Knowledge, Attitudes, and Practices Regarding Iodine-131 Therapy and Their Association with Depression and Anxiety...

This study aimed to evaluate the knowledge, attitudes, and practices (KAP) regarding iodine-131 (I-131) therapy and their relationship with depression and anxiety in postoperative thyroid cancer patients undergoing I-131 treatment.

A cross-sectional survey was conducted from January 3, 2025 to October 23, 2025 at the Affiliated Hospital of Zunyi Medical University, Guizhou Provincial People's Hospital, the Affiliated Hospital of Guizhou Medical University, and Zunyi First People's Hospital. Data concerning demographic and clinical characteristics, as well as KAP, were collected using a self-developed questionnaire. Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively.

A total of 386 participants were included. The mean (SD) scores were 9.98 (4.95) for knowledge (possible range: 0-24), 22.71 (4.02) for attitude (possible range: 6-30), and 31.53 (4.42) for practice (possible range: 9-45). Multivariable models revealed that higher knowledge (β=-0.169, 95% CI: -0.279 to -0.058; P=0.003) and practice (β=-0.360, 95% CI: -0.487 to -0.232; P<0.001) were independently associated with lower GAD-7 scores, while practice was also independently correlated with lower PHQ-9 scores (β=-0.435, 95% CI: -0.587 to -0.284; P<0.001). Structural equation modeling (SEM) indicated that knowledge had significant direct associations with attitude (β= 0.502, P = 0.005) and practice (β = 0.518, P = 0.015). Furthermore, knowledge also had a significant indirect association with practice mediated by attitude (β = 0.077, P = 0.043).

The level of knowledge regarding the I-131 therapy was found to be low. Higher KAP was associated with lower symptoms of anxiety and depression, and attitude partially mediating the relationship between knowledge and practice. These findings suggest that integrating standardized, targeted education alongside routine GAD-7/PHQ-9 screening and behavior coaching into I-131 care may enhance adherence and improve psychological well-being, although future interventional trials are needed to confirm these clinical benefits.