Introduction
Evidence indicates that medical students have high rates of psychiatric disorders and mental stress worldwide and are at high risk for suicidal ideation.1 Burnout of medical students increases after clinical rotations in which they are exposed to patients with debilitating illnesses, life-threatening diseases and death.2 Medical students also experience a variety of other stressors, such as examinations, living away from family and financial hardships—all making them more prone to mental disorders.3 Not surprisingly, the high prevalence of emotional disorders among medical students may increase their risk for other problems, such as low levels of life satisfaction, school incompletion and suicide.
Starting soon after the onset of the COVID-19 pandemic, universities closed their doors, and digital learning replaced in-person lectures. However, the clinical aspects of medical training are ill-suited for E-learning. Unfortunately, the pandemic continuously disrupted medical education and training throughout this period.4 An epidemiological study of 746 217 college students showed that acute stress, anxiety and depressive symptoms were prevalent during the COVID-19 pandemic.5 Moreover, COVID-related psychological stress in medical students was found to significantly increase the risk of negative impact on their health, academic performance, professional identity and future medical service quality.6
A novel study suggested that students who experienced psychological problems during the COVID-19 pandemic would more likely be affected by deficiencies in emotional identification and expression or, in other words, alexithymia.7 The disorder is a multifaceted personality construct, including difficulties identifying and describing feelings and poor externally-oriented thinking,8 that is more common in younger populations (24.1%), especially among college students.9
Furthermore, alexithymia is a sign of negative emotions and a significant risk factor for other medical and psychiatric problems.10 Thus, individuals with alexithymia are prone to reporting mental health–related concerns. In our previous research, nursing students showed significantly positive correlations between alexithymia and health anxiety.10 However, during the COVID-19 pandemic, the relationships between alexithymia and different aspects of stress in medical students were not evident and, thus, are worthy of attention.
A previous study found resilience plays a positive role in the mental health of medical students.11 For example, students with higher resilience scores exhibited better adaptive coping strategies when facing academic stress.11 Nevertheless, compared with non-medical students, medical students may have lower resilience levels.12 Many factors can influence students’ resilience, such as workplace and training stress, interpersonal relationships and alexithymia.13 14 Resilience and positive coping have also been shown to be protective factors for developing stress symptoms and decreasing the risks of pandemic-related distress.15 Therefore, we hypothesised that resilience could be a mediator for reducing stress and alexithymia in medical students. However, more research is needed to determine the relationships among resilience, stress and alexithymia, which is the aim of this study.