Alexisomia, Depression, and Adherence in Kidney Transplantation: A Cross-Sectional Preliminary Investigation

Background Adherence to immunosuppressive therapy (IT) is essential for long-term graft survival in kidney transplant recipients (KTRs). While depression and anxiety have been widely studied as determinants of nonadherence, the influence of emotional awareness and bodily perception constructs remain unclear. This study aimed to evaluate the associations of alexithymia, alexisomia, and affective symptoms with medication adherence among KTRs. Methods This cross-sectional study included 82 KTRs followed at a tertiary nephrology outpatient clinic. Participants completed validated psychometric instruments, including the Toronto Alexithymia Scale (TAS), Shitsu-taikan-sho Scale for alexisomia, Hospital Anxiety and Depression Scale (HADS), and the Immunosuppressant Therapy Adherence Scale (ITAS). Correlation analyses and stepwise linear regression were used to identify psychological predictors of adherence. Results The mean ITAS score was 10.49 ± 1.82. Medication adherence showed significant mild negative correlations with alexisomia (r = –0.267, p = 0.015), alexithymia (r = –0.327, p = 0.003), and depressive symptoms (r = –0.380, p < 0.001), while anxiety was not significantly associated with adherence (r = –0.189, p = 0.089). In the regression model, depressive symptoms were the only independent predictor of adherence (β = –0.380, p < 0.001), explaining 14.5% of the variance. To our knowledge, this is the first study to identify an association between alexisomia and IT adherence in KTRs. Conclusion Alexithymia, alexisomia, and depressive symptoms are significant psychological correlates of reduced IT adherence among KTRs. The novel finding regarding alexisomia suggests that impaired recognition and interpretation of internal bodily and emotional states may hinder consistent self-management after transplantation. Early psychosocial screening and targeted psychological interventions may improve adherence and reduce rejection risk in this population.