Mental health distress among undergraduate nursing students in Egypt: associations with self-concealment, alexithymia, and personality traits in a cross-sectional study

Abstract

BACKGROUND: Psychological distress among nursing students is a major concern in nursing education. Difficulties in emotional processing and stable personality traits may be associated with depression, anxiety, and stress, yet self-concealment, alexithymia, and personality traits have rarely been examined together in undergraduate nursing students, particularly in Egypt. This study aimed to examine how self-concealment, alexithymia, and personality traits are associated with depression, anxiety, and stress among undergraduate nursing students. METHODS: A cross-sectional correlational study was conducted among 353 undergraduate nursing students at the Faculty of Nursing, Alexandria University, Egypt. Participants were recruited using proportionate stratified random sampling across the four academic years. Data were collected using a socio-demographic and academic questionnaire, the Self-Concealment Scale, the Toronto Alexithymia Scale-20, the NEO Five-Factor Inventory, and the Depression Anxiety Stress Scales-21. Data were analyzed using descriptive statistics, Pearson correlation coefficients, independent-samples t-tests, one-way analyses of variance, and multiple linear regression. RESULTS: Psychological distress symptoms were common on self-reported screening measures, and anxiety showed the greatest severity, with 53.8% of participants falling in the extremely severe symptom range. These classifications reflect screening scores rather than clinical diagnoses. Self-concealment and alexithymia were positively associated with depression, anxiety, and stress. The adjusted regression models explained 53.1% of the variance in depression, 48.9% in anxiety, and 47.5% in stress. Self-concealment and alexithymia remained significant correlates across all three adjusted models; self-concealment showed the largest standardized coefficient for anxiety and stress, whereas alexithymia showed the largest standardized coefficient for depression. CONCLUSIONS: Psychological distress symptoms in nursing students were associated with self-concealment, alexithymia, and selected personality traits. The findings support early confidential screening, timely access to counseling through clear referral pathways, and targeted resilience-, mindfulness-, peer-support-, and emotion-focused programs within nursing education. Because the design was cross-sectional, these associations should not be interpreted causally.