Purpose

To investigate HRQoL, depression, anxiety, and stress in Belgian patients with AITD and active TAO, and to examine the role of clinical factors, diagnose and illness cognitions as determinants of these outcomes.

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Methods

In this cross-sectional study, 105 participants (34 TAO, 32 AITD, 39 healthy controls) completed validated questionnaires assessing generic HRQoL (SF-36), emotional well-being (DASS-21), illness cognitions (ICQ), and disease-specific quality of life (GO-QoL for TAO). Clinical and biochemical parameters were collected, and associations between demographics, clinical features, illness cognitions, and HRQoL outcomes were analyzed using hierarchical regression and Bayesian network modeling.

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Results

Both TAO and AITD patients had significantly lower physical and mental HRQoL and higher depression, anxiety, and stress compared with healthy controls, with no significant differences between patient groups. TAO patients reported greater helplessness than AITD patients. Helplessness emerged as the strongest predictor of impaired HRQoL and higher emotional distress, whereas TAO diagnosis itself contributed minimally to variance. Bayesian analysis indicated that physical and mental health influenced helplessness, which in turn shaped emotional outcomes, highlighting the central role of cognitive factors.

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Conclusion

Impaired HRQoL and emotional distress in AITD and TAO patients are largely driven by maladaptive illness cognitions, particularly helplessness, rather than clinical disease severity. These findings support the integration of psychological assessment and interventions targeting illness cognitions to improve patient-centered care.

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Additional Authors

First name	Last name	Base Hospital / Institution
Emelien	Lauwerier	Open University Netherlands
Geert	Crombez	Ghent University
Elke O	Kreps	Ghent University Hospital
Bart P	Leroy	Ghent University Hopstital
Bruno	Lapauw	Ghen University Hospital

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