Abstract
BACKGROUND: The most prevalent form of thyroid cancer is papillary thyroid carcinoma (PTC), and its prevalence has been steadily increasing globally, especially in women. Although the exact aetiology of PTC remains unclear, existing evidence indicates that psychological factors may exert a substantial influence on its pathogenesis. The primary objective of this research was to investigate the prevalence of psychological distress (including anxiety and depressive symptoms) and sleep disorders among patients with PTC, and to examine their interrelationships. METHODS: In this propensity score-matched (PSM) case-control study, we compared 446 PTC patients with demographically matched controls. Psychological distress was assessed using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), via validated scales. Multivariable logistic regression analyzed associations, controlling for demographic confounders. RESULTS: The analysis revealed significantly higher prevalence rates of anxiety disorders (9.6% vs 7.0%), clinically significant depressive symptoms (39.9% vs 30.0%), and sleep disturbances (52.2% vs 39.0%) among PTC patients. Notably, logistic regression analysis demonstrated that mild sleep disturbances (specifically) were associated with PTC status (OR = 1.694, 95%CI 1.276-2.248, p < 0.001). Our study also found a correlation between depression and multifocal tumors (p < 0.05). Furthermore, by further comparing specific dimensions of sleep quality, we found that PTC patients had significantly lower scores in daytime dysfunction, sleep efficiency, sleep latency, and subjective sleep quality compared to the normal population. CONCLUSION: These results reveal significant associations between psychological comorbidities, sleep dysfunction (particularly mild sleep disturbances), and PTC diagnosis, although the observational design precludes causal inference. Additionally, the results highlight the critical role of mental health in the clinical management of thyroid cancer. The incorporation of regular evaluations of depressive symptoms and sleep disturbances into clinical protocols is advised to improve the prognostic outcomes and quality of life of patients.