Alexithymia is a mediating factor in the relationship between adult attachment and severity of depression and social anxiety

Development and validation of a nomogram for predicting cognitive frailty in patients on maintenance haemodialysis

AIMS

This study aimed to construct a nomogram for predicting the risk of cognitive frailty in patients on maintenance haemodialysis.

DESIGN

An explorative cross-sectional design was adopted.

METHODS

From April 2022 to July 2022, 496 participants were recruited from five haemodialysis centres in Qingdao, Shandong Province, China. Participants with cognitive frailty were screened by Frailty Phenotype scale and Mini-Mental State Examination. Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression were utilized to determine predictors. The predictive performance of the nomogram was validated by calibration and discrimination. Decision curve analysis was used to assess clinical utility. Internal validation was implemented using 1000 bootstrap samples to mitigate overfitting.

RESULTS

The prevalence of cognitive frailty was 17.5% (n = 87). Six risk predictors, namely health empowerment, alexithymia, age, educational level, marital status and dialysis vintage, were screened and used to develop a nomogram model. The nomogram had satisfactory discrimination and calibration, and decision curve analysis revealed considerable clinical utility.

CONCLUSIONS

A nomogram incorporated with the six risk predictors was developed, and it exhibited excellent prediction performance. The nomogram may strengthen the effective screening of patients at high risk of cognitive frailty.

IMPACT

This study established a tool for healthcare staff to predict cognitive frailty probability and identify risk factors in patients on maintenance haemodialysis. The nomogram can meet the needs of personalized care and precision medicine simultaneously.

PATIENT OR PUBLIC CONTRIBUTION

Data were collected from patients on maintenance haemodialysis by using questionnaire survey.

REPORTING METHOD

STROBE checklist was used.

The association between dream activity and alexithymia during pregnancy: A cross-sectional study in a sample of pregnant women

The gestational period is a sensitive time marked by significant changes that can affect women's sleep and dreaming processes, with an augmented frequency and recall of dreams suggesting that dreaming represents an adaptive mechanism of emotional regulation. This study investigates the relationship between pregnancy-related variables, alexithymia, and depressive symptoms in influencing dream characteristics in women during the first trimester of pregnancy. A total of 118 pregnant women were recruited at the Obstetric Outpatient Service of an Italian University Hospital and completed the Mannheim Dream Questionnaire, the Toronto Alexithymia Scale-20, and the Edinburgh Postnatal Depression Scale. Regression analysis, t-test, and moderation analysis were conducted through Jamovi. Dream recall frequency was predicted by age, parity, and depressive symptoms. Nightmare frequency and lucid dream frequency were significantly predicted by depressive symptoms, while nightmare distress was predicted by an unplanned pregnancy. Alexithymia was linked to higher nightmare frequency and nightmare distress. Moderation analysis revealed that the presence of depressive symptoms predicted increased nightmare frequency only in women with higher levels of alexithymia. These findings highlight the role of emotional regulation in dreaming during pregnancy, particularly among women exhibiting alexithymic traits and depressive symptoms. Nightmare frequency may serve as an indicator of impaired emotional regulation, emphasising the need for targeted interventions to enhance emotional coping strategies in this population. Future research should examine the content of nightmares to further understand their implications for maternal mental health.

The association among negative life events, alexithymia, and depressive symptoms in a psychosomatic outpatient sample

BACKGROUND

Depression is a life-threatening mental health problem. Various factors have been demonstrated to be associated with depressive symptoms, including negative life events (NLEs) and alexithymia. A retrospective study was conducted to investigate the relationship among negative life events, alexithymia, and depression symptoms in a psychosomatic outpatient sample in China.

METHODS

A total of 2747 outpatients (aged 18 - 65) were included in this investigation. The Life Events Scale (LES), Toronto alexithymia scale (TAS-26), and 9-item Patient Health Questionnaire (PHQ-9) were used to assess NLEs, alexithymia, and depressive symptoms, respectively. A stepwise regression analysis model was established to investigate the relationship among alexithymia, NLEs, and depressive symptoms.

RESULTS

Overall, 67.0% of the patient sample had a PHQ-9 score of 10 or higher. The stepwise regression analysis model showed a well-fitted model, in which NLEs and alexithymia explain a total of 34.2% of the variance of depressive symptoms in these participants. NLEs (β = 0.256, p < 0.001) and dimensions of alexithymia (difficult describing feelings (β = 0.192, p < 0.001) and identifying feelings (β = 0.308, p < 0.001)) were positively correlated with symptoms of depression.

CONCLUSIONS

Previous studies have confirmed the correlation between NLEs and depression, alexithymia and depression, respectively. In our study, we used a stepwise regression model to explain the relationship among those variables simultaneously, and found that NLEs and alexithymia could function as predictors of depressive symptoms. Based on this discovery, alexithymia-focused treatment strategies could be alternative in depressive patients with alexithymia, but this remains to be verified in the future.

Case report: Short-term psychotherapy for alexithymia in a patient with generalized anxiety disorder

Alexithymia is common among patients with generalized anxiety disorder (GAD) and may negatively affect the efficacy of treatment. This case report described a sole short-term psychotherapy focusing on alexithymia for a GAD patient. The intervention extends over 3 weekly 50-minute sessions and incorporates components of: (a) understanding the basic categories of emotions and the importance of processing them consciously and building one's own vocabulary of emotions; (b) developing skills in identifying and labeling emotions and learning to register both positive and negative emotions in daily life; (c) observing and interpreting emotion-related body sensations and learning to get in touch with, be empathetic to, and take care of one's own inner feelings in daily life. The Hamilton Rating Scale for Depression (HRSD), Hamilton Anxiety Rating Scale (HAMA), and Toronto Alexithymia Scale (TAS) were used to evaluate depression, anxiety, and alexithymia before and after the sessions. The results suggested that the treatment was not only effective in reducing alexithymia helping the patient to clarify, identify and describe her feelings, but also effective in reducing anxiety and depression.

Prevalence of alexithymia in cancer patients: a systematic review and meta-analysis

PURPOSE

To systematically evaluate the prevalence of alexithymia in cancer patients and to compare the prevalence of alexithymia in different countries, genders, and cancer types.

METHODS

We thoroughly searched PubMed, EMBASE, Web of Science, The Cochrane Library, CINAHL, PsychINFO, China Integrated Knowledge Resource Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database for studies on the prevalence of alexithymia in cancer patients from the inception to April 2, 2023. Based on the Stata 15.0 software package, the prevalence of alexithymia in cancer patients was estimated using a random-effects model in this meta-analysis.

RESULTS

Eighteen studies with a total of 3,196 participants met the eligibility criteria for the meta-analysis. In 18 studies, 37.0% (95% CI: 28.0% - 46.0%) of cancer patients had alexithymia. 13 studies identified that the pooled mean score of alexithymia in cancer patients was 56.91 (95% CI: 54.44% to 59.37%). The prevalence of alexithymia was higher in cancer patients in developing countries (39.7%, 95% CI: 28.7% to 50.7%), males (40.0%, 95% CI: 24.0% to 55.9%), and colorectal cancer patients (47.3%, 95% CI: 21.3% to 93.3%).

CONCLUSIONS

Our study found that the pooled prevalence of alexithymia in cancer patients was 37.0%, and higher in developing countries, males, and patients with colorectal cancer. Understanding the current status of alexithymia in cancer patients, timely identification and treatment by medical practitioners can improve the prognosis of cancer patients.

CLINICAL TRIAL REGISTRATION

The protocol was registered in PROSPERO [CRD42023414665].

The relationship between alexithymia, depression, anxiety, and stress in elderly with multiple chronic conditions in China: a network analysis

Objective

This study aimed to construct a network structure to investigate the connections between alexithymia, depression, anxiety, and stress in Chinese older adults with multiple chronic conditions (MCC), identifying core and bridge symptoms, and comparing the network structure across different levels of alexithymia.

Methods

This study used a cross-sectional survey design and convenience sampling to recruit participants from six cities in Jiangsu Province. The study assessed the levels of alexithymia, depression, anxiety, and stress in older adults with MCC using the Toronto Alexithymia Scale (TAS-20) and the Depression Anxiety and Stress Scale-21 (DASS-21). Network analysis was performed using R language to identify core and bridge symptoms in the network and compare the network structure across different levels of alexithymia.

Results

A total of 662 participants were included in the analysis, including 395 men and 267 women. The mean age was 70.37 ± 6.92 years. The finding revealed that the "Difficulty Identifying Feelings" (DIF) node had the highest strength centrality (strength = 2.49) and predictability (rp = 0.76) in the network. The next highest strength centrality was observed for "Meaningless" (strength = 1.50), "Agitated" (strength = 1.47), "Scared" (strength = 1.42), and "No look forward" (strength = 0.75). They were identified as core symptoms. The bridge strength analysis identified "Panic," "Scared," "No wind down," "No initiative," and "No positive" as the bridge symptoms. There were notable differences in the overall network structure and specific connections between the groups with and without alexithymia (p < 0.05).

Conclusion

"DIF" is a core node in the network of older adults with MCC, indicating its significance as a potential target for psychological interventions in clinical practice. Preventing and mitigating bridge symptoms such as "panic," "Scared," "No wind down," "No initiative," and "No positive" can effectively impede the spread of symptom activation, thereby interrupting or severing the connections among comorbidities in older adults. Additionally, compared to non-alexithymia individuals, the psychological issues of older adults with alexithymia require prioritized intervention from healthcare professionals.

Impact of alexithymia on suicidal ideation among patients with ovarian cancer: a moderated mediation model of self-perceived burden and general self-efficacy

PURPOSE

Suicidal ideation (SI) and alexithymia are common psychological problems among patients with cancer. Studying how alexithymia predicts SI is helpful for its intervention and prevention strategies. The present study aimed to investigate whether self-perceived burden (SPB) mediates the impact of alexithymia on SI and if general self-efficacy moderates the associations of alexithymia with SPB and SI.

METHODS

To measure SI, alexithymia, SPB, and general self-efficacy, 200 patients with ovarian cancer at all stages regardless of the type of treatment completed the Chinese version of the Self-Rating Idea of Suicide Scale, Toronto Alexithymia Scale, Self-Perceived Burden Scale, and General Self-Efficacy Scale in a cross-sectional study. The PROCESS macro for SPSS v4.0 procedure was applied to perform moderated mediation analysis.

RESULTS

SPB significantly mediated the positive impact of alexithymia on SI (a×b = 0.082, 95% confidence interval [CI]: 0.026, 0.157). General self-efficacy significantly moderated the positive association between alexithymia and SPB (β = -0.227, P < 0.001). The mediating role of SPB was gradually reduced as general self-efficacy grew (low: 0.087, 95% CI: 0.010, 0.190; medium: 0.049, 95% CI: 0.006, 0.108; high: 0.010, 95% CI: -0.014, 0.046). Thus, a moderated mediation model involving SPB and general self-efficacy for explaining how alexithymia causes SI was supported.

CONCLUSION

Alexithymia could cause SI by inducing SPB among patients with ovarian cancer. General self-efficacy could attenuate the association between alexithymia and SPB. Interventions aimed at reducing SPB and enhancing general self-efficacy could reduce SI by partially preventing and attenuating the impact of alexithymia.

Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa

BACKGROUND

Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one's emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms.

METHODS

Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12-18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40).

RESULTS

Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers.

CONCLUSION

The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents' eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents' competence in identifying and dealing with their emotions.

Social Self-Efficacy and Internet Gaming Disorder Among Chinese Undergraduates: The Mediating Role of Alexithymia and the Moderating Role of Empathy

As an increasingly serious social problem, Internet gaming disorder (IGD) of college students may be related to their social self-efficacy. However, the relationship and its internal mechanisms underlying are still unclear. The current study tested the mediating effect of alexithymia in the association between social self-efficacy and IGD, and whether this mediating process was moderated by empathy. Social Self-Efficacy Scale (PSSE), Chinese version of Internet Game Addiction Scale (IGAS-C), Toronto Alexithymia Scale (TAS-20) and Interpersonal Response Scale (IRI-C) were adopted to examine the model on 888 Chinese college students. The results indicated that social self-efficacy was significantly negatively associate with IGD. Mediation analysis illustrated that alexithymia mediated the association between social self-efficacy and IGD. Further, moderated mediation analysis manifested that the mediated effects was stronger for lower level of empathy. The conclusions corroborate and clarify the mechanisms that alexithymia mediated the association between social self-efficacy and IGD, and the mediation effects is moderated via empathy. Besides, these findings provide available references for colleges to conduct educational activities, and at the same time provide scientific suggestions for preventing IGD among undergraduates.

The influence of alexithymia on problematic mobile phone use among Chinese adolescent students: Multiple mediating roles of social interaction anxiousness and core self-evaluations

BACKGROUND

Alexithymia can lead to problematic mobile phone use (PMPU). However, the underlying mechanisms remain unclear.

METHODS

Drawing on the Interaction of Person-Affect-Cognition-Execution model, the present study tests the mediating effects (parallel and serial) of social interaction anxiety (SIA) and core self-evaluations (CSE) on the relationship between alexithymia and PMPU. We obtained 1267 valid responses from adolescent students (mean age, 20.36, standard deviation, 0.97) from southeast China who completed the Mobile Phone Addiction Index, Toronto Alexithymia-20 Scale, Social Interaction Anxiousness Scale, and Core Self-Evaluation Inventory.

RESULTS

After controlling for demographic variables (i.e., gender) as covariates, the results revealed that: (1) alexithymia had a positive predictive effect on PMPU in adolescent students; (2) SIA and CSE mediated the association between alexithymia and PMPU; and (3) a series of indirect pathways (i.e., from alexithymia to PMPU via SIA and CSE) were detected. Thus, alexithymia can directly affect (parallel mediation) PMPU by increasing SIA and lowering CSE simultaneously. However, alexithymia can also indirectly affect (serial mediation) PMPU by increasing the level of SIA by decreasing CSE.

LIMITATIONS

Data were collected by participant self-report. This method may lead to recall bias. Further, we adopted a cross-sectional rather than an experimental design, thus precluding causal conclusions. Lastly, it would be useful to validate our findings with other age groups outside southeast China.

CONCLUSIONS

The current study findings are conducive to understanding the relationship between alexithymia and PMPU and inspire the prevention and intervention of PMPU.

Occurrence of Alexithymia and Its Association with Sports Practice from a Sample of University Students: Results from a French Cross-Sectional Study

Background: This study aimed to assess the prevalence of alexithymia in a sample of university students and to determine its association with specific sports practice characteristics (competition and training). Methods: In this cross-sectional study, anthropometric data and characteristics of sport practice were collected, as well as level of alexithymia (Toronto Alexithymia Scale, (TAS-20)). Results: The study included 253 French university students who completed a questionnaire specifying their regular sports practice and level of alexithymia (TAS-20). We found 76 subjects (30%) who had proven alexithymia and 92 (36.4%) who were borderline alexithymic. A significant positive relationship between alexithymia and the weekly amount of training practice was observed. It should be noted that students who engage in more than 5 h of physical activity are more prone to be borderline or alexithymic (respectively, 19.6 and 19.7% versus 7.1% for non-alexithymics; p = 0.03). Conclusion: With a 30% frequency, alexithymia is more prevalent in this context than in the general population. Furthermore, alexithymia and borderline alexithymia are most favorably associated with higher physical activity (over 5 h per week).

Adolescents' Attachment to Parents and Reactive-Proactive Aggression: The Mediating Role of Alexithymia

Aggressive behaviors can serve different functions, which might be understood by distinguishing between reactive (RA) and proactive (PA) aggression. Few studies were conducted on adolescents’ family precursors and emotional processes associated with RA or PA. Accordingly, the current study compared RA and PA by evaluating their association with adolescents’ attachment to parents and alexithymia. N = 453 Italian adolescents aged 15–19 years (Mage = 16.48; SD = 0.69; 33.6% males) participated in the study filling in self-report measures. Results showed that PA and RA are significantly associated and that PA was higher among males. Moreover, four mediational models were performed to assess the influence of adolescents’ attachment to mothers vs. fathers on RA or PA, considering the mediating role of alexithymia. Gender was included as a covariate. Mediational models’ results showed a direct and indirect effect, through lower alexithymia, of adolescents’ attachment to mothers and fathers on RA. Differently, only attachment to mothers showed a direct effect on PA, while attachment to fathers only an indirect effect, mediated by lower alexithymia, on PA was shown. Findings support the greater relevance of emotional processes for RA while highlighting the differential contribution of adolescents’ attachment to mothers vs. fathers upon PA. Implications are discussed, and suggestions for future research are provided.