Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients

Psychiatric Department, Sotiria General Hospital of Chest Diseases, Athens, Greece.
Annals of General Psychiatry (Impact Factor: 1.4). 04/2010; 9(1):16. DOI: 10.1186/1744-859X-9-16
Source: PubMed


Chronic obstructive pulmonary disease (COPD) is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients.
The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20), Spielberger Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively.
The mean BDI score was 12.88 (SD: 7.7), mean STAI score 41.8 (SD: 11.0) and mean TAS-20 score 48.2 (SD: 11.5). No differences were observed between genders regarding age and alexithymia (t test P > 0.05), while female patients presented higher depression and trait anxiety scores than males (t test P < 0.05). Clinically significant levels of anxiety were present in 37.1% of men, and in 45.7% of women. The mean depression score was also higher than the corresponding mean score in the general population (one-sample t test P < 0.01), while 27.7% and 30.5% of the sample presented mild and moderate to severe depression, respectively. Finally, a strong correlation was observed between alexithymia, depression and anxiety.
This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients.

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    • "Finally, the positive correlation between anxiety and depression is a common finding in both the general population [5,20] and in patients with COPD [1,6,68]. "
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    ABSTRACT: The presence of anxiety and depressive symptoms in COPD patients has been acknowledged for many years. The preponderance of recent studies supports the utility of pulmonary rehabilitation programs to reduce the levels of depression and anxiety in these patients. The aim of this study is to investigate possible changes in levels of anxiety and depression among patients enrolled in a pulmonary rehabilitation program, along with the role of disease severity in these changes. In 101 COPD patients, who attended a pulmonary rehabilitation program, levels of trait anxiety (STAI) and depressive symptoms (BDI) were assessed at the beginning and at the end of the program. Age, sex, level of education in years and stage of disease severity were recorded. Our study included 80 male and 21 female patients. Mean age and mean education level were 64.1 ± 8.1 and 11.3 ± 4.1 years, respectively. Regarding COPD staging, 11 patients suffered from mild, 16 from moderate, 47 from severe and 27 from very severe COPD. Significant decreases in anxiety (from 39.7 to 34.0, p < 0.001) and depression rates (from 10.7 to 6.3, p < 0.001) were observed. A statistically significant reduction in anxiety and depression was revealed (p < 0.05)at all stages of COPD. Pulmonary rehabilitation programs should be offered to all COPD patients irrespective of disease severity, since they all lead to improvement in anxiety and depressive symptoms.
    Multidisciplinary respiratory medicine 06/2013; 8(1):41. DOI:10.1186/2049-6958-8-41 · 0.15 Impact Factor
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    • "Alexithymia is a personality trait that involves difficulty identifying and describing feelings, difficulty distinguishing between feelings and the bodily sensations of emotional arousal, and an externally oriented cognitive style (Sifneos, 1973; Taylor, 1984). Given the lack of introspection and difficulty in expressing emotions to others experienced by individuals with this condition, the close association between alexithymia and certain psychosomatic (Tselebis et al., 2010) and psychiatric conditions, including major depression, delinquent and impulsive behaviors, eating disorders, and substance abuse disorders is not surprising (Taylor and Bagby, 2004). A recent study conducted by Chen et al. suggested that alexithymia directly affects and is a major predictor of adjustment disorder (Chen et al., 2011). "
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    ABSTRACT: Subpopulations of patients with adjustment disorder are at increased risk for suicide. The current study investigated whether personality traits, including alexithymia, temperament, and character, are associated with an increased risk of suicide in individuals with adjustment disorder. Age and sex-matched patients meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for adjustment disorder with (n=92) and without (n=92) a history of suicide attempts were recruited for the present study. Ninety-two healthy individuals who did not meet diagnostic criteria for Axis I or II diagnoses were used as controls. The Toronto Alexithymia Scale-20 (TAS-20) and the Temperament and Character Inventory (TCI) were used to assess personality traits. Significantly higher total and subscale scores on the TAS-20, including on the difficulty-identifying-feelings (DIF) and difficulty-describing-feelings (DDF) subscales, and lower scores on the TCI cooperativeness subscale were noted in adjustment-disorder patients with previous suicide attempts. In the multivariate regression analysis, high DDF and DIF and low cooperativeness increased the risk of suicide attempts in adjustment-disorder patients. A subsequent path analysis revealed that high DDF had a direct effect on suicide attempts, whereas high DIF had an indirect effect on suicide attempts via low cooperativeness.
    11/2012; 205(3). DOI:10.1016/j.psychres.2012.08.027
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    • "Both depression and anxiety are significantly associated with decreased functional status and worse health status when compared to those of patients without psychological symptoms, even after controlling for the effects of overall health status [24,29,30]. In a previous study we showed the high prevalence of anxiety and depressive symptoms, together with their association with alexithymia ('lack of words for emotions') in Greek COPD outpatients [31]. "
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    ABSTRACT: Several studies have reported high prevalence of anxiety and depression in chronic obstructive pulmonary disease (COPD) outpatients. Moreover, these patients share psychological or psychopathological characteristics that inhibit their ability to cope with the disease. In the present study we aimed to record the prevalence of psychological symptom patterns in a sample of Greek COPD outpatients and to assess which psychological factors (and to which degree) contribute to vital exhaustion (VE). The study included 139 COPD outpatients. We used the Symptom Checklist 90 - Revised (SCL-90-R) and the Maastricht Questionnaire (MQ) in order to evaluate psychological symptom patterns and VE, respectively. The mean MQ score was 19.6, which is significantly higher than the corresponding score in the general population. Regarding the SCL-90-R dimensions, depression was the highest followed by somatization, obsessive-compulsive and anxiety dimensions. Additionally, a positive correlation was observed between the MQ and the SCL-90-R dimensions. MQ failed to demonstrate correlation with age, gender, education level or the severity of the disease. Depression seems to be responsible for 57.9% of the variation of VE, while obsessive-compulsiveness is responsible for an additional 2.4%. All the remaining dimensions of SCL-90-R had no statistically significant contributions. Our findings suggest the high prevalence of VE, together with high rates in most of the SCL-90-R dimensions with greater depression, somatization, obsessive-compulsiveness and anxiety in a Greek COPD group at various Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria stages. The coexistence of such symptoms should be further assessed as an eventual unfavorable prognostic factor.
    Annals of General Psychiatry 12/2011; 10(1):32. DOI:10.1186/1744-859X-10-32 · 1.40 Impact Factor
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