2026 ECNP Congress

PS04-4091

Sleep, resilience, and coping in relation to depression and anxiety symptoms in children with Hashimoto’s thyroiditis: a pilot case-control study

Selin Erfiliz Özdal — Z. Koyuncu, H. Turan · Istanbul University-Cerrahpasa - Cerrahpasa Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul, Türkiye

2026 ECNP Congress

Objectives

Thyroid hormones play an important role in neurological and psychological well-being, as well as in growth and development in children and adolescents.The most common cause of acquired hypothyroidism in childhood is Hashimoto’s thyroiditis.Previous studies have suggested that autoimmune thyroiditis and thyroid dysfunction may be associated with depressive and anxiety symptoms, and that sleep problems may interact bidirectionally with these symptoms[1,2].In addition,psychological resilience and coping skills have also emerged as protective or risk-enhancing factors in mental health[3].This study aimed to comparatively examine,in children and adolescents diagnosed with Hashimoto’s thyroiditis and healthy controls,the relationship of sleep characteristics,psychological resilience,and coping skills with depressive and anxiety symptoms,and to evaluate difficulties in these domains as potential psychosocial factors associated with increased levels of psychiatric symptoms.

Methods

This pilot case-control study included 14 children and adolescents with Hashimoto’s thyroiditis and 12 healthy controls. Demographic and clinical data were collected,and thyroid function tests,including TSH and free T4,were recorded.Anti-TPO and anti-Tg antibody levels were also recorded in the Hashimoto’s thyroiditis group.Psychiatric assessment included the Sleep Disturbance Scale for Children(SDSC),the Child and Youth Resilience Measure-12(CYRM-12),the Coping Scale for Children and Adolescents, and the Revised Child Anxiety and Depression Scale–Child Version(RCADS-CV).RCADS-CV raw scores were used for group comparisons,and T-scores were used to identify borderline or clinically elevated symptom domains.Group comparisons were performed using appropriate parametric or non-parametric tests according to variable distribution,and p<0.05 was considered statistically significant.

Results

The Hashimoto’s thyroiditis group included 14 participants(13 girls,1 boy), while the control group included 12 participants, all of whom were girls. The groups were similar in terms of age [15.5(13.8–17.0) vs. 16.5(15.0–17.0) years; p=0.236] and sex distribution.

TSH levels were significantly higher in the patient group [3.9(1.6–7.4) vs. 1.2(0.9–1.6);p=0.002], while free T4 levels did not differ significantly. The SDSC total score was significantly higher in the patient group [46.0(34.5–51.0) vs. 28.0(27.0–30.2);p=0.001], with 71.4% of patients (10/14) exceeding the screening threshold for sleep disturbance. Several SDSC subdomains, including disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, excessive somnolence, and sleep hyperhidrosis, were also higher in the patient group.

The CYRM-12 score was lower in the patient group(47.9±7.4 vs. 52.9±4.7;p=0.047). The total coping score was also lower in the patient group [55.0(53.0–58.0) vs. 63.5(56.0–67.0);p=0.019], particularly in help-seeking and problem-solving subdomains. In contrast, cognitive and behavioral avoidance scores did not differ significantly between groups.

In the RCADS-CV assessment, depression [9.0(7.0–13.8) vs. 2.5(1.0–8.0);p=0.006], total anxiety [30.0(21.0–58.0) vs. 10.0(4.0–29.5);p=0.022], and total internalizing scores [39.5(25.0–69.8) vs.14.5(5.0–34.5);p=0.023] were significantly higher in the patient group. Based on RCADS-CV T-scores, 42.9% of patients (6/14) had at least one symptom domain in the borderline or clinically elevated range.

Conclusions

Children and adolescents with Hashimoto’s thyroiditis showed more sleep problems, lower psychological resilience, less functional coping, and higher depressive and anxiety symptoms than healthy controls. These findings suggest that sleep difficulties, reduced resilience, and insufficient coping skills may accompany increased psychiatric symptoms in this population and may represent targetable areas in clinical follow-up and psychosocial interventions. However, the findings should be interpreted cautiously because of the limited sample size of this pilot study.

References

  1. Siegmann EM, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018 Jun 1;75(6):577-584. doi: 10.1001/jamapsychiatry.2018.0190. Erratum in: JAMA Psychiatry. 2019 Aug 1;76(8):872. doi: 10.1001/jamapsychiatry.2019.1643. PMID: 29800939; PMCID: PMC6137529.
  2. Green ME, Bernet V, Cheung J. Thyroid Dysfunction and Sleep Disorders. Front Endocrinol (Lausanne). 2021 Aug 24;12:725829. doi: 10.3389/fendo.2021.725829. PMID: 34504473; PMCID: PMC8423342.
  3. Durcan G, Yavuz M. Staying Strong Despite Adversity: Resilience in Children and Adolescents. Turk Arch Pediatr. 2025 Sep 1;60(5):462-468. doi: 10.5152/TurkArchPediatr.2025.25108. PMID: 40958511; PMCID: PMC12432124.