The Role of Alexithymia in Quality of Life and Health Care Use in Asthma

Abstract

Background. Alexithymia is a personality trait characterized by difficulties in perceiving and expressing emotions. The relationship between alexithymia and health outcomes in asthma has been shown in a scarce number of studies, in which alexithymia has been considered as an homogeneous construct and the confounding potential effect of anxiety and depression has not been controlled for. Objectives. To determine the relationship between each of the three dimensions of alexithymia as assessed with the Twenty-Item Toronto Alexithymia Scale—Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking—and health-related quality of life and utilization of health care services, controlling anxiety and depression. Methods. Patients with moderate to severe asthma between 18 and 65 years old filled in the Twenty-Item Toronto Alexithymia Scale, the Short-Form 36 Health Survey, the St. George's Respiratory Questionnaire, the Trait Anxiety Inventory, and the Cognitive Depression Index. Sociodemographic and clinical data were collected and the frequency of emergency room visits and hospitalizations due to asthma during the following 24 months was recorded. Data were analyzed using the ?2 test, the Mann-Whitney U test, Spearman correlations and multiple linear regression analyses. Results. A total of 76 patients took part in the study (42.67 ± 15.33 years; 59.2% female; 81.6% severe asthma). Data on emergency room visits during the 24-month follow-up were collected for 42 patients; 13 of them (30.95%) with at least one emergency room visit during the follow-up. After controlling for sociodemographic variables, clinical variables, anxiety, and depression, the Difficulty Describing Feelings factor was related to dimensions of the Short-Form 36 Health Survey: Physical Functioning (p = .021), Role—Physical (p = 0.025), and the Physical Component Score (p = .012). The Difficulty Identifying Feelings factor was associated with a higher frequency of emergency room visits (p = .005). The Externally Oriented Thinking factor was not related to any of the dependent measures. Conclusions. Two dimensions of alexithymia, Difficulty Identifying Feelings and Difficulty Describing Feelings, are complicating factors in the management of asthma, but they operate via different mechanisms and over different outcomes and the effects of alexithymia remain even while controlling for the confounding effect of anxiety and depression.

Keywords :

• alexithymia
• anxiety
• asthma
• depression
• health-related quality of life

Acknowledgments

E. S. was supported by the Predoctoral grants from the Xunta de Galicia and Beca para a realización de teses de doutoramento Fundación José Otero-Carmela Martínez. E. R. was supported by a Formación de Profesorado Universitario (FPU) grant from the Ministerio Español de Educación y Ciencia.

The authors would like to thank to M. Luisa Rodríguez-Valcárcel, nurse at the Complejo Hospitalario Universitario de A Coruña, for her support in recruiting participants to this study.