Unravelling the link between alexithymia and psychological distress in nurses: a multi-hospital cross-sectional study exploring the mediating roles of workplace conflict and emotional exhaustion.

Abstract

Background: Nurses are particularly susceptible to the adverse psychological effects of alexithymia, a personality trait characterized by difficulties in identifying and describing emotions. However, the mechanisms linking alexithymia to psychological distress among nurses remain unclear. The present study aimed to unravel the link between alexithymia and psychological distress in nurses, and to explore the potential mediating roles of workplace conflict and emotional exhaustion.

Methods: A cross-sectional survey was conducted among 4088 nurses from 43 public hospitals in China. The participants completed a web-based questionnaire that comprised the Toronto Alexithymia Scale (TAS-20), the Interpersonal Conflict at Work Scale (ICAWS), the Emotional Exhaustion Scale (EES), and the Kessler Psychological Distress Scale (K6). The chain mediation model was evaluated using Mplus, with the bias-corrected bootstrap method. Moreover, a sensitivity analysis utilizing a structural equation modeling approach was performed to corroborate the findings.

Results: Among the 3977 nurses who returned valid questionnaires, participants reported mean scores of 53.95 ± 10.78 for alexithymia and 7.26 ± 5.75 for psychological distress, with 22.0% meeting the threshold for alexithymia and 16.9% exhibiting clinically significant psychological distress. The study revealed that alexithymia had a direct positive effect on psychological distress (β = 0.164, 95% CI [0.148-0.181]). Furthermore, workplace conflict (β = 0.036, 95% CI [0.031-0.042]) and emotional exhaustion (β = 0.118, 95% CI [0.108-0.128]) independently mediated the pathway linking alexithymia to psychological distress, and also operated sequentially in a chain mediation pathway (β = 0.010, 95% CI [0.008-0.012]). Sensitivity analyses confirmed the robustness of these findings.

Conclusions: This study suggests that alexithymia not only directly affects psychological distress but also exerts chain mediation effects through workplace conflict and emotional exhaustion. The findings unravel the complex mechanisms underlying the alexithymia-psychological distress link, providing valuable insights to guide efforts in safeguarding nurses' mental health. By addressing alexithymia and cultivating a supportive organizational environment, managers can facilitate the build-up of emotional resources, ultimately enhancing the psychological well-being of nurses.