| Publication Abstract Display | | Type: Poster | | Title: Alexithymia is associated with worse real-world functioning among people with controlled HIV disease. | | Authors: Morgan EE, Iudicello JE, Watson WM, Sun-Suslow N, Heaton RK | | Date: 02-03-2021 | | Abstract:Objective:
Alexithymia, or difficulty understanding one's own internal emotional states, is elevated among people with HIV (PWH), and linked to negative outcomes including poorer disease management, greater disease progression and severity, and lower quality of life. It is also associated with lower cognitive functioning, suggesting that its prevalence among PWH may result from the effect of HIV on frontostriatal circuits and related cortical regions. No studies have yet examined whether alexithymia contributes to poorer real-world functioning among PWH. We hypothesize that alexithymia will be associated with a range of real-world outcomes based on the observed downstream effects of chronic emotional dysregulation due to alexithymia across multiple populations, including maladaptive coping, somatization, and risk for worse disease outcomes.
Participants and Methods:
Participants included demographically-comparable groups of 121 PWH (virally suppressed on antiretroviral therapy) and 131 HIV- individuals. Participants with significant medical/neurological (e.g., stroke), or serious psychiatric (e.g., schizophrenia,) conditions were excluded, as were those with current substance use disorder (SUD). Participants completed the Toronto Alexithymia Scale – 20 Item version (TAS-20). This well-validated, widely-used scale has published cutpoints for "possible" (52-60) and "definite" (>60) alexithymia, which were collapsed into a single "clinically elevated" category (≥52). Participants also completed a battery of neuropsychological tests designed to be sensitive to HIV-associated neurocognitive impairment (NCI), which yielded a validated dichotomous measure of global cognitive impairment. Several domains of real-world functioning were assessed, including instrumental activities of daily living (IADL, from the Lawton and Brody Activities of Daily Living Scale), employment status (from the Patient’s Assessment of Own Functioning Inventory), social satisfaction (composite from the NIH Toolbox Emotions Battery), and frailty status (Fried Frailty Phenotype, collapsing pre-frail and frail status).
Results:
In PWH, 29% of participants scored in the clinically elevated range on the TAS-20 compared to 12% of the HIV- group (p=0.0009). In a logistic regression predicting clinically elevated alexithymia (controlling for current affective disorder, lifetime SUD, and sex/gender), PWH were 2.4 times more likely to score in the clinically elevated range (chi square=5.49, p=0.02) than HIV- inidividuals. Within PWH, a significantly higher proportion of cognitively impaired individuals had clinically elevated alexithymia (47%) compared to those whose cognition was within normal limits (23%; chi square=6.5, p=0.01). Controlling for relevant covariates (demographic, psychiatric, NCI, and/or HIV indices selected based on univariable association with outcomes), higher TAS-20 total score was a significant predictor of worse real-world functioning, including dependence in instrumental activities of daily living (p=0.01), unemployment (p=0.02), poor social satisfaction (p<0.0001), and frailty (p=0.02).
Conclusions:
Our findings support the association between alexithymia and HIV-associated NCI, and extend evidence of the negative impact of alexithymia to multiple poorer real-world outcomes in PWH with controlled HIV disease. Alexithymia appears to have a broad impact on functional status, leading to worse psychosocial and physical health outcomes, though future studies should confirm this directionality. Recent work suggests that alexithymia can be improved with targeted therapy (e.g., emotion training), with downstream benefits for disease outcomes. For PWH vulnerable to HIV-associated NCI and functional decline, alexithymia may be a valuable and productive intervention target. |
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