Abstract
ObjectiveAlexithymia has been considered both to predispose to depression and to worsen cardiac prognosis after an acute coronary syndrome. Nonetheless, no studies have evaluated its role as a risk factor for incident depression, in patients with acute coronary syndrome. MethodsIn 251 consecutive patients, the presence of a first-ever depressive episode was evaluated with the Primary Care Evaluation of Mental Disorders at baseline and 1, 2, 4, 6, 9, 12 and 24months after their first acute coronary syndrome. At baseline, patients completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale. ResultsOut of 251 subjects (80.9% males), a first-ever depressive episode was diagnosed in 66 patients. Depressed and never-depressed patients differed in female gender, living status, alexithymic scores at TAS-20 and depressive symptoms. Nonetheless, nor the TAS-20 factors nor its total score were predictive of developing a depressive episode in a Cox regression. Moreover, baseline differences in TAS-20 scores between the two groups, disappeared after controlling for anhedonic symptoms. ConclusionOur results do not support the hypothesis that alexithymia at TAS-20 is a risk factor for incident depression after acute coronary syndrome.
Highlights
Alexithymia is a multidimensional construct characterized by an impoverished fantasy life, difficulty in expressing or naming feelings, difficulty distinguishing between bodily sensations and feelings and a preoccupation with external events [1]
Patients were included in the study if at the time of enrolment: (1) their age was over 18 years; (2) they were native Italian speaker or with a proficiency in Italian; (3) they had no previous or current major depressive episode according DSM-IV [40]; (4) they had no substance abuse or dependence; (5) they did not show cognitive impairment as demonstrated by a Mini Mental State Examination (MMSE) [41] lower than 25; and (6) they did not take any psychotropic medication
(7) They presented for the first time with symptoms suggestive of an acute coronary syndrome and in whom an ST-segment elevation myocardial infarction (STEMI), a non–ST-segment elevation myocardial infarction (NSTEMI), or unstable angina had been diagnosed [24,43]
Summary
Alexithymia is a multidimensional construct characterized by an impoverished fantasy life, difficulty in expressing or naming feelings, difficulty distinguishing between bodily sensations and feelings and a preoccupation with external events [1]. The TAS-20 [2,3] is the most widely used and studied self-report measure of alexithymia. Factor analysis has supported a three-factor solution for this scale: (1) difficulty identifying feelings (DIF), (2) difficulty communicating and describing feelings (DDF), and (3) external-oriented thinking. Items representing impoverished fantasy or reduced daydreaming were dropped from the TAS-20 based on the factor analysis. Alexithymia, reflecting a disordered affect regulation, is thought to increase vulnerability to several medical disorders, such as rheumatoid arthritis, essential hypertension, cardiac disease, stroke, peptic ulcer, inflammatory bowel disease, breast cancer, diabetes and kidney failure [4]
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