Alexithymia as a possible specifier of adverse outcomes: Clinical correlates in euthymic unipolar individuals

Gianluca Serafini; Domenico De Berardis; Alessandro Valchera; Giovanna Canepa; Pierre A Geoffroy; Maurizio Pompili; Mario Amore

doi:10.1016/j.jad.2019.10.046

Alexithymia as a possible specifier of adverse outcomes: Clinical correlates in euthymic unipolar individuals

J Affect Disord. 2020 Feb 15:263:428-436. doi: 10.1016/j.jad.2019.10.046. Epub 2019 Oct 31.

Authors

Gianluca Serafini¹, Domenico De Berardis², Alessandro Valchera³, Giovanna Canepa⁴, Pierre A Geoffroy⁵, Maurizio Pompili⁶, Mario Amore⁴

Affiliations

¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: gianluca.serafini@unige.it.
² National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Italy; Department of Neurosciences and Imaging, University "G. D'Annunzio", Italy.
³ Villa San Giuseppe Hospital, Hermanas Hospitalarias.
⁴ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁵ Departement de psychiatrie et d'addictologie, AP-HP, Hopital Bichat - Claude Bernard, F-75018 Paris, France; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France.
⁶ Department of Neurosciences Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy.

PMID: 31969274
DOI: 10.1016/j.jad.2019.10.046

Abstract

Background: Alexithymia is a disabling condition frequently linked to major depressive disorder (MDD) and able to enhance symptoms severity and suicide risk. This study aimed to clarify whether patients with and without alexithymia may differ concerning illness presentation and clinical course, which is a major gap in the scientific literature.

Methods: The present sample included 381 euthymic outpatients with MDD recruited at the Department of Neuroscience (DINOGMI), University of Genoa. The Toronto Alexithymia Scale (TAS-20) and additional rating scales (Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), Intent Score Scale (ISS) were administered to all participants.

Results: Alexithymic patients were more likely to have lower educational level (11.6 ± 3.2 vs. 12.4 ± 3.4, p ≤ .05), have used previous psychiatric drugs (85.7% vs. 72.8%, p =.001), use current antidepressants (84.7% vs. 69.4%, p = <.001), and have higher cardiological comorbid disorders (10.7% vs. 5.0%, p = ≤.05). After multivariate analyses, alexithymia was associated with lower educational level (OR=0.928, p = .05), and higher current antidepressants use (OR 2.302, p = .01); difficulties in identifying feelings were associated with lower educational level (p = ≤.005), higher psychiatric comorbidity (p = ≤.001), and previous psychiatric medications (p = .01). Furthermore, having a lower educational level remained the only factor associated with both difficulties in communicating feelings (p = ≤.001) and thoughts oriented to external context (p = ≤.005).

Limitations: The study is limited by the small sample size and its cross-sectional nature.

Conclusions: Alexithymia appears a useful specifier of adverse outcomes, associated with distinct socio-demographic and clinical characteristics. Its identification would allow to provide a more personalized care.

Keywords: Alexithymia; Difficulties in communicating feelings; Difficulties in identifying feelings; Thoughts oriented to external context; Unipolar depression].

MeSH terms

Affective Symptoms* / complications
Anxiety
Anxiety Disorders
Cross-Sectional Studies
Depressive Disorder, Major* / complications
Depressive Disorder, Major* / drug therapy
Humans
Prognosis
Psychiatric Status Rating Scales
Treatment Outcome