Skip to main content
NCBI home page
Scientific Reports logoLink to Scientific Reports
. 2025 Dec 3;15:43772. doi: 10.1038/s41598-025-27479-8

Acceptance of disease as a mediator between social support and quality of life in women with Hashimoto’s disease—a pilot study

Kamilla Bargiel-Matusiewicz 1,✉, Magdalena Wnuk-Grzybowska 1, Natalia Ziółkowska 1, Agnieszka Łyś 2
PMCID: PMC12705652  PMID: 41339676

Abstract

Hashimoto’s disease is a thyroid disorder characterized by elevated antibody levels and altered gland structure seen on ultrasound. It is a common autoimmune disease, primarily affecting women. The disease has both physical and psychological consequences. Studies indicate an increased risk of mental health disorders, including depression and anxiety disorders. There is very little research in the literature focused on the quality of life of patients with Hashimoto’s disease and social support. The aim of the study was to verify the hypothesis that social support predicts health-related quality of life in patients with Hashimoto’s disease, both directly and indirectly. 143 women (aged 19–67) participated in the study. Participants completed a series of questionnaires. The mediation analyses have revealed that disease acceptance mediates the relationship between social support and the perceived impact of Hashimoto’s disease on quality of life. The present study thus provides new knowledge in the understudied area of social support, acceptance, and quality of life in women with Hashimoto’s disease. It is crucial to highlight the importance of ensuring the availability of psychological support for patients diagnosed with Hashimoto’s thyroiditis.

Keywords: Social support, Hashimoto’s disease, Autoimmune thyroiditis, Illness acceptance, Health-related quality of life, HRQoL

Subject terms: Thyroid diseases, Quality of life

Introduction

Characteristics of Hashimoto’s disease

Hashimoto’s disease (Hashimoto’s thyroiditis) is one of the most common autoimmune disorders1, also known as Hashimoto’s autoimmune thyroiditis or chronic lymphocytic thyroiditis. Women are significantly more likely to develop the disease than men, with an incidence rate 4 to 10 times higher2. The diagnosis is based on two key symptoms — elevated levels of anti-thyroid peroxidase antibodies (anti-TPO, TPOAb) and anti-thyroglobulin antibodies (anti-TG, TgAb), as well as characteristic ultrasound image showing distinct changes in the structure of the thyroid gland3. In most cases, Hashimoto’s disease also leads to hypothyroidism4. Caturegli et al. emphasize the variety of symptoms that can arise from Hashimoto’s disease, which can directly or indirectly disrupt various bodily functions, including the cardiovascular system (e.g., hypertension), the digestive system (e.g., constipation), or the respiratory system1. Additionally, symptoms may affect the skin, hair, nails, or vision5,6. These symptoms impact patients to varying degrees, depending on individual cases. A number of other chronic conditions may co-occur with Hashimoto’s disease, such as endometriosis, polycystic ovary syndrome, and premature ovarian failure, all of which can contribute to infertility in women with autoimmune thyroiditis7,8. Furthermore, developing one autoimmune disease significantly increases the risk of developing another. Hashimoto’s disease is often associated with conditions such as rheumatoid arthritis, Addison’s disease, and pernicious anemia9.

There is also an increased risk of mental health disorders among individuals with Hashimoto’s disease. Studies have confirmed a link between Hashimoto’s disease and depression and anxiety disorders10,11. Although not all studies have established this connection12, it is important to note that somatic symptoms resulting from autoimmune thyroiditis may also lead to a decline in mental health functioning. Additionally, cognitive representation of the disease and beliefs about its social implications may play a significant role in exacerbating psychopathological symptoms13.

Hashimoto’s disease involves a wide range of possible somatic symptoms affecting various aspects of patients’ health and life10. The abundance and variety of symptoms can cause considerable discomfort, as it is difficult to predict which symptoms will occur in a given patient and at what stage of the disease. This unpredictability seems particularly relevant in the context of the potential decline in the quality of life for patients with Hashimoto’s disease.

Quality of life in chronic diseases

In the context of Hashimoto’s disease, the concept of Health-Related Quality of Life (HRQoL) is important. It refers to the impact of the disease and its chronic treatment on how patients perceive their quality of life14. Although research results are inconclusive, many studies indicate a significant decline in quality of life for those with Hashimoto’s disease15,16. As mentioned earlier, patients encounter numerous challenges in both physical and mental health aspects. Given that Hashimoto’s disease is often associated with hypothyroidism, questions may arise about how to distinguish the effects of Hashimoto’s disease on patients’ quality of life from those of hypothyroidism. However, studies suggest that elevated thyroid antibodies may play a crucial role in this relationship. For example, Yalcin et al. conducted a study comparing two groups of individuals with normal thyroid function (euthyroidism) — study group had Hashimoto’s disease, while the control group consisted of individuals without Hashimoto’s autoimmune thyroiditis17. The results showed that the psychological well-being of those with Hashimoto’s disease was lower regardless of their use of levothyroxine, leading the authors to conclude that the decline in quality of life in Hashimoto’s patients may occur independently of thyroid hormone levels and is directly related to autoimmune thyroiditis. Similarly, in a study by Ott et al. 2011, as cited in Yalcin et al., 2017, a high level of antibodies in female patients was associated with a lower HRQoL, further suggesting that, regardless of hypothyroidism and thyroid hormone levels, patients with Hashimoto’s disease experience a reduced health-related quality of life17,18.

Tabakoglu and Celik, 2024 investigate the quality of life for individuals with Hashimoto’s disease. In their study analyzing the quality of life of patients with Hashimoto’s thyroiditis undergoing levothyroxine therapy, the authors indicate that achieving hormonal balance alone is not sufficient to eliminate the negative effects experienced by patients19. Tabakoglu and Celik, 2024 emphasize the need to develop effective therapeutic strategies that can improve the quality of life of individuals with Hashimoto’s thyroiditis19. Martino et al., 2021 suggests that it may be important to practice to identify and communicate feelings as some Hashimoto’s patients may remain in a state of unreported and unnoticed depression due to alexithymia, focusing instead on physical ailments. This could, in turn, contribute to their perception of a lower quality of life20.

Illness acceptance

Acceptance in the context of chronic illness is often understood as an individual’s internal agreement to endure the inevitable unpleasant experiences associated with the consequences of the illness (such as limitations and suffering), while still remaining engaged in activities aimed at achieving personal goals and values21. Numerous studies (e.g. Chabowski et al., 2017; Obiegło et al., 2017) show that illness acceptance is linked to quality of life in chronic conditions such as lung cancer22,23 and chronic heart failure23.

Researchers are also seeking answers about what can support disease acceptance. Wytrychiewicz et al., 2019 highlight the significance of psychological characteristics of individuals in the process of adapting to life with a disease, with effective stress coping strategies and a sense of self-efficacy being particularly important24.

However, a review of the literature reveals that few studies have specifically addressed Hashimoto’s disease in this regard. The role of disease acceptance in Hashimoto’s disease has been examined in relation to adopting health-promoting behaviors, but the results are inconclusive25,26. The literature review did not reveal any studies that more deeply explored the relationship between disease acceptance and quality of life in Hashimoto’s autoimmune thyroiditis.

Social support

Early researchers defined social support as meeting an individual’s basic life needs—such as respect, acceptance, support, and belonging27. Social support is commonly conceptualized as the social resources on which an individual can rely when dealing with stressful events28. It is generally assumed that social support as well as coping behaviour contributes to feelings of health and well-being. However, until nowadays researchers have discussed whether a main-effect model or a buffer model was the more appropriate way to explain the role of these factors in response to stressful situations [e.g.29]. In our study, we have expected to obtain results that are consistent with the main effects model.

Megari, 2013 and Kong et al., 2019 suggests that social support is crucial for quality of life. Many studies confirm a positive correlation between social support and quality of life30,31. Additionally, social support may be associated with higher levels of disease acceptance, as observed among patients with rheumatoid arthritis32 or type 1 diabetes33.

However, the role of social support in Hashimoto’s disease remains underexplored. Banakiewicz et al., 2021 research aimed to investigate whether social support is related to the well-being of women with Hashimoto’s disease34. The study found differences in support networks and a statistically significant relationship was found between well-being and emotional, evaluative, informational, and instrumental support—unlike the control group of healthy individuals, where no such relationship was observed. Among those with Hashimoto’s disease, a link was found between well-being and support from family, friends, and healthcare providers. This indicates that further research on social support and its connections to disease acceptance and quality of life in Hashimoto’s disease is needed to identify ways to enhance the well-being of patients.

Research problem

The study presented in this paper aims to explore why some patients manage to cope relatively well with the diagnosis of autoimmune Hashimoto’s thyroiditis—sometimes not even noticing a significant impact on their lives, while others perceive the disease as the root cause of most of their difficulties (often overlooking other potential causes for their ailments). Numerous studies on health-related quality of life in various diseases highlight the importance of social support. Therefore, this study seeks to investigate the relationship between social support and quality of life among patients with Hashimoto’s disease. Additionally, it is well-known that social support often plays a crucial role in the process of disease acceptance, which may in turn lead to better adaptation to the illness.

The aforementioned research findings indicate that the quality of life of patients with Hashimoto’s thyroiditis is an important issue due to the wide range of possible symptoms and the chronic, progressive nature of the disease. It is also worth noting that beyond the somatic effects, patients may be exposed to a range of mental health consequences. For this reason, it seems worthwhile to study these variables not only through objective measures, such as thyroid hormone levels, but also through the approach proposed in this study — focusing on patients’ subjective experiences. This approach allows us to assess how patients perceive their illness, regardless of their thyroid hormone test results.

The aim of the study presented in this paper was to verify the hypothesis that social support influences health-related quality of life in women with Hashimoto’s disease, both directly and indirectly. Epidemiological studies consistently show that women are affected at a substantially higher rate than men—a difference that strongly influences study design. A recent systematic review and meta-analysis of 48 studies including over 20 million adults reported an overall HT prevalence of 7.5%, with approximately 17.5% in women versus 6.0% in men, suggesting that adult women are affected nearly four times more often than men35. In European populations specifically, prevalence has been estimated at around 8.0%, again with a clear female predominance35. A review of the literature indicates that the majority of existing studies focus on women, which is consistent with epidemiological data showing that Hashimoto’s thyroiditis disproportionately affects females36. Given that women comprised a significantly larger proportion of the study sample, and in line with these epidemiological findings, it was decided to limit the subsequent analyses to the female subgroup only. This decision ensures that the study design accurately reflects the disease’s demographic distribution and enhances the relevance of the results for the most affected population.

Method

Research tools

To conduct the study, a survey was designed consisting of two parts. The first part aimed to collect sociodemographic data (such as gender, age, education, marital status, place of residence, country), as well as basic information related to the disease (e.g., the age at which the respondent was diagnosed with Hashimoto’s disease, whether they have comorbid conditions or mental health diagnoses). The second part of the survey included three questionnaires examining the studied variables: the Berlin Social Support Scales, the Acceptance of Illness Scale, and the ThyPROpl questionnaire.

Berlin social support scales

The Berlin Social Support Scales (BSSS), developed by Schwarzer and Schulz (2003)37 and adapted into Polish 38 by  Łuszczyńska et al. (2006), is a tool that consists of 27 questions regarding social support received from various sources. Responses are provided on a four-point scale, where 1 means “completely untrue” and 4 means “completely true.” The first part of the questionnaire contains 12 questions aimed at assessing whether the respondent generally has people around them whom they can rely on and who make them feel liked. Sample items from this section include: “Whenever I feel bad, others show that they sympathize with me,” “I know people I can always count on,” and “When I’m feeling down, I need someone to lift my spirits.” The next 15 questions are introduced by a short instruction asking the respondent to think about one closest person (such as a spouse, partner, friend, etc.). The respondent is then asked to evaluate the behavior of this chosen person. Sample items from this section include: “This person was there for me when I needed them,” “This person expressed concern about my condition,” “This person took care of things I couldn’t handle personally,” and “This person helped me find something positive in my situation.”

For the current sample (N = 143), the overall reliability coefficient (Cronbach’s alpha) for the tool was 0.95.

ThyPROpl questionnaire

The next tool used in this study was the ThyPRO questionnaire (Thyroid-related Patient Reported Outcome) in the Polish adaptation by the team led by Sawicka-Gutaj39. This questionnaire is designed to assess the quality of life in individuals with mild thyroid diseases40. It consists of thirteen scales, each containing a different number of questions regarding how patients experience thyroid disease symptoms in various aspects of life. These scales are related to symptoms of thyroid enlargement, hyperthyroidism, hypothyroidism, eye and vision problems, feelings of fatigue and fluctuations in the level of perceived energy, memory and concentration, anxiety, nervousness and tension, depression/mental well-being, coping difficulties/mood swings, and the impact of thyroid symptoms on relationships, daily activities, sexual life, and appearance. The last single question asks whether the respondent feels that thyroid disease has negatively impacted their quality of life. Responses are given on a five-point Likert scale, where 0 means “not at all” and 5 means “very much.” The instructions and questions on each scale are worded so that respondents focus on how much they have experienced specific symptoms or emotional states in the past four weeks, or to what extent a certain area of life has been affected by thyroid disease. Sample items include: “In the past 4 weeks, have you felt fatigued?“, “In the past 4 weeks, have you felt a fullness in the neck area?“, “Has your thyroid disease caused you to feel like a burden to others in the past 4 weeks?“, “Has your thyroid disease caused you to feel that everything you do takes more time in the past 4 weeks?“, “In the past 4 weeks, has your thyroid disease affected your appearance (e.g., neck swelling, eye changes, weight changes)?“, and “In the past 4 weeks, has your thyroid disease negatively affected your quality of life?”

In the present study, respondents were asked to focus primarily on their feelings related to Hashimoto’s disease.

The overall score for each scale can be presented on a scale of 0 to 100. The higher the score on a given scale, the more the respondent experiences (or has experienced in the past 4 weeks) the impact of thyroid disease symptoms in that area of life, and thus the lower the quality of life in that area. For the current sample (N = 143), Cronbach’s alpha reliability coefficients for each scale were as follows: symptoms related to thyroid enlargement 0.88; hyperthyroid symptoms 0.73; hypothyroid symptoms 0.67; eye-related symptoms 0.78; fatigue-related symptoms 0.92; energy-related symptoms 0.82; memory and concentration issues 0.88; anxiety, tension, and nervousness symptoms 0.85; depressive symptoms 0.61; coping/mood swing problems 0.74; impact of Hashimoto’s symptoms on relationships 0.75; impact of Hashimoto’s symptoms on daily activities 0.86; impact of Hashimoto’s symptoms on sexual life 0.88; and impact of Hashimoto’s symptoms on appearance 0.86.

Acceptance of illness scale

The next tool used in the study was the Acceptance of Illness Scale (AIS) developed by Felton, Revenson, and Hinrichsen (1984)41, with a Polish adaptation by Juczyński et al. in 200742. This questionnaire consists of eight questions designed to assess the degree of acceptance of illness by the respondent42. Respondents rate their current state on a five-point scale, where 1 means “strongly agree” and 5 means “strongly disagree.” The overall score is the sum of all points (ranging from 8 to 40). The questions are formulated in such a way that the higher the overall score a respondent achieves, the more that person accepts their illness.

A higher degree of acceptance suggests better adaptation to living with the illness and less psychological discomfort in the experienced situation. The statements relate to the difficult circumstances faced by the patient, their attitude toward their current health status, and primarily the limitations associated with it. Sample items include: “Health problems make me more dependent on others than I would like,” “My health condition makes me feel like I am not a worthy person,” “I have trouble adapting to the limitations imposed by the illness,” and “I think that people around me are often embarrassed because of my illness.”

Regarding the reliability of this test, the Cronbach’s alpha coefficient for the studied sample (N = 143) was 0.72 for the overall score of the questionnaire, indicating an acceptable level of reliability. In the instructions for this part of the study, respondents were asked to indicate their responses related to their current condition concerning Hashimoto’s disease.

Research procedure

The study was approved by the Ethics Committee at the Faculty of Psychology of University of Warsaw, (decision no. 05/11/2024/16), date of issue of the opinion by the Research Ethics Committee: November 5, 2024. The research involved completing a survey specifically designed for the purposes thereof. The survey was made available online via the social media platforms Facebook and Instagram. Respondents included, among others, members of support groups (forums) on Facebook that focused on thyroid diseases, with particular emphasis on support groups for people with Hashimoto’s disease. The survey was also shared on the Instagram profile of a nutritionist who takes a holistic approach to supporting patients, primarily those with Hashimoto’s disease. The instructions included the participation criteria — the study sought adults diagnosed with autoimmune thyroiditis (Hashimoto’s disease). Respondents were informed that they could withdraw from the study at any time, that their participation would remain anonymous, and that the results would be analyzed in aggregate. The study was conducted between April and September 2022, with the highest number of responses received in August 2022 (55%). The prepared survey consisted of four sections and was created using the Qualtrics program. A total of 148 completed surveys were collected, but ultimately 143 responses were included in the statistical analysis after excluding responses from men and those with hyperthyroidism.

The survey was directed at both women and men. This decision was made because, despite the fact that women constitute the majority of those affected by Hashimoto’s, there are also male patients. Paying attention to them and attempting to gather more responses from men could be important in ensuring their well-being, as most materials or content related to the disease are primarily targeted at women. However, only two fully completed surveys were received from men, which aligns with theoretical data indicating that women represent the majority of those affected by Hashimoto’s. Due to the inability to draw conclusions from such a small number of male responses, it was decided to exclude them from the analysis. Additionally, three individuals with hyperthyroidism were excluded from the results analysis, as hyperthyroidism represents an atypical course of Hashimoto’s disease.

In Table 1, the sociodemographic characteristics of the study participants and their self-reported occurrence of mental health disorders are presented.

Table 1.

Descriptive statistics of the sample.

Variable Distribution
Education Higher 74.8% Without higher 25.2%
Relationship Yes 76.9% No 23.1%
Residence  > City with over 100,000 inhabitants 49.7%  < 100,000 inhabitants 50.3%
Thyroid hormone levels Within the standard 71.3% Abnormal test result or respondents don’t know 28.7%
Self-reported occurrence of mental health disorders among the study participants

Depression 37.1%

Anxiety disorders 26.6%

Bipolar disorder 1.4%

Obsessive–compulsive disorders 5.6%

Panic attacks 16.1%

Other 2%

 Without 11.2%
Open in a new tab

In the vast majority of participants—88.8% of the patients (n = 127)—hypothyroidism was diagnosed in addition to Hashimoto’s disease. These findings align with existing literature, which indicates that hypothyroidism frequently co-occurs with Hashimoto’s disease, and that Hashimoto’s disease itself is the most common cause of hypothyroidism. Furthermore, most of the participants—91.6% (n = 131)—reported taking medication related to thyroid disease. The average age at which Hashimoto’s disease was diagnosed by a physician among the participants was 31.5 years. A significant majority of the participants—88.8% (n = 127)—were diagnosed with hypothyroidism alongside Hashimoto’s disease. The majority of participants—91.6% (n = 131)—reported taking medication for thyroid disease.

Results

In Table 2, descriptive statistics (mean, standard deviation, skewness and kurtosis), the results of the Shapiro-Wilk test, and the rho Spearman correlations for these variables are presented.

Table 2.

Descriptive statistics and normality of the distribution for the variables social support and disease acceptance (N = 143).

Variable Mean Standard deviation Skewness Kurtosis Shapiro–Wilk test 1 2
1.Social support 85.22 16.56 − 0.81 3.01 0.93***
2.Acceptance of illness 27,97 6.62 − 0.41 2.35 0.96*** 0.31***
3.Perceived influence of the illness on the quality of life 30.94 27.51 0.25 1.68 0.84*** − 0.31*** − 0.60***
Open in a new tab

*** p < .001.

To examine whether acceptance of illness serves as a mediator between social support and the perceived impact of Hashimoto’s disease on quality of life, a mediation analysis was conducted using Model 4 in the PROCESS macro. In order to adjust for the non-normality of the distribution we used bootstrapping (bootstrapped samples = 5,000). The model is presented in Fig. 1.

Fig. 1.

Fig. 1

Open in a new tab

Acceptance of illness as a mediator between social support and the perceived impact of the illness on quality of life.

The indirect effect of social support on perceived influence of the illness on quality of life through acceptance of illness [β = − .15; 95% CI = (-0.26, − 0.07)] was negative and significant. After taking into account the effect of acceptance of illness, the direct effect of social support on perceived influence of the illness on quality of life is still significant which demonstrates that the link between social support and perceived influence of the illness on quality of life is partially mediated by acceptance of illness. The r2 is 0.08 which means that the model explains 0.08 of variance.

Additionally we conducted a post-hoc power analysis with MedPower software. Given the sample size and the beta sizes, the power is from 0.925 (the ab indirect effect) to 0.999 (the c total effect), thus the sample size is adequate for this kind of analysis.

Discussion of results

Illness is a source of stress for every individual, disruption of normal functioning, well-being, or representing a type of disturbance in the rhythm of life. Often, illness necessitates changes in a person’s life43–45. It complicates previous functioning and often requires a shift in lifestyle and activities46,47. Consequently, upon diagnosis of a somatic illness, individuals may experience negative emotions or depressive states.

Hashimoto’s disease, also known as Hashimoto’s thyroiditis, is one of the most common autoimmune diseases2. The chronic nature of this condition is emphasized, along with the fact that it often leads to hypothyroidism in the majority of patients. This disease affects patients’ lives in many areas, although the severity and presence of individual symptoms vary from person to person.

Most research focuses on the numerous and diverse somatic symptoms accompanying Hashimoto’s disease10. The studies mentioned in the theoretical introduction indicate that this disease can affect patients’ appearance concerning skin, hair, nail issues, and a tendency towards edema6. The literature presents numerous studies (e.g. Bergink et al., 2018; Siegmann et al., 2018) indicating a relationship between the occurrence of Hashimoto’s disease and various mental disorders and a deterioration in quality of life, including its psychological dimension10,48. The range of possible symptoms is extensive, and similar to many other chronic diseases, despite the same diagnosis, patients’ well-being will depend on various factors and the individual course of the illness2. A review of the literature shows that in the case of many chronic diseases, a correlation between the chronic illness and its symptoms and the health-related quality of life has been established49,50.

The aim of this research was to verify the mediating role of illness acceptance in the relationship between social support and quality of life in chronic illness. The studies showed that illness acceptance mediates the relationship between social support and quality of life.

There is a lack of research and reports regarding how patients cope with Hashimoto’s disease. In the literature review conducted using the EBSCO database (Web of Science, PsyARTICLES, MedLine), no results were found when searching with keywords such as acceptance of illness, Hashimoto disease, and social support. In the case of combinations of words such as quality of life, well-being, or health-related quality of life, social support, and Hashimoto’s disease, only seven records appeared, none of which were related to Hashimoto’s disease, but to other conditions. This indicates a significant research gap regarding the functioning of patients, particularly women, due to the higher prevalence of the disease among females. However, literature indicates that in chronic illness situations, psychological resources can play an important role in adaptation. The importance of social support, illness acceptance, the use of adaptive stress coping strategies, and a sense of self-efficacy are emphasized24,51. Studies also show that stronger illness acceptance was associated with higher quality of life in patients with spinal cord injuries or lower frequency of depressive symptoms and better metabolic control in diabetes patients52–54. Similarly, studies on pain acceptance in patients with rheumatic diseases demonstrated that pain acceptance, and thus illness acceptance, was associated with less focus on experienced pain symptoms24,51, lower levels of anxiety and depression55,56, and less physical and psychosocial disability51,57. Similar results have been reported by Bussell and Naus and Iwanowicz-Palus et al.58,59.

However, literature shows reports indicating that the level of illness acceptance among patients treated for gynecological cancers was at a moderate level60. Illness acceptance was negatively correlated with unmet healthcare and psychological needs, as well as issues related to sexuality or daily life. Uslu-Sahan and Gulcan, 2023 indicate that interventions aimed at increasing illness acceptance are necessary60.

The results of our studies showed that illness acceptance mediates the relationship between social support and quality of life among patients with Hashimoto’s disease, connected with the perception of the disease’s impact on functioning in daily life and achieving life goals. Here, it is worth referring to the main effect hypothesis, according to which social support is one of the key variables concerning well-being. The level of support is significant for how life experiences are interpreted28. In the context of Lazarus and Folkman’s (61, as cited in3 stress paradigm, social support can be interpreted as a resource that fosters a more positive cognitive appraisal (in our study, cognitive appraisal is reflected in the level of illness acceptance). Our findings indicated that after accounting for the role of illness acceptance, the direct impact of social support on the perceived influence of the disease on quality of life remains significant. Social support is extremely important in coping with chronic illness. Studies show that this factor serves a protective function against the emergence of elevated levels of anxiety and depression62,63. Additionally, research indicates that support and illness acceptance are interconnected, with social support playing a significant role in the acceptance of chronic illness64,65. A meta-analysis even showed that having a high level of perceived support was associated with a 25% reduction in relative mortality risk among cancer survivors63,66. However, it is also important to mention the limitations of this study. Firstly, it was a cross-sectional study rather than a longitudinal one, which precludes establishing causal relationships between the analyzed variables. Another limitation is the lack of consideration of thyroid hormone levels among the subjects. Monitoring not only hormone levels but also the levels of thyroid antibodies seems an important aspect to consider in future studies on this topic. On the other hand, the fact that the study relies on subjective feelings and assessments of participants may be significant for a better understanding of how patients experience their illness. The study did not exclude responses from individuals with diagnosed mental disorders, which could be difficult and would require a much larger sample size, given that Hashimoto’s disease coexists with various mental disorders. Additionally, the study did not include male participants due to a very small number of responses.

Nonetheless, the study described in this article is important because there is virtually no data in the literature regarding quality of life and illness acceptance among patients with autoimmune thyroiditis. Researchers have examined these issues in groups of patients suffering from cancers, cardiovascular diseases, diabetes, while little attention has been paid to coping with autoimmune diseases, which significantly impact the quality of life of female patients.

Therefore, further work seems necessary to explore the significance of illness acceptance and social support on the quality of life of patients with Hashimoto’s disease, particularly in the context of longitudinal research models. Later, it would be valuable to develop interventions aimed at fostering and strengthening illness acceptance in various groups of patients dealing with chronic somatic illnesses, which may positively affect their quality of life. Furthermore, future research should also consider the role of gratitude in illness acceptance, perceived social support, and quality of life. Studies conducted in a group of breast cancer patients demonstrated that identifying reasons for gratitude led to higher rates in terms of daily psychological functioning, using adaptive stress coping strategies, as well as higher levels of perceived support67. The results suggest a beneficial impact of interventions aimed at fostering gratitude (where strengthening the sense of gratitude may be understood as awareness of past and present social support) on the functioning of patients with chronic illness. Thus, it would be worthwhile to direct such interventions to groups of patients struggling with Hashimoto’s disease.

Additionally, in the future, besides factors related to the functioning of the patients themselves and the level of support received from their immediate environment, it would be valuable to consider social factors, such as the quality of medical care, as they also have a significant impact on the functioning of patients with chronic illnesses68.

A review of the literature indicates that the quality of life of patients with Hashimoto’s disease is often lower than that of healthy individuals. Furthermore, there is a greater risk of mental disorders among patients with autoimmune thyroiditis. Therefore, it seems extremely important to conduct research and plan interventions aimed at minimizing the impact of Hashimoto’s disease on quality of life, and consequently, to support patients in coping better with their illness. The presented results of our research show that actions aimed at increasing social support and illness acceptance may be important in the context of the perceived impact of Hashimoto’s disease on patients’ quality of life, and thus be significant for improving the quality of life in this chronic illness. Further research in this area is important for planning more specific ways of providing social and psychological support.

Author contributions

All authors contributed to the study conception and design. Conceptualization: [Kamilla Bargiel-Matusiewicz and Magdalena Wnuk-Grzybowska]; methodology: [Kamilla Bargiel-Matusiewicz and Magdalena Wnuk-Grzybowska]; data collection [Magdalena Wnuk-Grzybowska]; formal analysis: [Agnieszka Łyś]; writing—original draft preparation: [Magdalena Wnuk-Grzybowska, Natalia Ziółkowska and Kamilla Bargiel-Matusiewicz]; writing—review and editing: [Kamilla Bargiel-Matusiewicz, Magdalena Wnuk-Grzybowska, Natalia Ziółkowska and Agnieszka Łyś]. All authors have read and agreed to the published version of the manuscript.

Funding

This research was supported by the Faculty of Psychology, University of Warsaw, from the funds awarded by the Ministry of Science and Higher Education in the form of a subsidy for the maintenance and development of research potential in 2023/2024 (501-D125-01-1250000 zlec* 501 1000 227).

Data availability

The datasets generated and analyzed during the current study are not publicly available due to protect the privacy of the research participants but are available from the corresponding author on reasonable request.

Declarations

Informed consent

Informed consent was obtained from all subjects involved in the study.

Institutional review board statement

This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee at the Faculty of Psychology of University of Warsaw, Warsaw, Poland (decision no. 05/11/2024/16).

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Caturegli, P., De Remigis, A. & Rose, N. R. Hashimoto thyroiditis: clinical and diagnostic criteria. AutoimmunityReviews13(4–5), 391–397. 10.1016/j.autrev.2014.01.007 (2014). [DOI] [PubMed] [Google Scholar]
  • 2.Ragusa, F. et al. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract. Res. Clin. Endocrinol. Metab.33(6), 101367. 10.1016/j.beem.2019.101367 (2019). [DOI] [PubMed] [Google Scholar]
  • 3.Amino, N., Tada, H., Hidaka, Y. & Hashimoto, K. History of hashimoto’s disease-Hashimoto’s disease and Dr. Hakaru Hashimoto EndocrineJournal. 49(4), 393–397. 10.1507/endocrj.49.393 (2002). [DOI] [PubMed] [Google Scholar]
  • 4.Rapoport, B. Pathophysiology of Hashimoto’s thyroiditis and hypothyroidism. Annu. Rev. Med.42(1), 91–96. 10.1146/annurev.me.42.020191.000515 (1991). [DOI] [PubMed] [Google Scholar]
  • 5.Tjiang, H., Lahooti, H., McCorquodale, T., Parmar, K. R. & Wall, J. R. Eye and eyelid abnormalities are common in patients with Hashimoto’s thyroiditis. Thyroid: Official J. Am. Thyroid Association. 20(3), 287–290. 10.1089/thy.2009.0199 (2010). [DOI] [PubMed] [Google Scholar]
  • 6.Koczorowska-Talarczyk, O. & Kordus, K. The impact of Hashimoto’s disease on skin, hair, and nails. Aesthetic Cosmetology Med.10(6), 277–285. 10.52336/acm.2021.10.6.03 (2021). [Google Scholar]
  • 7.Kuharić, M., Rozić, D. & Karner, I. Thyroid autoimmunity and infertility. Southeast. Eur. Med. Journal: SEEMEDJ. 1(2), 1–10. 10.26332/seemedj.v1i2.48 (2017). [Google Scholar]
  • 8.Romitti, M., Fabris, V. C., Ziegelmann, P. K., Maia, A. L. & Spritzer, P. M. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocr. Connections. 7(11), 1158–1167. 10.1530/ec-18-0309 (2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Boelaert, K. et al. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am. J. Med.123(2), 183e1–183e9. (2010). [DOI] [PubMed] [Google Scholar]
  • 10.Siegmann, E. M. et al. Association of depression and anxiety disorders with autoimmune thyroiditis: a systematic review and meta-analysis. JAMA Psychiatry. 75(6), 577–584. 10.1001/jamapsychiatry.2018.0190 (2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Gigilashvili, M., Matitashvili, G. & &Ramishvili, R. Association between Hashimoto’s thyroiditis and depression. Experimental Clin. Med. Ga.2, 25–29. 10.52340/jecm.2022.02.04 (2022). [Google Scholar]
  • 12.Bode, H. et al. Association of hypothyroidism and clinical depression: A systematic review and meta-analysis. JAMA Psychiatry. 78(12), 1375–1383. 10.1001/jamapsychiatry.2021.2506 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Pankowski, D., Wytrychiewicz, K., Walicka, M., Janowski, K. & Bargiel-Matusiewicz, K. Poznawcza reprezentacja choroby a nasilenie objawów lękowych, depresyjnych oraz gniewu w grupie pacjentek z Hashimoto [Cognitive Representation of Illness and the Severity of Anxiety, Depressive Symptoms, and Anger in a Group of Patients with Hashimoto’s Disease]. XII Ogólnopolska Konferencja Naukowa Sekcji Psychologii Zdrowia PTP pod hasłem „W zdrowiu i w chorobie - trajektorie jakości życia. 10.13140/RG.2.2.36167.55201 (2019).
  • 14.Schipper, H. L. & Clinch, J. &Powell, V. Definitions and conceptual issues. Quality Life Assess. Clin. Trials, 11–24 (1990).
  • 15.Shivaprasad, C. et al. Impairment of health-related quality of life among Indian patients with hypothyroidism. Indian J. Endocrinol. Metabol.22(3), 335–338. 10.4103/ijem.IJEM_702_17 (2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Morón-Díaz, M. et al. Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism. Endocrine72(1), 190–197. 10.1007/s12020-020-02449-4 (2021). [DOI] [PubMed] [Google Scholar]
  • 17.Yalcin, M. M. et al. Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto’s thyroiditis? Endocr. J.64(4), 425–429. 10.1507/endocrj.EJ16-0418 (2017). [DOI] [PubMed] [Google Scholar]
  • 18.Ott, J. et al. Hashimoto’s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid: Official J. Am. Thyroid Association. 21(2), 161–167. 10.1089/thy.2010.0191 (2011). [DOI] [PubMed] [Google Scholar]
  • 19.Tabakoglu, N. T. & Celik, M. Evaluation of health-related quality of life in patients with euthyroid hashimoto’s thyroiditis under long-term levothyroxine therapy: A prospective case-control study. J. Clin. Med.13(11), 3082. 10.3390/jcm13113082 (2024). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Martino, G. et al. Alexithymia, emotional distress, and perceived quality of life in patients with Hashimoto’s thyroiditis. Front. Psychol.12, 667237. 10.3389/fpsyg.2021.667237 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Fletcher, L. & Hayes, S. C. Relational frame theory, acceptance and commitment therapy, and a functional analytic definition of mindfulness. J. Rational-Emotive Cognitive-Behavior Therapy. 23(4), 315–336. 10.1007/s10942-005-0017-7 (2005). [Google Scholar]
  • 22.Chabowski, M. et al. The acceptance of illness, the intensity of pain and the quality of life in patients with lung cancer. J. Thorac. Disease. 9(9), 2952–2958. 10.21037/jtd.2017.08.70 (2017). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Obiegło, M., Siennicka, A., Jankowska, E. A. & Danel, D. P. Direction of the relationship between acceptance of illness and health-related quality of life in chronic heart failure patients. J. Cardiovasc. Nurs.32(4), 348–356. 10.1097/jcn.0000000000000365 (2017). [DOI] [PubMed] [Google Scholar]
  • 24.Wytrychiewicz, K., Pankowski, D., Bargiel-Matusiewicz, K., Dąbrowski, J. & Fal, A. M. The role of psychological and medical variables in the process of adaptation to life with chronic illness in a group of COPD outpatients. Psychol. Health Med.24(10), 1243–1254. 10.1080/13548506.2019.1619789 (2019). [DOI] [PubMed] [Google Scholar]
  • 25.Rode, D. & Rode, M. M. The relationship between self-esteem, sense of self-efficacy and level of illness acceptance, and healthful behaviours in patients with long-term illnesses (type II diabetes, Hashimoto’s disease). Health Psychol. Rep.6(2), 158–170. 10.5114/hpr.2018.71635 (2018). [Google Scholar]
  • 26.Seń, M., Grabowska, B. & Wójcik, J. Zachowania zdrowotne, stopień Akceptacji choroby i Poziom Wiedzy żywieniowej osób Chorych Na niedoczynność Tarczycy i autoimmunologiczne zapalenie Tarczycy typu Hashimoto. Badanie wstępne [Health Behaviors, degree of disease Acceptance, and level of nutritional knowledge in individuals with hypothyroidism and autoimmune thyroiditis type hashimoto: preliminary Study]. Medycyna Ogólna I Nauki O Zdrowiu. 26(4), 384–389. 10.26444/monz/126691 (2020). [Google Scholar]
  • 27.Kaplan, B. H., Cassel, J. C. & Gore, S. Social support and health. Med. Care. 15(5), 47–58 (1977). [DOI] [PubMed] [Google Scholar]
  • 28.Cohen, S. & Wills, T. A. Stress, social support, and the buffering hypothesis. Psychol. Bull.98(2), 310–357. 10.1037/0033-2909.98.2.310 (1985). [PubMed] [Google Scholar]
  • 29.Che, X., Cash, R., Ng, S. K., Fitzgerald, P. & Fitzgibbon, B. M. A systematic review of the processes underlying the main and the buffering effect of social support on the experience of pain. Clin. J. Pain. 34(11), 1061–1076. 10.1097/AJP.0000000000000624 (2018). [DOI] [PubMed] [Google Scholar]
  • 30.Megari, K. Quality of life in chronic disease patients. Health Psychol. Res.1(3). 10.4081/hpr.2013.e27 (2013). [DOI] [PMC free article] [PubMed]
  • 31.Kong, L. N., Hu, P., Yao, Y. & Zhao, Q. H. Social support as a mediator between depression and quality of life in Chinese community-dwelling older adults with chronic disease. Geriatr. Nurs.40(3), 252–256. 10.1016/j.gerinurse.2018.10.014 (2019). [DOI] [PubMed] [Google Scholar]
  • 32.Kostova, Z., Caiata-Zufferey, M. & Schulz, P. J. The impact of social support on the acceptance process among RA patients: a qualitative study. Psychol. Health. 29(11), 1283–1302. 10.1080/08870446.2014.925895 (2014). [DOI] [PubMed] [Google Scholar]
  • 33.Jankowski, K., Pankowski, D. & Wytrychiewicz-Pankowska, K. Wsparcie społeczne a akceptacja życia z chorobą u młodych dorosłych chorych na cukrzycę typu I [Social Support and Acceptance of Life with the Disease in Young Adults with Type 1 Diabetes]. W: J. Piekarska i A. Studzińska (red.), Perspektywy w psychologii (s. 153–164). Wydawnictwo AEH (2021).
  • 34.Banakiewicz, A., Bednarczyk, A. & Kulik, A. Wsparcie społeczne i dobrostan w chorobie Hashimoto u Kobiet w Okresie dorosłości [Social support and Well-Being in hashimoto’s disease among adult Women]. Ann. Universitatis Mariae Curie-Skłodowska Sectio J. Paedagogia-Psychologia. 34(2), 177–189. 10.17951/j.2021.34.2.177-189 (2021). [Google Scholar]
  • 35.Hu, X. et al. Global prevalence and epidemiological trends of Hashimoto’s thyroiditis in adults: A systematic review and meta-analysis. Front. public. Health. 10, 1020709. 10.3389/fpubh.2022.1020709 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Vargas-Uricoechea, H. et al. A scoping review on the prevalence of Hashimoto’s thyroiditis and the possible associated factors. Med. Sci. (Basel Switzerland). 13(2), 43. 10.3390/medsci13020043 (2025). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Schulz, U. & Schwarzer, R. Soziale Unterstützung Bei der Krankheitsbewältigung: die Berliner social support Skalen (BSSS) [Social support in coping with illness: the Berlin social support scales (BSSS)]. Diagnostica49(2), 73–82. 10.1026/0012-1924.49.2.73 (2003). [Google Scholar]
  • 38.Łuszczyńska, A., Mazurkiewicz, M., Kowalska, M. & Schwarzer, R. Berlińskie Skale Wsparcia Społecznego (BSSS): Wyniki wstępnych badań Nad adaptacją Skal i Ich własnościami psychometrycznymi [Berlin social support scales (BSSS): results of preliminary research on the adaptation of the scales and their psychometric Properties]. Studia Psychologiczne. 44(3), 17–27 (2006). [Google Scholar]
  • 39.Sawicka-Gutaj, N., Watt, T., Sowiński, J., Gutaj, P. & Waligórska-Stachura, J. & Ruchała, M. thypropl—The Polish version of the thyroid-specific quality of life questionnaire thypro. EndokrynologiaPolska66(4), 367–380. 10.5603/EP.2015.0047 (2015). [DOI] [PubMed] [Google Scholar]
  • 40.Sawicka-Gutaj, N. et al. Eye symptoms in patients with benign thyroid diseases. Sci. Rep.11(1), 1–7. 10.1038/s41598-021-98232-0 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Felton, B. J., Revenson, T. A. & Hinrichsen, G. A. Stress and coping in the explanation of psychological adjustment among chronically ill adults. Soc. Sci. Med.18(10), 889–898. 10.1016/0277-9536(84)90158-8 (1984). [DOI] [PubMed] [Google Scholar]
  • 42.Juczyński, Z. NPPPZ - Narzędzia Pomiaru W Promocji I Psychologii Zdrowia. [Measurement Tools in Health Promotion and Health Psychology] (Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego, 2012).
  • 43.Bargiel-Matusiewicz, K. Przewlekły Stres związany z dializoterapią. Zastosowanie interwencji Psychologicznych [Chronic stress related to Dialysis therapy: the use of psychological Interventions]. Wydawnictwa Uniwersytetu Warszawskiego. 10.31338/uw.9788323514756 (2014). [Google Scholar]
  • 44.Ilgen, J., Renovanz, M., Stengel, A. & Zipfel, S. & Schäffeler, N. Resilience as a factor influencing psychological distress experience in patients with Neuro-Oncological disease. Currentoncology (Toronto Ont). 29(12), 9875–9883. 10.3390/curroncol29120776 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Schenker, R. A. et al. Comprehensive preoperative psychological assessment of breast cancer patients. Psychol. Health Med.28(2), 359–374. 10.1080/13548506.2022.2059095 (2023). [DOI] [PubMed] [Google Scholar]
  • 46.Heszen-Celińska, I. & Sęk, H. Psychologia Zdrowia (Wydawnictwo Naukowe PWN, 2020).
  • 47.Castillo-Mayén, R. et al. Emotion regulation in patients with cardiovascular disease: development and validation of the stress and anxiety regulation strategies scale (STARTS). Anxiety Stress Coping. 34(3), 349–364. 10.1080/10615806.2020.1866173 (2021). [DOI] [PubMed] [Google Scholar]
  • 48.Bergink, V. et al. Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study. Psychol. Med.48(8), 1291–1298. 10.1017/S0033291717002732 (2018). [DOI] [PubMed] [Google Scholar]
  • 49.Bujok, G. & &Tombarkiewicz, M. Jakość życia Uwarunkowana Stanem Zdrowia Jako Nowy problem kliniczny [Health-Related quality of life as a new clinical Issue]. Wiadomości Lekarskie. 58(1–2), 67–70 (2005). [PubMed] [Google Scholar]
  • 50.Sierakowska, M., Sierakowski, S., Wróblewska, M. & Krajewska-Kułak, E. Problemy Zdrowotne pacjentów z chorobą zwyrodnieniową stawów i Ich wpływ Na jakość życia uwarunkowaną Stanem Zdrowia [Health issues of patients with osteoarthritis and their impact on Health-Related quality of Life]. Reumatologia48(6), 372–379 (2010). [Google Scholar]
  • 51.Cameron, N., Kool, M., Estévez-López, F., López-Chicheri, I. & Geenen, R. The potential buffering role of self-efficacy and pain acceptance against invalidation in rheumatic diseases. Rheumatol. Int.38(2), 283–291. 10.1007/s00296-017-3859-2 (2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Richardson, A., Adner, N. & Nordström, G. Persons with insulin-dependent diabetes mellitus: acceptance and coping ability. J. Adv. Nurs.33(6), 758–763. 10.1046/j.1365-2648.2001.01717.x (2001). [DOI] [PubMed] [Google Scholar]
  • 53.Ferrin, J. M. Acceptance of Loss after an adult-onset Disability: Development and Psychometric Validation of the Multidimensional Acceptance of Loss Scale (The University of Wisconsin-Madison, 2002).
  • 54.Dijkstra, A., Buunk, A. P., Tóth, G. & Jager, N. Psychological adjustment to chronic illness: the role of prototype evaluation in acceptance of illness. J. Appl. Biobehavioral Res.12(3-4), 119–140. 10.1111/j.1751-9861.2008.00018.x (2007). [Google Scholar]
  • 55.Healy, G. M. et al. Pretreatment anxiety and pain acceptance are associated with response to trigger point injection therapy for chronic myofascial pain. Pain Med. (Malden Mass). 16(10), 1955–1966. 10.1111/pme.1278 (2015). [DOI] [PubMed] [Google Scholar]
  • 56.McCracken, L. M. et al. Can a psychologically based treatment help people to live with chronic pain when they are seeking a procedure to reduce it? Pain Med. (Malden Mass). 16(3), 451–459. 10.1111/pme.12623 (2015). [DOI] [PubMed] [Google Scholar]
  • 57.Trompetter, H. R., Bohlmeijer, E. T., Veehof, M. M. & Schreurs, K. M. Internet-based guided self-help intervention for chronic pain based on acceptance and commitment therapy: a randomized controlled trial. J. Behav. Med.38(1), 66–80. 10.1007/s10865-014-9579-0 (2015). [DOI] [PubMed] [Google Scholar]
  • 58.Bussell, V. A. & &Naus, M. J. A longitudinal investigation of coping and posttraumatic growth in breast cancer survivors. J. Psychosoc. Oncol.28(1), 61–78. 10.1080/07347330903438958 (2010). [DOI] [PubMed] [Google Scholar]
  • 59.Iwanowicz-Palus, G., Zarajczyk, M., Pięta, B. & Bień, A. Quality of life, social support, acceptance of Illness, and self-efficacy among pregnant women with hyperglycemia. Int. J. Environ. Res. Public Health. 16(20), 3941. 10.3390/ijerph16203941 (2019). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Uslu-Sahan, F. & Gulcan, N. Supportive care needs in predicting the acceptance of illness among gynecological cancer patients undergoing therapy: a cross-sectional study. Supportive Care Cancer: Official J. Multinational Association Supportive Care Cancer. 32(1), 61. 10.1007/s00520-023-08270-9 (2023). [DOI] [PubMed] [Google Scholar]
  • 61.Lazarus, R. & Folkman, S. Stress, Appraisal, and Coping (Springer, 1984).
  • 62.de Gonzalez-Saenz, M. et al. Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients. Psycho-oncology26(9), 1263–1269. 10.1002/pon.4303 (2017). [DOI] [PubMed] [Google Scholar]
  • 63.Krok, D., Telka, E. & &Moroń, M. Marital satisfaction, partner communication, and illness acceptance among couples coping with breast cancer: A dyadic approach. Psycho-oncology32(8), 1240–1247. 10.1002/pon.6174 (2023). [DOI] [PubMed] [Google Scholar]
  • 64.Pasek, M., Dębska, G. & Wojtyna, E. Perceived social support and the sense of coherence in patient-caregiver dyad versus acceptance of illness in cancer patients. J. Clin. Nurs.26(23–24), 4985–4993. 10.1111/jocn.13997 (2017). [DOI] [PubMed] [Google Scholar]
  • 65.Budna, B., Bolanowska, Z., Juzwiszyn, J. & Chabowski, M. Impact of illness acceptance on the quality of life in cancer patients after surgical treatment. Srpskiarhiv Za Celokupnolekarstvo. 148(5–6), 338–343. 10.2298/SARH190827030B (2020). [Google Scholar]
  • 66.Pinquart, M. & Duberstein, P. R. Associations of social networks with cancer mortality: a meta-analysis. Crit. Rev. Oncol. Hematol.75(2), 122–137. 10.1016/j.critrevonc.2009.06.003 (2010). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Sztachańska, J., Krejtz, I. & &Nezlek, J. B. Using a gratitude intervention to improve the lives of women with breast cancer: A daily diary study. Front. Psychol.10, 1365. 10.3389/fpsyg.2019.01365 (2019). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Potter, C. M., Kelly, L., Hunter, C., Fitzpatrick, R. & Peters, M. The context of coping: A qualitative exploration of underlying inequalities that influence health services support for people living with long-term conditions. Sociol. Health Illn.40(1), 130–145. 10.1111/1467-9566.12624 (2017). [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets generated and analyzed during the current study are not publicly available due to protect the privacy of the research participants but are available from the corresponding author on reasonable request.

Articles from Scientific Reports are provided here courtesy of Nature Publishing Group

RESOURCES