Type 1 diabetes is associated with alexithymia in nondepressed, non-mentally ill diabetic patients: a case-control study.
OBJECTIVE
Alexithymia refers to difficulty in identifying and expressing emotions, and it is a characteristic common to several psychiatric and medical conditions, including autoimmune disorders. Type 1 diabetes (T1D) is an autoimmune disorder with increased psychiatric comorbidity. Previously reported associations between alexithymia and T1D may have been confounded by the presence of depression. The central aim of this study was to examine alexithymia levels in psychiatrically uncomplicated T1D outpatients with that of nondiabetic controls.


METHODS
Ninety-six T1D patients without any DSM-IV Axis I diagnoses and 105 age- and sex-matched healthy controls entered the study. Alexithymia and depressive symptoms were assessed with the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory (BDI-21), respectively. Multivariate regression models were used to evaluate the association of alexithymia with the presence of diabetes, duration of diabetes, diabetes control, parameters of treatment intensification, and diabetic complications.


RESULTS
T1D was positively associated with the TAS-20 "identifying feelings" (beta coefficient=2.64, P=.003) and "externally oriented thinking" (beta coefficient=1.73, P=.011) subscales. The prevalence of overall alexithymia (TAS-20 total score, > or =60) was 22.2% in T1D patients and 7.6% in the controls (OR, 4.6; 95% CI, 1.7-12.8). TAS-20 scores were positively associated with diabetes duration and negatively with treatment intensification parameters.


CONCLUSIONS
Alexithymia is higher in psychiatrically uncomplicated T1D patients than in healthy controls even after adjustment for confounding depressive symptoms; it is greater with longer diabetes duration and is associated with some reduced parameters of treatment intensification but not with worse outcome in terms of glycemic control or somatic complications.
Faculty of Medicine, Department of Social Medicine, University of Crete, Crete, Greece. lchatzi@med.uoc.gr
Leda
L
Chatzi
Panos
P
Bitsios
Eleni
E
Solidaki
Irini
I
Christou
Evridiki
E
Kyrlaki
Maria
M
Sfakianaki
Manolis
M
Kogevinas
Nikolaos
N
Kefalogiannis
Angelos
A
Pappas
D000328:Adult; D000342:Affective Symptoms / Q000097:blood / Q000175:diagnosis / Q000523:psychology*; D003327:Coronary Disease / Q000097:blood / Q000523:psychology; D003863:Depression / Q000097:blood / Q000175:diagnosis / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000523:psychology; D003930:Diabetic Retinopathy / Q000097:blood / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D012648:Self Care / Q000523:psychology
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human