Tesio Valentina, Di Tella Marialaura, Ghiggia Ada, Romeo Annunziata, Colonna Fabrizio, Fusaro Enrico, Geminiani Giuliano C, Castelli Lorys
Department of Psychology, University of Turin, Turin, Italy.
Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy.
Front Psychol. 2018 Apr 4;9:442. doi: 10.3389/fpsyg.2018.00442. eCollection 2018.
Pain in fibromyalgia (FM) is accompanied by a heterogeneous series of other symptoms, which strongly affect patients' quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL) of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI) and depressive symptoms explained the 45% of the variance of the physical component of HRQoL ( < 0.001). Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance ( < 0.001). The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia seems to directly contribute to worsen the impact that this chronic pain pathology has on the patients' quality of life, especially regarding the psychosocial functioning.
纤维肌痛（FM）患者的疼痛伴有一系列各种各样的其他症状，这些症状严重影响患者的生活质量，并干扰社交和工作表现。本研究旨在评估述情障碍对FM患者健康相关生活质量（HRQoL）的身体和心理社会成分的影响，同时控制抑郁、焦虑和疼痛的伴随影响。特别是，鉴于抑郁与述情障碍之间存在紧密联系，进一步研究了由抑郁症状介导的述情障碍与HRQoL之间的关系。对205例主要诊断为FM的女性患者的连续样本进行了数据收集。结果显示，根据多伦多述情障碍量表（TAS-20）评估，约26%的患者存在述情障碍。分别有61%和60%的患者存在临床相关水平的抑郁和焦虑症状。分层多元回归分析结果显示，疼痛强度（PI）和抑郁症状解释了HRQoL身体成分方差的45%（<0.001）。关于HRQoL的心理成分，抑郁和焦虑症状、述情障碍和PI显著解释了61%的方差（<0.001）。中介分析证实，述情障碍对HRQoL的心理成分有直接影响，并通过抑郁症状的中介作用，对身体和心理成分均显示出统计学上的显著间接影响。总之，本研究结果表明述情障碍，尤其是难以识别情感，对FM患者的HRQoL存在直接和间接影响。事实上，尽管抑郁症状的同时存在导致了间接影响，但述情障碍似乎直接导致这种慢性疼痛疾病对患者生活质量的影响恶化，尤其是在心理社会功能方面。
