Autoimmune Patient Health Through a Flourishing Framework: Protocol Scoping Review

Introduction

Autoimmune diseases affect over 50 million people in the United States, with more than 150 types of disease recognized.¹ A population-based study conducted in Sardinia, Italy, found that rheumatoid arthritis, systemic lupus erythematosus, and autoimmune thyroiditis were among the most common types. These diseases predominantly impact individuals in their productive age (>18 years), especially women, due to hormonal differences, including higher estrogen levels.²

Autoimmune disease also remains as major public health concern in Indonesia. The prevalence of type 1 diabetes –an autoimmune condition– in this country was reported at 41,000 cases in 2022,³ marking as the highest in Southeast Asia. Additionally, rheumatoid arthritis affects 7.3% of the population with 8.5% cases are women and 6.1% are men.⁴ The Center for Data and Information in Indonesia indicated that lupus cases in Indonesia increased by 2,166 in 2016, with the death rate increasing by 550 cases. This number is suspected to be even higher, as there is no national registry for Lupus patients.⁵

Autoimmune diseases are characterized by a malfunction of the immune system, resulting in the production of autoantibodies that attack healthy tissues and cause inflammation.⁶ Autoimmune diseases affect various organs and systems in the body, causing various susceptibility conditions, both physically and psychologically. Specifically, autoimmune disease associated with behavior and physiological problems, i.e., higher burnout and lower work engagement; cardiovascular risk and systolic blood pressure.^7,8 Additionally, study on Lupus patients indicated that the diseases associated with reduced appetite, difficulty sleeping, frequent illness, and fatigue quickly when autoimmune symptoms appeared.⁹ There is a 20% risk of miscarriage in pregnant women with autoimmune diseases,¹⁰ and patients with comorbid depression have a 19% higher mortality rate and are characterized by less adherence to treatment.¹¹ Previous studies indicated that psychological conditions were also compromised during the disease development: The patients’ perception, behavior, and overall wellbeing were affected, it even associated with psychosis¹² or eating disorder,¹³ thus, promote negative emotions (i.e., worry and sadness¹⁴). A study among pregnant women with autoimmune showed an increase risk of schizophrenia in their offspring when blood inflammation occurs during pregnancy.¹⁵

The existing literature draws upon closely related concept such as wellbeing, happiness, and mental health. However, limited study specifically focusing on flourishing among autoimmune population. A study conducted by Kayes¹⁶ among 3,032 people with chronic diseases identified that only minor sample (n = 1%) were flourishing and languishing – the opposite of flourishing – is linked to higher susceptibility to chronic diseases. Previous studies on flourishing conducted commonly drawn within healthy population (see^17,18). A study on flourishing in Indonesia was conducted by Irsyadiyah et al.¹⁹ on the effectivity of positive psychotherapy intervention using positive psychotherapy indicated that Lupus patients reported improvement on flourishing indicator after the intervention.

Given the limited empirical exploration of flourishing in the context of autoimmune, this scoping review aims to mapping the existing literature and identifying concept of flourishing as well as identify the research gaps that may beneficial to inform future empirical studies and interventions. Therefore, the objectives of this scoping review were threefold:

Methods and analysis protocol

This scoping review protocol methods and analyses followed the five-stages framework developed by Arksey and O’Malley.²⁰ This protocol of systematic review did not use informed consent because it’s not involving humans or animals including children. This research is part of a bigger project aimed at developing a framework of flourishing in the autoimmune context. Ethical clearance for this project was obtained from Ethics Committee of the Faculty of Psychology, Airlangga University, Indonesia number No.762/B/UN3.FPSI/III/TA.00.03/2025.

Conclusion

This protocol provides a systematic approach to conduct a scoping review of flourishing framework among individual with autoimmune context within five stages. It outlines obvious inclusion criteria, a transparent methodology, and a rationale for the scoping review scope. The limitations include the specific age range being studied and involving studies reported or translated in English only, thus may limits the scope of the subject being studied.