Managing anxiety levels may improve quality of life for adults with ITP: Study
Anxiety, difficulty expressing emotions found to negatively impact patients' lives
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High levels of anxiety and alexithymia, or difficulty in recognizing and expressing emotions, are associated with significantly poorer quality of life in people with primary immune thrombocytopenia (ITP).
That’s the finding of a new study from China, in which researchers investigated the impact of anxiety levels and a person’s degree of alexithymia on life quality among adults with the rare bleeding disorder.
“In summary, anxiety exerts a multifaceted negative impact on the [quality of life] of patients with ITP, spanning psychological, physiological and social dimensions,” the team wrote.
These results highlight the need for proactive efforts, potentially beginning with patient screening, for people with ITP, according to the researchers.
“Clinical work should pay attention to the psychological state of patients with ITP and the timely identification and intervention for anxiety and alexithymia to improve [quality of life],” the scientists wrote.
The study, “Influence of Anxiety Level and Degree of Alexithymia on Quality of Life in Adult Patients With Primary Immune Thrombocytopenia,” was published in the journal Actas Españolas de Psiquiatría.
ITP is caused by the immune system mistakenly attacking and destroying platelets, the cell fragments that help with blood clotting after an injury. This leads to symptoms such as internal or external bleeding and easy bruising. Primary ITP occurs without any other cause or underlying condition.
Older age, diabetes also linked to poorer quality of life
In this study, a team from The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army investigated anxiety levels and the degree of alexithymia and how it relates to quality of life for people with ITP.
A total of 148 patients, all treated at the hospital between 2021 and 2023, were assessed. Among them, 60% were women, and slightly more than half were age 50 or younger. About 6 of every 10 had chronic ITP. Some had coexisting high blood pressure (21%), diabetes (16.2%), and coronary heart disease (11.5%), which is marked by reduced blood supply to the heart.
Quality of life was assessed using the ITP-patient assessment questionnaire (ITP-PAQ), a tool specifically designed to evaluate quality of life for people with ITP across 10 domains: anxiety, psychology, fear, symptoms, fatigue/sleep, exercise, work, social interaction, women’s issues, and overall quality of life. The mean ITP-PAQ score for all patients was 68.97 on a 0-100 scale, with higher values indicating a better quality of life.
Individuals older than 50, those with diabetes, and those in the initial disease stages were all found to have a significantly lower quality of life. This finding also held true for those with platelet levels up to 100 billion/L, and with infections by Helicobacter pylori, bacteria that infect the lining of the stomach. Similar results were observed when looking separately at physical, emotional, and other modules included in ITP-PAQ.
Anxiety was assessed by the Hamilton Anxiety Scale, known as HAMA, for which the mean score was 14.3; the scale’s maximum is 56. Overall, according to the researchers, 61 individuals may have anxiety, 77 definitely had anxiety, and eight had significant anxiety.
The degree of alexithymia was assessed with the Toronto Alexithymia Scale-20 (TAS-20). That scale revealed that 59 patients had low levels of alexithymia, while the levels were high for 47.
“Alexithymia makes patients unable to accurately understand and express [their] emotions, resulting in a backlog of negative emotions in the heart,” the researchers wrote.
Researchers call for anxiety screening for adults with ITP
The data showed that HAMA and TAS-20 scores were negatively associated with ITP-PAQ scores — meaning that individuals with higher levels of anxiety and alexithymia have a poorer quality of life. Similar associations were observed when looking separately at the association between anxiety or alexithymia and different domains of quality of life, including the emotional and physical modules, the researchers noted
These findings highlight the complexity of the psychological status of patients with ITP and underscore the need to address mental health alongside physical symptoms in clinical management.
According to the team, “the long-term accumulation of [negative] emotions will lead to serious psychological problems such as anxiety and depression, which directly affect the psychological state and emotional stability of patients and thus reduce their [quality of life].”
Further analysis showed that anxiety levels, alexithymia, diabetes, disease stage, and platelet levels were independent risk factors for predicting the quality of life among people with ITP.
“These findings highlight the complexity of the psychological status of patients with ITP and underscore the need to address mental health alongside physical symptoms in clinical management,” the researchers wrote. “Specifically, routine screening for anxiety and alexithymia, coupled with targeted psychosocial support, may mitigate their detrimental effects.”
