Investigation of the Levels of Traumatic Stress and Alexitimia in Healthcare Workers in the Covid-19 Pandemic: An Example from Ordu Province
Year 2022,
, 58 - 64, 28.04.2022
Deniz Deniz Özturan
,
Vildan Çakır Kardeş
,
Filiz Özsoy
,
Muhammet Sevindik
,
Atila Gürgen
,
Fatih Vahapoğlu
Ebru Canakci
Abstract
Aim: In this study, we aimed to examine the traumatic stress levels caused by the Covid-19 pandemic
in healthcare workers and the relationship between traumatic stress levels and alexithymia Material and Methods: The study is cross-sectional and descriptive. In the study, we included 252 healthcare professionals who was
working in Ordu province and filled out the online questionnaire on a voluntary basis. Participants were all administered Sociodemographic
data form, Toronto Alexithymia Scale (TAS-20), and Impact of Events Scale (IES) online.
Results: Of 252 people included in the study, 60.3% were female, 39.6% were male. Of all the participants, 67.8% were doctors, 20.8% were
nurses/health officers, and 2% were medical secretaries. According to the scores of TAS-total and IES, the participants scored between 32
to 77 and between 0 to 79, respectively. There was no difference between genders regarding TAS (p>0.05). As for IES, women were found
out to get higher scores (p<0.05). A corelation was found between the scores of TAS-A and TAS-Total and the scores of IES.
Conclusion: In our study, female healthcare workers were reported to have higher levels of traumatic stress during the Covid-19 pandemic,
and alexithymia and trauma scores had a positive relationship. Our study showed that gender has an effect on traumatic stress. Getting
psychological support is vital for healthcare workers for them to work more efficiently during an pandemic period such as Covid-19.
References
- 1. Khanal P, Devkota N, Dahal M, Paudel K, Joshi D. Mental
health impacts among health workers during COVID-19 in a
low resource setting: A cross-sectional survey from Nepal.
Global Health 2020;16:89.
- 2. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T,
Li R. Factors associated with mental health outcomes among
health care workers exposed to coronavirus disease 2019.
JAMA Netw Open 2020;3(3):e203976.
- 3. Rajkumar RP. Covid-19 and mental health: A review of the
existing literature. Asian J Psychiatr 2020;52(20):102066.
- 4. Spoorthy MS. Mental health problems faced by healthcare
workers due to the Covid-19 pandemic-a review. Asian J
Psychiatr 2020;51:102119.
- 5. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, Yao L, Bai H,
Cai Z, Yang BX. Impact on mental health and perceptions of
psychological care among medical and nursing staff in Wuhan
during the 2019 novel coronavirus disease outbreak: A crosssectional
study. Brain Behav Immun 2020;87:11-17.
- 6. Neto MLR, Almeida HG, JDa E, Nobre CB, Pinheiro WR, de
Oliveira CRT, da Costa Sousa I, OMML L, NNR L, Moreira MM.
When health professionals look death in the eye: The mental
health of professionals who deal daily with the 2019 coronavirus
outbreak. Psychiatry Res 2020;288:112972.
- 7. Rodríguez BO, Sánchez TL. The Psychosocial Impact of
COVID-19 on health care workers. Int Braz J Urol 2020;46(Suppl
1):195-200.
- 8. Sekowski M, Gambin M, Hansen K, Holas P, Hyniewska
S, Wyszomirska J, Pluta A, Sobańska M, Łojek E. Risk of
developing post-traumatic stress disorder in severe COVID-19
survivors, their families and frontline healthcare workers: What
should mental health specialists prepare for? Front Psychiatry
2021;12:562899.
- 9. Sifneos PE. The prevalence of ‘alexithymic’ characteristics in
psychosomatic patients. Psychother Psychosom 1973;22:255-
262.
- 10. Grabe HJ, Spitzer C, Freyberger HJ. Alexithymia and
personality in relation to dimensions of psychopathology. Am J
Psychiatry 2004;161:1299-1301.
- 11. Gleichgerrcht E, Decety J. Empathy in clinical practice: How
individual dispositions, gender, and experience moderate
empathic concern, burnout, and emotional distress in
physicians. PLoS One 2013;8:e61526.
- 12. Panayiotou G, Constantinou E. Emotion dysregulation in
alexithymia: Startle reactivity to fearful affective imagery
and its relation to heart rate variability. Psychophysiology
2017;54(9):1323-1334.
- 13. Putica A, Van Dam NT, Steward T, Agathos J, Felmingham K,
O’Donnell M. Alexithymia in post-traumatic stress disorder is
not just emotion numbing: Systematic review of neural evidence
and clinical implications. J Affect Disord 2021;278:519-527.
- 14. Ogrodniczuk JS, Piper WE, Joyce AS: Effect of alexithymia on
the process and outcome of psychotherapy: A programmatic
review. Psychiatry Res 2011;190:43-48.
- 15. Hébert M, Boisjoli C, Blais M, Oussaïd E. Alexithymia as a
mediator of the relationship between child sexual abuse and
psychological distress in adolescence: A short-term longitudinal
study. Psychiatry Research 2018;260:468-472.
- 16. Güleç H, Köse S, Güleç MY, Çitak S, Evren C, Borckardt
J, Sayar K. Reliability and factorial validity of the Turkish
version of the 20-item Toronto alexithymia scale (TAS). Klinik
Psikofarmakoloji Bülteni 2009;19:214-220.
- 17. Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event
Scale—Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing
psychological trauma and PTSD (pp. 399–411).
- 18. Ç orapçıoğlu A, Yargıç İ, Geyran P, Kocabaşoğlu N. Olayların
etkisi ölçeği (IES-R) Türkçe versiyonunun geçerlik ve
güvenirliği. New/Yeni Symposium Journal 2006;44:14-22.
- 19. Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression,
anxiety and post-traumatic stress disorder in health care
workers during the COVID-19 pandemic: A systematic review
and meta-analysis. PLoS One 2021;16(3):e0246454.
- 20. Riethof N, Bob P, Laker M, Zmolikova J, Jiraskova T,
Raboch J. Alexithymia, traumatic stress symptoms and
burnout in female healthcare professionals. J Int Med Res
2020;48(4):300060519887633.
- 21. Kalaycı Ş. Faktör Analizi. In: Şeref Kalaycı (Ed). SPSS
Uygulamalı Çok Değişkenli İstatistik Teknikleri. 5th ed. Asil
Yayın Dağıtım Ltd. Şti., Ankara; 2010:116.
- 22. Babaoğlu AB, Tekindal M, Büyükuysal MÇ, Tözün M, Elmalı
F, Bayraktaroğlu T, Tekindal MA. Epidemiyolojide gözlemsel
çalışmaların raporlanması: STROBE kriterlerinin Türkçe
uyarlaması. Batı Karadeniz Tıp Dergisi 2021;5(1):86-93.
- 23. University of Bern. STROBE Statement: Supporting journals
& organisations. 2009. Available from: https://www.strobestatement.
org/index.php?id=strobeendorsement
- 24. De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz SA,
Ellis L, Polson R, O’Malley CM. A rapid review of the impact
of COVID-19 on the mental health of healthcare workers:
Implications for supporting psychological well-being. BMC
Public Health 20219;21(1):104.
- 25. Yakut E, Kuru Ö, Güngör Y. Sağlık personelinin Covid-19
korkusu ile tükenmişliği arasındaki ilişkide aşırı iş yükü ve
algılanan sosyal desteğin etkisinin yapısal eşitlik modeliyle
belirlenmesi. Ekev Akademi Dergisi 2020;83:241-261.
- 26. Walton M, Murray E, Christian MD. Mental health care for
medical staff and affiliated healthcare workers during the
COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care.
2020;9(3):241-247.
- 27. Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic:
Address mental health care to empower society. Lancet
2020;22(395):37-38.
- 28. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate
psychological responses and associated factors during the
initial stage of the 2019 coronavirus disease (Covid-19)
epidemic among the general population in China. Int J Environ
Res Public Health 2020;17(5):1729.
- 29. Du J, Dong L, Wang T, Yuan C, Fu R, Zhang L, Liu B, Zhang M,
Yin Y, Qin J, Bouey J, Zhao M, Li X. Psychological symptoms
among frontline healthcare workers during COVID-19 outbreak
in Wuhan. Gen Hosp Psychiatry 2020;67:144-145.
- 30. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social
support on sleep quality of medical staff treating patients with
coronavirus disease 2019 (Covid-19) in January and February
2020 in China. Med Sci Monit 2020;26:e923549.
- 31. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health
survey of medical staff in a tertiary infectious disease hospital
for COVID-19. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za
Zhi 2020;38(3):192-195.
- 32. González-Sanguino C, Ausín B, Castellanos MA, Saiz J, López-
Gómez A, Ugidos C, Muñoz M. Mental health consequences
during the initial stage of the 2020 Coronavirus pandemic
(Covid-19) in Spain. Brain Behav Immun 2020;87:172-176.
- 33. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely
S, Greenberg N, Rubin GJ. The psychological impact of
quarantine and how to reduce it: Rapid review of the evidence.
Lancet 2020;395(10227):912-920.
- 34. Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D.
Occurrence, prevention, and management of the psychological
effects of emerging virus outbreaks on healthcare workers:
Rapid review and metaanalysis. BMJ 2020;369:m1642.
- 35. Polat Ö, Coşkun F. COVID-19 salgınında sağlık çalışanlarının
kişisel koruyucu ekipman kullanımları ile depresyon, anksiyete,
stres düzeyleri arasındaki ilişkinin belirlenmesi. Batı Karadeniz
Tıp Dergisi 2020;4:51-58.
- 36. Karkın PÖ, Sezer G, Şen S, Duran M. Sağlık alanında çalışan
kadınlar ile sağlık alanı dışındaki kadınların coronavirüs-19
fobisinin karşılaştırılması. Batı Karadeniz Tıp Dergisi
2021;5:198-203.
- 37. Demirkol ME, Kaya M, Küçan O, Kocadağ D. Evaluating the
impact of the Covid-19 outbreak on healthcare professionals.
Batı Karadeniz Tıp Dergisi 2021;5:266-271.
- 38. Taylor GJ, Bagby RM. An overview of the alexithymia construct.
In: R Bar-On, JA Parker (Eds). The handbook of emotional
intelligence: Theory, development, assessment, and application
at home, school, and in the workplace San Francisco, CA US:
Jossey-Bass 2000;40-67.
- 39. Frewen PA, Dozois DJ, Neufeld RW, Lanius RA. Meta-analysis
of alexithymia in posttraumatic stress disorder. J Trauma Stress
2008;21(2):243-246.
- 40. Reeves RR, Hart RH, Burke RS, Epler AJ, Lyons JA. Does
alexithymia differ in combat veterans of different eras
with posttraumatic stress disorder? Ann Clin Psychiatry
2012;24(2):174-175.
- 41. Gaher RM, O’Brien C, Smiley P, Hahn AM. Alexithymia, coping
styles and traumatic stress symptoms in a sample of veterans
who experienced military sexual trauma. Stress and Health
2016;32(1):55-62.
- 42. Merlo EM, Sicari F, Frisone F, Costa G, Alibrandi A, Avena
G, Settineri S. Uncertainty, alexithymia, suppression and
vulnerability during the Covid-19 pandemic in Italy. Health
Psychology Report 2021;9(2):169-179.
- 43. Tang W, Hu T, Yang L, Xu J. The role of alexithymia in the
mental health problems of home-quarantined university
students during the COVID-19 pandemic in China. Pers Individ
Dif 2020;165:110131.
- 44. Osimo SA, Aiello M, Gentili C, Ionta S, Cecchetto C. The
influence of personality, resilience, and alexithymia on
mental health during COVID-19 pandemic. Front Psychol
2021;12:630751.
Covid-19 Pandemisinde Sağlık Çalışanlarında Travmatik Stres ve Aleksitimi Düzeylerinin Araştırılması: Ordu İli Örneği
Year 2022,
, 58 - 64, 28.04.2022
Deniz Deniz Özturan
,
Vildan Çakır Kardeş
,
Filiz Özsoy
,
Muhammet Sevindik
,
Atila Gürgen
,
Fatih Vahapoğlu
Ebru Canakci
Abstract
Amaç: Bu çalışmada yeni korona virüs hastalığı 2019 (Covid-19) salgınının sağlık çalışanları üzerinde
oluşturduğu travmatik stres düzeylerini ve travmatik stres düzeyleri ile aleksitimi arasındaki ilişkiyi
incelemeyi amaçladık.
Gereç ve Yöntemler: Bu araştırma kesitsel tipte ve tanımlayıcı bir çalışmadır. Araştırmaya gönüllülük
ilkesiyle, çevrimiçi anket formunu dolduran, Ordu ilinde görev yapan 252 sağlık çalışanı dahil edilmiştir.
Tüm katılımcılara sosyodemografik veri formu, Toronto Aleksitmi Ölçeği (TAÖ-20), Olayların Etkisi
Ölçeği (OEÖ) online ortamda uygulanmıştır.
Bulgular: Çalışmaya alınan 252 katılımcıdan %60,3’si kadın, %39,6’si erkekti. Ayrıca mesleki durumlarına
göre değerlendirildiğinde katılımcıların %67,8’si doktor, %20,8’si hemşire/sağlık memuru ve %2’si
ise tıbbi sekreterdi. TAÖ-toplam skoru için katılımcılar 32-77 arasında skor alırken; OEÖ için ise 0-79
arası skorlar elde edilmiştir. TAÖ için cinsiyetler arası farklılık saptanmadı (p>0,05). OEÖ için ise; kadınların
daha yüksek skorlar aldığı görüldü (p<0,05). TAS-A ve TAS-Toplam skoru ile OEÖ skorlarının
korelasyonuna bakıldığında iki ölçek arasında ilişki olduğu görüldü (p<0.05).
Sonuç: Çalışmamızda kadın sağlık çalışanlarının Covid-19 salgını sırasında daha fazla travmatik stres
düzeylerine sahip oldukları, aleksitimi ve travma skorları arasında pozitif yönde ilişki olduğu saptandı.
Çalışmamız cinsiyetin travmatik stres üzerinde etkisi olduğunu göstermiştir. Covid-19 gibi salgın
döneminde sağlık çalışanlarının psikolojik olarak desteklenmeleri daha verimli çalışabilmeleri açısından
oldukça önemli bir husustur.
References
- 1. Khanal P, Devkota N, Dahal M, Paudel K, Joshi D. Mental
health impacts among health workers during COVID-19 in a
low resource setting: A cross-sectional survey from Nepal.
Global Health 2020;16:89.
- 2. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T,
Li R. Factors associated with mental health outcomes among
health care workers exposed to coronavirus disease 2019.
JAMA Netw Open 2020;3(3):e203976.
- 3. Rajkumar RP. Covid-19 and mental health: A review of the
existing literature. Asian J Psychiatr 2020;52(20):102066.
- 4. Spoorthy MS. Mental health problems faced by healthcare
workers due to the Covid-19 pandemic-a review. Asian J
Psychiatr 2020;51:102119.
- 5. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, Yao L, Bai H,
Cai Z, Yang BX. Impact on mental health and perceptions of
psychological care among medical and nursing staff in Wuhan
during the 2019 novel coronavirus disease outbreak: A crosssectional
study. Brain Behav Immun 2020;87:11-17.
- 6. Neto MLR, Almeida HG, JDa E, Nobre CB, Pinheiro WR, de
Oliveira CRT, da Costa Sousa I, OMML L, NNR L, Moreira MM.
When health professionals look death in the eye: The mental
health of professionals who deal daily with the 2019 coronavirus
outbreak. Psychiatry Res 2020;288:112972.
- 7. Rodríguez BO, Sánchez TL. The Psychosocial Impact of
COVID-19 on health care workers. Int Braz J Urol 2020;46(Suppl
1):195-200.
- 8. Sekowski M, Gambin M, Hansen K, Holas P, Hyniewska
S, Wyszomirska J, Pluta A, Sobańska M, Łojek E. Risk of
developing post-traumatic stress disorder in severe COVID-19
survivors, their families and frontline healthcare workers: What
should mental health specialists prepare for? Front Psychiatry
2021;12:562899.
- 9. Sifneos PE. The prevalence of ‘alexithymic’ characteristics in
psychosomatic patients. Psychother Psychosom 1973;22:255-
262.
- 10. Grabe HJ, Spitzer C, Freyberger HJ. Alexithymia and
personality in relation to dimensions of psychopathology. Am J
Psychiatry 2004;161:1299-1301.
- 11. Gleichgerrcht E, Decety J. Empathy in clinical practice: How
individual dispositions, gender, and experience moderate
empathic concern, burnout, and emotional distress in
physicians. PLoS One 2013;8:e61526.
- 12. Panayiotou G, Constantinou E. Emotion dysregulation in
alexithymia: Startle reactivity to fearful affective imagery
and its relation to heart rate variability. Psychophysiology
2017;54(9):1323-1334.
- 13. Putica A, Van Dam NT, Steward T, Agathos J, Felmingham K,
O’Donnell M. Alexithymia in post-traumatic stress disorder is
not just emotion numbing: Systematic review of neural evidence
and clinical implications. J Affect Disord 2021;278:519-527.
- 14. Ogrodniczuk JS, Piper WE, Joyce AS: Effect of alexithymia on
the process and outcome of psychotherapy: A programmatic
review. Psychiatry Res 2011;190:43-48.
- 15. Hébert M, Boisjoli C, Blais M, Oussaïd E. Alexithymia as a
mediator of the relationship between child sexual abuse and
psychological distress in adolescence: A short-term longitudinal
study. Psychiatry Research 2018;260:468-472.
- 16. Güleç H, Köse S, Güleç MY, Çitak S, Evren C, Borckardt
J, Sayar K. Reliability and factorial validity of the Turkish
version of the 20-item Toronto alexithymia scale (TAS). Klinik
Psikofarmakoloji Bülteni 2009;19:214-220.
- 17. Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event
Scale—Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing
psychological trauma and PTSD (pp. 399–411).
- 18. Ç orapçıoğlu A, Yargıç İ, Geyran P, Kocabaşoğlu N. Olayların
etkisi ölçeği (IES-R) Türkçe versiyonunun geçerlik ve
güvenirliği. New/Yeni Symposium Journal 2006;44:14-22.
- 19. Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression,
anxiety and post-traumatic stress disorder in health care
workers during the COVID-19 pandemic: A systematic review
and meta-analysis. PLoS One 2021;16(3):e0246454.
- 20. Riethof N, Bob P, Laker M, Zmolikova J, Jiraskova T,
Raboch J. Alexithymia, traumatic stress symptoms and
burnout in female healthcare professionals. J Int Med Res
2020;48(4):300060519887633.
- 21. Kalaycı Ş. Faktör Analizi. In: Şeref Kalaycı (Ed). SPSS
Uygulamalı Çok Değişkenli İstatistik Teknikleri. 5th ed. Asil
Yayın Dağıtım Ltd. Şti., Ankara; 2010:116.
- 22. Babaoğlu AB, Tekindal M, Büyükuysal MÇ, Tözün M, Elmalı
F, Bayraktaroğlu T, Tekindal MA. Epidemiyolojide gözlemsel
çalışmaların raporlanması: STROBE kriterlerinin Türkçe
uyarlaması. Batı Karadeniz Tıp Dergisi 2021;5(1):86-93.
- 23. University of Bern. STROBE Statement: Supporting journals
& organisations. 2009. Available from: https://www.strobestatement.
org/index.php?id=strobeendorsement
- 24. De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz SA,
Ellis L, Polson R, O’Malley CM. A rapid review of the impact
of COVID-19 on the mental health of healthcare workers:
Implications for supporting psychological well-being. BMC
Public Health 20219;21(1):104.
- 25. Yakut E, Kuru Ö, Güngör Y. Sağlık personelinin Covid-19
korkusu ile tükenmişliği arasındaki ilişkide aşırı iş yükü ve
algılanan sosyal desteğin etkisinin yapısal eşitlik modeliyle
belirlenmesi. Ekev Akademi Dergisi 2020;83:241-261.
- 26. Walton M, Murray E, Christian MD. Mental health care for
medical staff and affiliated healthcare workers during the
COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care.
2020;9(3):241-247.
- 27. Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic:
Address mental health care to empower society. Lancet
2020;22(395):37-38.
- 28. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate
psychological responses and associated factors during the
initial stage of the 2019 coronavirus disease (Covid-19)
epidemic among the general population in China. Int J Environ
Res Public Health 2020;17(5):1729.
- 29. Du J, Dong L, Wang T, Yuan C, Fu R, Zhang L, Liu B, Zhang M,
Yin Y, Qin J, Bouey J, Zhao M, Li X. Psychological symptoms
among frontline healthcare workers during COVID-19 outbreak
in Wuhan. Gen Hosp Psychiatry 2020;67:144-145.
- 30. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social
support on sleep quality of medical staff treating patients with
coronavirus disease 2019 (Covid-19) in January and February
2020 in China. Med Sci Monit 2020;26:e923549.
- 31. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health
survey of medical staff in a tertiary infectious disease hospital
for COVID-19. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za
Zhi 2020;38(3):192-195.
- 32. González-Sanguino C, Ausín B, Castellanos MA, Saiz J, López-
Gómez A, Ugidos C, Muñoz M. Mental health consequences
during the initial stage of the 2020 Coronavirus pandemic
(Covid-19) in Spain. Brain Behav Immun 2020;87:172-176.
- 33. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely
S, Greenberg N, Rubin GJ. The psychological impact of
quarantine and how to reduce it: Rapid review of the evidence.
Lancet 2020;395(10227):912-920.
- 34. Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D.
Occurrence, prevention, and management of the psychological
effects of emerging virus outbreaks on healthcare workers:
Rapid review and metaanalysis. BMJ 2020;369:m1642.
- 35. Polat Ö, Coşkun F. COVID-19 salgınında sağlık çalışanlarının
kişisel koruyucu ekipman kullanımları ile depresyon, anksiyete,
stres düzeyleri arasındaki ilişkinin belirlenmesi. Batı Karadeniz
Tıp Dergisi 2020;4:51-58.
- 36. Karkın PÖ, Sezer G, Şen S, Duran M. Sağlık alanında çalışan
kadınlar ile sağlık alanı dışındaki kadınların coronavirüs-19
fobisinin karşılaştırılması. Batı Karadeniz Tıp Dergisi
2021;5:198-203.
- 37. Demirkol ME, Kaya M, Küçan O, Kocadağ D. Evaluating the
impact of the Covid-19 outbreak on healthcare professionals.
Batı Karadeniz Tıp Dergisi 2021;5:266-271.
- 38. Taylor GJ, Bagby RM. An overview of the alexithymia construct.
In: R Bar-On, JA Parker (Eds). The handbook of emotional
intelligence: Theory, development, assessment, and application
at home, school, and in the workplace San Francisco, CA US:
Jossey-Bass 2000;40-67.
- 39. Frewen PA, Dozois DJ, Neufeld RW, Lanius RA. Meta-analysis
of alexithymia in posttraumatic stress disorder. J Trauma Stress
2008;21(2):243-246.
- 40. Reeves RR, Hart RH, Burke RS, Epler AJ, Lyons JA. Does
alexithymia differ in combat veterans of different eras
with posttraumatic stress disorder? Ann Clin Psychiatry
2012;24(2):174-175.
- 41. Gaher RM, O’Brien C, Smiley P, Hahn AM. Alexithymia, coping
styles and traumatic stress symptoms in a sample of veterans
who experienced military sexual trauma. Stress and Health
2016;32(1):55-62.
- 42. Merlo EM, Sicari F, Frisone F, Costa G, Alibrandi A, Avena
G, Settineri S. Uncertainty, alexithymia, suppression and
vulnerability during the Covid-19 pandemic in Italy. Health
Psychology Report 2021;9(2):169-179.
- 43. Tang W, Hu T, Yang L, Xu J. The role of alexithymia in the
mental health problems of home-quarantined university
students during the COVID-19 pandemic in China. Pers Individ
Dif 2020;165:110131.
- 44. Osimo SA, Aiello M, Gentili C, Ionta S, Cecchetto C. The
influence of personality, resilience, and alexithymia on
mental health during COVID-19 pandemic. Front Psychol
2021;12:630751.