Depressive Tendency and Counseling Outcomes in Thymoma-Associated MG

Primary outcomes

1. Change in Myasthenia Gravis Activities of Daily Living (MG-ADL) Score from baseline to post-intervention

   Time frame: Baseline to 4 months

   The Myasthenia Gravis Activities of Daily Living scale (MG-ADL) is an 8-item measure used to assess symptom severity and the impact of myasthenia gravis on daily functioning. The scale consists of eight items covering ocular function (two items: diplopia and ptosis), bulbar function (three items: speech, chewing, and swallowing), respiratory function (one item), and limb muscle function (two items: personal hygiene and ability to rise from a chair). Each item is scored on a 4-point scale ranging from 0 (normal) to 3 (most severe). Higher scores indicate greater functional impairment. Total scores range from 0 to 24, with higher scores indicating greater disease-related impairment and therefore a worse outcome. Participants completed the MG-ADL before the intervention and again after completing the four-unit online program to evaluate changes in disease-related functional status.

2. Change in Myasthenia Gravis Quality of Life 15-item (MG-QOL15) Score from baseline to post-intervention

   Time frame: Baseline to 4 months

   The Myasthenia Gravis Quality of Life 15-item scale (MG-QOL15) is a disease-specific measure used to assess the impact of myasthenia gravis on daily functioning and overall quality of life. The MG-QoL15 consists of 15 items encompassing four domains: mobility (9 items), symptoms (3 items), emotional well-being (2 items), and general contentment (1 item). Each item is rated on a 5-point Likert scale ranging from 0 ("not at all") to 4 ("very much"). Total scores range from 0 to 60, with higher scores indicating poorer quality of life and therefore a worse outcome. Participants completed the MG-QOL15 before the intervention and again after completing the four-unit online program to evaluate changes in disease-related quality of life.

3. Change in the indicator of mental health BMI on well-being (mBMI) Score from baseline to post-intervention

   Time frame: Baseline to 4 months

   The indicator of mental health BMI (mBMI) is a measure of positive psychological well-being that includes three domains:

   • Befriend (B), representing interpersonal support and closeness
   • Mindfulness (M), representing emotional stability and awareness
   • Identity (I), representing self-worth and meaning.

   Each domain is assessed using a single self-rated item scored from 0 to 10, with higher total scores indicating better psychological well-being. A total score ≥ 20.5 is considered indicative of favorable mental health status. Accordingly, the mBMI is considered a practical and concise instrument for evaluating psychological health in intervention studies.

   Scores were collected before the intervention and after completion of the four-unit online program to evaluate changes in psychological well-being.

4. Change in the indicator of mental health BMI on well-being (PHQ-9) Score from baseline to post-intervention

   Time frame: Baseline to 4 months

   The PHQ-9 is a nine-item self-administered questionnaire designed to evaluate the frequency of depression-related symptoms experienced during the preceding two weeks. Total scores range from 0 to 27, with higher scores indicating greater severity of de-pressive symptoms. Depression severity can be categorized as minimal (1-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Higher PHQ-9 scores are associated with greater predictive value and likelihood ratios for major depressive disorder.