Associations of loneliness, psychological resilience, social support, and sleep quality with alexithymia among 7,964 Chinese adolescents: a cross-sectional study

Alexithymia, a difficulty in identifying and describing emotions, is a significant psychological risk factor during adolescence. However, a comprehensive understanding of its modifiable correlates, including psychological, social, and physiological factors, within the Chinese adolescent population remains limited. This study aimed to investigate the levels of alexithymia and their associations with psychological resilience, social support, loneliness, and sleep quality among Chinese adolescents. A cross-sectional, school-based survey was conducted from February to April 2024 among 7,964 adolescents from 13 secondary schools across six provinces and autonomous regions in China. Participants completed the Chinese version of the Perth Alexithymia Questionnaire (PAQ-24), the Connor-Davidson Resilience Scale (CD-RISC-10), the UCLA Loneliness Scale (ULS-6), the Perceived Social Support Scale (PSSS-3), and the Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI). Data were analyzed using t-tests, analysis of variance (ANOVA), correlation analysis, and hierarchical regression, with linear mixed models used as a sensitivity analysis to account for school clustering. The mean PAQ total score was 80.52 ± 26.43. Adolescents reported greater difficulties in identifying and describing negative emotions than positive emotions. After adjustment for demographic, family, and behavioral factors, loneliness (β = 0.313, 95% CI [1.575, 1.817]) and poor sleep quality (higher B-PSQI scores; β = 0.099, 95% CI [0.826, 1.290]) were positively associated with alexithymia, whereas psychological resilience (β = −0.162, 95% CI [− 0.531, − 0.400]) and perceived social support (β = −0.058, 95% CI [− 0.569, − 0.248]) were inversely associated with alexithymia. The final model explained 23.9% of the variance. Additionally, variables such as gender, grade, boarding, and smoking were also associated with alexithymia after adjustment. Loneliness and poor sleep quality were associated with higher alexithymia scores, whereas psychological resilience and perceived social support showed inverse associations with alexithymia. These findings identify potentially modifiable correlates that may warrant consideration in future longitudinal and intervention research.