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.