological characteristics examined. However, the findings remain observational: the preoperative sample, reliance on patient reports and cross-sectional timing constrain conclusions about cause and effect.

Subject of Research: Patient-reported symptoms and lifestyle factors associated with preoperative psychological distress in papillary thyroid carcinoma

Article Title: Patient-reported somatic symptoms and lifestyle factors associated with psychological distress in patients with papillary thyroid carcinoma: a cross-sectional analysis

Article References: Li, Y., Peng, L.-L., Lin, F., Li, S.-Q., Wei, Y., Zhao, Z.-L., Wu, J., Cao, S.-L., Yu, N., Cai, W.-J., Li, S., Wu, Q., Cong, T.-H., & Yu, M.-A. (2026). Patient-reported somatic symptoms and lifestyle factors associated with psychological distress in patients with papillary thyroid carcinoma: a cross-sectional analysis. BMC Psychology. https://doi.org/10.1186/s40359-026-05570-7

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05570-7

Keywords: papillary thyroid carcinoma, psychological distress, preoperative anxiety, depression, somatic symptoms, fatigue, palpitations, irregular meals, sleep duration, cross-sectional study, Patient-reported, somatic