Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations

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.

Keywords:

• adolescents
• major depressive disorder
• insomnia
• alexithymia

Abbreviations

MDD, major depressive disorder; YLDs, years lived with disability; MDE, major depressive episode; PSG, polysomnography; DSM-5, the diagnostic and statistical manual; BMI, body mass index; CES-D, the Center for Epidemiologic Studies of Depression Scale; TAS-20, the 20-item Toronto Alexithymia Scale; DIF, difficulty in identifying emotions; DDF, difficulty in describing emotions; EOT, externally oriented thinking; PSQI, the Pittsburgh Sleep Quality Index; SD, standard deviations; ANOVA, the analysis of variance; CI, confidence interval; OR, odds ratio; MAIA, multidimensional assessment of interoceptive awareness; COVID-19, Corona Virus Disease 2019; CBT, cognitive behavioral therapies; STPP, short-term psychoanalytic psychotherapy.

Data Sharing Statement

As this study is still ongoing, the raw datasets for the current study will not be available until the end of this research project. Please contact the first author (Xiaoxue Yang, [email protected]) for raw data requests.

Ethical Statement and Consent to Participate

This study received ethical approval from the Ethics Committee of Chaohu Hospital, Anhui Medical University (202009-kyxm-04). This study was conducted in accordance with the declaration of Helsinki. Written informed consent was obtained from all participants.

Acknowledgments

We thank all the participants who volunteered to participate in this study.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Key Clinical Specialty Project Foundation (CN) and the Research Fund Project of Anhui Translational Research Institute (No. 2022zhyx-B01).