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Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients

Athanasios Tselebis1*, Epaminondas Kosmas2, Dionisios Bratis1, Georgios Moussas1, Athanasios Karkanias1, Ioannis Ilias3, Nikolaos Siafakas4, Alexandros Vgontzas5 and Nikolaos Tzanakis46

Author Affiliations

1 Psychiatric Department, Sotiria General Hospital of Chest Diseases, Athens, Greece

2 Pulmonary Rehabilitation Centre, Sotiria General Hospital of Chest Diseases, Athens, Greece

3 Endocrine Department, Elena Venizelou Hospital, Athens, Greece

4 Department of Thoracic Medicine, University of Crete, Medical School, Heraklion, Greece

5 Psychiatric Department, University of Crete, Medical School, Heraklion, Greece

6 Departement of Social Medicine, Laboratory of Epidemiology, University of Crete, Medical School, Heraklion, Greece

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Annals of General Psychiatry 2010, 9:16  doi:10.1186/1744-859X-9-16

Published: 14 April 2010



Chronic obstructive pulmonary disease (COPD) is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients.


The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20), Spielberger Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively.


The mean BDI score was 12.88 (SD: 7.7), mean STAI score 41.8 (SD: 11.0) and mean TAS-20 score 48.2 (SD: 11.5). No differences were observed between genders regarding age and alexithymia (t test P > 0.05), while female patients presented higher depression and trait anxiety scores than males (t test P < 0.05). Clinically significant levels of anxiety were present in 37.1% of men, and in 45.7% of women. The mean depression score was also higher than the corresponding mean score in the general population (one-sample t test P < 0.01), while 27.7% and 30.5% of the sample presented mild and moderate to severe depression, respectively. Finally, a strong correlation was observed between alexithymia, depression and anxiety.


This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients.