Mapping the interplay among somatic symptoms, alexithymia, and emotion regulation difficulties in community-dwelling older adults with multiple chronic conditions: a network analysis

Background Somatic symptoms are highly prevalent among older adults with multiple chronic conditions and are associated with functional impairment and reduced quality of life. Emerging evidence suggests that psychological factors, particularly alexithymia and emotion regulation difficulties, are closely associated with somatic symptom burden. However, the conditional associations among the dimensions of these constructs remain unclear. Network analysis provides a complementary approach to examining these relationships. This study aimed to examine these associations and identify central and bridge nodes among older adults with multiple chronic conditions. Methods This cross-sectional study used convenience sampling to recruit 1,497 participants from 13 prefecture-level cities in Jiangsu Province between February 2024 and February 2026. Data were collected using the Somatic Symptom Scale-China (SSS-CN), the Toronto Alexithymia Scale (TAS-20), and the short form of the Difficulties in Emotion Regulation Scale (DERS-16). R version 4.2.0 was used to construct a network of symptom dimensions and identify central and bridge nodes, and SPSS 26.0 was used for descriptive analyses. Results A total of 1,497 participants were included, with a mean age of 71.02 ± 4.69 years. Centrality analysis identified “Limited access to emotion regulation strategies perceived as effective” (strength z-score = 1.61), “Difficulty Identifying Feelings” (strength z-score = 1.38), and “Physical disorder” (strength z-score = 0.98) as central nodes in the network. Bridge centrality analysis identified “Difficulty Identifying Feelings” (bridge strength = 0.40), “Limited access to emotion regulation strategies perceived as effective” (bridge strength = 0.32), and “Depression disorder” (bridge strength = 0.25) as the nodes with the highest bridge strength within the predefined alexithymia, emotion regulation difficulties, and somatic symptom communities, respectively. The network showed good stability (CS = 0.75). Network comparison analysis revealed significant differences between participants with SSS-CN scores below 30 and those with scores of 30 or above in overall network structure (M = 0.438, P < 0.001) and global strength (S = 1.358, P < 0.001). Conclusions Somatic symptoms, alexithymia, and emotion regulation difficulties showed close conditional associations among community-dwelling older adults with multiple chronic conditions. “Difficulty Identifying Feelings” and “Limited access to emotion regulation strategies perceived as effective” exhibited relatively high strength and bridge strength, while “Physical disorder” also occupied a central position in the network. Significant differences in network structure and global strength were observed between groups with different levels of somatic symptom burden. These findings highlight potentially relevant dimensions for future longitudinal and intervention studies.