Impact of anxiety levels and alexithymia degree on the quality of life in patients with anxiety disorders

doi:10.3969/j.issn.1674-8115.2024.05.006

Abstract

Abstract:

Objective ·To evaluate the relationship between anxiety level, alexithymia degree and quality of life in patients with anxiety disorders. Methods ·Anxiety disorder patients admitted to the outpatient department of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from October 1, 2020 to March 31, 2023 were selected as the research subjects, and 438 patients were ultimately included after exclusion. Among them, there were 271 patients with generalized anxiety disorder, 101 patients with panic disorder, 48 patients with social anxiety disorder, 12 patients with agoraphobia, and 6 patients with specific phobia. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), the twenty-item Toronto Alexithymia Scale (TAS-20) and World Health Organization Quality of Life Scale-Brief Form Questionnaire (WHOQOL-BREF) were used to assess the patients' anxiety level, depression level, alexithymia degree and quality of life, respectively, and the scale scores of patients with different subtypes of anxiety disorders were evaluated. Spearman correlation coefficient was used to analyze the correlation between anxiety level, depression level, alexithymia degree and quality of life in patients with anxiety disorders. Stepwise regression model was used to analyze the key variables affecting the quality of life in patients with anxiety disorders. Results ·There were no significant differences in HAMA score, HAMD-17 score and TAS-20 score among patients with different subtypes of anxiety disorders, but the differences in WHOQOL-BRIEF score were statistically significant (H=10.076, P=0.039). The results of Spearman correlation analysis showed that the WHOQOL-BRIEF score of anxiety disorder patients was negatively correlated with HAMA score, HAMD-17 score and TAS-20 score (r=-0.256, P=0.000; r=-0.311, P=0.000; r=-0.342, P=0.000). The results of stepwise regression analysis showed that age, HAMA score, HAMD-17 score and TAS-20 score had significant impact on the quality of life of patients (all P<0.05). Conclusion ·The quality of life in patients with different subtypes of anxiety disorders is different. The anxiety level, depression level and alexithymia degree are the key variables affecting their quality of life.

Key words: anxiety disorder, anxiety level, depression level, alexithymia, quality of life

CLC Number:

R749

SU Shanshan, JIANG Wenhui, WANG Shuting, XU Mizhen, REN Xueqing, QIU Jianyin. Impact of anxiety levels and alexithymia degree on the quality of life in patients with anxiety disorders[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(5): 584-590.

Figures/Tables 5

TrendMD

References 28

1	HUANG Y, WANG Y, WANG H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-224.
2	MOMEN N C, PLANA-RIPOLL O, AGERBO E, et al. Association between mental disorders and subsequent medical conditions[J]. N Engl J Med, 2020, 382(18): 1721-1731.
3	PLAISIER I, BEEKMAN A T F, DE GRAAF R, et al. Work functioning in persons with depressive and anxiety disorders: the role of specific psychopathological characteristics[J]. J Affect Disord, 2010, 125(1/2/3): 198-206.
4	IANCU S C, BATELAAN N M, ZWEEKHORST M B M, et al. Trajectories of functioning after remission from anxiety disorders: 2-year course and outcome predictors[J]. Psychol Med, 2014, 44(3): 593-605.
5	曹悦. 高中生中度考试焦虑缓解的小组工作实务研究: 以铁岭市Y高级中学为例[D]. 大连: 大连海事大学, 2022.
	CAO Y. A practical study of group work on alleviating moderate test anxiety of senior high school students: a case study of Y senior high school in Tieling city[D]. Dalian: Dalian Maritime University, 2022.
6	ONUR E, ALKıN T, SHERIDAN M J, et al. Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder[J]. Psychiatr Q, 2013, 84(3): 303-311.
7	PORCELLI P, MICHAEL BAGBY R, TAYLOR G J, et al. Alexithymia as predictor of treatment outcome in patients with functional gastrointestinal disorders[J]. Psychosom Med, 2003, 65(5): 911-918.
8	LEWEKE F, BAUSCH S, LEICHSENRING F, et al. Alexithymia as a predictor of outcome of psychodynamically oriented inpatient treatment[J]. Psychother Res, 2009, 19(3): 323-331.
9	WITTCHEN H U, HEINIG I, BEESDO-BAUM K. Anxiety disorders in DSM-5: an overview on changes in structure and content[J]. Nervenarzt, 2014, 85(5): 548-552.
10	MAIER W, BULLER R, PHILIPP M, et al. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders[J]. J Affect Disord, 1988, 14(1): 61-68.
11	ZHENG Y P, ZHAO J P, PHILLIPS M, et al. Validity and reliability of the Chinese Hamilton Depression Rating Scale[J]. Br J Psychiatry, 1988, 152: 660-664.
12	蚁金瑶, 姚树桥, 朱熊兆. TAS-20中文版的信度、效度分析[J]. 中国心理卫生杂志, 2003, 17(11): 763-767.
	YI J Y, YAO S Q, ZHU X Z. The Chinese version of the TAS-20: reliability and validity[J]. Chinese Mental Health Journal, 2003, 17(11): 763-767.
13	GOES M, LOPES M, MARÔCO J, et al. Psychometric properties of the WHOQOL-BREF(PT) in a sample of elderly citizens[J]. Health Qual Life Outcomes, 2021, 19(1): 146.
14	GRUPP H, KÖENIG H H, KONNOPKA A. Cost measurement of mental disorders in Germany[J]. J Ment Health Policy Econ, 2014, 17(1): 3-8.
15	PENNINX B W, PINE D S, HOLMES E A, et al. Anxiety disorders[J]. Lancet, 2021, 397(10277): 914-927.
16	The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization[J]. Soc Sci Med, 1995, 41(10): 1403-1409.
17	SIVERTSEN H, BJØRKLØF G H, ENGEDAL K, et al. Depression and quality of life in older persons: a review[J]. Dement Geriatr Cogn Disord, 2015, 40(5/6): 311-339.
18	WU X R, LIU Q, LI Q, et al. Health-related quality of life and its determinants among criminal police officers[J]. Int J Environ Res Public Health, 2019, 16(8): 1398.
19	WILNER J G, DUFOUR S, KENNEDY K, et al. Quality of life in heterogeneous anxiety disorders: changes across cognitive-behavioral treatments[J]. Behav Modif, 2020, 44(3): 343-364.
20	OLATUNJI B O, CISLER J M, TOLIN D F. Quality of life in the anxiety disorders: a meta-analytic review[J]. Clin Psychol Rev, 2007, 27(5): 572-581.
21	LOCHNER C, MOGOTSI M, DU TOIT P L, et al. Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder[J]. Psychopathology, 2003, 36(5): 255-262.
22	刘力, 朱宇章, 吴枫, 等. 社交焦虑障碍和惊恐障碍对患者生活质量的不同影响[J]. 中国医科大学学报, 2008, 37(3): 418-419.
	LIU L, ZHU Y Z, WU F, et al. Different effects of social anxiety disorder and panic disorder on life quality[J]. Journal of China Medical University, 2008, 37(3): 418-419.
23	KUGBEY N, OPPONG ASANTE K, MEYER-WEITZ A. Depression, anxiety and quality of life among women living with breast cancer in Ghana: mediating roles of social support and religiosity[J]. Support Care Cancer, 2020, 28(6): 2581-2588.
24	WU Z G, CHEN J, YUAN C M, et al. Difference in remission in a Chinese population with anxious versus nonanxious treatment-resistant depression: a report of OPERATION study[J]. J Affect Disord, 2013, 150(3): 834-839.
25	魏寿洪, 刘婉. 伴有述情障碍的孤独症谱系障碍者情绪问题及其影响[J]. 中国特殊教育, 2022(6): 60-67, 77.
	WEI S H, LIU W. Emotional problems in individuals with autism spectrum disorder and alexithymia and their impacts[J]. Chinese Journal of Special Education, 2022(6): 60-67, 77.
26	FRANCO P, TESIO V, BERTHOLET J, et al. Professional quality of life and burnout amongst radiation oncologists: the impact of alexithymia and empathy[J]. Radiother Oncol, 2020, 147: 162-168.
27	MARTÍNEZ-SÁNCHEZ F, ATO-GARCÍA M, ORTIZ-SORIA B. Alexithymia: state or trait?[J]. Span J Psychol, 2003, 6(1): 51-59.
28	杨文辉. 述情障碍影响生活质量的心理中介作用模型研究[D]. 长沙: 中南大学, 2006.
	YANG W H. The effect of alexithymia on quality of life: psychological mediator modeling[D]. Changsha: Central South University, 2006.

Item	Generalized anxiety disorder patients (n=271)	Panic disorder patients (n=101)	Social anxiety disorder patients (n=48)	Agoraphobia patients (n=12)	Specific phobia patients (n=6)	H/χ² value	P value
Gender/n(%)						10.340	0.036
Male	118 (43.54)	29 (28.71)	22 (45.83)	3 (25.00)	4 (66.67)
Female	153 (56.46)	72 (71.29)	26 (54.17)	9 (75.00)	2 (33.33)
Age/year	35.00 (28.00, 43.00)	34.00 (27.00, 41.00)	28.00 (22.00, 35.00)	32.00 (27.00, 39.75)	32.50 (21.75, 31.00)	6.415	0.000

Item	Generalized anxiety disorder patients (n=271)	Panic disorder patients (n=101)	Social anxiety disorder patients (n=48)	Agoraphobia patients (n=12)	Specific phobia patients (n=6)	H/χ² value	P value
Gender/n(%)						10.340	0.036
Male	118 (43.54)	29 (28.71)	22 (45.83)	3 (25.00)	4 (66.67)
Female	153 (56.46)	72 (71.29)	26 (54.17)	9 (75.00)	2 (33.33)
Age/year	35.00 (28.00, 43.00)	34.00 (27.00, 41.00)	28.00 (22.00, 35.00)	32.00 (27.00, 39.75)	32.50 (21.75, 31.00)	6.415	0.000

Scale	Generalized anxiety disorder patients (n=271)	Panic disorder patients (n=101)	Social anxiety disorder patients (n=48)	Agoraphobia patients (n=12)	Specific phobia patients (n=6)	H value	P value
HAMA/score	20.00 (16.00, 24.00)	21.00 (17.00, 25.75)	19.00 (16.00, 24.00)	21.50 (16.00, 29.5)	23.00 (16.75, 31.50)	4.809	0.307
HAMD-17/score	11.67 (9.50, 14.00)	11.34 (8.25, 14.00)	10.36 (8.00, 13.00)	11.17 (8.25, 14.00)	9.67 (4.50, 15.75)	1.705	0.148
TAS-20/score	30.00 (26.00, 35.25)	30.50 (26.00, 37.75)	32.00 (29.00, 36.00)	31.00 (27.00, 34.75)	28.00 (19.00, 42.25)	2.465	0.651
WHOQOL-BRIEF/score	50.21 (44.94, 56.95)	51.52 (46.71, 55.71)	46.83 (42.69, 53.31)	49.83 (45.02, 57.32)	46.73 (37.47, 57.78)	10.076	0.039

Scale	Generalized anxiety disorder patients (n=271)	Panic disorder patients (n=101)	Social anxiety disorder patients (n=48)	Agoraphobia patients (n=12)	Specific phobia patients (n=6)	H value	P value
HAMA/score	20.00 (16.00, 24.00)	21.00 (17.00, 25.75)	19.00 (16.00, 24.00)	21.50 (16.00, 29.5)	23.00 (16.75, 31.50)	4.809	0.307
HAMD-17/score	11.67 (9.50, 14.00)	11.34 (8.25, 14.00)	10.36 (8.00, 13.00)	11.17 (8.25, 14.00)	9.67 (4.50, 15.75)	1.705	0.148
TAS-20/score	30.00 (26.00, 35.25)	30.50 (26.00, 37.75)	32.00 (29.00, 36.00)	31.00 (27.00, 34.75)	28.00 (19.00, 42.25)	2.465	0.651
WHOQOL-BRIEF/score	50.21 (44.94, 56.95)	51.52 (46.71, 55.71)	46.83 (42.69, 53.31)	49.83 (45.02, 57.32)	46.73 (37.47, 57.78)	10.076	0.039

Item	HAMA score	HAMD-17 score	WHOQOL-BRIEF score
HAMA score	‒	‒	‒
HAMD-17 score	0.388 (0.000)	‒	‒
WHOQOL-BRIEF score	-0.256 (0.000)	-0.311 (0.000)	‒
TAS-20 score	0.162 (0.001)	0.220 (0.000)	-0.342 (0.000)