Sohag Journal of Nursing Sciences Ahmed et al.

Alexithymia and its relation with Social Media among nursing students
Asmaa Atef Thabit Ahmed1, Mawaheb Mahmoud Zaki2 and Fathyea Abdallah shams El-Din 3
1
Demonstrator of Psychiatric and Mental Health Nursing, Sohag University,
2
Assistant Professor of Psychiatric and Mental Health Nursing, Benha University, Egypt
3
Lecturer of Psychiatric and Mental Health Nursing, Benha University, Egypt
Corresponding author email: asmaaatef069@[Link]
Phone number: 002-01021343504

Abstract
Back ground: Nursing students need to be aware of the optimal use of the social media because they spend a
lot of time conducting scientific research that complements the academic curriculum, but when a nursing student
becomes unable to control the use of the platform’s, this leads to internet addiction and this will affect their
physical, psychological and social health . Aim: This study aimed to explore the relation between alexithymia
and social media among nursing students. .Design: Correlational research design was used in the current study.
Sample: quota sample Consists of 352 Nursing was chosen from the four- grades students of Faculty of
Nursing, Benha University. Tools: Three tools were used (1st tool): Structured Interview Questionnaire sheet.
(2nd tool): Toronto Alexithymia Scale. (3rd tool): Social Media Scale Student Form. Results: nearly half
(48.6%) of the studied students have moderate level of social media addiction and more than half (51.1%) of the
studied students have possible alexithymia level. Conclusion: there was a highly statistically positive
correlation between total level of social media addiction and total level of alexithymia. Recommendations: The
hazards and determinants of social media addiction should be added to the educational curricula and the
methods that must be followed to avoid its adverse effects on physical, psychological, and social well.
Key words: Alexithymia, Nursing Students, and Social Media

Introduction Social media addiction is a behavioral addiction

Nowadays, social media is a crucial aspect of life, characterized by being too obsessed with social
particularly for students. In keeping with this, media, being driven by an uncontrolled want to log
previous research found that more than half of on to or use social media, and investing so much
pupils had a moderate level of internet addiction. It time and effort to social media that it impacts other
also demonstrates that students prefer to be online vital life areas. Excessive Internet use may have a
24 hours a day, which defines students' addiction to detrimental impact on a student's life, causing them
social media. The influence of social media usage to experience family troubles and lose social
on their academic achievement is both positive and communication. Because nursing is centered on
negative. Many colleges throughout the world have delivering comprehensive health care utilizing
changed their curricula. Distance education is current technologies, including internet technology,
becoming increasingly popular. Students and nurses must teach students how to avoid being
teachers might readily engage with one another via hooked to the Internet so that we may construct a
social media. Social networking sites such as healthy professional life. Shaban, (2022).
Facebook, Twitter, What's Up, and Instagram Previous research shows that alexithymia is
divert students' attention away from their studies, associated with the development of addictive
negatively impacting their academic grades. behaviors Hao & Jin , (2020 ).People with
Kaptangil & Calisir (,2023). alexithymia have difficulty in expressing their
Social media has altered the way we engage with emotions and thus they have fewer close
one another online. It enables us to learn what's relationships, poor social support networks and
going on in the world in real time, to connect with often feel disconnected from others [Link] &
one another and remain in contact with long- Hess,(2020). All these factors amplify the feeling
distance pals, and to have access to an infinite of loneliness. Also the direct effect of alexithymia
quantity of knowledge at our fingertips. In many on loneliness and found out that this strong
ways, social media has enabled many people to association was a result of lack of trust in others.
connect with others online, making the globe Alexithymia is linked to the development of
appear more approachable. It is sometimes difficult addictive behaviors'. Relevant field study links
for pupils to distinguish between time spent online internet addiction (social media addiction) to
for educational and non-educational purposes. As a Alexithymia in students and late teens.
result, students have to recognize and distinguish Alexithymics are more likely to become addicted to
between excessive internet usage and internet the internet than non-alexithymics. The intensity of
addiction, and appropriate treatments and strategies addiction in university students is positively
must be employed to identify and minimize social connected with alexithymia, although the direction
media use. Shehata & Abdeldaim, (2021). and elements that may moderate this association

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Sohag Journal of Nursing Sciences Ahmed et al.,

remain unknown. Soranidou & Papastylianou, Research Design

(2019). A correlational research design was utilized to fulfill
the aim of this study.
Significance of the study
Several studies revealed that, 58.7% 58.7% of the Setting
world's population, or 4.65 billion individuals, This study was conducted at the Faculty of
utilized social media platforms. Many people now Nursing at Benha University, Qalyubia
rely heavily on social media as their primary governorate.
means of receiving and processing news, and they Sample type & technique
often make important life choices on what they Convenience sample method was chosen from the
read there. It's safe to say that the Internet is now four- grades students of Faculty of Nursing,
an integral part of almost every industry because Benha University.
to the meteoric rise in Internet users throughout Sample size
the globe. Over 4.54 billion individuals Quota sample of 352 students was chosen from
throughout the world have access to the Internet, the four- grades students of Faculty of Nursing,
with 3.80 billion using social media and online Benha University
video social apps Kurniawan, 2020 &Zmavc et al This sample should meet the following
.,(2022). Inclusion criteria
Furthermore, research has shown that college  Both sex of students.
students have an overwhelming interest in social  All grade students.
media. In the world, 330 million individuals are  Free from psychiatric disorders.
addicted to social media. Social media addiction  Willing to participate in this study.
has become a worldwide issue, and excessive usage Tools of data collection
among college students has caused alarm all In order to fulfill the aim of this study, the data was
around the world Gao et al.,( 2022). collected by using the following four tools:-
Nursing role in management of social media Tool I : A self-Administered Questionnaire :
addiction:- The role of psychiatric nurse in It was developed by the researcher and it included
management of social media addiction divided in two parts:
three phases (Assessment, treatment, relapse Part I: Personal data of students:
phase). In assessment phase, the nurses' role is to It included student's age (years), sex, marital status,
encourage the client to assess their online activities. educational grade, residence, family income,
It's safe to say that the Internet is now an integral parent’s working status, and family stability .
part of almost every industry because to the Part II: Data related to social media use:
meteoric rise in Internet users throughout the globe. Consists of four questions; (what are the most
In treatment phase, The nurse encourages the social media used, How many days do you use
student to adopt time management skills and assists social media, what is duration of social media
him in identifying problem-solving strategies such use,and What is the most time you use social
as exploring reasons of loneliness and moving to media?).
social life real-world scenarios.. In Relapse phase, Tool (II): Social Media Scale Student Form
the nurse helps him to identify the benefits of the (SMAS-SF):
recovery process, consequences of relapse, identify This scale designed by Sahin,(2018) in an English
potential relapse triggers and develop alternative language and translated by investigator into an
behaviors Shen, (2019). Arabic language to determine the levels of social
Aim of the study media addiction of [Link] consisted of 29
This study this study aimed to explore the relation items. The scale was divided into four domains:
between alexithymia and social media among virtual tolerance (5 items),virtual communication
nursing students. (9 items), virtual problem (9 items), and virtual
Research questions information (6 items).The scale was on a three-
Q1-What is the level of social media addiction point likert scale, ranging from agree (3), strongly
among students of Faculty of Nursing? agree, (2) somewhat agree, (1) disagree”
Q2-What is the alexithymia among students of All of the items in the scale are positive. Total
Faculty of Nursing? scale score ranged from 29-87. The higher scores
Q3- Is there relationship between social media indicate that agent perceives himself as a “social
addiction and alexithymia among students in media addict”.
Faculty of Nursing? Scoring system
Subject and methods  Score of 52 or less (<60%) mean no social
I. Technical Design media addiction.
Technical design for this study included research  Score from 53 to 56 (60-<65%) mean mild
design, research setting, research subject and tools social media addiction.
of data collection.
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Sohag Journal of Nursing Sciences Ahmed et al.,

 Score from 57 to 78 (65-<90%) mean moderate disagree ;4=Agree;5 = strongly agree) to be as the
social media addiction. following: 3-point Likert-type scale “(3) strongly
 Score of 79 to 87 (≥90%) indicate high social agree, (2) somewhat agree, (1) disagree”.
media addiction Sahin,(2018).
Researchers and experts in psychiatric nursing Field Work
made translation and back translation. The Arabic 1. The investigator presented herself to the students
version of the Social Media Scale Student Form who accepted to participate in this study and
was tested for content validity, revised by three satisfied the inclusion criteria.
psychiatric nursing experts. 2. Before collecting each student's date, the
investigator described the goal of the study.
Reliability of the Tools 3. Distributed the questionnaire and offered the tool
The tools' trustworthiness was assessed using to students to fill out, while the investigator was
Alpha Cronbach reliability analysis, which found there to clarify the instrument and ensure that all
that each tool was constructed from up of quite questions were answered.
comparable items, as shown by the moderate to 4. After receiving authorization from the Dean of
high reliability of each tool. the Faculty of Nursing at Benha University, data
Tools No. of Alpha Cronbach collecting began in early March 2022 and lasted
items until the end of May 2022. The pilot project lasted
two weeks.
Toronto 20 0.955
5. The investigator went to the chosen location
Alexithymia Scale
three times per week on Saturday, Sunday, and
Social media 29 0.897 Monday.
Pilot Study [Link] days were divided according to the study
Before starting of data collection pilot study was schedules for each of the four grades to collect data
conducted to test the applicability of the tools, the from the studied students :-
feasibility of tools and estimate the time for collecting  First grade on Saturday from 12 pm to 2 pm
the date needed for collecting the data. It was and Sunday from 2 pm to 3 pm for 4 weeks.
conducted on 10% of the total sample (35 students)  Second grade on Sunday from 9 am to 11 am
according to the selecting criteria. All students and Monday from 2 pm to 3 pm for 6weeks.
participated in the pilot study excluded from the  Third grade on Saturday from 9 am to 11am
actual study sample. and Monday from 12 pm to 1 pm for 3 weeks
Tool III: Toronto Alexithymia Scale (TAS):  Fourth grade on Sunday from 12 pm to 1 pm
It was developed by Bagby et al., (1994) in an to and Monday from 9 am to 11 am
English language and translated by investigator for7weeks.
into an Arabic language. used to measures 7. The examined students completed the study tools
difficulty in identifying and describing emotions, independently, and each student needed around 10-
which is a big part of used to evaluate emotion of 15 minutes to complete the study tools and review
students It consisted of 20-item, and 3 subscales: them to ensure their completeness in order to avoid
“Difficulty describing feeling: 5 item (2, 4, 11, 12. missing data. The average number of pupils
and 17), “Difficulty identity feeling: 7 item (1, 3, 6, questioned each day was between 9 and 10 per day.
7, 9, 13, and14); and “Externally oriented thinking, 8. After providing an explanation and comfort to
8 items (5, 8,10, 15,16,18,19, and 20)”. the researched nursing student, the investigator
Scoring system took special measures (wearing a mask, keeping a
 Scores equal to or less than 30 (≤60%) mean safe distance, and using alcohol) according to
no alexithymia. corona virus conditions.
 Scores of 31–40 (>60- 80%) mean possible
alexithymia. III. Administrative design
 Scores equal to or more than 41-50 (>80%) Administrative approval
mean alexithymia Bagby et al., (1994). An official permission letter was obtained from the
Content Validity of the tools dean of the Faculty of Nursing, Benha university to
Some modifications were done in tool (1) Social the vice dean for education and students affaires. A
Media Scale was modified were in the scoring full explanation about the aim of the study was
system from 5point likert type is used in this scale: explained to the administration personal of the
“(1) strongly disagree,(2)disagree ,(3)neither agree study setting to gain their cooperation during data
nor disagree ,(4)agree ,(5)strongly agree” to 3 point collection.
likert type is used in this scale: “(3) strongly agree, Ethical consideration:
(2) somewhat agree, (1) disagree” and also tool(2) The researcher was clarified objectives and the aim
Toronto Alexithymia Scale was modified were in the of the study to students. And all subjects were
scoring system from 5-point Likert-type scale (1 = informed that participation in the study is voluntary
strongly disagree; 2=Disagree ;3=neither agree nor and will assured anonymity and confidentiality of
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Sohag Journal of Nursing Sciences Ahmed et al.,

the subject data. Selected subjects were informed (54.5%) are female, 95.7%of them are single;
that the content of tools was used for research while, more than one third of them (36.4%) are
purpose only and they are allowed to choose to studied at fourth grade, furthermore, 91.5%of them
participate or not in the study and that they have have enough family income; also, more than half
the right to withdraw from the study at any time. of them (56.5%) are residing at rural area, more
than three quarters of their fathers (80.4%) are
IV. Statistical design work and 94.6% of them consider their family are
The collected data were organized, coded, stable.
computerized, tabulated, and analyzed by using Table (2) Show that more than half (54.3%) of the
Statistical Package for Social Science (SPSS) studied students has moderate virtual information
program (version 25). Data were presented using subscale. Moreover, more than half (54.3%&
descriptive statistics in the form of frequencies and 51.4%) of them have moderate levels of
percentage for categorical data: the arithmetic communication & information subscale of social
mean (X) and standard deviation (SD) for media addiction, respectively, while minority
quantitative data. While the qualitative variables (0.56%) of them have high level of tolerance
were compared using Chi Square test ( X2) which subscale of social media addiction.
used for relation tests and person correlation Figure (1) shows that majority of the studied
coefficient (r) was used for correlation analysis. students (48.6%) had a moderate level of social
The degree of significance was identified at: media addiction. While a minority of them (2.0%)
 Significant result when P-value ˂ 0.05. had high level of social media addiction.
 Highly significant result when .P-value ˂ 0.001. Figure (2) shows that more than half of the studied
 Non-significant result when P-value > 0.05. students (51.1%) have a possible alexithymia
41.2%have alexithymia , and the minority (7.7%)
Results have no alexithymia .
Table 1 Shows that, the studied students Mean ± Table (3) shows that, there is a highly statistically
SD age is 20.71 ± 1.21years old, less than three positive correlation between total score of social
quarters (71.1%) of the studied students aged media and total score of alexithymia at (p=<0.01)
from18-<23 years old , more than half of them

Results
Table 1 : Frequency distribution of personal characteristics of nursing students ( n-352).
Personal characteristics No. %
18-<23 years old 250 71.1
Age (years) 23-26 years old 102 28.9
Mean ± SD 20.71 ± 1.21
Male 160 45.5
Sex
Female 192 54.5
Single 337 95.7
Marital status
Married 15 4.3
First grade 64 18.2
Second grade 104 29.5
Educational grade
Third grade 56 15.9
Fourth grade 128 36.4
Enough 322 91.5
Family income
Not Enough 30 8.5
Rural 199 56.5
Residence
Urban 153 43.5
Mother
Work 106 30.1
Not work 246 69.9
Parents' working status
Father
Work 283 80.4
Not work 69 19.6
Yes 333 94.6
Do you consider your family is stable?
No 19 5.4

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Sohag Journal of Nursing Sciences Ahmed et al.,

Table 2: Frequency distribution of the studied students according to total social media addiction sub-
dimensions (n=352).
Total of social media addiction sub
dimensions No. % No. % No. % No. %
Virtual tolerance sub-dimension 160 45.5 11 3.12 179 50.8 2 0.56
Virtual communication sub-dimension 143 40.6 15 4.3 181 51.4 13 3.7
Virtual problem sub dimension 181 51.4 7 1.9 155 44.1 9 2.5
Virtual information sub dimensions 136 38.7 14 3.9 191 54.3 11 3.12

Figure (1) Percentage distribution of the studied students according to total level of social media (n=352).

50.00% 46.00% 48.60%

45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
3.40%
5.00%
0.00% 2.00%

NO
ADDICTION MILD
ADDICTION MODERATE
ADDICTION HIGH
ADDICTION

Figure (2) Percentage distribution of the Nursing students regarding alexithymia levels (n=352).

60.00%
50.00% 51.10%

40.00% 41.20%
30.00%
20.00%
10.00% 7.70%

0.00%

No alexithymia
Possible
alexithymia Alexithymia

No alexithymia Possible alexithymia Alexithymia

Series1 7.70% 51.10% 41.20%

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Sohag Journal of Nursing Sciences Ahmed et al.,

Table (3): Correlations matrix between total score of alexithymia and social media among the studied
students (n=352).
Total social media
Total alexithymia
Variables addiction
r P-value r P-value
Total alexithymia .342 .000** -- -
Total social media - - .342 .000**
(*) Statistically significant at p<0.05. (**) highly statistically significant at p<0.01

Discussion connection, transition to practise, and self care. As

Nursing is a profession that requires direct they prepare to enter the workforce, assist nursing
involvement with people, thus necessitating face-to- students in exploring topics such as delegating and
face communication. However, social media has supervising, adjusting to change, risk and quality
become increasingly popular among nursing management, and legal and ethical challenges. As a
students in recent years. It is obvious that idle time result of these factors, nursing students spend more
spent on social media will have a negative impact time on social media, leading to the risk of
on the nursing care provided. Excessive social addiction.
media use leads to behavioural addiction, These results were consistent with those of Zaw and
disconnection from real life, and worse academic Azenal, (2021), who did a research titled
accomplishment. People who are terrified of being "Association between Social Media Addiction and
without social media report feeling lonely when Mental Health Among International Islamic
they are not using it. Boluktas,(2022) and Xuan & University Malaysia (IIUM) Undergraduate Nursing
Amat, (2021). Students." Also, Fauzi et al.,(2021), who conducted
In regards to the total level of social media a study titled "Effect of social media addiction on
addiction subscales, this study found that more than academic performance among nursing students," and
half of the studied students had moderate levels of Ahmed,(2021), who conducted a study titled "Social
information and communication subscale of social media addiction and its relation to loneliness among
media addiction, while a minority of them had high adolescent" and mentioned that the majority of
levels of tolerance subscale of social media nursing students had moderately levels of social
addiction.. This result was consistent with the media addiction. It could be said that social media
findings of Bhandarkar et al., (2021), who plays a considerable role in their life as it brings
conducted a study titled "Impact of social media on addiction to them.
the academic success of undergraduate medical According to the total alexithymia subscales , more
students" and found that more than half of the than half of the studied students had possible
students studied had levels of the information & alexithymia related to difficulty identity feeling
communication subscale of social media addiction. subscale. Moreover, more than two fifths of them
Furthermore, it was shown that a minority of them had alexithymia related to difficulty identity feeling
exhibited a high level of tolerance subscale of social and difficulty describing feeling subscale, from the
media addiction. researcher’s point of view, this may be due to the
On the other hand, contradicted the findings of majority of studied students have difficulty identity
Filiz,(2022), who conducted a study titled feeling because alexithymia leads to a lack of
"Perceived Stress, Social Support, and the Use of emotions, inadequate emotional response, and a lack
Social Media in University Students During the of empathy causes communication disorders and
COVID-19 Pandemic" and discovered that the physiological distress in students, nursing focuses on
majority of students had a high virtual tolerance skills such as listening, understanding, respect,
level and almost two-thirds of them deployed virtual communication, and empathy. Good communication
communication. and empathy with the patient will improve the
Regarding to the total level of social media quality of nursing care. For this reason, the
addiction, this study revealed that, nearly half of the components of communication and the development
studied students had moderate level of social media of empathy skills in students are emphasized during
addiction and less than half of them had not social the nursing education process.
media addiction while, minority of them had mild These findings were consistent with the findings of
and high levels of social media addiction. As to the Salarian et al. (2019), who conducted a study titled
study, this might be because social media is defined "Predicting Social Adjustment in University
as a medium used by nursing students for a variety Students based on Alexithymia and Psychological
of official teaching and learning goals. Reflections Vulnerability" and reported that nearly half of the
can be facilitated by using blogging, Facebook, or students studied had alexithymia related to difficulty
YouTube as a teaching technique for issues such as identity feeling subscale. On the other hand, these
cultural competency, empathy, the therapeutic findings contradicted those of Mersin et al.,(2020),
who conducted a study titled "Social media usage
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Sohag Journal of Nursing Sciences Ahmed et al.,

and alexithymia in nursing students" and discovered For further researchers

that the majority of the students had a higher level of 1- Further research on social media addiction is
alexithymia in the difficulty identifying feeling and needed to fully understand how to prevent
difficulty describing feeling subscales. behavioral indications of addiction and
This study found a highly statistically significant problematic use among university students.
positive correlation between total level of social References
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