Alexithymia, psychological signs, social support, and the levels of hematological parameters in diabetes

Sayed Saeed Madanian; Elham Froozandeh

doi:10.4103/jepr.jepr_41_16

ORIGINAL ARTICLE

Year : 2017 | Volume : 3 | Issue : 4 | Page : 219-223

Alexithymia, psychological signs, social support, and the levels of hematological parameters in diabetes

Sayed Saeed Madanian, Elham Froozandeh
Department of Psychology, Islamic Azad University, Isfahan, Iran

Date of Web Publication

9-Feb-2018

Correspondence Address:
Dr. Elham Froozandeh
Department of Psychology, Naein Branch, Islamic Azad University, Naein
Iran

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/jepr.jepr_41_16

Abstract

AIM: The main aim of the study is to investigate relationship between alexithymia, psychological signs, social support, and hematological parameters (cholesterol, glycosylated hemoglobin, and blood sugar) in a sample of patients with type II diabetes.
METHODOLOGY: One hundred and twenty-six patients with type II diabetes (38 males and 88 females) with a medical history in the division of diabetes of the health center no. 1 in Isfahan participated in the study in 2015. They filled in the Farsi version of Toronto Alexithymia Scale (Bagby, Parker and Taylor, 1994), social support questionnaire in chronic patients (Khodapanahi, 2009), and depression anxiety stress scales (Lovibond and Lovibond, 1995).
RESULTS: The results showed that there was a positive significant relationship between cholesterol level and difficulty identifying and describing feelings (P < 0.05) and between glycosylated hemoglobin and anxiety and stress (P < 0.05). Furthermore, there was a negative significant relationship between fasting blood sugar and emotional support (P < 0.05).
DISCUSSION: Therefore, it is therapeutically important to regard the psychological states of patients (especially alexithymia, psychological signs, and social support) to make a speedy recovery of type II diabetes.
CONCLUSION: Regarding the results, it can be concluded that complexity and extent of effects of diabetes on an individual with alexithymia make diabetes difficult to treat and prevent its progress.

Keywords: Alexithymia, blood sugar, cholesterol, glycosylated hemoglobin, psychological signs, social support, type II diabetes

How to cite this article:
Madanian SS, Froozandeh E. Alexithymia, psychological signs, social support, and the levels of hematological parameters in diabetes. Int J Educ Psychol Res 2017;3:219-23

How to cite this URL:
Madanian SS, Froozandeh E. Alexithymia, psychological signs, social support, and the levels of hematological parameters in diabetes. Int J Educ Psychol Res [serial online] 2017 [cited 2019 Feb 20];3:219-23. Available from: http://www.ijeprjournal.org/text.asp?2017/3/4/219/225096

Introduction

Diabetes is a metabolic disease characterized by chronic increase in blood sugar and metabolic disorders of carbohydrates, lipids, and proteins, thereby causes defects in insulin secretion, insulin action, or both.^[1] Stress inherent in industrial lifestyle, lack of centers for the support of patients with diabetes, decreased emotional support of patients with diabetes, difficulty identifying and describing feelings have made blood sugar difficult to control in the patients with diabetes.^[2]

It is suggested that alexithymia is difficulty identifying feelings, difficulty describing feeling to others, and externally oriented thinking.^[3] The main features of alexithymia are inability to recognize and describe emotions verbally and lack of symbolic thought, thereby inhibits conflicts, feelings, tendencies, and drives to be revealed and causes deficient emotional self-regulation and management.^[4]

Many researchers believe psychological signs intensify diabetes or prevent recovery from it.^[5] They believe that anxiety, stress and depression interfere with blood sugar control in patients with diabetes. It relates to metabolism,^[6] nerve pains, chest pain, and migraine headaches.^[7] Furthermore, social support affects the process of treating diabetes; it is a mechanism of interpersonal relations protecting people from negative tension.^[8] In fact, it moderates adverse effects of stress in five ways ^[4]:

Emotional attention including listening, empathy, care, and moral support
Assisting and supporting the patient to result in adaptive and compatible behaviors
Informing and guiding to increase ability to cope with difficulties
Providing performance feedback from others
Socialization and receiving social support and its beneficial effects.

A study on 64 patients with diabetes and alexithymia, who received support from medical staff about for 2 months in a hospital, who were trained how to show their feelings and underwent medical treatment, showed that their glycosylated hemoglobin significantly decreased.^[9] In addition, there are studies on depression in individuals with alexithymia and diabetes.^[10] In this study, the question was that whether there is evidence of relationship between alexithymia, psychological signs, and social support in patients with diabetes in Iran.

Methodology

In the study, the population was all patients with type II diabetes, who had a medical history in the division of diabetes of the health center No. 1 in Isfahan and referred to the center to be treated and follow their condition. The sample was selected through convenience sampling and consented to participate in the study. They were asked to fill in Toronto alexithymia scale, depression anxiety stress scales-21 (anxiety, stress, and depression), and social support questionnaire in chronic patients. One hundred and twenty-six patients were sampled. It included 38 males and 88 females with a percentage frequency of 30.2 and 69.8, respectively. The mean age was 59.72 years with standard deviation (SD) 8.98 years; the mean weight was 60.52 kg with SD 11.17 kg; the mean height was 157.91 cm with SD 9.65.

Tools

Toronto alexithymia scale

It is a 20-item test with three subscales difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking. The items are rated on a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Alexithymia has a total score. For the Farsi version of Toronto Alexithymia Scale, Cronbach alpha coefficients of the total score and three subscales difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking were computed 0.85, 0.82, 0.75, and 0.72, respectively, that suggest its internal consistency.^[11] Its test-retest reliability coefficients of 0.87 above were obtained in a sample of 67 individuals at the interval of 4 weeks for the total score and its subscales. Its concurrent validity was confirmed on the basis of correlation between its subscales and those of scales of emotional intelligence, psychological well-being, and psychological distress.^[12]

Depression anxiety stress scales-21

It is the short form of the original scale; it was developed to study psychological signs (anxiety, depression, and stress). It includes 21 items; each subscale has seven items. Each item is rated from 0 (it does not apply to me at all) to 3 (it applies to me very much).

Social support questionnaire in chronic patients

It has 79 items; they are rated on a four-point Likert scale from 4 (strongly agree) to 1 (strongly disagree). The scores of factors are individually calculated, the sum of item scores shows the total score of social support. Cronbach's alpha reliability coefficients are 0.95, 0.74, 0.85, 0.87, and 0.97 for total score of social support, emotional support, informational support, support seeking, instrumental support respectively.

Findings

[Table 1] shows the mean, SD, and minimum and maximum scores of variables in the sample.

Table 1: Descriptive statistics of Hematological parameters, Alexithymia and social support

Click here to view

[Table 2] shows the correlation coefficients between alexithymia, psychological signs, social support, and the levels of hematological parameters.

Table 2: Correlation coefficients between alexithymia, psychological signs, social support, and the levels of hematological parameters

Click here to view

As [Table 2] shows, there is a positive significant relationship between glycosylated hemoglobin, fasting blood sugar, and anxiety at the level, P< 0.05. [Table 1], [Table 2], [Table 3], [Table 4], [Table 5] summarize the research questions on relationship between alexithymia, psychological signs, social support, and hematological parameters in the patients with type II diabetes.

Table 3: Correlation coefficients between alexithymia and hematological parameters

Click here to view

Table 4: Correlation coefficients between psychological signs and hematological parameters

Click here to view

Table 5: Correlation coefficients between alexithymia and hematological parameters

Click here to view

[Table 3] shows the correlation coefficients between alexithymia and hematological parameters.

According to [Table 3], there is a positive significant relationship between blood cholesterol and difficulty identifying and describing feelings at the level of P< 0.05, but there is no significant relationship between blood cholesterol and externally oriented thinking. It means less difficulty describing feelings and lower blood cholesterol. The coefficient of determination is 0.115.

[Table 4] shows the correlation coefficients between psychological signs and hematological parameters.

According to [Table 4], there is a positive significant relationship between anxiety, stress, and glycosylated hemoglobin at the level P< 0.05. Furthermore, there is a significant relationship between anxiety, stress, and fasting blood sugar. It likely means glycosylated hemoglobin and fasting blood sugar increase with anxiety.

[Table 5] shows the correlation coefficients between social support and hematological parameters.

As [Table 5] shows, there is a negative significant relationship between fasting blood sugar and emotional support at the level of P< 0.05. It means more emotional support and lower fasting blood sugar. It applies to glycosylated hemoglobin at the level of P< 0.05 too.

Discussion

The results showed that three hematological parameters, fasting blood sugar, glycosylated hemoglobin, and cholesterol, relate to some components of alexithymia, psychological signs, and social support in the patients with type II diabetes. The findings are consistent with some previous research.^[10],[13] The results can be explained in terms of the following probabilities:

Mazaheri and Afshar ^[14] found that there was a positive relationship between difficulty identifying feelings, difficulty describing feelings, and depression and anxiety. In addition, the variables cause numerous problems such as psychosomatic disorders,^[15] social phobia,^[16] irritable bowel syndrome,^[17] posttraumatic stress disorder,^[18] high blood pressure, and high triglycerides in some people. Therefore, the finding supported that there is a positive significant relationship between blood cholesterol and difficulty identifying and describing feelings
In the patients with type II diabetes, there is a positive significant relationship between glycosylated hemoglobin, fasting blood sugar, and anxiety and stress. The two findings are greatly consistent with Deschênes et al.^[6] that found the individuals with generalized anxiety disorder are very prone to diabetes and Hasan et al.^[19] that showed if fertilizable women undergo stressful events for a long time, they will be more prone to diabetes. Therefore, uncontrolled anxiety may make people afflicted with different metabolic diseases such as diabetes
The negative correlation coefficient between fasting blood sugar and emotional support in the study suggests that fasting blood sugar decreases as emotional support of the patient with type II diabetes increases. It also applies to glycosylated hemoglobin. The result is consist with studies that showed glycosylated hemoglobin significantly decreased in the patients with diabetes, who received support from medical staff in a hospital, who were trained to show their difficult feelings, and who followed medical and alimentary instructions for 8 weeks ^[10]
Regarding the direct relationship between overweight and type II diabetes in the study, weight must be controlled to prevent diabetes or its progress. According to Li et al.,^[20] there is a positive relationship between overweight and type II diabetes and elders are more prone to type II diabetes. Therefore, it is necessary to review consumer foods, activity, and exercise in elders. However, it is necessary to do more research on whether there is a positive significant relationship between insulin secretion, glucose tolerance, overweight, low activity, and increased age. According to the study and above-mentioned studies, the relationship between alexithymia, psychological signs, social support, and type II diabetes can be justified. It may be a basis to treat metabolic diseases.

Conclusion

Regarding the results, it can be concluded that complexity and extent of effects of diabetes on an individual with alexithymia make diabetes difficult to treat and prevent its progress. The relationship between psychotherapists and physicians may facilitate remedy.

Two limitations of the study are that the study was conducted on a sample of patients with type II diabetes. Therefore, its generalization to other fields must be made cautiously. The lack of sufficient motivation to cooperate with researcher in some subjects might affect the results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	American Diabetes Association. Standards of medical care in diabetes–2012. Diabetes Care 2012;35 Suppl 1:S11-63. [PUBMED]
2.	Richmond CA, Ross NA, Egeland GM. Social support and thriving health: A new approach to understanding the health of indigenous Canadians. Am J Public Health 2007;97:1827-33. [PUBMED]
3.	Lumley MA, Smith JA, Longo DJ. The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: Comparisons with self-efficacy, catastrophizing, and depression. J Psychosom Res 2002;53:823-30.
4.	Humphreys J, Jiao N, Sadler T. Emotional categorization and creative problem solving. Motiv Emot 2008;24:149-74.
5.	Yu M, Zhang X, Lu F, Fang L. Depression and risk for diabetes: A Meta-analysis. Can J Diabetes 2015;39:266-72. [PUBMED]
6.	Deschênes SS, Burns RJ, Schmitz N. Associations between diabetes, major depressive disorder and generalized anxiety disorder comorbidity, and disability: Findings from the 2012 Canadian community health survey – Mental health (CCHS-MH). J Psychosom Res 2015;78:137-42.
7.	Hamedi V, Ameri A, Ameri A. Comparison of anxiety, depression, stress and anger in migraine, diabetic and cardiac patients and healthy people. Soc Behav Sci 2013;84:1885-8.
8.	Decker CL. Social support and adolescent cancer survivors: A review of the literature. Psychooncology 2007;16:1-1. [PUBMED]
9.	Luminet O, Timary Ph de, Buysschaert M, Luts A. The role of alexithymia factors in glucose control of persons with type 1 diabetes: a pilot study. Diabetes and Metabolism 2006;32:417-424.
10.	Mnif L, Damak R, Mnif F, Ouanes S, Abid M, Jaoua A, et al. Alexithymia impact on type 1 and type 2 diabetes: A case-control study. Ann Endocrinol (Paris) 2014;75:213-9. [PUBMED]
11.	Besharat M. Alexithymia and defensive style. Found Ment Health J 2009;39:181-90.
12.	Zaki Yi A. The Relationship Between Alexithymia, Irrational Beliefs, Positive and Negative Affect Mental Disorders, Psychology Master's Thesis. University of Kermanshah; 2012.
13.	Dubey A, Pandey R, Mishra K. Role of emotion regulation difficulties and positive/negative affectivity in explaining alexithymia-health relationship an overview. J Soc Sci Res 2010;7:20-31.
14.	Mazaheri M, Afshar H. Association of alexithymia with depression and anxiety in psychiatric patients. J Ment Health 2010;12:475-66.
15.	Woolfolk RL, Allen LA. Treating Somatization: A Cognitive – Behavioural Approach. New York: Guilford Press; 2007.
16.	Corstorphin E. Cognitive – Emotional – Behavioural therapy for the eating disorders: Working with beliefs about emotions. Eur Eat Dis Rev 2006;14:448-61.
17.	17. Ali A, Toner BB, Stuckless N, Gallop R, Diamant NE, Gould MI, et al. Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome. Psychosom Med 2000;62:76-82.
18.	Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther 2000;38:319-45. [PUBMED]
19.	Hasan SS, Clavarino AM, Mamun AA, Kairuz T. Anxiety symptoms and the risk of diabetes mellitus in Australian women: Evidence from 21-year follow-up. Public Health 2016;130:21-8. [PUBMED]
20.	Li L, Chen J, Wang J, Cai D. Prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetes mellitus patients with overweight/obese in Guangdong province, China. Prim Care Diabetes 2015;9:191-5. [PUBMED]