Prevalence of and factors associated with alexithymia among patients with chronic obstructive pulmonary disease in China: a cross-sectional study

Abstract

Background Alexithymia is a common psychological disorder. However, few studies have investigated its prevalence and predictors in patients with chronic obstructive pulmonary disease (COPD). Therefore, we aimed to determine the prevalence and predictors of alexithymia in Chinese patients. Methods This cross-sectional study included 842 COPD patients to assess the prevalence and predictors of alexithymia using the 20-item Toronto Alexithymia Scale (TAS-20). We used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression, the modified British Medical Research Council dyspnea Rating Scale (mMRC) to assess dyspnea, St. George's Respiratory Questionnaire (SGRQ) to assess quality of life, and the age-adjusted Charlson comorbidity index (ACCI) to assess comorbidities. Alexithymia-related predictors were identified using univariate and multivariate logistic regression analyses. Results The prevalence of alexithymia in COPD patients was 23.6% (199/842). Multivariate analysis showed that age [odds ratio (OR) 0.886; 95% confidence interval (CI) 0.794–0.998], body mass index (OR 0.879; 95% CI 0.781–0.989), HADS-anxiety (OR 1.238; 95% CI 1.097–1.396), HADS-depression (OR 1.178; 95% CI 1.034–1.340), mMRC (OR 1.297; 95% CI 1.274–1.320), SGRQ (OR 1.627; 95% CI 1.401–1.890), ACCI (OR 1.165; 95% CI 1.051–1.280), and GOLD grade (OR 1.296; 95% CI 1.256–1.337) were independent predictors for alexithymia in patients with COPD. Conclusions The prevalence of alexithymia was high in Chinese COPD patients. Anxiety, depression, dyspnea, quality of life, comorbidities, and disease severity are independent risk factors, and age and BMI are predictive factors for alexithymia in COPD patients.

Psychological distress and its associated factors among patients with chronic obstructive pulmonary disease in Hunan, China: a cross-sectional study

“…These health conditions seem related to psychological distress. However, the results of univariate analysis showed these factors are not related to psychological distress, which is contrary to Zhang et al 50 . This disparity may be explained as follows: 1) limited sample size leads to an inapparent association; 2) the relationship between health conditions and psychological distress may be restricted by other factors; 3) when collecting data, the research population didn't fill in measurements carefully, which might present fatigue effect or social desirability bias.…”

Alexithymia and asthma: a systematic review

“…Researchers also investigated the relationship between alexithymia and chronic obstructive pulmonary disease (COPD), noting that this variable is associated with anxiety, depression, and impaired quality of life ( Tselebis et al, 2010 ; Zhang et al, 2023 ), thus confirming the relevance of analyzing alexithymia in clinical settings.…”

“…According to different studies, alexithymia has been described as impacting, complicating, and often directly affecting the psychological condition of subjects ( Baiardini et al, 2015 ; Myles and Merlo, 2021 ). Selinheimo et al (2022) and Zhang et al (2023) highlighted a bidirectional influence between alexithymia and chronic respiratory diseases, and thus, reported that alexithymia increases the risk of developing chronic airway inflammation and vice versa. In the first study, subjects were followed for alexithymia for 11 years using binary logistic regressions to investigate the role of psychological factors in the onset and maintenance of physical conditions.…”

“…These features have been frequently recognized in psychosomatic disorders, demonstrating that alexithymia is implicated in the alteration of the body–mind communication axis ( Taylor et al, 1997 ; Kano and Fukudo, 2013 ). Moreover, in several chronic conditions, a high prevalence of alexithymia was observed among patients with negative health outcomes, also increasing the risk of developing anxiety and depression ( Tselebis et al, 2010 ; Nekouei et al, 2014 ; Martino et al, 2020a,b ; Zhang et al, 2023 ).…”

Anxiety and depression status in patients with idiopathic pulmonary fibrosis and outcomes of nintedanib treatment: an observational study

“…The SGRQ score is an important indicator of quality of life in patients with chronic lung disease and can be used as an independent predictor of COPD combined with anxiety and depression [ 26 ]. The SGRQ score has now been widely used to assess quality of life in patients with IPF, and a higher SGRQ-T score implies a poorer quality of life.…”