Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

Modeling of structural relations between alexithymia and depression with the mediation of sleep quality in rheumatoid arthritis patients

Document Type : Research Paper

Authors
Nazanin Lahijanian
Hasan Rezaei Jamalouei
Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
10.22038/mjms.2022.20225
Abstract
Introduction: Rheumatoid arthritis is a chronic inflammatory disease with an unknown reason mostly associated with a high prevalence of psychological disorders. As a result, the aim of this study was to explain the modeling of structural relations between alexithymia and depression with the mediation of sleep quality in rheumatoid arthritis patients.
Materials and Methods: The research method is cross-sectional in correlation type using modeling of structural equations. The statistical population of this study includes people of Iran in 2020 with rheumatoid arthritis disorder who were active in cyberspace, and 412 people among them were selected by convenience sampling. The tools used in this study were Center for Epidemiologic Studies Depression Scale, Pittsburgh Sleep Quality Index and Toronto Alexithymia Scale. For analysis of the research data, SPSS 23 and AMOS 22 software were used at the descriptive and inferential level.
Results: The research results showed that alexithymia through sleep quality has an indirect and significant effect on the depression of rheumatoid arthritis patients, and is able to predict the depression significantly.
Conclusion: Based on the current research findings, it can be said that sleep quality mediates the relationship between alexithymia and depression, and has a significant role in depression of the rheumatoid arthritis patients. Thus, considering these variables by researchers and experts prevents from aggravation of the disease, and improves people’s treatment more efficiently.
Keywords
Rheumatoid arthritis patients
Depression
Sleep quality
Alexithymia
  1. Iaquinta M, McCrone S. An Integrative Review of Correlates and Predictors of Depression in Patients with Rheumatoid Arthritis. Archives of Psychiatric Nursing. 2015.
  2. Luyster FS, Chasens ER, Wasko MC, Dunbar-Jacob J. Sleep quality and functional disability in patients with rheumatoid arthritis. J Clin Sleep Med 2011;7(1):49-55.
  3. Centers for Disease Control and Prevention. Rheumatoid arthritis. (Retrieved from cdc.gov/arthritis/basics/rheumatoid.htm). 2012.
  4. Heather L, Rogers, Hardin T, Brotherton, Olivera Plaza SL, Segura Durán MA, Pena Altamar ML. Depressive and anxiety symptoms and social support are independently associated with disease-specific quality of life in Colombian patients with Rheumatoid Arthritis. REVISTA BRASILEIRA DE REUMATOLOGIA.
  5. Allaire SH, Prashker MJ, & Meenan RF. The costs of rheumatoid arthritis. Pharmacoeconomics, 1994; 6, 513-522.
  6. Yelin E, & Callahan LF. The economic cost and social and psychological impact of musculoskeletal conditions. Arthritis and Rheumatism, 1995; 38, 1351-1362.
  7. Englbrecht M, Alten R, Aringer M, Baerwald CG, Burkhardt H, Eby N, et al. Validation of standardized questionnaires evaluating symptoms of depression in rheumatoid arthritis patients: approaches to screening for a frequent yet underrated challenge. Arthritis Care Res (Hoboken), 2017; 69(1): 58-66.
  8. Anderson K, Bradley L, Young L, McDaniel L, & Wise C. Rheumatoid arthritis: Review of psychological factors related to etiology, effects, and treatment. Psychological Bulletin,1985; 98, 358-387.
  9. Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG, et al. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS). BMC Psychiatry, 2012; 12:
  10. Dickens C, McGowan L, Clark-Carter D, & Creed F. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosomatic Medicine, 2002; 64, 52-60.
  11. Katz PP, Yelin EH. Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. Journal of Rheumatology, 1993; 20, 790–796.
  12. Umay EK, Bal A, Gundogdu I, Karsli PB. Polyneuropathy and radiculopathy in rheumatoid arthritis patients with low back pain: clinical characteristics, functional disability, depression, anxiety and quality of life. Egypt Rheumatol, 2015; 37(4): 151–7.
  13. Lin MC, Guo HR, Lu MC, Livneh H, Lai NS, Tsai TY. Increased risk of depression in patients with rheumatoid arthritis: a seven-year population-based cohort study. Clinics, 2015; 70: 91–96.
  14. Lu MC, Guo HR, Lin MC, Livneh H, Lai NS, Tsai TY. Bidirectional associations between rheumatoid arthritis and depression: a nationwide longitudinal study. Sci Rep, 2016; 6: 20647.
  15. Kekow J, Moots R, Khandker R, Melin J, Freundlich B, Singh A. Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis. Rheumatology, 2011; 50: 401–09.
  16. Hider SL, Tanveer W, Brownfield A, Mattey DL, Packham JC. Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic. Rheumatology, 2009; 48: 1152–54.
  17. Michelsen B, Kristianslund EK, Sexton J, et al. Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicenter NORDMARD study. Ann Rheum Dis, 2017; 76: 1906–10.
  18. Irwin M. Psychoneuroimmunology of depression: Clinical implications. Brain, Behavior, and Immunity,2012; 16,1–16, http://dx.doi.org/10.1006/brbi.2001.0654.
  19. Sheehy C, Murphy E, & Barry M. Depression in rheumatoid arthritis- underscoring the problem. Rheumatology, 2006; 45,1325–1327, http://dx.doi.org/10.1093/ rheumatology/kcl.231.
  20. Sokka T. Assessment of pain in patients with rheumatic diseases. Best Pract Res Clin Rheumatol, 2003;17:427–49.
  21. Sharpe L, Sensky T, Allard S. The course of depression in recent onset rheumatoid arthritis: the predictive role of disability, illness perceptions, pain and coping. J Psychosom Res, 2001; 51: 713–9.
  22. Schoenfeld-Smith K, Petroski GF, Hewett JE, Johnson JC, Wright GE, Smarr KL, Walker SE, Parker JC. A biopsychosocial model of disability in rheumatoid arthritis. Arthritis Care Res, 1996; 9: 368 –75.
  23. Mikuls T, Saag K, Criswell L, Merlino L, Cerhan JR. Health related quality of life in women with elderly onset rheumatoid arthritis. J Rheumatol, 2003; 30: 952–7.
  24. Ang DC, Choi H, Kroenke K, & Wolfe F. Comorbid depression is an indepen- dent risk factor for mortality in patients with rheumatoid arthritis. The Journal of Rheumatology, 2005; 32(6), 1013–1019.
  25. Mella LFB, Bértolo MB, & Dalgalarrondo P. Depressive symptoms in rheuma- toid arthritis patients. Revista Brasileira de Psiquatria, 2010; 32(3), 257–263, http://dx.doi.org/1590/S1516-44462010005000021.
  26. Hammam N, Gamal RM, Rashed AM, Elfetoh NA, Mosad E, Khedr EM, Fatigue in rheumatoid arthritis patients: Association with sleep quality, mood status, and disease activity. Reumatol Clin 2018; S1699-258X(18)30169-4.
  27. Abad VC, Sarinas PS, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev, 2008; 12: 211-28.
  28. Nicassio PM, Wallston KA. Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol, 1992; 101: 514–20.
  29. Wolfe F, Michaud K, Li T. Sleep disturbance in patients with rheumatoid arthritis: evaluation by medical outcomes study and visual analog sleep scales. J Rheumatol, 2006; 33: 1942–51.
  30. Sariyildiz MA, Batmaz I, Bozkurt M, Bez Y, Cetincakmak MG, Yazmalar L, et al. Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life. J Clin Med Res, 2014; 6: 44–52.
  31. Bourguignon C, Labyak SE, Taibi D. Investigating sleepdisturbances in adults with rheumatoid arthritis. Holist NursPract, 2003; 17: 241–9.
  32. Louie GH, Tektonidou MG, Caban-Martinez AJ, Ward MM. Sleep disturbances in adults with arthritis: prevalence, mediators, and subgroups at greatest risk. Data from the 2007National Health Interview Survey. Arthritis Care Res, 2011; 63: 247–60.
  33. Xu Y, Zhang L, Huang A, Zhao Y, Liu Y. An investigation of sleep disturbance and related factors in rheumatoid arthritis patients. Zhonghua nei ke za zhi. 2015; 54: 927-30.
  34. Westhovens R, Van der Elst K, Matthys A, Tran M, Gilloteau I. Sleep problems in patients with rheumatoid arthritis. J Rheumatol 2014; 41 (1): 31–40.
  35. Radwan A, Borai A. Quality of sleep in rheumatoid arthritis patients: Relationship with disease activity, depression and functional status. The Egyptian Rheumatologist, 2020, https://doi.org/10.1016/j.ejr.2020.08.002.
  36. Taylor DJ, Lichstein KL, Durrence HH, et al. Epidemiology of insomnia, depression, and anxiety. Sleep 2005; 28(11): 1457e64.
  37. Tsuno N, Besset A, & Ritchie K. Sleep and depression. The Journal of Clinical Psychiatry, 2005; 66(10), 1254–1269.
  38. Sunderajan P, Gaynes BN, Wisniewski SR, et al. Insomnia in patients with depression: a STAR* D report. CNS Spectr 2010; 15(6): 394e406.
  39. Ji XW, Chan CH, Lau BH, et al. The interrelationship between sleep and depression: a secondary analysis of a randomized controlled trial on mindbody-spirit intervention. Sleep Med 2017; 29: 41e6.
  40. Ashworth DK, Sletten TL, Junge M, et al. A randomized controlled trial of cognitive behavioral therapy for insomnia: an effective treatment for comorbid insomnia and depression. J Counsel Psychol 2015; 62(2): 115e23.
  41. Bauermann MT, Paker JDA, Taylor JG. Sleep problems and sleep hygiene in young adults with Pers Indiv Differ, 2008; 45(4): 318–22.
  42. Bazydlo R, Lumley MA, & Roehrs T. Alexithymia and polysomnographic measures of sleep in healthy adults. Psychosomatic Medicine, 2001; 63(1), 56–61.
  43. Taylor GJ, Bagby RM. New trends in alexithymia research. Psychother Psychosom, 2004; 73: 68–77.
  44. Li S, Zhang B, Guo Y, Zhang J. The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: a meta-analysis. Psychiatry Res. 2015; 227: 1-9.
  45. Corcos M, Guilbaud O, Paterniti S, Curt F, Hjalmarsson L, Moussa M, et al. Correlation between serum levels of interleukin- 4 and alexithymia scores in healthy female subjects: preliminary findings. Psychoneuroendocrinology, 2004; 29: 686–91.
  46. De Berardis D, Serroni N, Campanella D, Carano A, Gambi F, Influence of Alexithymia on Pain, Depression, and Inflammation 685 Valchera A, et al. Alexithymia and its relationships with C-reactive protein and serum lipid levels among drug naive adult outpatients with major depression. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 1982–6.
  47. Honkalampi K, Lehto SM, Koivumaa-Honkanen H, Hintikka J, Niskanen L, Valkonen-Korhonen M, et al. Alexithymia and tissue inflammation. Psychother Psychosom, 2011; 80: 359–64.
  48. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol, 2011; 67: 942–68.
  49. Lumley MA, Beyer J, & Radcliffe A. Alexithymia and physical health: A critique of potential pathways and a research agenda. In A. Vingerhoets, I. Nyklicek, & J. Denollet (Eds.), Emotion regulation: Conceptual and Clinical Issues (pp. 43-68). New York: Springer. 2008.
  50. Cox BJ, et al., Alexithymia in somatoform disorder patients with chronic pain, J. Psychosom. Res. 1994; 38 (6): 523–527.
  51. Tella MDI, Castelli L, Alexithymia in chronic pain disorders, Curr. Rheumatol. Rep. 2016; 18 (7): 41.
  52. Goerlich KS. The multifaceted nature of alexithymia - a neuroscientific perspective, Front. Psychol. 9 (2018) 1614.
  53. Sifneos PE. Alexithymia: past and present, Am. J. Psychiatry 153 (7 Suppl) (1996) 137–142.
  54. Bagby RM, & Taylor GJ. Measurement and validation of the alexithymia construct. In G. J. Taylor, R. M. Bagby, & J. D. A. Parker (Eds.), Disorders of affect regulation: Alexithymia in medical and psychiatric illness (pp. 46–66). Cambridge: Cambridge University Press. 1977.
  55. Brewer R, Cook R, Cardi V, Treasure J, & Bird G. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. Royal Society Open Science, 2015; 2(1), 140382.
  56. Cook R, Brewer R, Shah P, & Bird G. Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychological Science, 2013; 24(5): 723–732.
  57. Grynberg D, Chang B, Corneille O, Maurage P, Vermeulen N, Berthoz S, & Luminet O. Alexithymia and the processing of emotional facial expressions (EFEs): Systematic review, unanswered questions and further perspectives. PLoS One, 2012; 7(8): e42429.
  58. Heaton P, Reichenbacher L, Sauter D, Allen R, Scott S, & Hill E. Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development. Psychological Medicine, 2012; 42(11): 2453–2459.
  59. Bird G, Silani G, Brindley R, White S, Frith U, & Singer T. Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 2010; 133(5): 1515–1525.
  60. De Gennaro L, Ferrara M, Cristiani R, Curcio G, Martiradonna V, Bertini M. Alexithymia and dream recall upon spontaneous morning Psychosom Med 2003; 65(2): 301–6.
  61. Kim HJ, Kim SJ, Lee S-A. Severity of Idiopathic Rapid Eye Movement Sleep Behavior Disorder Correlates with Depression and Alexithymia. Sleep Medicine, 2020. https://doi.org/10.1016/ j.sleep.2020.05.039.
  62. Hyyppae MT, Lindholm T, Kronholm E, & Lehtinen V. Functional insomnia in relation to alexithimic features and cortisol hypersecretion in a community sample. Stress Medicine. 1990; 6(1): 277–83.
  63. Lumley MA, Bazydlo RA. The relationship of alexithymia characteristics to dreaming. J Psychosom Res. 2000; 48: 561-7.
  64. Nielsen T, Levrier K, Montplaisir J. Dreaming correlates of alexithymia among sleep-disordered patients. Dreaming. 2011; 21: 16.
  65. De Gucht V, Heiser W. Alexithymia and somatisation: quantitative review of the literature, J. Psychosom. Res. 2003; 54(5): 425–434.
  66. Di Tella M, et al, Pain experience in fibromyalgia syndrome: the role of alexithymia and psychological distress, J. Affect. Disord. 208 (2017) 87–93.
  67. Hosoi M, et al. Relationships among alexithymia and pain intensity, pain interference, and vitality in persons with neuromuscular disease: considering the effect of negative affectivity, Pain. 2010; 149(2): 273–277.
  68. Kindler S, et al. Alexithymia and temporomandibular joint and facial pain in the general population, J. Oral Rehabil. 2019; 46(4): 310–320.
  69. Kosturek A, et al. Alexithymia and somatic amplification in chronic pain, Psychosomatics. 1998; 39 (5): 399–404.
  70. Shibata M, et al. Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: The Hisayama study, PLoS One. 2014; 9 (3): e90984.
  71. Hooman HA. Structural equation modeling book using lisrel software, Samt publications, 2005. (Persian)
  72. Andersen EM, Malmgren JA, Carter WB, & Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine. 1994; 10, 77-84.
  73. Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program for patients with chronic disease. Eff Clin Pract 2001; 4(6): 256-62.
  74. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1977; 1, 385–401.
  75. Rezaei S, Afsharnezhad T, Kafi M, Soltani R, Fallah Kohan S. [Relation between depression and coping strategies in chronic back pain patients: A cross sectional study with controlling pain intensity and duration]. Daneshvar medicine. 2009; 81: 63-74. (Persian)
  76. Rezaei S, Afsharnezhad T, Moosavi SV, Yusefzadeh Sh, Soltani R. Validation of the Persian version of pain self-efficacy scale: A psychometric chronic low back pain patients. Journal of Fundamentals of Mental Health. 2012; 13(4): 328-45. (Persian)
  77. Buysee DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburg sleep quality index: A new instrument for psychiatric practice and Researchers. Psychiatry Researh, 1989; 28(2), 193-213.
  78. Farrahi J, Nakhaee N, Sheibani V, et al. Psychometric properties of the Persian version of the Pittsburgh Sleep Quality Index addendum for PTSD (PSQI-A). Sleep Breath. 2009 Aug; 13 (3): 259-62. (Persian)
  79. Bagby RM, Parker JD, & Taylor GJ. The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor Journal of Psychosomatic Research, 1994; 38, 23–32.
  80. Besharat MA. Reliability and factorial validity of Farsi version of the Toronto Alexithymia Scale with a sample of Iranian students. Psychol Rep. 2007; 102(1): 209-20. (Persian)
  81. Hagashino y, yamazaki s, Takemagi m, nakagama t, soke jima s, fukuhara s. Asssocation bet ween n amber of comor bid condition, depression and sleep quality using thepitts bory sleep Quality Index: Resalts from a. population –besed sarvey. sleep Mdicin. 2010; 11, 366-371.
  82. Elizabeth JM, Martica H, Karen AM. Are sleep and depression independent or overlapping risk factors for cardiometabolic disease? Sleep MedRev. 2011; 15(1): 51-63.
  83. Berk M. "Sleep and depression-theory and practice", Australian Family Physician, 2009; 38 (5), 302-304.
  84. Janiszewski Goes AC, Busatto Reis LA, Marilia Barreto G, Silva, Kahlow BS, Thelma L, Skare. Rheumatoid arthritis and sleep quality. REVISTA BRASILEIRA DE REUMATOLOGIA. 2016.
  85. Katz PP, Yelin EH. Activity loss and the onset of depressive symptoms: do some activities matter more than others?. Arthritis Rheum. 2001; 44(5): 1194–202.
  86. Saarijärvia S, Salminenb JK, Toikkab TB. Alexithymia and depression: A 1-year follow-up study in outpatients with major depression. 2001.
Medical Journal of Mashhad university of Medical Sciences
Volume 64, Issue 6 - Serial Number 6
March and April 2022
Pages 4176-4191