Abstract
The association among alexithymia, somatic symptoms and clinical correlates has been scantly investigated in children. The present study examined alexithymic features and somatic symptomatology in schoolchildren with high and low levels of depression, testing the role of depressive symptoms in mediating the associations between alexithymia and somatic symptoms. Seven-hundred schoolchildren were involved in this study and divided into two subgroups (8–10 years and 11–14 years) in order to test differences according to the age. Participants completed the Children’s Somatization Inventory-24 for the assessment of somatic symptoms, the Alexithymia Questionnaire for Children to evaluate alexithymic features and the Children’s Depression Inventory-2 to investigate depressive symptoms. Results showed that children with high levels of depression reported both higher alexithymia and somatic symptoms levels. Despite a direct effect of alexithymia on somatic symptoms, the mediation analyses also highlighted an indirect effect of alexythimia on somatic symptoms through depressive symptoms. Findings suggested that a depressive symptomatology may clarify why schoolchildren with high alexithymia scores tend to report higher levels of health problems. Results also support the possibility that depressive symptoms may contribute to the development of somatic symptomatology among schoolchildren in the presence of high levels of alexithymia.
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References
Taylor GJ, Bagby RM, Parker JDA. Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press; 1997.
Taylor GJ, Bagby RM. Psychoanalysis and empirical research: the example of alexithymia. J Am Psychoanal Assoc. 2013;61:99–133.
Ebeling H, Moilane I, Linna SL, Räsänen E. Somatically expressed psychological distress and alexithymia in adolescence-reflecting unbearable emotions? Nord J Psychiat. 2001;55:387–93.
Rieffe C, Terwogt MM, Bosch JD. Emotion understanding in children with frequent somatic complaints. Eur J Dev Psychol. 2004;1:31–47.
Rieffe C, Oosterveld P, Terwogt MM. An alexithymia questionnaire for children: factorial and concurrent validation results. Personal Individ Differ. 2006;40:123–33.
Rieffe C, Oosterveld P, Terwogt MM, Novin S, Nasiri H, Latifian M. Relationship between alexithymia, mood and internalizing symptoms in children and young adolescents: evidence from an Iranian sample. Personal Individ Differ. 2010;48:425–30.
Honkalampi K, Tolmunenc T, Hintikkad J, Rissanena ML, Kylmäe J, Laukkanenc E. The prevalence of alexithymia and its relationship with youth self-report problem scales among Finnish adolescents. Compr Psychiatry. 2009;50:263–8.
Di Trani M, Tomassetti N, Capozzi F, Solano L, Romani M, Levi G. Alexithymia, internalizing, externalizing and obsessive-compulsive symptomatology in pre-adolescence: an empirical study on 160 subjects. Rassegna Psicol. 2013;3:77–93.
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.
Zonnevylle-Bender MJS, van Goozen SHM, Cohen-Kettenis PT, van Elburg A, van Engeland H. Emotional functioning in adolescent anorexia nervosa patients: a controlled study. Eur Child Adolesc Psychiatry. 2004;13:28–34.
van de Putte EM, Engelbert RHH, Kuis W, Kimpen JLL, Uiterwaal CSPM. Alexithymia in adolescents with chronic fatigue sindrome. J Psychosom Res. 2007;63:377–80.
Donfrancesco R, Di Trani M, Gregori P, Auguanno G, Melegari MG, Zaninotto S, et al. Attentiondeficit/hyperactivity disorder and alexithymia: a pilot study. J Atten Disord. 2013;5:361–7.
Griffin C, Lombardo MV, Auyeung B. Alexithymia in children with and without autism spectrum disorders. Autism Res. 2016;9:773–80.
Fukunishi I, Tsuruta T, Hirabayashi N, Asukai N. Association of alexithymic characteristics and posttraumatic stress response following medical treatment for children with refractory hematological diseases. Psychol Rep. 2001;89:527–34.
Natalucci G, Faedda N, Calderoni D, Cerutti R, Verdecchia P, Guidetti V. Headache and alexithymia in children and adolescents: what is the connection? Front Psychol. 2018;9:48.
Mishra VS, Maudgal S, Theunissen SCPM, Rieffe C. Alexithymia in children with cancer and their siblings. J Psychosom Res. 2012;72:266–8.
Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, et al. Alexithymia and somatization in general population. Psychosom Med. 2008;70(6):716–22.
Lumley MA. Alexithymia and negative emotional conditions. J Psychosom Res. 2000;49(1):51–4.
Lumley MA, Smith JA, Longo DJ. The relationship of alexithymia to pain severity and impairment among patients with chronic myo¬fascial pain: comparisons with self-efficacy, catastrophizing, and depression. J Psychosom Res. 2002;53(3):823–30.
Rieffe C, Terwogt MM, Bosch JD, Kneepkens CMF, Douwes AC, Jellesma FC. Interaction between emotions and somatic complaints in children who did or did not seek medical care. J Cogn Emot. 2007;21(8):1630–46.
Honkalampi K, Hintikka J, Saarinen P, Lehtonen J, Viinamäki H. Is alexithymia a permanent feature in depressed patients? Psychother Psychosom. 2000;69:303–8.
Lipsanen T, Saarijarvi S, Lauerma H. Exploring the relations between depression, somatization, dissociation and alexithymia-overlapping or independent constructs? Psychopathology. 2004;37:200–6.
Salminen JK, Saarijarvi S, Toikka T, Kauhanen J, Aärelä E. Alexithymia behaves as a personality trait over a 5-year period in Finnish general population. J Psychosom Res. 2006;61:275–8.
Marchesi C, Bertoni S, Cantoni A, Maggini C. Is alexithymia a personality trait increasing the risk of depression? A prospective study evaluating alexithymia before, during and after a depressive episode. Psychol Med. 2008;38:1717–22.
Bailey PE, Henry JD. Alexithymia, somatization and negative affect in a community sample. Psychiatry Res. 2007;150:13–20.
Lundh L, Simonsson-Sarnecki M. Alexithymia, emotion, and somatic-complaints. J Pers. 2001;69:483–510.
Allen LB, Lu Q, Tsao JCI, Hayes LP, Zeltzer LK. Depression partially mediates the relationship between alexithymia and somatization in a sample of healthy children. J Health Psychol. 2011;16(8):1177–86.
Di Trani M, Piperno F, Renzi A, Sogos C, Tambelli R, Ferruzzi G, et al. Alessitimia in età evolutiva: riflessioni teoriche e costruzione di un nuovo strumento per bambini tra i 4 e gli 8 anni. Rassegna Psicol. 2016;34:13–26.
Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto alexithymia scale--I. item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23–32.
Walker LS, Garber J, Greene JW. Somatization symptoms in pediatric abdominal pain patients: relation to chronicity of abdominal pain and parent somatization. J Abnorm Child Psychol. 1991;19:379–94.
Garber J, Walker LS, Zeman J. Somatization symptoms in a community sample of children and adolescents: further validation of the Children’s somatization inventory. Psychol Assess. 1991;3(4):588–95.
Walker LS, Beck JE, Garber J, Lambert W. Children's somatization inventory: psychometric properties of the revised form (CSI-24). J Pediatr Psychol. 2009;34(4):430–40.
Cerutti R, Spensieri V, Valastro C, Presaghi F, Canitano R, Guidetti V. A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children. PLoS One. 2017;12(2):e0171867.
Kovacs M.. Children’s depression inventory (CDI and CDI2). Encycl Clin Psychol 2015;1–5.
Camuffo M, Cerutti R. Manuale del CDI-2 (children depression inventory, second edition). Adattamento italiano. Hogrefe Editore: Firenze; 2018.
Kovacs M. The Children’s depression inventory (CDI) manual north Tanawanda. Multi-Health Systems: New York; 1992.
Hayes AF, Scharkow M. The relative trustworthiness of inferential tests of the indirect effect in statistical mediation analysis: does method really matter? Psychol Sci. 2013;24:1918–27.
Bakker RJ, van de Putte EM, Kuis W, Sinnema G. Risk factors for persistent fatigue with significant school absence in children and adolescents. Pediatrics. 2009;124(1):e89–95.
Ferdinand RF, Verhulst FC. Psychopathology from adolescence into young adulthood: an 8-year follow-up study. Am J Psychiatry. 1995;152:1586–94.
Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Di Lorenzo C. A prospective school-based study of abdominal pain and other common somatic complaints in children. J Pediatr. 2009;154(3):322–6.
Klemenc-Ketiš Z, Križmarić M, Kersnik J. Age- and gender-specific prevalence of self-reported symptoms in adults. Cent Eur J Public Health. 2013;21(3):160–4.
Bingefors K, Isacson D. Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain-a gender perspective. Eur J Pain. 2004;8(5):435–50.
Beck JE. A developmental perspective on functional somatic symptoms. J Pediatr Psychol. 2008;33:547–62.
Perquin CW, Hazebroek-Kampschreur AM, Hunfeld JM, Bohnen AM, Suijlekom-Smit L, PaSschier J. Pain in children and adolescents: a common experience. Pain. 2000;87:51–8.
Vila M, Kramer T, Hickey N, Dattani M, Jefferis H, Singh M. Assessment of somatic symptoms in British secondary school children using the Children's somatization inventory (CSI). J Pediatr Psychol. 2009;34:989–98.
Cerutti R, Spensieri V, Valastro C. The relation between somatic symptoms, anxiety symptoms and risk for depression in adolescence. Rassegna Psicol. 2015;3:99–112.
Romero-Acosta K, Canals J, Hernández-Martínez C, Penelo E, Zolog TC, Domènech-Llaberia E. Age and gender differences of somatic symptoms in children and adolescents. J Ment Health. 2013;22(1):33–41.
Bettge S, Wille N, Barkmann C, Schulte-Markwort M, Rawens-Sieberer U, BELLA Study Group. Depressive symptoms of children and adolescents in a German representative sample: results of the BELLA study. Eur Child Adolesc Psychiatry. 2008;17(Suppl. 1):71–81.
Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in the developmental course of depression. J Affect Disord. 2010;127:185–90.
Burdzovic Andreas J, Brunborg GS. Depressive symptomatology among Norwegian adolescent boys and girls: the patient health Questionnaire-9 (PHQ-9) psychometric properties and correlates. Front Psychol. 2017;8:887.
Eastabrook JM, Flynn JJ, Hollenstein TJ. Internalizing symptoms in female adolescents: associations with emotional awareness and emotion regulation. J Child Fam Stud. 2014;23:487.
Spensieri V, Cerutti R, Presaghi F, Amendola S, Ray CW. Italian validation of the children’s shyness questionnaire: exploring associations between shyness and psychosocial functioning. PLoS One. 2019;14(6):e0217722.
Rothermund K, Brandtstadter J. Depression in later life: cross-sequential patterns and possible determinants. Psychol Aging. 2003;18:80–90.
Bamonti PM, Heisel MJ, Topciu RA, Franus N, Talbot NL, Duberstein PR. Association of alexithymia and depression symptom severity in adults aged 50 years and older. Am J Geriatr Psychiatry. 2010;18(1):51–6.
Leweke F, Leichsenring F, Kruse J, Hermes S. Is alexithymia associated with specific mental disorders? Psychopathology. 2012;45:22–8.
Son SH, Jo H, Rim HD, Kim JH, Kim HW, Bae GY, et al. A comparative study on alexithymia in depressive, somatoform, anxiety, and psychotic disorders among Koreans. Psychiatry Investig. 2012;9(4):325–31.
Tesio V, Di Tella M, Ghiggia A, Annunziata R, Colonna F, Fusaro E, et al. Alexithymia and depression affect quality of life in patients with chronic pain: a study on 205 patients with fibromyalgia. Front Psychol. 2018;9:442.
Bagby M, Taylor GJ, Parker JDA, Dickens SE. The development of the Toronto structured interview for alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother Psychosom. 2006;75:25–39.
Lane RD, Ahern GL, Schwartz GE, Kaszniak AW. Is alexithymia the emotional equivalent of blindsight? Biol Psychiatry. 1997;42:834–44.
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Cerutti, R., Spensieri, V., Presaghi, F. et al. Alexithymic Traits and Somatic Symptoms in Children and Adolescents: a Screening Approach to Explore the Mediation Role of Depression. Psychiatr Q 91, 521–532 (2020). https://doi.org/10.1007/s11126-020-09715-8
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DOI: https://doi.org/10.1007/s11126-020-09715-8