Alexithymia impact on type 1 and type 2 diabetes: A case-control study

Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus

BACKGROUND

Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM.

METHODS

105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively.

RESULTS

A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM.

CONCLUSIONS

Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.

The prevalence and characteristics of alexithymia in patients with type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Alexithymia is common in patients with type 2 diabetes mellitus (T2DM). Although the estimated prevalence of alexithymia in patients with T2DM is widely reported, these results have not been synthesized.

AIM

To systematically assess the prevalence and characteristics of alexithymia in patients with T2DM.

METHODS

We searched for relevant publications in PubMed, Embase, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database, and Weipu Database. The prevalence of alexithymia, the mean scores, and standard deviations of the total scale of the 20-item Toronto Alexithymia Scale (TAS-20) were pooled using random effects meta-analysis in Stata 13.0, with studies stratified by study location in this meta-analysis.

RESULTS

This meta-analysis included thirteen articles. Pooled prevalence of alexithymia (TAS-20 total scores ≥61) were 43.0% (95%CI 35.0-51.0%), and the prevalence of alexithymia was higher in China (45.0%, 95%CI 36.0-54.0%) compared with non-China (41.0%, 95%CI 29.0-54.0%). The pooled mean score for the TAS-20 total scale was 57.70 (95% CI 55.25-60.15). Leave-one-out analysis showed that none of the studies significantly impacted the overall pooled results.

CONCLUSIONS

This meta-analysis indicated a high prevalence of alexithymia in patients with T2DM. Thus, clinicians need to be aware of and assess appropriately for alexithymia in patients with T2DM.

Efficiency of Nanohydroxyapatite on Repairing Type II Diabetes Dental Implant-Bone Defect

The purpose of this study was to see how a nanohydroxyapatite (n-HA) composite polyamide 66 (PA66) affected the repair of bone defects in diabetics with titanium implants, as well as to develop experimental materials for the creation of the interface between bone tissue and titanium implants. Rabbit bone marrow mesenchymal stem cells (MSCs) were isolated using n-HA/PA66 composite material, and the effect of coculture with the material on cell proliferation was analyzed after induction of mineralization. Bone defect models of diabetic experimental rabbits and titanium implants were prepared. Normal rabbits with bone defects were used as control (NC group, N = 8). After the diabetic bone defect (DM group, N = 8) and the implantation of n-HA/PA66 composite material (n-HA/PA66 group, N = 8), the differences in body weight, blood glucose, scanning electron microscopy of the implant-bone interface, bone mineral density, new bone trabecular parameters, histomorphology, and biomechanical properties of the implant-bone interface were compared and analyzed. In vitro test results showed that MSC cell growth could be promoted by mineralization induction, the cell growth condition was good after coculture with n-HA/PA66, and the proliferation activity of MSCs was not affected by the material. In vivo test results showed that the body weight of the DM group and n-HA/PA66 group was considerably inferior to that of the NC group, and the blood glucose was dramatically superior to that of the NC group (P < 0.05). However, the body weight of the n-HA/PA66 group was dramatically superior to that of the DM group (P < 0.05). The bone mineral density, bone volume fraction (BV/TV), bone surface area fraction (BS/BV), bone trabecular thickness (Tb.Th), bone trabecular number (Tb.N), bone trabecular area, and biomechanical properties in the DM group were considerably inferior to those in the NC group and n-HA/PA66 group (P < 0.05). The trabecular space (Tb.Sp) in the NC group and n-HA/PA66 group was dramatically superior to that in the NC group (P < 0.05). The bone mineral density, BV/TV, BS/BV, Tb.Th, Tb.N, trabecular area, and biomechanical properties of the n-HA/PA66 group were dramatically superior to those of the NC group (P < 0.05), while Tb.Sp was considerably inferior to that of the NC group (P < 0.05). These findings showed that the n-HA/PA66 material had good biocompatibility and minimal cytotoxicity, and that filling the space between the surrounding bone and the titanium implant can enhance bone repair. This research paved the way for future research into the tissue-engineered bone in the field of oral surgery.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Alexithymia in diabetes patients: its relationship with perceived social support and glycaemic control

AIM AND OBJECTIVE

This study was conducted to assess whether there is an association between alexithymia in patients with diabetes and the levels of perceived social support and glycaemic control.

BACKGROUND

In the literature, whether inadequate perceived social support is a cause or effect of alexithymia has also not been clearly explained. It is stated that it is difficult to determine from where these contradictions arise, and there is a need for more studies on this topic.

METHOD

This cross-sectional and correlational study included 537 patients with type I and type 2 diabetes. The data were collected using a Patient Information Form including the patient's HbA1c value that reflected their glycaemic control level, the Toronto Alexithymia Scale and the Multidimensional Scale of Perceived Social Support. The study was reported according to the STROBE Declaration.

RESULTS

Among the patients with diabetes, 63.9% showed signs of alexithymia. Alexithymia had a negative relationship with perceived social support and a positive relationship with HbA1c. Additionally, it was determined that the patients who showed signs of alexithymia had lower levels of perceived social support in comparison with those who did not show such signs, whereas the HbA1c levels of the former were also higher than those of the latter. Moreover, it was found that the duration of the disease, HbA1c levels and levels of perceived social support from family and a significant other explained 30% of the total variance in the level of alexithymia.

CONCLUSION

Alexithymia was seen prevalently among the patients with diabetes, and it was associated with a reduced level of perceived social support and weak glycaemic control.

RELEVANCE TO CLINICAL PRACTICE

It is recommended to provide patients with psychosocial support in the scope of holistic care and include the individuals who provide care for and support the patient in the patient's management of the disease.

Alexithymia, Stress and Depression in Infertile Women: a Case Control Study

Background:

Alexithymia and stress are two main psychological factors which affect not only fertility, but also the outcome of assisted reproductive technology treatment.

Objective:

The primary aim of this study was to compare the levels of alexithymia and stress between infertile women undergoing assisted reproductive treatment and women with no fertility issues. The present study aims to: (i) explore the relation between alexithymia and infertility, (ii) investigate whether women with infertility problems show elevated levels of alexithymia compared to women with no fertility problems, and (iii) compare stress levels between women undergoing assisted reproductive technology treatment and women with no fertility problems.

Methods:

A case control trial was conducted. In total, data from 177 women were collected. The control group consisted of 102 women with no fertility problems, whilst the study group included 75 women undergoing assisted reproductive program. In order to measure the levels of alexithymia and the fertility-related stress among women in both groups and compare the results, validated questionnaires were distributed to every participant. Self-report instruments were used to measure alexithymia (TAS-20), fertility-related stress (FPI), depressive symptomatology (CES-D) and anxiety (STAI). Univariate and bivariate statistical analyses were used.

Results:

The mean values of alexithymia, anxiety and depressive symptomatology were higher in women with lower educational background and not within a marriage than in women with higher education and within marriage. Additionally, infertile women had similar levels of alexithymia, anxiety and depressive symptomatology compared to women with no fertility problems.

Conclusion:

Results from the present study suggest that infertile women show similar levels of alexithymia and stress in comparison to women who have not been confronted with fertility problems. Our study findings are in accordance with many previous published studies that have concluded that alexithymia rates are similar between group of patients and group of healthy individuals. However, future studies should aim to investigate the prevalence of alexithymia in infertile women with idiopathic and non-idiopathic infertility as well as to assess the levels of alexithymia in infertile women that are not in a fertility treatment.

Changes in Sexual Functions and Alexithymia Levels of Patients with Type 2 Diabetes During the COVID-19 Pandemic

This study was conducted to determine the changes in sexual functioning and alexithymia levels in patients with type 2 diabetes during the COVID-19 pandemic. This descriptive, cross-sectional study was conducted with 162 patients with type 2 diabetes. Data were collected using the Information Form, Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale. For 83.3% of the participants, there was a decrease in sexual functioning after diabetes, 69.8% after the COVID-19 pandemic, and 67.2% due to both conditions. The majority of the patients stated the reasons for experiencing sexual problems related to not seeing sexuality as a priority (77.1%), and stress/anxiety experienced during the COVID-19 pandemic (67.9%). Moreover, patients' alexithymia, anxiety, and depression levels were found to be high during the pandemic, when the study was conducted. A positive correlation was identified between alexithymia and anxiety and depression. Further, multiple regression results indicated that about 50% of alexithymia levels could be explained by anxiety and depression levels. The anxiety, depression, and alexithymia scores of those who had decreased sexual functioning before and during the pandemic period were statistically significantly higher than those who did not have any change (p < 0.01). During the COVID-19 pandemic when the study was conducted, high levels of alexithymia, anxiety, and depression were observed in participants, and it was found that their sexual functioning was negatively affected. Healthcare professionals should evaluate their patients in extraordinary situations such as epidemics and pandemics in terms of sexual functioning as well as other vital functions.

The Relationship Between Alexithymia and Type 2 Diabetes: A Systematic Review

Background: This systematic review analyzed the relationship between alexithymia, considered as the inability to recognize and express thoughts and emotions, and type 2 diabetes mellitus (T2DM), one of the most common chronic illness, characterized by a metabolic disorder burdened by high morbidity and mortality worldwide due to its outcomes. Methods: PRISMA guidelines were followed throughout this systematic review of the recent literature indexed in the databases PubMed, PsycInfo, Scopus, and Web of Science. Search terms for eligible studies were: "Type 2 diabetes" OR "T2DM" AND "Toronto Alexithymia Scale" OR "TAS-20"[All Fields]. Results: The initial search identified 61 indexed scientific publications. After screening we found that seven publications met the established scientific inclusion and exclusion criteria. It emerged that alexithymic patients ranged from 25 to 50% across the examined publications and it appeared that patients with T2DM generally reflected greater values of alexithymia, revealing particular differences among TAS domains. Moreover, emlpoyed participants were alexithymic to a greater extent compared to non-working participants (77.8 vs. 35.4%) and alexithymia was 2.63 times more severe among working participants when examining predictors of alexithymia. When evaluating the correlations between alexithymia and HbA1c or fasting blood glucose levels we found strong associations equal to 0.75 and 0.77 for TAS-20 total scores, respectively. While alexithymic participants showed significantly higher levels of HbA1c and blood glucose when compared to the non-alexithymic participants. Conclusions: The results of this systematic review of the current literature highlight the need of alexithymia evaluation in patients with T2DM. The high prevalence in T2DM and strong associations with poorly regulated diabetes and psychological distress, indicate a significant relationship between poor glycemic control and psychological distress, such as anxiety and depression, and quality of life. Further studies are needed focusing on age and gender differences in order to be able to improve clinical psychological care and prevention.

Impact of alexithymia on glycemic control among Lebanese adults with type 2 diabetes

Purpose

Alexithymia, defined as the inability of a person to identify, describe and express emotions, has been found to influence glycemic control in type 2 diabetes patients (D2). The characteristics and influencing factors of alexithymia and the association of this psychological construct with D2 has not yet been studied in Lebanon where 14.6% of adults are diagnosed with the disease. This study aims at evaluating the prevalence of alexithymia and its relationship with glycemic control among Lebanese adults with D2.

Methods

Alexithymia was assessed in 104 patients diagnosed with D2 and 100 healthy controls using the 20-item Toronto Alexithymia Scale (TAS-20). The impact of alexithymia on glycemic control was evaluated using HbA1c values, fasting blood glucose levels, number of severe hyperglycemic episodes and hospitalizations for hyperglycemia within the past months.

Results

Alexithymia prevalence was significantly higher in D2 patients compared to controls (35.5% vs 15%). Patients with alexithymia showed higher levels of HbA1c and glucose in comparison to those without alexithymia. Consistently, significant positive correlations were found between the TAS-20 total and subscale scores and both HbA1c and glucose levels. Alexithymic patients had three times more severe hyperglycemic episodes and five times more hospitalizations for hyperglycemia compared to those without alexithymia. According to multivariate regression analysis, lifestyle factors alone were not found predictive of alexithymia in D2 patients.

Conclusion

Given the impact of alexithymia on D2 regulation, screening of alexithymia in case of D2 and appropriate psychological follow-up are important for a better prognosis, management and treatment of the disease.

Prevalence and associated factors of alexithymia among adult prisoners in China: a cross-sectional study

BACKGROUND

Prison is an extremely stressful environment and prisoners have an increasing risk of suffering from alexithymia. Therefore, this study aims to investigate the prevalence and associated factors of alexithymia among prisoners in China.

METHODS

A cross-sectional study was conducted in five main jails of the district of Zhejiang province in China, and a total of 1705 adult prisoners ultimately took part in the study. Toronto Alexithymia Scale, Childhood Trauma Questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale and several short demographic questions were applied.

RESULTS

Over 30% of prisoners were classified as alexithymics and as high as 96.2% of prisoners suffered from at least one traumatic experience in their childhood, meanwhile, 81.5%, 53.4% and 85.8% were found to be positive for depression, anxiety and hopelessness symptoms respectively. Education, childhood trauma, negative emotional symptoms including depression, anxiety and hopelessness of the respondents, were negatively or positively associated with alexithymia among prisoners.

CONCLUSIONS

The results indicated that high prevalence of alexithymia among prisoners is linked with their level of education, experience of childhood trauma and symptoms of negative emotions. Accordingly, the findings in our study can be used for prevention and intervention of alexithymia among prisoners.

Alexithymia: a general deficit of interoception

Alexithymia is a sub-clinical construct, traditionally characterized by difficulties identifying and describing one's own emotions. Despite the clear need for interoception (interpreting physical signals from the body) when identifying one's own emotions, little research has focused on the selectivity of this impairment. While it was originally assumed that the interoceptive deficit in alexithymia is specific to emotion, recent evidence suggests that alexithymia may also be associated with difficulties perceiving some non-affective interoceptive signals, such as one's heart rate. It is therefore possible that the impairment experienced by those with alexithymia is common to all aspects of interoception, such as interpreting signals of hunger, arousal, proprioception, tiredness and temperature. In order to determine whether alexithymia is associated with selectively impaired affective interoception, or general interoceptive impairment, we investigated the association between alexithymia and self-reported non-affective interoceptive ability, and the extent to which individuals perceive similarity between affective and non-affective states (both measured using questionnaires developed for the purpose of the current study), in both typical individuals (n = 105 (89 female), mean age = 27.5 years) and individuals reporting a diagnosis of a psychiatric condition (n = 103 (83 female), mean age = 31.3 years). Findings indicated that alexithymia was associated with poor non-affective interoception and increased perceived similarity between affective and non-affective states, in both the typical and clinical populations. We therefore suggest that rather than being specifically associated with affective impairment, alexithymia is better characterized by a general failure of interoception.

Alexithymia in patients with type 2 diabetes mellitus: the role of anxiety, depression, and glycemic control

OBJECTIVE

This study was aimed at determining the prevalence of alexithymia in patients with type 2 DM and the factors affecting it.

METHODS

This cross-sectional study was conducted with 326 patients with type 2 DM. Study data were collected with the Personal Information Form, Toronto Alexithymia Scale, and Hospital Anxiety and Depression Scale. Glycemic control was assessed by glycated haemoglobin (HbA1c) results. The analysis was performed using descriptive statistics, chi-square test, Pear-son's correlation, and logistic regression analysis.

RESULTS

Of the patients, 37.7% were determined to have alexithymia. A significant relationship was determined between alexithymia and HbA1c, depression, and anxiety. According to binary logistic regression analyses, alexithymia was 2.63 times higher among those who were in a paid employment than those who were not, 2.09 times higher among those whose HbA1c levels were ≥7.0% than those whose HbA1c levels were <7.0%, 3.77 times higher among those whose anxiety subscale scores were ≥11 than those whose anxiety subscale scores were ≤10, and 2.57 times higher among those whose depression subscale scores were ≥8 than those whose depression subscale scores were ≤7.

CONCLUSION

In this study, it was determined that two out of every five patients with DM had alexithymia. Therefore, their treatment should be arranged to include mental health care services.