Patient-Reported Outcomes in Irritable Bowel Syndrome: The Role of Alexithymia in Health-Related Quality of Life

Abstract

Background: Irritable bowel syndrome (IBS) is a disorder of gut–brain interaction, in which psychological factors, including alexithymia and psychosomatic syndromes, are thought to influence patients' perceived health and quality of life. Patient-Reported Outcome Measures (PROMs) provide valuable insights into these patient-centered outcomes.

Objectives: This study aimed to investigate the association between alexithymia, psychosomatic syndromes and patient-reported health status in individuals with IBS.

Methods: A total of 143 patients diagnosed with IBS (81.8% female; age range 18–78 years, M = 30.90, SD = 14.39) were enrolled in this cross-sectional study. Participants completed a sociodemographic questionnaire, the Toronto Alexithymia Scale-20 (TAS-20), a self-report scale composed of 20 items based on a 5-point Likert scale ranging from “strongly disagree” to “Strongly agree” assessing alexithymia. The scale is composed of three factors: difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT). It represents a widely recognized valid instrument for the assessment of alexithymia and related factors in a wide set of pathological and non-pathological domains, the Diagnostic Criteria for Psychosomatic Research–Structured Interview (DCPR-SI), and the SF-36 Health Survey as a measure of patient-reported health-related quality of life. Generalized linear models were estimated with the TAS-20 (total score and single factors) as predictors and health status and psychosomatic variables as outcomes.

Results: Higher levels of alexithymia were significantly associated with greater psychosomatic symptom burden and poorer patient-reported health-related quality of life, emerging as significant predictor of both psychosomatic syndrome severity and reduced scores across health status domains assessed by the SF-36. Specifically, higher levels of alexithymia were associated with lower scores on health status variables, including physical functioning, role limitations due to emotional problems, emotional well-being, social functioning, pain and general health. In terms of psychosomatic conditions, alexithymia was associated with higher levels of disease phobia, thanatophobia, Type A behaviour, irritable mood and demoralization.

Considering DIF, DDF and EOT as predictors, all significant associations between DIF and DDF and health status were negative, indicating a deterioration in health associated with alexithymia. Contrarywise, all significant associations between alexithymia factors and psychosomatic syndromes were positive, highlighting the role of alexithymia in the onset and maintenance of psychosomatic disorders. Significant negative associations involving DIF were observed with role limitations due to emotional problems, emotional well-being, social functioning, pain, and general health. Positive associations emerged with disease phobia, thanatophobia, illness denial, conversion symptoms, Type A behaviour, irritable mood, and demoralization. A significant negative association was found between DDF and role limitations due to emotional problems, while significant negative associations were identified with conversion, Type A behaviour and clinically detected alexithymia. EOT was found associated with higher levels of role limitations due to emotional problems, energy/fatigue, and emotional well-being. Conversely, lower levels of Type A behaviour, irritable mood, and demoralization emerged.

Conclusions: Alexithymia is strongly associated with worse patient-reported outcomes in individuals with IBS. These findings support the integration of PROMs into the assessment of IBS and suggest that interventions targeting alexithymia may contribute to improving patients' perceived health and quality of life.