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Yang X, Liu L, Tian Y, Yang C, Ling C, Liu H. Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations. Psychol Res Behav Manag 2024; 17:615-625. [PMID: 38404923 PMCID: PMC10893783 DOI: 10.2147/prbm.s446788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose Insomnia is related to alexithymia in adults, but the relationship between insomnia and alexithymia in adolescents with major depressive disorder remains unclear. This study aimed to investigate the sex differences and the association between insomnia and alexithymia in adolescents with major depressive disorder. Patients and Methods From October 2020 to April 2022, adolescent patients with major depressive disorder were recruited from psychiatric departments of seven hospitals in Anhui Province, China. Their general demographic and clinical information were collected. The 20-item Toronto Alexithymia Scale, the Center for Epidemiologic Studies of Depression Scale, and the Insomnia Severity Index Scale were used to assess their alexithymia, depression, and insomnia symptoms, respectively. The analysis of variance (ANOVA), Student's t-test and Mann-Whitney U-test were used for continuous variables and chi-square tests for categorical variables. Pearson's correlation analysis and Spearman correlation analysis were used to examine the correlation between ISI and demographic and clinical variables. Multiple binary logistic regression analyses with the "Enter" method were carried out to explore the correlations of insomnia. Results The prevalence of insomnia in female adolescent patients was similar to that of male patients (χ2=1.84, p = 0.175). Compared with those without insomnia, patients with insomnia had worse family relationships (F = 7.71, p = 0.021), perceived heavier academic stress (F = 6.32, p = 0.012), more likely to take sedative-hypnotics (F = 5.51, p = 0.019), had higher levels of depression (F = 81.57, p < 0.001) and alexithymia (F = 28.57, p < 0.001). Correlation analysis showed that alexithymia was significantly associated with insomnia in adolescent patients (r = 0.360, p < 0.01). Binary logistic regression analyses showed that, alexithymia was significantly associated with insomnia in female patients (OR = 1.050, p < 0.05) but not male patients. Conclusion In female adolescent patients, alexithymia is a risk factor of insomnia, which is of great importance in the understanding of the psychopathological mechanisms, treatments and psychological interventions of insomnia in adolescents with major depressive disorder.
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Affiliation(s)
- Xiaoxue Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
| | - Lewei Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
| | - Yinghan Tian
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
| | - Cheng Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
| | - Chen Ling
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, People’s Republic of China
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Cai F, Jiang H, Tong S, Zhou S, Wang M, Sun S, Liu J, Xu Y, Lin N, Dai J, Wang X, Wang W, Zhao K, Wu X. Alexithymia is associated with insomnia in Chinese patients with schizophrenia. Front Psychiatry 2023; 14:1252763. [PMID: 38161729 PMCID: PMC10757626 DOI: 10.3389/fpsyt.2023.1252763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Background Sleep disorders are prevalent among patients with schizophrenia and are associated with several negative consequences. Although, researchers have recently suggested that sleep disorders have a close correlation with alexithymia, and schizophrenia also has a strong correlation with alexithymia, there have been few studies on the relationships between schizophrenia, sleep disorders and alexithymia. Therefore, this study aimed to explore the relationships between psychiatric symptoms, alexithymia and sleep problems in patients with schizophrenia so as to provide a reference for the clinical treatment of this comorbidity. Methods In total, 977 patients with schizophrenia were recruited for this study. The Insomnia Severity Index (ISI) was used to assess sleep disorders, and the Positive and Negative Syndrome Scale (PANSS), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Toronto Alexithymia Scale (TAS) were used to evaluate clinical symptoms, cognitive functions and the ability to express emotion, respectively. Results The results indicated that the PANSS subscales (G-subscore) and TAS group were risk factors for insomnia in schizophrenia patients (all p < 0.05). The mediation model showed the standardized path coefficients from schizophrenia to alexithymia (β = 0.104, p < 0.001) and from alexithymia to insomnia (β = 0.038, p < 0.001) were statistically significant. Conclusion The results of this study indicated that alexithymia is associated with sleep disturbance in patients with schizophrenia. These findings may provide a new avenue for the treatment of schizophrenia patients with sleep disorders.
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Affiliation(s)
- Fangfang Cai
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Huixia Jiang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Siyu Tong
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Siyao Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Mengpu Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Nankai Lin
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jiajing Dai
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xinyao Wang
- Renji College of Wenzhou Medical University, Wenzhou, China
| | - Wei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Lishui Second People’s Hospital Affiliated to Wenzhou Medical University, Lishui, China
- The Affiliated Kangning Hospital of Wenzhou Medical University, Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China
| | - Xixi Wu
- Wenzhou Lucheng District Third People’s Hospital, Wenzhou, China
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Akram U, Stevenson JC, Gardani M, Allen S, Johann AF. Personality and insomnia: A systematic review and narrative synthesis. J Sleep Res 2023; 32:e14031. [PMID: 37654128 DOI: 10.1111/jsr.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
The inherent nature of personality serves as a predisposing, and possible maintaining, factor of insomnia. However, methodological differences limit the ability to draw causal conclusions regarding the specific traits involved in the aetiology of the disorder. This systematic review of the relationship between insomnia and personality provides a narrative synthesis of the literature to date. Here, we identified N = 76 studies meeting the inclusion/exclusion criteria. The outcomes reliably evidenced the experience of insomnia to be associated with personality traits that are typically considered to be negative or maladaptive in nature. More specifically, insomnia was related to neuroticism, introversion, perfectionistic doubts and concerns, elevated personal standards, negative affect, social inhibition and avoidance, hysteria, hypochondriasis, psychasthenia, impulsive behaviour, anger, hostility, and psychopathic tendencies, schizotypal and borderline traits, reduced conscientiousness and self-directedness, and negatively perceived perception of the self. Several studies examined the role that personality plays in predicting the treatment efficacy and adherence of CBTi. Moving forward, longitudinal research, methodological consistency, the mediating role of treatment outcomes and adherence, and clinical and population representative samples should be prioritised. Methodological strengths and limitations of the literature are discussed alongside the next steps that should be taken to advance our understanding of the literature.
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Affiliation(s)
- Umair Akram
- School of Psychology, University of Lincoln, Lincoln, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Maria Gardani
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Sarah Allen
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Do alexithymia and negative affect predict poor sleep quality? The moderating role of interoceptive sensibility. PLoS One 2022; 17:e0275359. [PMID: 36191028 PMCID: PMC9529110 DOI: 10.1371/journal.pone.0275359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Emotion-related hyperarousal is an important core pathology of poor sleep. Studies investigating the interplay of alexithymia and affective experiences in determining sleep quality have yielded mixed results. To disentangle the inconsistency, this study examined the concurrent predictive power of alexithymia, and negative and positive affect, while incorporating interoceptive sensibility (IS) as a possible moderator. METHODS A sample of 224 (70.10% were female) participants completed the Toronto Alexithymia Scale, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Interoceptive Awareness (MAIA), and Marlowe-Crowne Social Desirability Scale (for controlling response bias) using paper and pencil. A two-stage cluster analysis of the MAIA was used to capture IS characteristics. Stepwise regression was conducted separately for each IS cluster. RESULTS A three-group structure for IS characteristics was found. Higher alexithymia was predictive of poor sleep quality in the low IS group, while higher negative affect predicted poor sleep quality in the moderate and high IS groups. Additionally, alexithymia and positive affect were significantly different in the three IS groups, while negative affect and sleep quality were not. CONCLUSIONS Emotion and cognitive arousal may impact sleep quality differently in individuals with different levels of internal focusing ability, depending on physiological versus emotional self-conceptualization. The implications on pathological research, clinical intervention, study limitations and future directions are discussed.
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Zhu R, Wang D, Tian Y, Du Y, Chen J, Zhou H, Chen D, Wang L, Alonzo BA, Emily Wu H, Yang Zhang X. Sex difference in association between insomnia and cognitive impairment in patients with chronic schizophrenia. Schizophr Res 2022; 240:143-149. [PMID: 35026599 DOI: 10.1016/j.schres.2021.12.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Sex differences in schizophrenia have been noted across domains such as sleep and cognitive function; however, how they interact remains unclear. This study aimed to explore sex differences in the relationship between insomnia and cognitive function in patients with chronic schizophrenia. METHODS 718 schizophrenia patients (480 males and 238 females) and 397 healthy controls were recruited. Insomnia was collected by a questionnaire. Insomnia severity index (ISI) was used to evaluate the severity of insomnia. The clinical symptoms and cognition were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. RESULTS Schizophrenia patients showed significantly lower scores compared to healthy controls on the RBANS total score and four indexes (all p < 0.05). Male patients had a lower rate of insomnia, higher scores on the RBANS visuospatial/constructional, language, and total score than female patients (all P < 0.05). Insomnia patients had lower RBANS immediate memory, language, and total scores than non-insomnia patients, and the results only appeared in female patients (all P < 0.05). In addition, there were significant negative correlations between ISI and RBANS language and delayed memory in male patients, while ISI was significantly negatively correlated with RBANS immediate memory in female patients (all P < 0.05). CONCLUSION Our findings suggest that there are sex differences in insomnia, cognitive performance, and their association in patients with chronic schizophrenia. These sex differences may have important potential clinical significance for the identification, evaluation, and treatment of insomnia in patients with chronic schizophrenia.
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Affiliation(s)
- Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuxuan Du
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huixia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Breanna A Alonzo
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Alimoradi Z, Majd NR, Broström A, Tsang HWH, Singh P, Ohayon MM, Lin CY, Pakpour AH. Is alexithymia associated with sleep problems? A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 133:104513. [PMID: 34958823 DOI: 10.1016/j.neubiorev.2021.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
Alexithymia, a difficulty identifying and expressing emotions experienced by oneself or others, measurably harms quality of sleep. Research has observed the association between alexithymia and sleep problems; however, the cumulative effect of this association is still unknown. Therefore, this systematic review and meta-analysis was conducted to present scientific evidence regarding the relationship between alexithymia and sleep quality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and using relevant keywords, we searched six databases: Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, EMBASE, and Science Direct. We selected observational studies on the association between alexithymia and sleep. We conducted meta-analysis using a random-effect model to calculate the effect size (ES) with Fisher's z transformation. Eligible studies (N = 26) in 24 papers included 7546 participants from 12 countries. The entire ES for the association between alexithymia and sleep was 0.44 (95 % CI: 0.31, 0.56). Additionally, patient populations had a larger ES (ES = 0.55; 95 % CI: 0.30, 0.79) than healthy populations (ES = 0.30; 95 % CI: 0.20, 0.41). The results of the present systematic review and meta-analysis revealed a significant association between alexithymia and sleep problems, especially among people with any medical condition.
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Affiliation(s)
- Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran.
| | - Nilofar Rajabi Majd
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, 55111 Jönköping, Sweden; Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong; Graduate Research Assistant at the Pennsylvania State University, USA.
| | - Parmveer Singh
- P. G. Department of Agriculture, Khalsa College Amritsar, Punjab, India.
| | - Maurice M Ohayon
- Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, USA.
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran; Department of Nursing, School of Health and Welfare, Jönköping University, 55111 Jönköping, Sweden.
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Dawes C, Danielmeier C, Haselgrove M, Moran PM. High Schizotypy Predicts Emotion Recognition Independently of Negative Affect. Front Psychiatry 2021; 12:738344. [PMID: 34630186 PMCID: PMC8495418 DOI: 10.3389/fpsyt.2021.738344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Deficits in Emotion Recognition (ER) contribute significantly to poorer functional outcomes in people with schizophrenia. However, rather than reflecting a core symptom of schizophrenia, reduced ER has been suggested to reflect increased mood disorder co-morbidity and confounds of patient status such as medication. We investigated whether ER deficits are replicable in psychometrically defined schizotypy, and whether this putative association is mediated by increased negative affect. Methods: Two hundred and nine participants between the ages of 18 and 69 (66% female) were recruited from online platforms: 80% held an undergraduate qualification or higher, 44% were current students, and 46% were in current employment. Participants were assessed on psychometric schizotypy using the O-LIFE which maps onto the same symptoms structure (positive, negative, and disorganised) as schizophrenia. Negative affect was assessed using the Depression Anxiety and Stress Scale (DASS-21). Emotion Recognition of both positive and negative emotions was assessed using the short version of the Geneva Emotion Recognition Task (GERT-S). Results: Negative schizotypy traits predicted poorer ER accuracy to negative emotions (β = -0.192, p = 0.002) as predicted. Unexpectedly, disorganised schizotypy traits predicted improved performance to negative emotions (β = 0.256, p = 0.007) (primarily disgust). Negative affect was found to be unrelated to ER performance of either valence (both p > 0.591). No measure predicted ER accuracy of positive emotions. Positive schizotypy traits were not found to predict either positive or negative ER accuracy. However, positive schizotypy predicted increased confidence in decisions and disorganised schizotypy predicted reduced confidence in decisions. Discussion: The replication of ER deficits in non-clinical negative schizotypy suggests that the association between negative symptoms and ER deficits in clinical samples may be independent of confounds of patient status (i.e., anti-psychotic medication). The finding that this association was independent of negative affect further suggests ER deficits in patients may also be independent of mood disorder co-morbidity. This association was not demonstrated for the positive symptom dimension of the O-LIFE, which may be due to low levels of this trait in the current sample.
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