Relationship between alexithymia and post-traumatic stress disorder (PTSD) in patients with a history of early pregnancy loss (EPL) after frozen-thawed embryo transfer (FET): mediating effects of intolerance of uncertainty (IU).

BACKGROUND: The risk factors for post-traumatic stress disorder (PTSD) and its relationship with alexithymia and intolerance of uncertainty (IU) remain unclear in patients undergoing frozen-thawed embryo transfer (FET) with a history of early pregnancy loss (EPL). This study aims to investigate the prevalence and contributing factors of PTSD symptoms in FET patients with prior EPL and to examine the associations among IU, alexithymia, and PTSD in this population. METHODS: This study employed a cross-sectional design. A total of 270 participants were recruited through convenience sampling from a gynecology and obstetrics hospital in Zhejiang Province, Mainland China, between June 2024 and January 2025. They were asked to complete a set of questionnaires, comprising the General Information Questionnaire, the Toronto Alexithymia Scale, the Post-Traumatic Stress Disorder Checklist-Civilian Version, and the Intolerance of Uncertainty Scale. Multiple linear regression was used to identify factors associated with PTSD symptoms, and a mediation analysis was conducted to test the mediating role of IU. RESULTS: The mean PTSD score among patients with a history of EPL after FET was (36.89 ± 13.89), with a positive screening rate of 39.02%. PTSD symptoms were positively correlated with both alexithymia (r = 0.469, P < 0.01) and IU (r = 0.662, P < 0.01). Multiple linear regression analysis identified alexithymia and IU as significant factors influencing PTSD symptoms. Furthermore, mediation analysis showed that IU partially mediated the relationship between alexithymia and PTSD, accounting for 61.0% of the total effect. CONCLUSION: This study identified relatively high alexithymia and PTSD scores among patients with a history of EPL after FET, accompanied by elevated levels of IU. The findings revealed a significant positive correlation between alexithymia and PTSD symptoms, and also confirmed that IU was significantly associated with both. Clinically, these observed correlations suggest that integrating routine screening for PTSD, alexithymia, and IU into clinical practice could provide an evidence-based strategy for improving the management of this population.