Latent profile analysis of alexithymia and its influencing factors in patients undergoing total knee arthroplasty.

BACKGROUND

Alexithymia, characterized by difficulty identifying and describing emotions and a tendency toward externally oriented thinking, is common among people living with chronic pain and may compromise perioperative communication and rehabilitation engagement. However, previous studies have largely adopted variable-centered approaches, which may overlook clinically meaningful heterogeneity in alexithymia among patients undergoing TKA.

OBJECTIVE

To identify latent alexithymia profiles using latent profile analysis (LPA) of alexithymia among patients undergoing TKA and to determine demographic, clinical, and psychosocial factors associated with profile membership.

METHODS

A cross-sectional survey was conducted among 467 patients scheduled for TKA at a tertiary hospital in Ningxia, China, between July 2025 and April 2026. Participants completed a general information questionnaire, the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20), the Numerical Rating Scale for pain (NRS), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Social Support Scale (PSSS). LPA was conducted using the three TAS-20 subscale scores (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) as profile indicators. Multinomial logistic regression was used to identify factors associated with profile membership.

RESULTS

The mean TAS-20 score was 57.02 ± 5.76, indicating moderate alexithymic traits. A three-profile solution was identified: emotionally competent (n = 106, 22.70%), emotionally expressive difficulty (n = 197, 42.18%), and emotional-cognitive deficit (n = 164, 35.12%). Educational level, monthly income, pain duration, pain intensity, anxiety, depression, and perceived social support were associated with profile membership in univariable analyses (all p < 0.05). In multivariable multinomial logistic regression, higher perceived social support was associated with lower odds of membership in both the emotionally expressive difficulty profile (OR = 0.883, 95% CI: 0.793-0.983) and the emotional-cognitive deficit profile (OR = 0.767, 95% CI: 0.673-0.873). The emotional-cognitive deficit profile was additionally associated with higher anxiety scores (OR = 1.363, 95% CI: 1.124-1.652) and was associated with a broader range of adverse socioeconomic and psychological factors. Than the emotionally expressive difficulty profile (e.g., pain intensity: OR = 8.517 vs. 2.356; monthly income < 2,000 RMB: OR = 10.549 vs. 3.592).

CONCLUSION

Alexithymia in patients undergoing TKA comprises three clinically distinguishable profiles. Profile membership is closely related to socioeconomic status, pain burden, psychological distress, and social support.

IMPLICATIONS FOR NURSING: Routine preoperative TAS-20 screening could facilitate early identification of patients at risk for alexithymia-related communication barriers. Profile-specific interventions should combine tailored communication strategies, pain management, psychological support, and family-inclusive social support, particularly for patients with emotional-cognitive deficits.