Latent profile analysis of psychological distress in adolescents and young adults with thyroid cancer: A cross-sectional study

doi:10.21203/rs.3.rs-5232784/v1

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Latent profile analysis of psychological distress in adolescents and young adults with thyroid cancer: A cross-sectional study

https://doi.org/10.21203/rs.3.rs-5232784/v1

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Purpose

This study aims to identify the potential profiles of psychological distress (PD) among adolescents and young adults (AYAs) with thyroid cancer, and to explore the affect factors of different subgroups.

Methods

Convenience sampling was applied to collect 227 AYAs with thyroid cancer from a general hospital in China. The assessment instrument included the general information questionnaire, Strategies Used by People to Promote Health (SUPPH), and the specific Cancer Distress Scales for Adolescents and Young Adults (CDS-AYA). The latent profile analysis (LPA) method was used to fit the latent psychological distress categories in subjects with AYAs with thyroid cancer. The factors influencing the subgroups of psychological distress were identified using univariate analysis and multinomial logistic regression analyses.

Results

A total of 213 valid questionnaires were received. Three potential profiles of psychological distress were finally identified: “low PD group” (67.1%), “moderate PD with high employment group” (25.8%), and “high PD with high confidence group” (7.1%). Multivariate logistic regression analysis showed that the presence of underlying disease, treatment modality, tumor-node-metastasis (TNM), and self-management efficacy were influencing factors of subgroups.

Conclusion

The psychological distress level among AYAs with thyroid cancer can be divided into three subgroups, which have obvious classification characteristics. It is suggested that healthcare professionals (HCPs) should pay attention to the mental health status of AYAs with thyroid cancer. And they could adopt personalized interventions for AYAs with different characteristics of psychological distress.

adolescents and young adults

thyroid cancer

psychological distress

latent profile analysis

factor

Thyroid cancer is a malignant tumor of the parenchymal cells of the thyroid gland[1]. The global incidence of thyroid cancer is increasing annually, and the number of incidence cases rapidly increased from 212,000 cases in 2008 to 821000 cases in 2022, ranking among the top seventh high-incidence cancers in the world[2, 3]. Compared with most cancers, the incidence of thyroid cancer tends to be more pronounced among younger populations[4, 5]. Several studies have shown that thyroid cancer is the most common type of cancer among Adolescents and young adults (AYAs) in all countries[5, 6]. AYAs with thyroid cancer have a better prognosis with a 5-year survival rate approaching 100%[4, 7, 8]. Despite a favorable prognosis for survival, long-term survival does not necessarily result in a complete restoration of the patient's quality of life. AYAs were at a critical stage of career development and socialization, and the experience of cancer may have a more profound psychological impact on this population[9, 10].

Psychological distress (PD) is a multifactorial cause of unpleasant emotional experiences in patients, including psychological, cognitive, behavioral, social, and spiritual dimensions, which can affect patients' attitudes and behaviors to cope positively with cancer (somatic symptoms and side effects of treatment) [11]. This can be a sensitive reflection of patients' quality of life in clinical settings [12]. AYAs diagnosed with cancer report more psychological distress than their healthy peers, including negative emotions, post-traumatic stress, and obsessive worrying[13]. Studies have shown that 29.33–43.3% of patients with thyroid cancer have significant psychological distress, and it is noteworthy that females, patients using antidepressants, and patients treated with radioactive 131-iodine (RAI) therapy exhibit higher levels of psychological distress[12, 14]. In addition, employment and educational environments have been identified as key determinants influencing the occurrence of psychological distress in AYAs affected by thyroid cancer[15]. These factors may exert an influence on the psychological state of patients via specific mechanisms. Nevertheless, most previous studies on psychological distress in cancer patients employ total scale scores as the sole criterion for identifying the presence of psychological distress, overlooking inter-individual variations at the same level.

Latent profile analysis (LPA), an individual-centered statistical method to determine the classification of an individual's latent traits through the individual's response pattern on extraneous variables, helps to examine the characteristics of different latent-profile populations further [16]. Most previous studies used a distress thermometer (DT) [17] and the Kessler Psychological Distress Scale (K10) [18] to assess the patient's level of psychological distress. these tools are more generalizable but lack specificity for PD in AYAs with cancer. A Canadian scholar [19] developed the Cancer Distress Scales for Adolescent and Young Adults (CDS-AYA) in 2019, with Cronbach's coefficients of 0.85 ~ 0.94 for each dimension. The scale was made more specific with the addition of questions related to relationships, academics, and employment.

Accordingly, the present study employed the Specific Psychological Distress Scale for Young Cancer Patients to assess psychological distress in AYAs with thyroid cancer. For the first time, latent profile analysis was used to explore in-depth the characteristics and factors of psychological distress in AYAs with thyroid cancer. This study aimed to provide a theoretical reference for the development of individualized psychological interventions for AYAs with thyroid cancer and different types of psychological distress.

2.1. Study design and participants

This cross-sectional study was conducted in Chongqing, China. Participants were recruited by convenience sampling in the Breast and Thyroid Surgery Department of a general hospital from February to July 2023. Patients were eligible if they (1) were aged 15–39 years (Miller et al., 2020; Trama et al., 2023); (2) were diagnosed with thyroid cancer by cytologic examination, and (3) were informed of the condition. AYAs with thyroid cancer were not considered for recruitment: (1) those who had mental illness and (2) those with other malignant tumors in combination.

2.2. Measures

2.2.1. General information questionnaire

This study used a self-designed questionnaire to collect data on sociodemographic information and clinical characteristics of AYAs with thyroid cancer. The questionnaire included 12 items: gender、age、education level、marital status、occupation、monthly economic income、payment for medical expenses、TNM、treatment modality、underlying disease、extent of thyroidectomy、cervical lymph node dissection.

2.2.2. Psychological distress

The specific Cancer Distress Scales for Adolescents and Young Adults (CDS-AYA) was designed to measure psychological distress in AYAs with cancer (Tsangaris, D’Agostino, Rae, Breakey, & Klassen, 2019). The content included the impact of cancer (11 items), physical (10 items), emotional (10 items), cognitive (8 items), cancer worry (5 items), and employment/schooling (6 items), totaling 50 items across the six dimensions. The items were assessed using a four-point Likert scale. The CDS-AYA has a total score of 0-150 points; the higher the score, the more severe the psychological problems the patient has and the higher the degree of psychological distress. The Cronbach’s α for the Chinese version of the CDS-AYA was 0.971.

2.2.3. Self-management effectiveness

The Strategies Used by People to Promote Health (SUPPH) have been designed to measure individual self-management skills[20]. The content included positive attitudes (15 items), self-stress reduction (3 items), and self-determination (10 items), totaling 28 items across three dimensions. The items were assessed on a five-point Likert scale. SUPPH has a total score of 28–140 points. The higher the score, the higher the patient’s self-management ability level. The internal consistency of the Chinese version of the SUPPH total and subscale scores was high (Cronbach’s α ranged from 0.849 to 0.970)[21].

2.3. Data collection

A combination of paper and electronic questionnaires was used. The participants were allowed to fill out the paper version of the questionnaire within 10–15 min and were required to complete the questionnaire independently. All entries in the electronic questionnaire were mandatory. The same account can be completed only once to ensure completeness and avoid duplication. An automatically generated answer sheet was then submitted. A combination of paper and electronic questionnaires was used. Throughout the completion process, investigators used consistent terminology to explain the purpose, significance, and caveats of the study. The participants were allowed to fill out the paper version of the questionnaire within 10 ~ 15 minutes and were required to complete the questionnaire independently. All entries in the electronic questionnaire were mandatory. The same account could only be filled out once to ensure completeness and avoid duplication. The automatically generated answer sheet could then be submitted. A total of 227 questionnaires were received, of which 14 were excluded as invalid, and the remaining 213 valid questionnaires were included in the final sample, representing a recovery rate of 93.8%.

2.4. Statistical analysis

This study used Mplus 8.3 to analyze the data for LPA. Based on the six psychological distress dimensions as exogenous indicators, one to six categories were set for the model fit estimation for potential profile analysis. The model fit assessment was based on the Akaike (AIC) and Bayesian (BIC) information criteria, adjusted BIC (aBIC), entropy, and Lo-Mendell-Rubin (LMRT) and bootstrap (BLRT) likelihood ratio tests. Among these, the smaller the AIC, BIC and aBIC, the better is the model fit. Entropy assumes a value ranging from 0 to 1; the closer it is to 1, the more accurate is the classification. When the difference between the LMRT and BLRT indices is statistically significant, it indicates that the k profile models are better than the k-1 profile models. The above evaluation indices only provide a reference for profile decision-making, and the interpretability of each category should be considered when determining the best model.

The data were statistically analyzed using SPSS 26.0. Count data are expressed as frequencies and percentages, and measurement data are expressed as mean ± standard deviation (M ± SD) or median (quartile) [M(IQR)]. Kruskal-Wallis H and chi-square tests or Fisher’s exact probability method were used to conduct univariate analyses of potential psychological distress profiles in young patients with thyroid cancer. Multivariate unordered logistic regression was used to analyze the factors in the potential psychological distress profiles of AYAs with thyroid cancer, with P < 0.05 level of statistical significance.

2.5. Ethical considerations

All the respondents provided informed consent and signed a consent form to voluntarily participate in the survey. This study was approved by the Academic and Ethics Committee of the Hospital [(A)KY2023021].

3.1. Characteristics of the participants

A total of 227 questionnaires were received, of which 14 were excluded as invalid. The remaining 213 valid questionnaires were included in the final sample with a valid recovery rate of 93.8%. 213 AYAs with thyroid cancer was 32.79 (SD = 4.57), the majority of AYAs surveyed were females (71.8%), married (81.3%), bachelor education and above (48.8%), Monthly economic income of 5000-10,000 yuan (46.9%), surgery (69%). The detailed demographic characteristics are presented in Table 1.

Table 1

Characteristics of the 213 AYAs with thyroid cancer.
Characteristics	low PD group (n = 143)	moderate PD with high employment group (n = 55)	high PD with high confidence group (n = 15)	χ²/H	P
Gender				2.0310¹⁾	0.315
male	44(30.8%)	14(25.5%)	2(13.3%)
female	99(69.2%)	41(74.5%)	13(86.7%)
Age				1.170³⁾	0.557
18–20	3(2.1%)	0(0.0%)	1(6.7%)
21–30	28(19.6%)	9(16.4%)	1(6.7%)
31–39	112(78.3%)	46(83.6%)	13(86.7%)
Education level				11.888³⁾	0.018
Elementary and below	1(0.7%)	0(0.0%)	3(20.0%)
Junior school	13(9.1%)	7(12.7%)	5(33.3%)
High school	20(14.0%)	7(12.7%)	2(13.3%)
Three-year college	38(26.5%)	10(18.2%)	3(20.0%)
Bachelor and above	71(49.7%)	31(56.4%)	2(13.3%)
Marital status				2.107¹⁾	0.349
No spouse	30(21.0%)	9(16.4%)	1(6.7%)
Have a spouse	113(79.0%)	46(83.6%)	14(93.3%)
Occupation				29.660¹⁾	0.001
None	7(4.9%)	6(10.9%)	6(40.0%)
Student	3(2.1%)	1(1.8%)	1(6.7%)
Unit of business	47(32.9%)	10(18.2%)	0(0.0%)
Public service unit	39(27.3%)	19(34.5%)	4(26.7%)
Freelance work	15(10.5%)	8(14.5%)	1(6.7%)
Other	32(22.4%)	11(20.0%)	3(20.0%)
Monthly economic income (yuan)				10.679³⁾	0.005
< 5000	26(18.2%)	12(21.8%)	11(73.3%)
5000-10,000	68(47.6%)	28(50.9%)	4(26.7%)
≥ 10,000	49(34.3%)	15(27.3%)	0(0.0%)
Payment for medical expenses				22.013²⁾	0.000
Resident medical insurance	25(17.5%)	18(32.7%)	9(60.0%)
Employee medical insurance	110(76.9%)	37(67.3%)	4(26.7%)
Commercial medical insurance	3(2.1%)	0(0.0%)	1(6.7%)
Self-financed	5(3.5%)	0(0.0%)	1(6.7%)
TNM				17.643³⁾	0.000
Ⅰ	67(46.9%)	16(29.1%)	3(20.0%)
Ⅱ	70(49.0%)	33(60.0%)	6(40.0%)
III and above	6(4.2%)	6(10.9%)	6(40.0%)
Treatment modality				11.003¹⁾	0.004
Surgery	106(74.1%)	36(65.5%)	5(33.3%)
Surgery and RAI	37(25.9%)	19(34.5%)	10(66.7%)
Underlying disease				8.635²⁾	0.010
No	140(97.9%)	48(87.3%)	14(93.3%)
Yes	3(2.1%)	7(12.7%)	1(6.7%)
Extent of thyroidectomy				15.258¹⁾	0.000
Portion	103(72.0%)	30(54.5%)	4(26.7%)
Total	40(28.0%)	25(45.5%)	11(73.3%)
Cervical lymph node dissection				22.588¹⁾	0.000
No	125(87.4%)	39(70.9%)	6(40.0%)
Yes	18(12.6%)	16(29.1%)	9(60.0%)
Note. PD, psychological distress; AYAs, adolescents and young adults; TC, thyroid cancer; TNM, tumor-node-metastasis; RAI, radioactive 131-iodine; N, number; 1) χ²; 2) Fisher’s exact test; 3) Kruskal-Wallis test.

3.2. Latent profile of psychological distress

The six dimensions of the CDS-AYA scale were directly employed as one to six profile models for LPA, the fit index for each model is shown in Table 2. As the number of profiles increased, AIC, BIC, and aBIC values decreased. Upon retaining the three profiles, the entropy approached 1 and the LMRT and BLRT values reached significance (P < 0.05). After retaining the four profiles, the information evaluation indices continued to decline, and the LMRT and BLRT values also reached significance (P < 0.05). However, there were multiple profiles with category probabilities of less than 10%. The LMRT did not reach significance (P > 0.05) when five and six profiles were retained. After careful consideration, model 3 was considered the best model, and the three potential profiles were retained and plotted (Fig. 1). The attribution probabilities for each potential profile ranged from 0.954 to 0.998, which also demonstrates the reasonableness of the categorization model with three potential profiles.

Table 2

Indicators for the potential profile of psychological distress in AYAs with thyroid cancer
Profile	k	AIC	BIC	aBIC	Entropy	LMRT(P)	BLRT(P)	Proportion
1	12	7476.039	7516.374	7478.35
2	19	6797.774	6861.638	6801.433	0.982	< 0.001	< 0.001	85.45/14.55
3	26	6581.779	6669.172	6586.786	0.946	< 0.05	< 0.001	67.14/25.82/7.04
4	33	6503.186	6614.109	6509.542	0.929	< 0.05	< 0.001	61.97/24.41/7.98/5.63
5	40	6490.262	6624.713	6497.965	0.931	0.8646	< 0.05	3.29/60.56/ 8.45/22.07/5.63
6	47	6460.697	6618.678	6469.749	0.823	0.4743	< 0.05	41.32/25.82/3.29/ 16.43/5.63/7.51
Note. K, free parameters; AYAs, adolescents and young adults; AIC, akaike information criterion; BIC, bayesian information criterion; aBIC, adjusted BIC; LMRT, lo-mendell-rubin likelihood ratio; BLRT, bootstrap likelihood ratio test.

The psychological distress scores for Category 1 were low. Thus, this category was named the “low PD group,” which comprised 143 patients (67.1%). In Category 2, participants’ scores on all psychological distress dimensions were at a medium level, with the lowest scores on the employment/schooling dimension. Therefore, this category was named “moderate PD with high employment group,” with 55 patients (25.8%). In Category 3, participants’ scores on all psychological distress dimensions were high and lowest on the cancer worry dimension. Thus, this category was named the “high PD with high confidence group,” with 15 patients (7.1%) (Table 2).

3.3. Univariate LPA of psychological distress in AYAs with thyroid cancer

Univariate analysis showed that the three latent models were statistically different in terms of education level, monthly economic income, occupation, payment for medical expenses, TNM, extent of thyroidectomy, cervical lymph node dissection and treatment modality (P < 0.05) (Table 1).

3.4. Multivariate LPA of psychological distress in AYAs with thyroid cancer

Multiple unordered logistic regression was used to investigate the factors in the three psychological distress profiles of AYAs with thyroid cancer. The results revealed that AYAs with thyroid cancer with underlying diseases, surgical and RAI treatment, and lower self-management efficacy were more likely to be categorized into the “moderate PD with high employment group” than those in the “low PD group.” Additionally, AYAs with thyroid cancer with higher TNM and lower self-management efficacy were more likely to be categorized into the “high PD with high confidence group” than those in the “low PD group” (Table 3).

Table 3

Multivariate LPA of psychological distress in AYAs with thyroid cancer
Variables	moderate PD with high employment group					moderate PD with high employment group
Variables	β	P	OR	95%CI		β	P	OR	95%CI
Underlying diseases	-2.164	0.011	0.115	0.022 ~ 0.612	-0.190		0.915	0.827	0.025 ~ 27.012
Treatment modality	1.324	0.030	3.76.	1.141 ~ 12.392	0.964		0.301	2.622	0.421 ~ 16.328
TNM
Ⅰ	-1.422	0.147	0.241	0.035 ~ 1.645	-3.298		0.006	0.037	0.004 ~ 0.386
Ⅱ	-0.575	0.524	0.563	0.096 ~ 3.295	-2.956		0.003	0.052	0.007 ~ 0.368
Self-management efficacy	-0.036	0.000	0.965	0.949 ~ 0.981	-0.046		0.002	0.955	0.928 ~ 0.984
Note. LPA, latent profile analysis; AYAs, adolescents, and young adults; both groups were compared to the low PD group.

This study used LPA for the first time in AYAs with thyroid cancer to analyze their psychological distress characteristics. This method helps healthcare professionals (HCPs) identify different subgroups of individual psychological distress in AYAs with thyroid cancer from a person-centered perspective.

This study through LPA found that three potential psychological distress profiles in AYAs with thyroid cancer were identified: “low PD group,” “moderate PD with high employment group,” and “high PD with high confidence group.” This demonstrates the heterogeneity of psychological distress profiles in AYAs with thyroid cancer. These results were similar to those of a previous study[22]. Among the three subgroups, the highest dimension scores were for the impact of cancer and emotional dimensions, which is consistent with the results of previous studies[23]. A possible explanation is that the diagnosis of cancer is a greater shock to AYAs, affecting many aspects of their lives, including socialization, marriage, and work. In the face of a cancer diagnosis, depression is often the earliest psychological change in patients[24]. In a state of depression and sadness, patients often have difficulty coping with the challenges of reality, and the treatment process and disease prognosis are highly uncertain, leading to strong psychological concerns that affect the acceptance of treatment and confidence in recovery[25]. Psychosocial adjustment is key to the social integration of patients with AYA and requires the attention and intervention of HCPs and family members.

The “low PD group” accounted for 67.1%, indicating that the psychological distress of most AYAs with thyroid cancer was at a low level, which was the same as the results of the previous study[14]. This may be because patients with thyroid cancer have a better prognosis. Studies have shown that the 5-year survival rate of AYAs with thyroid cancer is approximately 100% [7, 26].

The “moderate PD with high employment group,” accounted for 25.8%, and the psychological distress of this category of patients was at a moderately low level. Patients in this category had a moderately low level of psychological distress and the lowest scores on the employment/schooling dimensions, indicating that they were at a high level of employment and that thyroid cancer had a low impact on their work. The study found that patients in this category had a bachelor's degree, and most were employed in public institutions with better welfare benefits and higher protection for medical care. In addition, most patients came to the hospital for surgery on vacation or sick leave from their units, and the hospitalization time was shorter, usually about one week, so it had less impact on their work.

The “high PD with high confidence group,” accounted for 7%, indicating that there is a low number of patients in this category, but with a high level of psychological distress. In the dimension scores, the lowest scores for cancer worry, cancer impact, and mood were the highest. This showed that thyroid cancer treatment had a greater impact on the life and emotional aspects of these patients. However, they were confident in the recovery and prognosis of the disease. The results showed that patients in this category were predominantly female, jobless, low-income, and undergoing RAI therapy. Female patients with thyroid cancer were more concerned about the formation of surgical scarring in the neck and were prone to more negative emotions, which is consistent with the results of previous studies [27, 28]. The condition of this group of patients is relatively serious, requiring not only total thyroidectomy but also comprehensive treatment. The cost of patient care increases with the increase in the number of thyroid cancer treatment options. For patients with lower family incomes, subsequent treatment undoubtedly further increases their financial burden and degree of psychological distress[29]. This study suggests that HCPs and societies should prioritize the mental health of females, low-income individuals, those with low education, and those with higher stages of AYAs with thyroid cancer. To identify the psychosocial needs of patients with different population characteristics[30] and provide targeted information on support and disease care at various stages of treatment. At the same time, society should give more financial support to poor patients[31].

Our study showed that compared with the “low PD group,” the patients with underlying diseases were more likely to belong to the “moderate PD with high employment group.” Similar to the results of the previous research[32]. Patients with underlying diseases incur higher medical costs, leading to increased economic and psychological burden[33]. More than half of AYAs reported having a health-related need to be met[34]. The study found that patients with more comorbid disorders reported higher levels of psychological distress and fewer sought help from mental healthcare providers[35]. HCPs should focus on the unmet health needs of AYAs and target support and care. HCPs could help patients reduce their level of psychological distress through measures such as mental health education, the establishment of patient support groups, and regular follow-up and counseling.

This study demonstrated that compared with the “low PD group,” the AYAs with thyroid cancer who were treated with surgery and RAI were more likely to belong to the “moderate PD with high employment group,” which was consistent with previous study results[29]. RAI is based on the ionizing effect of short-range beta rays of radionuclide 131-iodine (¹³¹I) for ablation of residual thyroid and metastatic foci and is an important component of the standard treatment regimen for thyroid cancer (Surgery + RAI + Hormonal suppression) [36]. AYAs with thyroid cancer (56.9%) are more likely to receive RAI than older patients (52.2%)[37]. Gastrointestinal reactions, radiation thyroiditis, radiation pneumonitis, altered sense of taste, decreased menstrual flow, sperm count reduction, and transient myelosuppression have also been observed in patients with thyroid cancer treated with RAI therapy[1]. AYAs with thyroid cancer who need to continue to receive RAI therapy after surgery face the adverse effects of radiation therapy, as well as an increase in the cost and duration of treatment, which would increase the degree of psychological suffering. HCPs can help AYAs with thyroid cancer among those treated with RAI therapy by informing them of the risks associated with treatment and offering educational and psychosocial support resources[9]. In addition, protection of other organs and tissues during RAI therapy should be prioritized to minimize potential radiation damage.

This study reported that compared with the “low PD group,” the higher the TNM stage, the greater the probability that AYAs with thyroid cancer belonged to the “high PD with high confidence group.” This suggests that the higher the TNM stage and the more serious the disease, the higher the psychological distress level of patients, which is similar to previous results[38]. The TNM classification not only serves as a scientific evaluation standard but also affects communication between doctors and patients[39]. Differences in disease severity and more frequent lymph node metastases were observed in AYAs with thyroid cancer patients at presentation than in older[40]. A higher TNM stage indicated a more complex surgical procedure. Consequently, the probability of a patient experiencing postoperative complications such as hoarseness and dysphagia is higher[41]. Social support from various sources, including healthcare professionals and family and peer relationships, plays an important role in the mental health of AYAs with cancer[42]. HCPs should appeal to families and society to provide more care and support to AYAs with cancer. To alleviate AYAs’ negative emotions, reduce their psychological stress, and provide more favorable support.

This study revealed that patients with higher scores on self-management efficacy were more likely to belong to the “low PD group than to the other two groups. This means that high scores in self-management efficacy were associated with lower levels of psychological distress among AYAs with thyroid cancer, consistent with previous studies[43]. Self-management effectiveness was defined by the Cancer Experience Research Collaboration UK as an individual’s approach to coping with cancer or other life-threatening illnesses and its impact on illness and quality of life[44]. Studies have demonstrated that if patients can produce favorable changes in physiological and psychological aspects through self-management, they can reduce the adverse effects of the disease to a certain extent, which can reduce their pain, fatigue, and psychological distress levels [4]. Self-management efficacy plays an important role in maintaining individuals’ physical and mental health, and when patients rely on their subjective initiative to transform and control their behaviors according to their condition, purpose, etc., they have a positive attitude toward the treatment of their disease, which helps them control their disease[45]. HCPs can provide comprehensive psychological interventions such as long-term positive motivation and information support to patients through web-based multimedia or mobile health self-management devices.

5.1 Study Limitations

This study was limited to a third-class hospital, with a small sample size. This study focused on AYAs with thyroid cancer one week after surgery. In the future, the sample size should be increased to verify these results.

5.2 Clinical Implications

Maintaining a good psychological state is important for the physical and mental health of AYAs. The results of our study showed that although most AYAs with thyroid cancer have a good psychological condition, the mental health problems of some AYAs should not be ignored. While treating the disease, medical personnel should also pay attention to the psychological condition of AYAs and provide more psychological support and care to women, AYAs with a high stage of disease, and more serious conditions. Society should provide more financial support to AYAs and families with poor economic conditions.

This study identified three subgroups of psychological distress in AYAs with thyroid cancer. Underlying disease, TNM stage, treatment modality, and self-management efficacy could affect the potential psychological distress of AYAs with thyroid cancer. This study provides a reference for exploring interventions aimed at reducing psychological distress. HCPs should pay attention to the psychological health status of AYAs with thyroid cancer and take appropriate timely intervention measures according to the characteristics of the different groups.

Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the First Affiliated Hospital of Army Medical University [(A)KY2023021].

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent to Publish

Patients signed informed consent regarding publishing their data.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author Contribution

Jia Zhang, Dan Xiong, and Yanmei Fang conceived , designed the project, investigated and data curation; Chaixiu Li and Dan Li analyzed; Xiaowei Qi, Yinhuan Wang, and Ying Yang supervised the project; Jia Zhang, wrote the main manuscript text;Ying Yang, revised the original draft;All the authors have read, edited, and approved the fnal version of the manuscript;

Data Availabitity

All authors of the study can view and use all data from the study. Data can be provided to the publisher from the corresponding author.

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No competing interests reported.

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Latent profile analysis of psychological distress in adolescents and young adults with thyroid cancer: A cross-sectional study

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Abstract

Purpose

Methods

Results

Conclusion

Figures

1. Introduction

2. Methods

2.1. Study design and participants

2.2. Measures

2.2.1. General information questionnaire

2.2.2. Psychological distress

2.2.3. Self-management effectiveness

2.3. Data collection

2.4. Statistical analysis

2.5. Ethical considerations

3. Results

3.1. Characteristics of the participants

3.2. Latent profile of psychological distress

3.3. Univariate LPA of psychological distress in AYAs with thyroid cancer

3.4. Multivariate LPA of psychological distress in AYAs with thyroid cancer

4. Discussion

5.1 Study Limitations

5.2 Clinical Implications

6. Conclusions

Declarations

Competing Interests

Ethics Approval

Funding

Author Contribution

References

Additional Declarations

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