Effects of attachment styles, childhood traumas, and alexithymia in Turkish patients with epilepsy and functional seizures

INTRODUCTION

In this cross-sectional study, we used self-report scales to compare childhood traumas, attachment styles, and alexithymia among patients with functional seizures (FS) to patients with epilepsy and healthy controls. We also investigated risk factors associated with FS.

MATERIAL AND METHODS

A total of 44 patients with epilepsy, 14 patients with FS, and 25 healthy controls were included. All participants were over the age of 18 and were referred to the Baskent University Adana Epilepsy and Video-EEG Center. The patients underwent neurological examinations, brain MRIs, and video-EEG evaluations. Epileptic seizures were classified based on video EEG. The control group consisted of healthy individuals without neurological or psychiatric illness and a history of epileptic seizures or syncope. Beck Depression Inventory (BDI), Childhood Trauma Questionnaire (CTQ), Adult Attachment Scale (AAS), and Toronto Alexithymia Scale-20 (TAS-20) were applied to all participants.

RESULTS

Patients with FS had lower educational levels, higher rates of unemployment and single-marital status. The FS group had higher depression, childhood trauma, and alexithymia scores than the other groups. Furthermore, FS patients had a higher prevalence of avoidant attachment. The alexithymia and childhood trauma scores were both correlated with depression. Through the logistic regression analysis, childhood trauma scores and alexithymia were significant risk factors for FS.

CONCLUSION

The use of video-EEG for diagnosing FS can reduce the risk of misdiagnosis and inappropriate antiepileptic treatment. Psychiatric comorbidities, childhood traumas, and alexithymia are prevalent in patients with FS. Therefore, implementing a multidisciplinary treatment approach that addresses the psychological, medical, and social aspects of FS can significantly improve outcomes.

Press Play to Feel: The Role of Attachment Styles and Alexithymic Features in Problematic Gaming

Problematic gaming has been consistently associated with insecure attachment styles and alexithymia. However, there is limited knowledge regarding the impact of specific alexithymic features and insecure attachment styles on problematic gaming. The study included a sample of 358 online game players (242 males, 67.6%) between the ages of 18 and 59 (M = 28.46; SD = 8.76) who were recruited from online gaming communities. The participants completed a sociodemographic schedule and measures on attachment styles, alexithymia, and problematic gaming. The results provide evidence for a positive prediction of problematic gaming by dismissing attachment style and the alexithymic factors concerning the difficulty identifying feelings and externally oriented thinking, even when controlling for potentially confounding factors, such as age, sex, education, marital status, and self-reported time devoted to online games. Additionally, the analysis revealed a significant interaction effect between externally oriented thinking and dismissing attachment style in the prediction of problematic gaming. The interaction implies that the alexithymia factors pertaining to externally oriented thinking hold significant relevance in predicting problematic gaming behaviors, especially in cases where dismissive attachment levels are moderately to highly present. These findings emphasize the significance of considering specific insecure attachment styles and alexithymic features when studying problematic gaming behaviors.

Sleep problems in adolescents with depression: Role of childhood trauma, alexithymia, rumination, and self-esteem

BACKGROUND

While sleep problems are common in adolescents with depression, the exact prevalence has not been reported. Although previous studies have shown that childhood trauma, alexithymia, rumination, and self-esteem are related to sleep problems, the interactions between these factors remain unclear.

METHODS

This study, conducted from March 1, 2021 to January 20, 2022, employed a cross-sectional design. The participants were 2192 adolescents with depression with a mean age of 15 years. The Chinese version of the Pittsburgh Sleep Quality Index, Childhood Trauma Questionnaire, Toronto Alexithymia Scale-20, Ruminative Response Scale, and Rosenberg Self-Esteem Scale were used to measure sleep problems, childhood trauma, alexithymia, rumination, and self-esteem, respectively. We used PROCESS 3.3 for SPSS to determine the chain mediating effect of alexithymia and rumination and the moderating effect of self-esteem in the relationship between childhood trauma and sleep problems.

RESULTS

Up to 70.71 % of adolescents with depression had sleep problems. Furthermore, alexithymia and rumination played a chain mediation role in the relationship between childhood trauma and sleep problems. Finally, self-esteem moderated the relationships between alexithymia and sleep problems and rumination and sleep problems.

LIMITATIONS

Owing to the study design, we cannot derive causal relationships between variables. Further, the self-reported data may have been influenced by subjective participant factors.

CONCLUSIONS

This study reveals potential ways of how childhood trauma influences sleep problems in adolescents with depression. These findings suggest that interventions targeting alexithymia, rumination, and self-esteem in adolescents with depression may be effective in reducing their sleep problems.

[Alexithymia in Multiple Sclerosis - Narrative Review]

Alexithymia is a multidimensional construct of personality implicating difficulties in identifying and describing another's feelings, and externally oriented thinking. It is broadly reported in psychiatric patients but has gained little attention regarding its occurrence and pathophysiology in multiple sclerosis (MS). This narrative review aims to address prevalence, etiology, neurobiological, and clinical findings of alexithymia. The prevalence of alexithymia in MS ranges from 10 to 53%. There seems to be an association with anxiety, depression, fatigue, and some aspects of social cognition, while the relationship with clinical and classical cognitive variables was rarely evaluated. Only a few studies referred to its pathophysiology assuming an aberrant interhemispheric transfer or regional cerebral abnormalities. The prevalence of alexithymia in MS and the potential negative impact on quality of life and interpersonal communication could severely impact clinical MS management and a screnning for these factors should be mandatory. Thus, further evaluation is needed concerning its relationship with clinical, emotional, and cognitive confounders. Large-scale studies employing neuroimaging techniques are needed for a better understanding of the neural underpinnings of this MS feature.

Childhood traumatic events, alexithymia and perceived stress in patients with rheumatoid arthritis during the COVID-19 pandemic

Rheumatoid arthritis (RA) is a chronic inflammatory disease, causing joint-swelling and pain. International literature highlights that patients with RA are more likely to report high levels of alexithymia, adverse childhood events (ACEs) and stress, but studies investigating the association between these dimensions are lacking. The general aim of the present study is to investigate the association between alexithymia, ACEs, and stress in RA patients and to highlight possible predictors of greater perceived stress. One hundred and thirty-seven female patients with RA (mean age = 50.74; SD = 10.01) participated in an online survey between April and May 2021. Participants completed a questionnaire for the collection of sociodemographic and clinical information, the 20-item Toronto Alexithymia Scale, the Adverse Childhood Events questionnaire and the 10-item Perceived Stress Scale. The correlational analysis highlighted several significant associations between the dimensions evaluated. Regression analyses showed that alexithymia, ACEs and the perceived health status have a predictive effect on the perceived stress of RA patients. More specifically, the role of difficulty in identifying feelings, and the physical and emotional neglect, has been highlighted. ACEs and high levels of alexithymia are common in RA clinical populations and seem to affect the wellbeing of these patients. The use of a biopsychosocial approach to RA treatment appears essential in achieving a better quality of life and illness control in this specific clinical population.

Differences in the associations between psychoactive substance use and alexithymia: A series of Meta-analyses

The present meta-analytic study examined the association between alexithymia and psychoactive substance use. Studies published from 1988 to August 20, 2022 were identified by a systematic search and 168 eligible studies were included in five meta-analyses. Results showed that (1) the correlation between substance use and alexithymia is small but significant (r = 0.177); (2) substance users have substantially higher alexithymia than nonusers (g = 0.545); (3) alexithymic participants have significantly but slightly higher levels of substance use than non-alexithymics (g = 0.242); (4) substance users are significantly but only slightly more likely to be alexithymic than nonusers (OR = 2.392); and (5) alexithymic individuals are not more likely to be substance users than non-alexithymics. Larger effects were observed among samples diagnosed with substance use disorder (SUD), and the use of depressants, alcohol, opiates, and illicit stimulants had stronger relation to alexithymia. We found a tendency for a larger association with problematic use as compared to other indicators (e.g., frequency and duration) of substance use. Among the components of alexithymia, difficulties in identifying feelings has the strongest association with substance use. Our findings support clinical practice by suggesting the improvement of emotion regulation in SUD.

Gender Differences in Adolescents' Affective Symptoms and Behavioral Disorders After Mild Traumatic Brain Injury

OBJECTIVE

Mild traumatic brain injuries (mTBI) are considered self-limiting and full recovery is expected. Recent studies identify deficits persisting years after mTBI. Large-scale prospective data permit testing the hypothesis that mTBI increases incidence of affective and behavioral symptoms after new, past , or new and past mTBI.

SETTING

The study involved secondary analyses of survey responses from the Adolescent Brain Cognitive Development (ABCD) Study.

PARTICIPANTS

Adolescents in the ABCD Study ( n = 11 869; Wave 1, aged 9-10 years; Wave 2, aged 11-12 years) whose parents reported a new ( n = 157), past ( n = 1318), or new and past ( n = 50) mTBI on the Ohio State University Traumatic Brain Injury Identification Method short form were compared with controls who had no history of mTBI ( n = 9,667).

DESIGN

Multivariable binary logistic regression models examined associations between a new, past, or new and past mTBI and current affective (aggression, depression, anxiety) and behavioral (somatic, thought, social, attention, attention deficit hyperactivity disorder, conduct) disorders while controlling for demographic factors and baseline symptoms.

MAIN MEASURES

The primary measure was parental reports of psychiatric and behavioral symptoms on the Child Behavior Checklist.

RESULTS

Girls exhibited no significant effects after a new mTBI, although a past mTBI increased anxiety (adjusted odds ratios [aOR] = 1.83, 95% confidence interval [CI: 1.15-2.90]) and attention (1.89 [1.09-3.28]) problems. Girls with new and past mTBIs reported elevated anxiety (17.90 [4.67-68.7]), aggression (7.37 [1.49-36.3]), social (9.07 [2.47-33.30]), thought (7.58 [2.24-25.60]), and conduct (6.39 [1.25-32.50]) disorders. In boys, new mTBI increased aggression (aOR = 3.83, 95% CI [1.42-10.30]), whereas past mTBI heightened anxiety (1.91 [1.42-2.95]), but new and past mTBIs had no significant effects.

CONCLUSION

Adolescents are at greater risk of affective and behavioral symptoms after an mTBI. These effects differ as a function of gender and time of injury. Extended screening for mTBI history and monitoring of affective and behavioral disorders after mTBI in adolescents are warranted.

The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic

The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.

The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

People with fibromyalgia (FM) often report having difficulty with emotional identification and expression, and this "alexithymia" may contribute to their pain and other symptoms. Multiple studies have assessed alexithymia in FM, and we systematically reviewed and meta-analyzed this literature to: (a) describe the prevalence of alexithymia in people with FM; (b) compare the level of alexithymia in FM to both healthy controls and controls with other pain conditions; and (c) determine the association of alexithymia to pain intensity, depression, and anxiety in people with FM.

DATABASES AND DATA TREATMENT

Following PRISMA guidelines, we searched multiple databases (Scopus, PubMed/MEDLINE, Embase, Web of Science, PsycINFO and Google Scholar) from inception to May 31, 2022. Study quality was assessed with The Joanna Briggs Institute (JBI) tools for cross-sectional studies, and STATA:17 was used for meta-analysis. A total of 32 studies met eligibility criteria and were included in meta-analyses.

RESULTS

The prevalence of alexithymia in FM averaged 48%. People with FM had substantially higher alexithymia than healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22), as well people with other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), particularly rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08-0.91). Alexithymia was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) among people with FM.

CONCLUSIONS

Due to the high level of alexithymia in people with FM and the positive relationship of alexithymia with pain and psychological distress, interventions to improve emotional awareness, expression, and processing in FM are recommended.

Emotional Loneliness, Suicidal Ideation, and Alexithymia in Adolescents Who Commit Child-to-Parent Violence

The objective of this research was to explore the relationship between involvement in child-to-parent violence (CPV) and the development of emotional loneliness, suicidal ideation, and alexithymia based on sex; 1,928 adolescents of both sexes participated (50.5% males and 49.5% females), aged between 12 and 18 years (M = 14. 67, SD = 1.77), enrolled in four educational centers in Spain. A multivariate analysis of variance (3 × 2 MANOVA) was applied using sex and CPV levels as independent variables. Univariate analyses were carried out to explore the significant relationships detected. Results showed that the adolescents with higher CPV scored higher in emotional loneliness, suicidal ideation, and alexithymia. Girls showed a greater prevalence of CPV at the medium and high levels. An interaction of sex and CPV with alexithymia was detected. Girls with high and moderate values of CPV presented a higher level of alexithymia. These results provide novel information in the field of CPV. Previous research has placed the main focus of analysis on the adolescents' behavior problems and not so much on their perceptions of personal adjustment and their emotional experiences. The information presented in this study contributes to achieve a more precise definition of the profile of adolescent who assault their parents for better prevention of CPV.

FEATURES OF AFFECTIVE SYMPTOMS IN COMBATANTS WITH NON-PSYCHOTIC MENTAL DISORDERS THAT HAVE SUFFERED FROM COVID-19

OBJECTIVE

The aim: To establish the level of anxiety and depressive disorders and the impact of covid-19 on affective pathology in combatants with non-psychotic mental disorders who have suffered from COVID-19 in a comparative aspect.

PATIENTS AND METHODS

Materials and methods: 252 male combatants with non-psychotic mental disorders who suffered from COVID-19 were clinically examined using HRDS and HARS scales.

RESULTS

Results: A lower prevalence of anxiety or fear was found in combatants who did not have COVID-19: 70.5% vs. 80.8%; low mood - 55.3% vs. 66.7%; emotional lability - 44.7% vs. 58.3%; irritability - 40.9% vs. 55.0%; emotional sensitivity - 53.0% vs. 71.7%; dulling of emotions - 6.8% vs. 6.7%; anhedonia - 77.3% vs. 83.3% of patients, rapid fatigue - 51.5% vs. 65.8%, feelings of guilt, futility, anxiety or fear - 78.0% vs. 87.5%, dissomnia - 47.0% vs. 61.7%; inability to concentrate and make decisions - 25.8% vs. 43.3%; thoughts of death or suicide - 25.0% vs. 35.8% pessimism - 21.2% vs. 31.7%, low self-esteem - 21.2% vs. 31.7%, unstable appetite and weight loss-17.4% vs. 24.2%. The overall HDRS depression score in combatants with non-psychotic mental disorders who did not have COVID-19 was also significantly lower: 15.29±4.16 points vs. 18.05±4.29 points. Similar patterns were found for indicators of anxiety on the HARS scale: 20.52±7.14 points vs. 24.53±6.69 points.

CONCLUSION

Conclusions: Combatants with non-psychotic mental disorders are characterized by high levels of depressive and anxiety disorders. COVID-19 disease aggravates the course of affective pathology in combatants with non-psychotic mental disorders and increases the incidence of their depressive and anxiety symptoms.

Associations between childhood maltreatment and suicidal ideation in depressed adolescents: The mediating effect of alexithymia and insomnia

BACKGROUND

People with depression appear to experience higher levels of childhood maltreatment (CM) and suicidal behaviour. However, no studies have discussed the factors through which CM influences suicidal ideation (SI) in adolescents with depression. The present study examined the effects of alexithymia and insomnia on the relationship between CM and SI in a population of Chinese adolescents with depression.

METHODS

A total of 262 adolescents with depression (198 females) completed the Childhood Trauma Questionnaire-Short Form, the Toronto Alexithymia Scale-20, the Insomnia Severity Index, and the Positive and Negative Suicide Ideation.

RESULTS

With the exception of sexual abuse (SA), four types of CM were associated with SI in depressed individuals. The highest incidence was found for physical neglect (PN) (65.27 %). Alexithymia and insomnia were both positively associated with SI. Externally oriented thinking (EOT) and insomnia had significant mediating effects on the relationship between emotional abuse (EA) and SI. EOT and insomnia also had significant mediating effects on the relationship between physical neglect (PN) and SI.

LIMITATIONS

The major limitations of this study include the impacts of cross-sectional studies and recall bias on the results.

CONCLUSIONS

Alexithymia and insomnia have an impact on SI in adolescents with depression who have experienced CM. Therefore, we should be aware of the impact of alexithymia and insomnia on depression patients. Rates of suicide among adolescents with depression should be reduced by identifying targeted measures.

Autism traits dimensionality and multivariate relationship with alexithymia and anxiety in the general population

BACKGROUND

Autism is characterized by social and non-social alterations observed beyond the clinical diagnosis. Research analyzing the expression of autism traits in the general population helps to unravel the relationship between autism dimensions and other associated variables, such as alexithymia and anxiety. The Autism-Spectrum Quotient (AQ) was developed to assess autism traits in the general population; however, inconsistent results regarding its dimensionality have emerged.

AIMS

This study aimed to extend evidence about the AQ measurement model, and explore the multivariate relationship between autism traits, alexithymia, and trait anxiety.

METHODS

292 adults of the general population were recruited. An Exploratory Factor Analysis and Confirmatory Factor Analysis were performed to assess the factorial structure of AQ. A path analysis was carried out to explore the relationship between autism traits, alexithymia, and trait anxiety.

RESULTS

The results supported a three-factor model of AQ. The path analysis model showed evidence of a significant role of alexithymia as a mediator of the relationship between autism traits and anxiety.

CONCLUSIONS AND IMPLICATIONS

The present study provides empirical support for a three-factor model of AQ in the general population. The association between autism traits, alexithymia, and anxiety dimensions highlights the multidimensional nature of these variables and the need to account for their distinct impact on autism-related variables.

How are the youth? A brief-longitudinal study on symptoms, alexithymia and expressive suppression among Italian adolescents during COVID-19 pandemic

Studies documented the negative consequences on adolescents' mental health of the stay-at-home measures adopted in reaction to the COVID-19 outbreak. However, few contributions focused on the psychopathological trajectories after the end of these stressful measures or investigated the moderating role of this context in the relationship linking psychological symptoms with emotion regulation. This brief longitudinal study was performed with two measurement times: during the severe lockdown (T1), and when the restrictive measures were relaxed (T2). Ninety-three community adolescents (45% boys; Mage  = 14.94 years, SD = 1.64) completed the Youth Self Report, the Social Media Disorder Scale, the Binge Eating Scale, the Emotion Regulation Questionnaire and the Toronto Alexithymia Scale 20 items. Except for binge eating and externalising symptoms, all variables significantly decreased between T1 and T2. The relationship between expressive suppression and binge eating scores significantly decreased across time whereas the link between alexithymia and internalising symptoms increased with time. The study supported the idea that low-risk adolescents experienced psychological relief from the relaxation of stay-at-home measures. Results suggest the importance of considering contextual factors when explaining the role of expressive suppression and alexithymia in binge eating and internalising symptoms among adolescents.

Alexithymia Among People Living with HIV: A Scoping Review

The present scoping review aimed to identify studies that investigated alexithymia, defined as a difficulty in identifying and describing one's own emotions, in people living with HIV (PLWH).A literature search, in line with the guidelines of PRISMA-ScR, was conducted in the following bibliographic databases: PubMed, PsycINFO, and Web of Science. The databases were queried using the following strings (using Boolean operators): ("alexithymia" OR "alexithymic") AND ("HIV" OR "Human Immunodeficiency Virus"). In line with the eligibility criteria, fourteen articles were found.Ten studies showed the involvement of alexithymia in disease severity (e.g., viral load levels), and adherence to antiretroviral therapy. Three studies revealed an association between alexithymia and cardiovascular disease, and three studies highlighted the implication of alexithymia in cognitive impairment.This review revealed the complex role of alexithymia in HIV disease. A careful clinical assessment of the emotional regulation process of PLWH can provide useful prognostic information.

Early Trauma and Later Sexual Victimization in College Women: A Multiple Mediation Examination of Alexithymia, Impulsivity, and Alcohol Use

Childhood abuse and sexual violence against women are prevalent in the United States. However, researchers have not fully explored the intersection among important predisposing factors that predict recent sexual violence experienced by women who are also survivors of childhood abuse. The purpose of this study was to examine the relationships among early childhood trauma, alexithymia, impulsivity, alcohol use severity, and sexual victimization in later life among female college students from the United States (n = 1,178). Participants were part of a larger cross-cultural study, conducted between 2012 to 2014, which examined sexual aggression and victimization in the context of alcohol use. The current study aimed to examine if: (a) early trauma, impulsivity, alexithymia, and alcohol use severity impact sexual victimization in later life, and (b) if impulsivity, alexithymia, and alcohol use severity mediate the relationship between early trauma and victimization in later life. It was hypothesized that impulsivity, alexithymia, and alcohol use severity would significantly mediate the relationship between early trauma and sexual victimization in later life. Using a multiple mediation path analysis, results indicated that early childhood trauma was significantly linked with impulsivity, alcohol use severity, and sexual victimization in later life. A partial mediation through impulsivity and alcohol use severity was observed. Alexithymia did not produce mediation effects. These findings align with previous research examining how early childhood trauma influences the occurrence of sexual victimization in later life and provides further recommendations for helping professionals as they attempt to stifle the sexual victimization rates among female college students.

Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms

BACKGROUND

Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood.

METHODS

In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms.

RESULTS

Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07-0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41-0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08-0.62).

CONCLUSIONS

Our findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.

Psychological Predictors of Fibromyalgia Among High School Students

The purpose of the current study was to examine prediction power of psychological factors (i.e., alexithymia and psychological distress) on fibromyalgia among high school students. A cross-sectional, correlational design was used. Data related to alexithymia, psychological distress, and fibromyalgia were collected from 483 high school students from the northern part of Jordan using stratified cluster random sampling. Results showed that psychological distress is a significant predictor of fibromyalgia (odds ratio = 1.1, p < 0.001). Significant differences were found between males and females in relation to alexithymia (t = -4.87, p < 0.001), psychological distress (t = -6.0, p < 0.001), and fibromyalgia (χ2 = 4.14, p = 0.04, phi = 0.07). Age was only significantly correlated with alexithymia (r = 0.06, p < 0.05). Given the relationship among psychological distress, alexithymia, and fibromyalgia, mental health professionals should carefully observe psychological disturbances among high school students. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Relationship between stress and alexithymia, emotional processing and negative/positive affect in medical staff working amid the COVID-19 pandemic

The psychological burden of the COVID-19 pandemic may have a lasting effect on emotional well-being of healthcare workers. Medical personnel working at the time of the pandemic may experience elevated occupational stress due to the uncontrollability of the virus, high perceived risk of infection, poor understanding of the novel virus transmission routes and unavailability of effective antiviral agents. This study used path analysis to analyze the relationship between stress and alexithymia, emotional processing and negative/positive affect in healthcare workers. The sample included 167 nurses, 65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in COVID-19-designated hospitals. Respondents were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing Scale, and the Positive and Negative Affect Schedule. The model showed excellent fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). Multiple group path analysis demonstrated physicians differed from nurses and paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, p<0.01, respectively). The relationship between alexithymia and emotional processing was stronger in nurses than in physicians (difference in beta=0.27; p<0.05). Individual path χ2 tests also revealed significantly different paths across these groups. The results of the study may be used to develop evidence-based intervention programs promoting healthcare workers' mental health and well-being.

Association between Leisure Screen Time and Emotional and Behavioral Problems in Spanish Children

OBJECTIVE

To assess the relation between leisure screen time and emotional and behavioral problems in Spanish children aged 4-14 years.

STUDY DESIGN

This cross-sectional study used a representative sample of children aged 4-14 years included in the 2017 Spanish National Health Survey (n = 4073). Emotional and behavioral problems of children were assessed through the parent-report Strengths and Difficulties Questionnaire. Daily leisure screen time in minutes was categorized as 0-59, 60-119, 120-179, and ≥180. We calculated adjusted prevalence ratios (aPR) and their 95% CIs of being at risk of developing emotional and behavioral problems. Associations were adjusted for potential confounding variables.

RESULTS

Children spending 180 minutes or more of daily leisure screen time compared with children spending less than 1 hour were more likely to be at risk of developing emotional and behavioral problems: aPR_≥180: 2.19 (95% CI 1.53-3.14), emotional symptomology: aPR_≥180: 2.09 (95% CI 1.37-3.18), conduct problems aPR_≥180: 1.85 (95% CI 1.34-2.54), peer problems aPR_≥180: 1.78 (95% CI 1.15-2.75), and to behave less prosocially: aPR_≥180: 2.20 (95% CI 1.43-3.37).

CONCLUSIONS

We have found significant associations between daily leisure screen time and emotional and behavioral problems in Spanish children between 6 and 14 years of age. However, these findings should be confirmed in cohort studies, so institutions might consider including screen time as a new risk factor for children.

Alexithymia, Dissociation, and Family Functioning in a Sample of Online Gamblers: A Moderated Mediation Study

The diffusion of the internet and technological progress have made gambling on online platforms possible, also making it more anonymous, convenient, and available, increasing the risk of pathological outcomes for vulnerable individuals. Given this context, the present study explores the role of some protective and risk factors for problematic gambling in online gamblers by focusing on the interaction between alexithymia, dissociation, and family functioning. A sample of 193 online gamblers (Mage = 28.8 years, SD = 10.59; 17% females, 83% males) completed the South Oaks Gambling Screen, Twenty-Items Toronto Alexithymia Scale, Dissociative Experience Scale-II, and Family Adaptability and Cohesion Evaluation Scales-IV through an online survey. MANOVA, ANOVA and moderated mediation analyses were carried out to analyse the data. Significant differences in cohesive family functioning, alexithymia and dissociation have been found between online gamblers with problematic, at-risk or absent levels of gambling disease. Furthermore, the results showed a significant and positive association between alexithymia and problematic online gambling, partially mediated by dissociation, with the moderation of cohesive family functioning. Such data may have relevant clinical implications, highlighting the interaction of some core personal and environmental variables that may be involved in the etiology of online pathological gambling and could be kept in mind to tailor preventive interventions.

Mediating Role of Stress at Work in the Relationship of Alexithymia and PTSD among Emergency Call Operators

Aim: The main purpose of this research was to investigate the relationship between alexithymia, stress at work, and post-traumatic stress disorder (PTSD) in impact emergency call center operators working in Poland (province of Greater Poland). The risk of exposure to critical life events was also considered. Methods: Data were collected using self-report questionnaires administered after dispatchers’ shifts. The emergency call center operators (N = 66) completed the Impact of Event Scale—Revised, 20-item Toronto Alexithymia Scale, Workplace Perceived Stress Questionnaire, and a questionnaire measuring the frequency and intensity of potentially traumatic events faced by emergency operators (a questionnaire developed by the authors). Results: Twenty of the most frequent events (e.g., child sexual harassment, rape, etc.) were identified. Results indicated that post-traumatic stress positively correlated with (a) work-related stress and (b) one aspect of alexithymia: difficulty expressing feelings. Additionally, work-related stress was identified as a mediator for the relation between alexithymia and the intensity of post-traumatic stress. Conclusions: The results of this study confirm that emergency operators are a high-risk group for the development of PTSD. The study results suggest that performing the work of an emergency dispatcher is not only demanding but also inherently involves participation in potentially traumatic events (as encountered through emergency calls).

Childhood trauma, dissociation, alexithymia, and anger in people with autoimmune diseases: A mediation model

BACKGROUND

Despite research linking dissociation, alexithymia, and anger with childhood trauma and ADs, the investigation addressing the relationships between the potential mediators has not yet been established within the literature.

OBJECTIVE

The present study examined the relationship between childhood trauma and autoimmune disorders, using a multiple mediation model that included dissociation, alexithymia, and anger as hypothesized mediators.

PARTICIPANTS AND SETTING

306 autoimmune patients and 292 self-declared healthy controls were included in the study. They completed self-report questionnaires regarding childhood abuse, alexithymia, dissociation, and anger.

METHODS

Multiple mediation analysis was conducted to investigate the study's proposed model.

RESULTS

The results of the Structural Equation Model (SEM) suggest an indirect relationship between childhood trauma and autoimmune disorders, mediated by dissociation [z = 4.57, p < .01, β = 0.19, 90% CI (0.08-0.10)], alexithymia [z = 10.74, p < .01, β = 0.43, 90% CI (0.08-0.10)], but not by anger [z = 1.58, p = .11, 90% CI (0.08-0.10)].

CONCLUSIONS

These findings are in line with previous studies that show associations between childhood trauma, dissociation, alexithymia, and ADs. They indicate that mental health professionals and medical doctors should assess childhood trauma in autoimmune patients. They also should consider the possible maintaining role of dissociation and alexithymia in the treatment of autoimmune diseases.

Impact of the COVID-19 Pandemic on the Mental Health of Adolescent Students in Daegu, Korea

BACKGROUND

In February 2020, as coronavirus disease 2019 (COVID-19) spread rapidly in Daegu, South Korea, students in that region experienced many emotional difficulties. In this study, we analyzed the stress and emotional crisis experienced by students during the COVID-19 pandemic, its causative factors, and the factors that affect negative emotions.

METHODS

We identified the demographic information related to the experiences of unbearable stress and emotional crisis and their causal factors at three points in time: before the pandemic, during its peak, and at the time of the survey (2-3 months after the peak). In addition, we analyzed the factors related to depression and anxiety experienced by students during the COVID-19 pandemic. The Korean version of the Patient Health Questionnaire 9 and the Korean version of the Generalized Anxiety Disorder 7 was used to assess for depressive and anxiety symptoms in the subject students, respectively.

RESULTS

A total of 8,177 students participated in the analysis, with 4,072 boys (49.8%), 4,105 girls (50.2%), and 4,463 middle school students (54.6%) and 3,177 high school students (45.4%). The percentage of students who experienced unbearable stress was 9% before the COVID-19 pandemic, increased to 16% at the peak of the COVID-19 pandemic, then decreased to 12.7% at the time of the survey. Stress was experienced more by girls (18.1% versus 13.8% in boys; χ² = 28.159, P < 0.001) and high school students (19.0% versus 13.5% in middle school students; χ² = 45.437, P < 0.001). Overall, 7.6% experienced emotional crises during the COVID-19 pandemic, which was more prevalent in girls (10.1% versus 5.2% in boys; χ² = 71.025, P < 0.001) and in high school students (8.8% versus 6.7% in middle school students; χ² = 12.996, P < 0.001). Depression and anxiety was seen in 19.8% and 12.3% of students during the COVID-19 pandemic, respectively. The risk factors for depression and anxiety included unbearable stress before the COVID-19 pandemic (P < 0.001), mental health (P = 0.044), and age (P = 0.040), whereas resilience was identified as a protective factor for depression and anxiety (P = 0.001).

CONCLUSION

Students in Daegu experienced lots of mental difficulties since the COVID-19 pandemic. It will be necessary to improve stress management and resilience to improve students' mental health in disasters such as the COVID-19 pandemic.

Late Adolescents' Attachment to Parents and Peers and Psychological Distress Resulting from COVID-19. A Study on the Mediation Role of Alexithymia

The scientific literature has shown the key role played by attachment to parents and peers and difficulties in recognizing, processing, and regulating emotions (i.e., alexithymia) in the (mal-)adaptive psychological response to the COVID-19 pandemic during late adolescence. No study has yet explored the complex interplay between these variables. We recruited a sample of 454 late adolescents (Mage = 22.79, SD = 2.27) and assessed attachment to parents and peers, alexithymia, and peritraumatic distress due to COVID-19 through self-report instruments. Attachment to fathers and peers, but not to mothers, and alexithymia significantly predicted levels of peritraumatic distress. Alexithymia fully and partially mediated the effect of, respectively, attachment to mothers and attachment to peers on peritraumatic distress due to COVID-19. These findings suggested that intervention programs focused on the promotion of peer social relationships, supportive parent-adolescent relationships, and the ability to recognize and discriminate one's own and others' emotions are needed in helping late adolescents to face the current health emergency and preventing short- and long-term psychopathological consequences related to the COVID-19 pandemic.