Table 2.
Characteristics of included studies.
| Authors | Year | Study design | Country | Sample | Measure | Main findings |
|---|---|---|---|---|---|---|
| Amore et al. | 2013 | Observational cohort | Italy | 117 patients with BA | TAS-20 | A subgroup of patients with high levels of alexithymia and low pulmonary function (FEV1) who reported lower symptom control scores and more maladaptive coping strategies than the group with low alexithymia and higher lung function. The two groups reported no differences in anxiety and depression variables. Furthermore, alexithymia was positively correlated with the severity of anxiety and depression. |
| Baiardini et al. | 2011 | Cross-sectional | Italy | 115 patients with asthma and comorbid rhinitis | TAS-20 | 19% of the sample reported high levels of alexithymia scores. These subjects presented lower levels of asthma control and worse quality of life than non-alexithymic subjects. Furthermore, patients with alexithymia referred to more negative effects of asthma and rhinitis and reported higher levels of depression and stress, with negative consequences on disease management. |
| Barbosa et al. | 2011 | Cross-sectional | Portugal | 53 patients with systemic lupus erythematosus 41 patients with asthma | TAS-20 | A high percentage of alexithymia in both groups. No significant differences were found between the groups, either in total TAS-20 scores or in single dimensions of the instrument (DIF, DDF, and EOT). |
| Brown et al. | 1981 | Cross-sectional | United States | 136 asthmatic patients with alexithymia 134 asthmatic patients without alexithymia | MMPI Alexithymia Scale | Asthmatic individuals with alexithymia minimized reporting their somatic and affective symptoms, showing lower scores than asthmatic subjects with low alexithymia scores. |
| Chugg et al. | 2009 | Cross-sectional | Australia | 25 patients with asthma | TAS -20 | Alexithymia scores were elevated in 12% of the sample associated with poor asthma management, adherence, and worse quality of life; alexithymia did not influence the level of satisfaction and physician-patient communication. |
| Dafauce et al. | 2021 | Cross-sectional | Spain | 63 patients with severe asthma | TAS-20 | A large portion of the sample reported high TAS-20 scores (42.9%). Older age, depression, and/or anxiety (HADS) were more present in asthmatic patients with alexithymia. Furthermore, subjects with hyperventilation syndrome showed higher TAS-20 and HADS scores. Quality of life was worse in asthmatic patients with alexithymia, depression, anxiety, and hyperventilation syndrome. |
| Dirks et al. | 1981 | Observational Cohort | United States | 579 patients with asthma | MMPI alexithymia scale | A strong association between alexithymia and rehospitalization as patients with asthma and alexithymia showed a higher rate of rehospitalization. |
| Feiguine et al. | 1982 | Cross-sectional | United States | 474 patients with asthma | MMPI alexithymia scale | Alexithymia was associated with the age of the participants. Results showed higher levels of alexithymia in middle (43%) and late (60%) adulthood than in adolescents and early adulthood. |
| Feldman et al. | 2002 | Cross-sectional | United States | 74 patients with asthma | TAS-26 | Subscale DIF was associated with emotional and physical symptoms, but not with pulmonary function. Subscale DDF was associated with decreased pulmonary function. EOT was not associated with other measures. |
| Ghorbani et al. | 2017 | Cross-sectional | Iran | 300 patients with asthma 100 control group | TAS-20 | Patients with asthma reported higher scores in all dimensions of TAS-20, as well as non-adaptive emotion regulation strategies, than the control group. DIF, DDF, and EOT were associated with physical symptoms indirectly, through catastrophizing. |
| Innamorati et al. | 2015 | Cross-sectional | Italy | 153 BA patients | TAS-20 | 22% presented severe airway obstruction and 51% reported higher levels of alexithymia. These subjects reported more depressive symptoms and higher self-reflectiveness. |
| Khosravani et al. | 2016 | Cross-sectional | Iran | 300 patients with asthma 100 control group | TAS-20 | Higher alexithymia scores and maladaptive emotion regulation strategies than the control group. Patients with alexithymia presented higher asthma severity and physical symptoms than other subjects affected by asthma. Three TAS-20 factors and maladaptive emotion regulation strategies predicted physical symptoms. |
| Khosravani et al. | 2020 | Cross-sectional | Iran | 300 patients with asthma from mild to severe | TAS-20 | Higher levels of alexithymia in the sample (47%). DIF factor was associated with high levels of negative affectivity and low empathy. Alexithymia influenced physical symptoms. |
| Kleiger and Dirks | 1980 | Observational cohort | United States | 202 patients with asthma | MMPI alexithymia scale | Both alexithymia and panic-fear personality scale scores were associated with a higher number of rehospitalizations. These patients showed more difficulty in adherence to treatment in the opinion of clinicians. Alexithymia and panic-fear personality traits had no association with pulmonary function measured in the long-term. |
| Kleiger and Jones | 1980 | Cross-Sectional | United States | 76 patients with asthma 16 COPD 8 tuberculosis | BIQ SSPS | Assessment with the BIQ showed high levels of alexithymia in all groups. Asthmatic subjects with high levels of alexithymia had lower psychasthenia and higher scores on the lies (L)-scale assessed with MMPI. |
| Liotta et al. | 2021 | Before-after (pre-post) studies with no control group | Italy | 18 patients with severe allergic asthma | TAS-20 | 6 of 18 patients presented high levels of alexithymia. All subjects reported an improvement in asthma control and symptom exacerbation rates during omalizumab treatment. |
| Martínez-Rivera et al. | 2011 | Cross-sectional | Spain | 264 patients with asthma 111 control group | TAS-20 | In the asthma group, dysfunctional breathing was higher than in the control group. These patients presented higher alexithymia and anxiety, poorer control of asthma symptoms, and worse quality of life than asthmatic patients without dysfunctional breathing. |
| Moes-Wójtowicz et al. | 2012 | Cross-sectional | Poland | 54 patients with asthma | TAS-26 | Alexithymia was present in 21.6% of cases. This variable was not associated with stress, strong emotions, and asthma symptom control. |
| Nielsen et al. | 1997 | Cross-sectional | Canada | 76 patients with asthma | TAS-26 | Different results by gender. High TAS scores, especially EOT subscale, in men was associated with low dream recall, regardless of age and neuroticism. In women participants dream and nightmare recall was correlated only with neuroticism. |
| Plaza et al. | 2006 | Observational cohort | Spain | 50 NFA patients 25 non-NFA patients 25 non-asthmatic control | TAS-26 | Higher alexithymia scores in the NFA group (24%) than in the non-NFA (12%) and non-asthmatic control groups (12%). The mean (SD) TAS score was 63.6 (14.9%). Poor ventilatory responses and breathlessness perception were not associated with alexithymia. The presence of alexithymia was associated with a greater number of hospitalizations in the past. |
| Serrano et al. | 2006 | Observational cohort | Spain | 179 Near Fatal Asthma (NFA) patients 40 non-NFA patients, as a control group | TAS-26 | Higher alexithymia scores in NFA subjects than in non-NFA ones. Higher age percentage in patients with NFA and elevated alexithymia, together with more psychopathological issues, lower education, and a higher proportion of persistency and symptom exacerbation. |
| Smyth et al. | 2002 | Controlled intervention study | United States | 39 patients with asthma 32 patients with rheumatoid arthritis | TAS-20 | High levels of alexithymia and non-expressive characteristics were not associated with an inability to write about traumatic experiences for both groups. |
| Vanegas et al. | 2020 | Cross-sectional | Latin America (multicentric) | 265 patients with asthma | TAS-20 | High levels of alexithymia were reported in asthmatic patients (30.2%). Lower levels of education were correlated with the presence of alexithymia. Subjects with high alexithymia scores had more uncontrolled and severe asthma. |
| Vázquez et al. | 2010a | Cross-sectional | Spain | 44 NFA patients 44 non-NFA patients | TAS-20 | Higher levels of anxiety and alexithymia in patients with NFA than in the non-NFA group. These patients reported higher scores on DDF subscales and higher psychopathological onset risk than patients from the control group, even years after the asthma attack. |
| Vazquez et al. | 2010b | Cross-sectional | Spain | 76 patients with asthma | TAS-20 | DIF was correlated with physical components of quality of life, DDF was associated with the number of hospitalizations. EOT was not related to any of the dependent measures. |
| Vliet et al. | 2002 | Observational cohort and cross-sectional | United States | 30 multiple chemical sensitives 19 patients with asthma 31 healthy controls | TAS-26 | Levels of alexithymia were similar among groups. Subjects with asthma and Multiple Chemical Sensitivities (MCS) showed no differences from the control group. |
BA, Bronchial Asthma; FEV1, Forced Expiratory Volume in the 1st second; TAS, Toronto Alexithymia Scale; DIF, Difficulty Identify Feelings; DDF, Difficulty Describing Feelings; EOT, External-Oriented Thinking; U.S., United States; MMPI, Minnesota Multiphasic Inventory; HADS, Hospital Anxiety and Depression Scale; COPD, Chronic Obstructive Pulmonary Disease; BIQ, Beth Israel Hospital Psychosomatic Questionnaire; SSPS, Schalling-Sifneos Personality Scale; NFA, Near Fatal Asthma.