Resilience and its relation to Alexithymia and personality traits in Egyptian medical students: A Cross-Sectional Study

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Ata, Mennatullah Elagouz, Mariam H. Nabih, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5510628/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Mental health issues among medical students are increasingly prevalent. Resilience, the ability to positively adapt in the face of adversity, is crucial for reducing psychological distress and enhancing overall well-being. About half of students in Egypt have low resilience. Alexithymia, the difficulty in identifying and describing emotions, alongside personality traits, influences resilience. This study aims to assess the level of resilience in medical students at Mansoura University and to explore the effects of alexithymia and personality traits on resilience. Methods: A uni-centre descriptive cross-sectional study with an analytical component was conducted at the Faculty of Medicine, Mansoura University from December 2023 to May 2024. A sample of 598 students was selected using a convenience method. Our survey consisted of the Connor-Davidson Resilience Scale (CD-RISC-10), the Toronto Alexithymia Scale (TAS-20), and the NEO Five-Factor Inventory (NEO-FFI). IBM SPSS version 25 software was used for data analysis. Significance was set at p ≤ 0.05. Results: Almost half of the students showed low resilience (50.8%). Alexithymia was present in 25.3%. Significant associations were found between resilience and gender ( p = 0.003), academic program ( p < 0.05), and alexithymia ( p = 0). Multivariate analysis revealed that positive predictors of high resilience were high levels of extraversion [ AOR= 4; CI= 1.29 – 12.46; p = 0.02] and conscientiousness (AOR= 8.203; CI= 2.58 – 26.13; p = 0.00), while high neuroticism was a negative predictor of high resilience (AOR= 0.5; 95℅CI= 0.01– 0.22; p = 0.00). Conclusions: The majority of medical students exhibited low resilience, associated with higher levels of alexithymia and neuroticism and lower levels of extraversion and conscientiousness. Gender and the academic program also influenced resilience levels. Future research should examine the long-term relationship between resilience, alexithymia, and personality traits, and assess the effectiveness of resilience-building strategies. Strategies to enhance resilience and mental health programs are needed. Resilience Alexithymia Personality Traits Medical Students Psychological Well-being Figures Figure 1 Introduction Mental health problems among medical students are increasing [ 1 ]. Contributory factors to this include personal factors, such as lack of social support or stress-related and under-controlled personality traits [ 2 ], [ 3 ]. Mental health conditions negatively correlate with the self-efficacy of students affecting self and patient care in the future [ 4 ]. Resilience is the capacity to recover from adversity and exhibit favorable psychophysiological effects even in a high-stress setting [ 5 ]. Psychological resilience can greatly lessen academic burnout [ 3 ], psychological discomfort, and alexithymia [ 6 ]. Additionally, it is beneficial to people's mental health in general and undergraduate medical students specifically [ 7 ]. Interpersonal interactions, alexithymia, and stress from the job and training, can affect students' resilience [ 8 ], [ 9 ]. Regretfully, a recent multi-centric Egyptian study found that 49.9% of Egyptian students had low resilience [ 10 ]. Alexithymia, first used by Sifneos in 1973, describes the personality trait of inability to express emotions or physical feelings [ 11 ], [ 12 ]. Alexithymia coupled with low resilience is a significant risk factor for suicidal ideation and other psychiatric and medical problems [ 13 ], [ 14 ]. Evidence suggests that Medical students are more prone to alexithymia due to the nature of their studying and career [ 15 ], [ 16 ]. The personality traits are described using the Five-Factor Model [ 17 ]. This paradigm includes five major categories of personality which are: neuroticism (prone to vulnerability, self-doubt, angry hostility, and emotional instability), extraversion (seeks excitement, is sociable, and experiences positive emotions), openness (curious and has the will to try new experiences), agreeableness (selfless and sympathetic to others), and conscientiousness (diligent, success-oriented, well-organized and disciplined). Higher neuroticism scores have a positive association with depression in medical students [ 18 ] and have a negative correlation with resilience [ 19 ]. Extraverted personality traits play a protective role in mental health and lower rates of depression in medical students, with alexithymia and neurotic personality predictive of somatic and mental health symptoms [ 20 , 21 ]. Resilience shows a direct relation with the personality traits of extraversion, conscientiousness, openness and agreeableness, and an inverse relation with neuroticism. The predictor personality traits of resilience are extraversion, neuroticism, and openness [ 22 ]. The personality traits also influence the relationship between psychological distress and resilience [ 3 ]. To the best of our knowledge, we found little research on the relation between personality traits, alexithymia, and resilience in medical students. Thus this study aimed to assess the level of resilience and explore the effect of alexithymia and personality traits on resilience in medical students at Mansoura University. Methods Design Our cross-sectional study was descriptive with an analytical component conducted at the Faculty of Medicine at Mansoura University. Data was collected from December 2023 to May 2024. We calculated the required sample size with the OpenEpi online calculator [ 23 ] with a 50% anticipated proportion rate, a 95% confidence interval, and a 40% expected drop rate. The minimum required sample size was 524 and we collected complete questionnaires from 598 students with a 114℅ response rate. The sample consisted of students from the first year to intern and enrolled in the three programs of the faculty: Mansoura Manchester Program for Medical Education (MMPME), Integrated, and Conventional programs. Data were collected through a printed questionnaire that was distributed in lecture halls and clinical rounds. Participants were selected using a convenience sampling technique. Students who were not willing to participate and incomplete responses were excluded. Data collection tools Our survey consisted of three questionnaires and a section to collect socio-demographics of the students, including gender, nationality, age, academic year, faculty program, religion, and present, past, or family history of psychiatric disorders. The first questionnaire was the Connor Davidson Resilience scale (CD-RISC-10) [ 24 ], a 10-item 5-point scale ranging from 0 (never) to 4 (almost always). Higher scores reflect higher resilience. It evaluates an individual's capacity to withstand challenging situations such as changes, personal issues, illness, stress, failure, and emotional distress. The second questionnaire used was the Toronto Alexithymia scale (TAS-20) [ 25 ], a multidimensional self-report instrument designed to evaluate the extent of difficulty in recognizing and articulating emotions. It consists of 20 items rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree) and measures three factors: difficulty identifying feelings (DIF), difficulty describing feelings to others (DDF), and externally-oriented thinking (EOT). The third questionnaire was the Personality NEO Five-Factor Inventory test (NEO-FFI) [ 26 ], a 60-item assessment tool that provides a quick, reliable, and accurate measurement of the five major personality domains: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Statistical analysis IBM Statistical Package for Social Science (SPSS) software version 25 software was used for data entry and statistical analysis. Categorical data were summarized and described using numbers and percentages. Continuous data were summarized and described using mean and standard deviation (SD) as normal distribution was evident on normality plots. Categorical data were compared using the chi-square test. Continuous data were compared using independent t-test. Pearson’s correlation coefficient was used for the correlation between continuous variables. We calculated the crude odds ratio (COR) along with its corresponding 95% confidence interval. Adjusted logistic regression was used for predictors of high resilience. Results were considered statistically significant if the p value was less than or equal to 0.05. Ethical consideration The study protocol followed the latest version of the Declaration of Helsinki and was approved by the Institutional Research Board (IRB) at Faculty of Medicine, Mansoura University (R.23.11.2394). A written informed consent was obtained from participants at the beginning of the questionnaire and they were allowed to refuse to participate or proceed till the end of the questionnaire. We ensured voluntary participation, anonymity and confidentiality for all participants and the collected data were used for research purposes only. Results Study Characteristics Table 1 shows the baseline characteristics of our sample. A total of 598 students participated in the survey. The students’ age ranged from 16 to 26 years with a mean of 21.79 (2.27). Females represented the majority, 334 (55.9 %), while 264 (44.1%) were males. Most of the participants, 257 (43%), were in their clinical years and especially 4th year, 98 (16.4%). The integrated program represented most students, 343 (57.4 %), followed by the Manchester program, 201 (33.6℅). A total of 435 (72.7 %) were Egyptians and 163 (27.3℅) were foreigners with the majority from Syria, Palestine, Bahrain and Malaysia. 449 (75.1%) were from an urban residence, and 580 (97%) were single. Regarding history of psychiatric disorders, only 25 (4.2%) had a present history, 27 (4.5%) had a past history and 56 (9.4%) had a family history. Prevalence of resilience, alexithymia and personality traits The majority, 304 (50.8 %), had low resilience and 294 (49.2 %) had high resilience (Figure 1, Table 2). Resilience scores had a mean of 24.9 (5.8) (Table 2). A total of 151 (25.3 %) had alexithymia representing the minority, 176 (29.4 %) had possible alexithymia and 271 (45.3 %) did not have alexithymia representing the majority. Regarding NEO-FFI personality traits, most students had average and low scores in the five traits. Factors affecting resilience Table 3 shows the factors affecting resilience. We found a significant association between gender and resilience where 148 (56.1%) of males had high resilience and 188 (56.3 %) of females had low resilience ( p = 0.003). A total of 109 (54.2%) Manchester students and 31 (57.4%) of conventional students had high resilience, while most integrated students had low resilience 189 (55.1%) with significant results ( p < 0.05). Regarding the history of psychiatric disorders, present history was significantly associated with resilience ( p =0.01). The majority reported negative present history in high and low resilience 296 (51.6℅), 252 (48.4℅), respectively. Other factors didn't show significant results including age, academic year, academic year subgroups, nationality, residence, religion, marital status, past and family history of psychiatric disorders, p= 0.63, 0.65, 0.96, 0.1, 0.6, 0.58, 0.87, 0.06, 0.07, respectively. Alexithymia differed significantly between high and low resilience ( p = 0). 64.9% of students with alexithymia had low resilience, while 58.7% of students without alexithymia had high resilience. For NEO-FFI personality traits classes of T scores, there was a significant association between resilience and neuroticism, extraversion, agreeableness, and conscientiousness, p= 0, 0, 0.03, 0, respectively. Openness didn't show a significant difference between high and low resilience, p =0.79. Table 4 presents the results of correlation between numerical variables and resilience scores. There was a significant negative correlation between resilience and TAS scores ( r = -0.32, p= 0), and Neuroticism T scores ( r = -0.41, p= 0). There was significant positive correlation between resilience and Extraversion and Conscientiousness T scores ( r = 0.29, p = 0), ( r = 0.36, p= 0), respectively. Table 5 presents the results of logistic regression. In univariate analysis, significant variables associated with high resilience included males, MMPME students, high extraversion and conscientiousness personality T scores, (COR= 1.64; 95% CI 1.187 - 2.274), (COR= 1.45; 95% CI= 1.03 - 2.06), (COR= 9.43; 95% CI= 3.29 – 27.02), (COR= 11.81; 95% CI= 4.11 – 33.91), respectively. Other significant negative predictors of high resilience were high neuroticism personality scores (COR= 0.025; 95% CI= 0.01 – 0.10), present history of psychiatric disorders (COR= 0.364; 95% CI= 0.15 – 0.89), alexithymia (COR= 0.381; 95% CI= 0.25 – 0.58). In multivariate analysis, significant independent positive predictors of high resilience were determined in NEO personality traits as follows: high and average extraversion scores (AOR= 4; 95℅CI= 1.29 – 12.46), (AOR= 4.13; 95℅CI= 1.68 - 10.2), respectively, and high, average and low conscientiousness scores (AOR= 8.203; CI= 2.58 – 26.13), (AOR= 4,27; 95℅CI= 1.726 - 10.583), (AOR= 2.88; 95℅CI= 1.162 - 7.112), respectively (Table 5). Independent negative predictors of high resilience included high and average neuroticism scores(AOR= 0.5; 95℅CI= 0.01– 0.22), (AOR= 0.23; 95℅CI= 0.084 - 0.631), respectively, and average agreeableness scores, (AOR= 0.41; 95℅CI= 0.17 - 0.96) Discussion Our study found that almost half of our sample had low resilience. Previous research indicates that non-medical students generally have higher resilience compared to medical students, who often face greater psychological distress due to factors like lack of sleep, stress, and depression [ 27 – 30 ]. A study conducted on Egyptian medical students found also that the majority had low resilience which is in agreement with our study results [ 10 ]. Low Resilience in this study was due to stress, sleeping less than six hours, low academic achievements, low socioeconomic status and increased technology consumption more than two hours per day [ 10 ]. Our study highlighted that males had higher resilience compared to females. Females were found to be more vulnerable to stress and low resilience, possibly due to biological and emotional factors and differences in coping strategies and psychosocial factors [ 10 , 31 ]. We found that other factors such as age, academic year, nationality, religion and marital status did not show significant results. On the contrary, some studies noted a decrease in life satisfaction and resilience while upgrading in medical school [ 13 ]. We found resilience was significantly associated with the present history of psychiatric disorders. Students with a history of psychiatric disorders showed lower resilience, while a negative correlation was found between psychological well-being, resilience, and mindfulness [ 32 ]. In multiple studies, resilience negatively correlated with depression, anxiety, and somatization symptoms, demonstrating a dynamic relationship between resilience and psychological disorders like stress and depression [ 33 ]. MMPME students were more liable to high resilience than integrated program students. The program uses a problem solving based teaching method that trains the students to logical and critical thinking in small groups. This facilitates communication with medical staff and improves quality of learning, suggesting high prevalence of high achieving students. A study conducted in Malaysia concluded that high-achieving students were more motivated and adaptable to overcome obstacles [ 34 ]. Low-achieving students were less resilient with avoidant coping mechanisms. The MMPME also depends on extracurricular activities as a crucial method of learning. Extracurricular activities were positively correlated with resilience, emphasizing the importance of a balanced lifestyle [ 35 ]. Physical exercise and social relationships also enhanced resilience. Resilience had a negative association with alexithymia confirming the findings of other studies conducted in France, China and Italy with authors suggesting that students with alexithymic traits can benefit from resilience resources to overcome academic challenges [ 5 , 36 ] [ 6 , 37 ]. Resilience involves the application of proactive and adaptive coping techniques, dispositional optimism, and positive emotions, and indicate one's capacity to handle stress or adversity in life all of which are absent in people with alexithymia. Our work expands upon several previous studies that explored the relationship between alexithymia and resilience in general populations, depressive patients, and patients after kidney transplantation [ 9 , 36 , 38 ]. We found high and average neuroticism, and average agreeableness are negative predictors of high resilience. While high and average extraversion, conscientiousness positively predicts high resilience. Similarly, neuroticism was negatively associated with resilience in freshman Chinese nursing students [ 39 ] which aligns with our study outcomes. Another study suggests that personality significantly moderated the association between psychological distress and resilience[ 3 ]. Strengths, limitations, and recommendations Our study is the first to assess the relation between resilience and alexithymia and personality traits of medical students. It provides a good variety of data representing all the available academic years, genders, ages, nationalities and educational programmes inside Mansoura faculty of Medicine. Wide range of classification of continuous variables to detect the slightest changes provides more accuracy of assessment. However, our study had some limitations. The cross-sectional design collects data at one specific moment, which means it cannot establish a temporal relationship between resilience, alexithymia, personality traits, and related factors. These are dynamic processes that evolve over time due to various influences, but this design only offers a snapshot of these processes at a single point in time. We conducted our study in a single center which restricts generalisability of results. We did not assess other factors that can affect resilience such as emotional status, effect of daily habits, academic performance, economic status, health issues, familial relationship, peer relationship, and teacher-student relationship. Future longitudinal research should explore the long-term relationship between resilience, alexithymia, and personality traits in medical students to better understand how these factors evolve over time. Studies should also investigate the impact of additional factors such as emotional well-being, academic performance, socioeconomic status, and peer and familial relationships on resilience. Interventional studies focusing on resilience-building strategies, including emotional intelligence and stress management programs, could provide insights into effective approaches for enhancing resilience in medical students. Expanding research to include multi-center and cross-cultural studies would help generalize findings across different populations and educational systems. Conclusion We conclude that low resilience is most prevalent in Mansoura medical students. Gender differences show males with higher resilience, while the MMPME program students exhibit better resilience than those in the integrated program. Resilience is positively correlated with extraversion and conscientiousness and negatively correlated with neuroticism and alexithymia. Our results can help develop strategies to increase the resilience of medical students to qualify them as future healthcare providers. Additional improvements to the educational systems and mental health programs can also be provided. We encourage participation in extracurricular activities and implementation of stress management strategies to improve student well-being and resilience. Abbreviations SPSS Statistical Package for Social Science SD Standard Deviation COR Crude Odds Ratio AOR Adjusted Odds Ratio CI Confidence Interval CD-RISC Connor Davidson Resilience Scale TAS Toronto Alexithymia Scale DIF Difficulty identifying feelings DDF Difficulty describing feelings EOT Externally-oriented thinking NEO-FFI Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory Declarations Supplementary information Not applicable Acknowledgements We thank Mansoura Manchester Research Society (MMRS), a student non-profit research association, for providing this research opportunity and facilitating communication between authors and faculty professors. We also acknowledge its efforts in providing a research environment and research workshops and resources that helped authors a lot to conduct and publish this study. We acknowledge the contribution of Mohamed Elmekkawi, Rahma M. Almetwaly, Samaa T. Hassan, Nada E. Mokhtar, Omar Reisha, and Hesham Helmy in completing the process of data collection. Authors’ contributions I.M.A.I, H.A, K.A, M.H. contributed to conception and design. All authors contributed to the data collection process. H.A, A.H.A, M.E, M.H.N conducted statistical analysis. H.A prepared tables and figures. H.A, K.A, M.E, M.N, M.E.E wrote the manuscript. I.M.A.I supervised the work. H.A finalized and prepared the manuscript for submission. All authors revised and approved the final version of the manuscript. Funding There were no funding resources available; the study was self-funded. Availability of data and materials The data are available from the corresponding author upon request . Clinical trial number Not applicable Ethics approval and consent to participate The study protocol followed the latest version of the Declaration of Helsinki and was approved by the Institutional Research Board (IRB) at Faculty of Medicine, Mansoura University (R.23.11.2394). 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Tables Table 1: Baseline characteristics Students’ characteristics The studied group (n= 598) Age (years) Mean ± SD Min-Max 21.79 ± 2.27 16-26 Sex Male Female 264 (44.1 %) 334 (55.9 %) Academic Year Academic years 1st year 2nd year Clinical years 3rd year 4th year 5th year Interns 155 (25.9 %) 72 (12 %) 83 (13.9 %) 257 (43 %) 74 (12.4 %) 98 (16.4 %) 85 (14.2 %) 186 (31.1 %) Program Integrated Conventional MMPME 343 (57.4 %) 54 (9 %) 201 (33.6 %) Nationality Egyptian Non-Egyptians Britain Bahrain India Jordan Kuwait Malaysia Iraq Palestine Saudi Arabia Saudan Syria Yemen Singapore Somalia Other 435 (72.7 %) 163 (27.3 %) 1 (0.2 %) 23 (3.8 %) 1 (0.2 %) 9 (1.5 %) 1 (0.2 %) 21 (3.5 %) 1 (0.2 %) 26 (4.3 %) 8 (1.3 %) 19 (3.2 %) 27 (4.5 %) 7 (1.2 %) 1 (0.2 %) 3 (0.5 %) 15 (2.5 %) Residence Urban Rural Other 449 (75.1 %) 142 (23.7 %) 7 (1.2 %) Marital status Single Engaged Married 580 (97 %) 12 (2 %) 6 (1 %) The present history of Psychiatric disorders Past history of Psychiatric disorders Family history of Psychiatric disorders Yes Uncertain No Yes Uncertain No Yes Uncertain No 25 (4.2 ℅) 52 (8.7 ℅) 521 (87.1 ℅) 27 (4.5 ℅) 51 (8.5 ℅) 520 (87 %) 56 (9.4 %) 470 (78.6 %) 72 (12 %) MMPME: Mansoura Manchester Program for Medical Education Data are presented as numbers and % calculated by column Table 2: Mean scores for the questionnaires used in the study The studied group (n= 598) CD-RISC score /40 Mean ± SD 24.9 ± 5.8 Resilience class High (>25.5/40) Low (<25.5/40) 294 (49.2 %) 304 (50.8 %) TAS total score DDF DIF EOT Mean ± SD Mean ± SD Mean ± SD Mean ± SD 53.1 ± 10.8 14.27 ± 4.21 18.1 ± 5.92 20.7 ± 4.46 Alexithymia classes Alexithymia Possible Alexithymia No Alexithymia 151 (25.3 %) 176 (29.4 %) 271 (45.3 %) NEO-FFI classes Neuroticism T scores Extraversion T scores Openness T scores Agreeableness T scores Conscientiousness T scores Very high High Average Low Very low Very high High Average Low Very low Very high High Average Low Very low Very high High Average Low Very low Very high High Average Low Very low 0 41 (6.9 %) 265 (44.3 %) 260 (43.5 %) 32 (5.4 %) 0 39 (6.5 %) 272 (45.5 %) 247 (41.3 %) 40 (6.7 %) 3 (0.5 %) 40 (6.7 %) 273 (45.7 %) 246 (41.1 %) 36 (6 %) 0 41 (6.9 %) 247 (41.3 %) 276 (46.2 %) 34 (5.7 %) 0 44 (7.4 %) 271 (45.3 %) 245 (41 %) 38 (6.4 %) CD-RISC: Connor Davidson Resilience Scale; TAS: Toronto Alexithymia Scale; DIF: Difficulty identifying feelings; DDF: Difficulty describing feelings; EOT: Externally-oriented thinking; NEO-FFI: Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory Data are presented as number and % calculated by column Table 3: Factors Affecting Resilience Students’ characteristics High resilience ( n=294 ) Low resilience ( n=304 ) P value Age (years) Mean ± SD 21.83 ± 2.27 21.75 ± 2.27 0.63 Sex Male Female 148 (56.1 %) 146 (43.7 %) 116 (43.9 %) 188 (56.3 %) 0.003* Academic years Clinical years Interns 1st year 2nd year 3rd year 4th year 5th year 75 (48.4 %) 32 (44.4 %) 43 (51.8 %) 128 (49.8 %) 32 (43.2 %) 54 (55.1 %) 42 (49.4 %) 91 (48.9 %) 80 (51.6 %) 40 (55.6 %) 40 (48.2 %) 129 (50.2 %) 42 (56.8 %) 44 (44.9 %) 43 (50.6 %) 95 (51.1 %) 0.96 0.65 Program Integrated Conventional MMPME 154 (44.9 %) 31 (57.4 %) 109 (54.2 %) 189 (55.1 %) 23 (42.6 %) 92 (45.8 %) 0.05* Nationality Egyptians Non-Egyptians 205 (47.1 %) 89 (54.6 %) 230 (52.9 %) 74 (45.4 %) 0.1 Residence Urban Rural Other 225 (50.1 %) 65 (45.8 %) 4 (57.1 %) 224 (49.9 %) 77 (54.2 %) 3 (42.9 %) 0.6 Marital status Single Engaged Married 286 (49.3 %) 5 (41.7 %) 3 (50 %) 294 (50.7 %) 7 (58.3 %) 3 (50 %) 0.87 Present history of psychiatric disorders Yes Uncertain No 7 (28 ℅) 18 (34.6 ℅) 269 (51.6 ℅) 18 (72℅) 34 (65.4 ℅) 252 (48.4 ℅) 0.01* Past history Yes Uncertain No 13 (48.1 ℅) 17 (33.3 ℅) 264 (50.8 ℅) 14 (51.9 ℅) 34 (66.7 ℅) 256 (49.2 ℅) 0.06 Family hx Yes Uncertain No 20(35.7℅) 34(47.2℅) 240(51.1℅) 36(64.3℅) 38(52.8℅) 230(48.9℅) 0.09 TAS total score DDF DIF EOT Mean ± SD Mean ± SD Mean ± SD Mean ± SD 50.44 ± 10.86 13.6 ± 4.35 16.68 ± 5.9 20.17 ± 4.28 55.66 ± 10.14 14.92 ± 3.97 19.49 ± 5.61 21.25 ± 4.57 0* 0* 0* 0.003* Alexithymia class Alexithymia Possible No Alexithymia 53 (35.1 %) 82 (46.6 %) 159 (58.7 %) 98 (64.9 %) 94 (53.4 %) 112 (41.3 %) 0* NEO-FFI Neuroticism T scores Extraversion T scores Openness T scores Agreeableness T scores Conscientiousness T scores Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD 46.37 ± 9.22 52.68 ± 9.02 50.19 ± 9.69 50.84 ± 10.31 52.70 ± 9.67 53.51 ± 9.47 47.41 ± 10.23 49.81 ± 10.3 49.19 ± 9.64 47.39 ± 9.63 0* 0* 0.643 0.04* 0* NEO-FFI classes Neuroticism T scores Very high High Average Low Very low 0 4 (9.8 %) 102 (38.5 %) 162 (62.3 %) 26 (81.3 %) 0 37 (90.2 %) 163 (61.5 %) 98 (37.7 %) 6 (18.8 %) 0* Extraversion T scores Very high High Average Low Very low 0 26 (66.7 %) 164 (60.3 %) 97 (39.3 %) 7 (17.5 %) 0 13 (33.3 %) 108 (39.7 %) 150 (60.7 %) 33 (82.5 %) 0.79 Openness T scores Very high High Average Low Very low 1 (33.3 %) 21 (52.5 %) 140 (51.3 %) 116 (47.2 %) 16 (44.4 %) 2 (66.7 %) 19 (47.5 %) 133 (48.7 %) 130 (52.8 %) 20 (55.6 %) 0.03* Agreeableness T scores Very high High Average Low Very low 0 28 (68.3 %) 124 (50.2 %) 123 (44.6 %) 19 (55.9 %) 0 13 (31.7%) 123 (49.8 %) 153 (55.4 %) 15 (44.1 %) 0* Conscientiousness T scores Very high High Average Low Very low 0 32 (72.7 %) 156 (57.6 %) 99 (40.4 %) 7 (18.4 %) 0 12 (27.3 %) 115 (42.4 %) 146 (59.6 %) 31 (81.6 %) 0* *Significant MMPME: Mansoura Manchester Program for Medical Education; TAS: Toronto Alexithymia Scale; DIF: Difficulty identifying feelings; DDF: Difficulty describing feelings; EOT: Externally-oriented thinking; NEO-FFI: Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory Table 4: Correlation between continuous variables and resilience scores Students’ characteristics CD-RISC scores Age (years) Correlation coefficient p value 0.013 0.758 TAS sum scores DDF DIF EOT Correlation coefficient p value Correlation coefficient p value Correlation coefficient p value Correlation coefficient p value -0.32 0* -0.19 0* -0.19 0* -0.2 0* NEO-FFI personality traits Neuroticism T scores Extraversion T scores Openness T scores Agreeableness T scores Conscientiousness T scores Correlation coefficient p value Correlation coefficient p value Correlation coefficient p value Correlation coefficient p value Correlation coefficient p value -0.41 0* 0.29 0* 0.02 0.58 0.08 0.06 0.364 0* *Significant CD-RISC: Connor Davidson Resilience Scale; TAS: Toronto Alexithymia Scale; DIF: Difficulty identifying feelings; DDF: Difficulty describing feelings; EOT: Externally-oriented thinking; NEO-FFI: Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory Table 5: Logistic regression, predictors of high resilience Students’ characteristics COR (95% CI) p value AOR (95% CI) p value Male Female 1.64 (1.187 - 2.274) Reference 0.00* 1.151 (.770 - 1.722) Reference 0.49 MMPME Conventional Integrated 1.45 (1.03 - 2.06) 1.65 (0.93 – 2.95) Reference 0.04* 0.09 1.436 (.953 - 2.165) 1.742 (.890 - 3.413) Reference 0.08 0.11 Present history Yes Uncertain No 0.364 (.150 - .887) 0.496 (.273 - .901) Reference 0.03* 0.02* 0.377 (.138 - 1.031) 0.628 (.317 - 1.246) Reference 0.57 0.18 TAS Alexithymia Possible No Alexithymia 0.381 (0.25 – 0.58) 0.614 (0.42 – 0.90) Reference 0.00* 0.01* 0.736 (0.451 - 1.202) 0.887 (0.574 - 1.370) Reference 0.59 0.22 Neuroticism High Average Low Very low 0.025 (0.01 – 0.10) 0.114 (0.06 – 0.36) 0.381 (0.15 – 0.96) Reference 0.00* 0.00* 0.04* 0.051 (0.012 - 0.220) 0.230 (0.084 - 0.631) 0.497 (0.184 - 1.341) Reference 0.00* 0.00* 0.17 Extraversion High Average Low Very low 9.43 (3.29 – 27.02) 7.16 (3.06 – 16.77) 3.05 (1.297 – 7.17) Reference 0.00* 0.00* 0.01* 4.003 (1.286 - 12.463) 4.133 (1.675 - 10.200) 2.201 (.894 - 5.416) Reference 0.02* 0.00* 0.09 Agreeableness High Average Low Very low 1.700 (0.662 - 4.370) 0.796 (0.387 - 1.637) 0.635 (0.310 - 1.300) Reference 0.27 0.54 0.21 0.685 (.225 - 2.079) 0.407 (0.172 - .963) 0.439 (0.190 - 1.015) Reference 0.5 0.04* 0.054 Conscientiousness High Average Low Very low 11.810 (4.112 - 33.914) 6.007 (2.555 - 14.123) 3.003 (1.272 - 7.089) Reference 0.00* 0.00* 0.01* 8.203 (2.576 - 26.126) 4.274 (1.726 - 10.583) 2.875 (1.162 - 7.112) Reference 0.00* 0.00* 0.02* *Significant COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; MMPME: Mansoura Manchester program for Medical Education Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5510628","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":405851235,"identity":"e2ca41c9-ae23-4bde-a797-7184e076d272","order_by":0,"name":"Hajer Azzam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACAwaGBCiT+eADIMnDR4IWtmQDkBY2IrTAAI+ZBFgnIS3m7AcePq6oqbPnn3bArPJrjp0MGwPzw0c38Gix7ElINjxzjI1Z4nZC2m3ZbclAh7EZG+fgc9iBhDTJBjagwtsJx25LbmMGsnjYpPFqOf8g/WfDPwke+duJbcWS2+qJ0HIjIY2xsc1AwuB2Mhvjx22HidHyIFmysS/BwPB2GrM047bjPGzMhPxyPifxY8O3Onu52/kfP/7cVm3Pz9788DE+LcDoSIAzmXnAJF7lIMB+AM5k/EFQ9SgYBaNgFIxEAABpL0ZGk8mO4gAAAABJRU5ErkJggg==","orcid":"","institution":"Integrated Program, Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia, Egypt","correspondingAuthor":true,"prefix":"","firstName":"Hajer","middleName":"","lastName":"Azzam","suffix":""},{"id":405851236,"identity":"4b7b0992-b4bf-4005-b24a-aca9fc3b8f9c","order_by":1,"name":"Kariem Awad","email":"","orcid":"","institution":"Manchester Program, Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Kariem","middleName":"","lastName":"Awad","suffix":""},{"id":405851237,"identity":"01ce9cbe-4541-4a19-a7bb-bbbbb5d1d1b5","order_by":2,"name":"Ahmed H. Ata","email":"","orcid":"","institution":"Manchester Program, Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"H.","lastName":"Ata","suffix":""},{"id":405851238,"identity":"ff1fb73b-8445-48e2-87b9-29ad52308b9b","order_by":3,"name":"Mennatullah Elagouz","email":"","orcid":"","institution":"Integrated Program, Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Mennatullah","middleName":"","lastName":"Elagouz","suffix":""},{"id":405851239,"identity":"d3dda84d-262c-47ef-ba37-12c9397d95ee","order_by":4,"name":"Mariam H. Nabih","email":"","orcid":"","institution":"Integrated Program, Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Mariam","middleName":"H.","lastName":"Nabih","suffix":""},{"id":405851241,"identity":"7a1ec748-a160-420c-8e8e-63b8dc49bb20","order_by":5,"name":"Mahmoud E. ElKaffas","email":"","orcid":"","institution":"Manchester Program, Faculty of Medicine, Mansoura University, Mansoura City, Dakahlia, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"E.","lastName":"ElKaffas","suffix":""},{"id":405851243,"identity":"1f1bd209-647e-426b-9dea-7c64b0a2a4da","order_by":6,"name":"Mohamed Hafiz","email":"","orcid":"","institution":"AZ Zurayqi health unit, El Senbellawein City, Dakahlia, Ministry of Health, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Hafiz","suffix":""},{"id":405851244,"identity":"8644b67a-3a2f-4d89-adb3-961d4e2d4438","order_by":7,"name":"Ibtihal M.A. Ibrahim","email":"","orcid":"","institution":"Psychiatry department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Ibtihal","middleName":"M.A.","lastName":"Ibrahim","suffix":""}],"badges":[],"createdAt":"2024-11-23 15:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5510628/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5510628/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75285811,"identity":"fd84d038-8564-49d6-a9e4-e122d3d5f622","added_by":"auto","created_at":"2025-02-03 04:28:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19381,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of high and low resilience among Mansoura medical students\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5510628/v1/6d7f9a7f4c8dedfe1b9366c9.png"},{"id":75286020,"identity":"8b38814d-8211-4996-962c-dcb801b0ee96","added_by":"auto","created_at":"2025-02-03 04:36:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1139634,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5510628/v1/83712c43-d49a-4ac4-9149-36731a86ff46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Resilience and its relation to Alexithymia and personality traits in Egyptian medical students: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health problems among medical students are increasing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Contributory factors to this include personal factors, such as lack of social support or stress-related and under-controlled personality traits [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Mental health conditions negatively correlate with the self-efficacy of students affecting self and patient care in the future [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResilience is the capacity to recover from adversity and exhibit favorable psychophysiological effects even in a high-stress setting [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Psychological resilience can greatly lessen academic burnout [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], psychological discomfort, and alexithymia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, it is beneficial to people's mental health in general and undergraduate medical students specifically [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Interpersonal interactions, alexithymia, and stress from the job and training, can affect students' resilience [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Regretfully, a recent multi-centric Egyptian study found that 49.9% of Egyptian students had low resilience [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlexithymia, first used by Sifneos in 1973, describes the personality trait of inability to express emotions or physical feelings [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Alexithymia coupled with low resilience is a significant risk factor for suicidal ideation and other psychiatric and medical problems [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Evidence suggests that Medical students are more prone to alexithymia due to the nature of their studying and career [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe personality traits are described using the Five-Factor Model [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This paradigm includes five major categories of personality which are: neuroticism (prone to vulnerability, self-doubt, angry hostility, and emotional instability), extraversion (seeks excitement, is sociable, and experiences positive emotions), openness (curious and has the will to try new experiences), agreeableness (selfless and sympathetic to others), and conscientiousness (diligent, success-oriented, well-organized and disciplined).\u003c/p\u003e \u003cp\u003eHigher neuroticism scores have a positive association with depression in medical students [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and have a negative correlation with resilience [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Extraverted personality traits play a protective role in mental health and lower rates of depression in medical students, with alexithymia and neurotic personality predictive of somatic and mental health symptoms [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Resilience shows a direct relation with the personality traits of extraversion, conscientiousness, openness and agreeableness, and an inverse relation with neuroticism. The predictor personality traits of resilience are extraversion, neuroticism, and openness [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The personality traits also influence the relationship between psychological distress and resilience [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, we found little research on the relation between personality traits, alexithymia, and resilience in medical students. Thus this study aimed to assess the level of resilience and explore the effect of alexithymia and personality traits on resilience in medical students at Mansoura University.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eOur cross-sectional study was descriptive with an analytical component conducted at the Faculty of Medicine at Mansoura University. Data was collected from December 2023 to May 2024. We calculated the required sample size with the OpenEpi online calculator [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] with a 50% anticipated proportion rate, a 95% confidence interval, and a 40% expected drop rate. The minimum required sample size was 524 and we collected complete questionnaires from 598 students with a 114℅ response rate. The sample consisted of students from the first year to intern and enrolled in the three programs of the faculty: Mansoura Manchester Program for Medical Education (MMPME), Integrated, and Conventional programs. Data were collected through a printed questionnaire that was distributed in lecture halls and clinical rounds. Participants were selected using a convenience sampling technique. Students who were not willing to participate and incomplete responses were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eOur survey consisted of three questionnaires and a section to collect socio-demographics of the students, including gender, nationality, age, academic year, faculty program, religion, and present, past, or family history of psychiatric disorders. The first questionnaire was the Connor Davidson Resilience scale (CD-RISC-10) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], a 10-item 5-point scale ranging from 0 (never) to 4 (almost always). Higher scores reflect higher resilience. It evaluates an individual's capacity to withstand challenging situations such as changes, personal issues, illness, stress, failure, and emotional distress. The second questionnaire used was the Toronto Alexithymia scale (TAS-20) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], a multidimensional self-report instrument designed to evaluate the extent of difficulty in recognizing and articulating emotions. It consists of 20 items rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree) and measures three factors: difficulty identifying feelings (DIF), difficulty describing feelings to others (DDF), and externally-oriented thinking (EOT). The third questionnaire was the Personality NEO Five-Factor Inventory test (NEO-FFI) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], a 60-item assessment tool that provides a quick, reliable, and accurate measurement of the five major personality domains: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIBM Statistical Package for Social Science (SPSS) software version 25 software was used for data entry and statistical analysis. Categorical data were summarized and described using numbers and percentages. Continuous data were summarized and described using mean and standard deviation (SD) as normal distribution was evident on normality plots. Categorical data were compared using the chi-square test. Continuous data were compared using independent t-test. Pearson\u0026rsquo;s correlation coefficient was used for the correlation between continuous variables. We calculated the crude odds ratio (COR) along with its corresponding 95% confidence interval. Adjusted logistic regression was used for predictors of high resilience. Results were considered statistically significant if the \u003cem\u003ep\u003c/em\u003e value was less than or equal to 0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003e The study protocol followed the latest version of the Declaration of Helsinki and was approved by the Institutional Research Board (IRB) at Faculty of Medicine, Mansoura University (R.23.11.2394). A written informed consent was obtained from participants at the beginning of the questionnaire and they were allowed to refuse to participate or proceed till the end of the questionnaire. We ensured voluntary participation, anonymity and confidentiality for all participants and the collected data were used for research purposes only.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows the baseline characteristics of our sample. A total of 598 students participated in the survey. The students’ age ranged from 16 to 26 years with a mean of 21.79 (2.27). Females represented the majority, 334 (55.9 %), while 264 (44.1%) were males. Most of the participants, 257 (43%), were in their clinical years and especially 4th year, 98 (16.4%). The integrated program represented most students, 343 (57.4 %), followed by the Manchester program, 201 (33.6℅). A total of 435 (72.7 %) were Egyptians and 163 (27.3℅) were foreigners with the majority from Syria, Palestine, Bahrain and Malaysia. 449 (75.1%) were from an urban residence, and 580 (97%) were single. Regarding history of psychiatric disorders, only 25 (4.2%) had a present history, 27 (4.5%) had a past history and 56 (9.4%) had a family history. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of resilience, alexithymia and personality traits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority, 304 (50.8 %), had low resilience and 294 (49.2 %) had high resilience (Figure 1, Table 2). Resilience scores had a mean of 24.9 (5.8) (Table 2). A total of 151 (25.3 %) had alexithymia representing the minority, 176 (29.4 %) had possible alexithymia and 271 (45.3 %) did not have alexithymia representing the majority. Regarding NEO-FFI personality traits, most students had average and low scores in the five traits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors affecting resilience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 shows the factors affecting resilience. We found a significant association between gender and resilience where 148 (56.1%) of males had high resilience and 188 (56.3 %) of females had low resilience (\u003cem\u003ep\u003c/em\u003e = 0.003). A total of 109 (54.2%) Manchester students and 31 (57.4%) of conventional students had high resilience, while most integrated students had low resilience 189 (55.1%) \u0026nbsp;with significant results (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). Regarding the history of psychiatric disorders, present history was significantly associated with resilience (\u003cem\u003ep\u003c/em\u003e=0.01). The majority reported negative present history in high and low resilience 296 (51.6℅), 252 (48.4℅), respectively. Other factors didn't show significant results including age, academic year, academic year subgroups, nationality, residence, religion, marital status, past and family history of psychiatric disorders, \u003cem\u003ep=\u003c/em\u003e0.63, 0.65, 0.96, 0.1, 0.6, 0.58, 0.87, 0.06, 0.07, respectively. Alexithymia differed significantly between high and low resilience (\u003cem\u003ep\u003c/em\u003e = 0). 64.9% of students with alexithymia had low resilience, while 58.7% of students without alexithymia had high resilience. For NEO-FFI personality traits classes of T scores, there was a significant association between resilience and neuroticism, extraversion, agreeableness, and conscientiousness, \u003cem\u003ep=\u003c/em\u003e0, 0, 0.03, 0, respectively. Openness didn't show a significant difference between high and low resilience, \u003cem\u003ep\u003c/em\u003e=0.79.\u003c/p\u003e\n\u003cp\u003eTable 4 presents the results of correlation between numerical variables and resilience scores. There was a significant negative correlation between resilience and TAS scores (\u003cem\u003er\u003c/em\u003e = -0.32, \u003cem\u003ep=\u0026nbsp;\u003c/em\u003e0), and Neuroticism T scores (\u003cem\u003er\u003c/em\u003e = -0.41, \u003cem\u003ep=\u003c/em\u003e0). There was significant positive correlation between resilience and Extraversion and Conscientiousness T scores (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= 0.29, \u0026nbsp;\u003cem\u003ep =\u0026nbsp;\u003c/em\u003e0), (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= 0.36, \u003cem\u003ep=\u003c/em\u003e0), respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 presents the results of logistic regression. In univariate analysis, significant variables associated with high resilience included males, MMPME students, high extraversion and conscientiousness personality T scores, (COR= 1.64; 95% CI 1.187 - 2.274), (COR= 1.45; 95% CI= 1.03 - 2.06), (COR= 9.43; 95% CI= 3.29 – 27.02), (COR= 11.81; 95% CI= 4.11 – 33.91), respectively. Other significant negative predictors of high resilience were high neuroticism personality scores (COR= 0.025; 95% CI= 0.01 – 0.10), present \u0026nbsp; history of psychiatric disorders (COR= 0.364; 95% CI= 0.15 – 0.89), \u0026nbsp;alexithymia (COR= 0.381; 95% CI= 0.25 – 0.58).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn multivariate analysis, significant independent positive predictors of high resilience were determined in NEO personality traits as follows: high and average extraversion scores (AOR= 4; 95℅CI= 1.29 – 12.46), (AOR= 4.13; 95℅CI= 1.68 - 10.2), respectively, and high, average and low conscientiousness scores (AOR= 8.203; CI= 2.58 – 26.13), (AOR= 4,27; 95℅CI= 1.726 - 10.583), (AOR= 2.88; 95℅CI= 1.162 - 7.112), respectively (Table 5). Independent negative predictors of high resilience included high and average neuroticism scores(AOR= 0.5; 95℅CI= 0.01– 0.22), (AOR= 0.23; 95℅CI= 0.084 - 0.631), respectively, and average agreeableness scores, (AOR= 0.41; 95℅CI= 0.17 - 0.96)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study found that almost half of our sample had low resilience. Previous research indicates that non-medical students generally have higher resilience compared to medical students, who often face greater psychological distress due to factors like lack of sleep, stress, and depression [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A study conducted on Egyptian medical students found also that the majority had low resilience which is in agreement with our study results [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Low Resilience in this study was due to stress, sleeping less than six hours, low academic achievements, low socioeconomic status and increased technology consumption more than two hours per day [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study highlighted that males had higher resilience compared to females. Females were found to be more vulnerable to stress and low resilience, possibly due to biological and emotional factors and differences in coping strategies and psychosocial factors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe found that other factors such as age, academic year, nationality, religion and marital status did not show significant results. On the contrary, some studies noted a decrease in life satisfaction and resilience while upgrading in medical school [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe found resilience was significantly associated with the present history of psychiatric disorders. Students with a history of psychiatric disorders showed lower resilience, while a negative correlation was found between psychological well-being, resilience, and mindfulness [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In multiple studies, resilience negatively correlated with depression, anxiety, and somatization symptoms, demonstrating a dynamic relationship between resilience and psychological disorders like stress and depression [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMMPME students were more liable to high resilience than integrated program students. The program uses a problem solving based teaching method that trains the students to logical and critical thinking in small groups. This facilitates communication with medical staff and improves quality of learning, suggesting high prevalence of high achieving students. A study conducted in Malaysia concluded that high-achieving students were more motivated and adaptable to overcome obstacles [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Low-achieving students were less resilient with avoidant coping mechanisms. The MMPME also depends on extracurricular activities as a crucial method of learning. Extracurricular activities were positively correlated with resilience, emphasizing the importance of a balanced lifestyle [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Physical exercise and social relationships also enhanced resilience.\u003c/p\u003e \u003cp\u003eResilience had a negative association with alexithymia confirming the findings of other studies conducted in France, China and Italy with authors suggesting that students with alexithymic traits can benefit from resilience resources to overcome academic challenges [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Resilience involves the application of proactive and adaptive coping techniques, dispositional optimism, and positive emotions, and indicate one's capacity to handle stress or adversity in life all of which are absent in people with alexithymia. Our work expands upon several previous studies that explored the relationship between alexithymia and resilience in general populations, depressive patients, and patients after kidney transplantation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe found high and average neuroticism, and average agreeableness are negative predictors of high resilience. While high and average extraversion, conscientiousness positively predicts high resilience. Similarly, neuroticism was negatively associated with resilience in freshman Chinese nursing students [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] which aligns with our study outcomes. Another study suggests that personality significantly moderated the association between psychological distress and resilience[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrengths, limitations, and recommendations\u003c/h2\u003e \u003cp\u003eOur study is the first to assess the relation between resilience and alexithymia and personality traits of medical students. It provides a good variety of data representing all the available academic years, genders, ages, nationalities and educational programmes inside Mansoura faculty of Medicine. Wide range of classification of continuous variables to detect the slightest changes provides more accuracy of assessment.\u003c/p\u003e \u003cp\u003eHowever, our study had some limitations. The cross-sectional design collects data at one specific moment, which means it cannot establish a temporal relationship between resilience, alexithymia, personality traits, and related factors. These are dynamic processes that evolve over time due to various influences, but this design only offers a snapshot of these processes at a single point in time. We conducted our study in a single center which restricts generalisability of results. We did not assess other factors that can affect resilience such as emotional status, effect of daily habits, academic performance, economic status, health issues, familial relationship, peer relationship, and teacher-student relationship.\u003c/p\u003e \u003cp\u003eFuture longitudinal research should explore the long-term relationship between resilience, alexithymia, and personality traits in medical students to better understand how these factors evolve over time. Studies should also investigate the impact of additional factors such as emotional well-being, academic performance, socioeconomic status, and peer and familial relationships on resilience. Interventional studies focusing on resilience-building strategies, including emotional intelligence and stress management programs, could provide insights into effective approaches for enhancing resilience in medical students. Expanding research to include multi-center and cross-cultural studies would help generalize findings across different populations and educational systems.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe conclude that low resilience is most prevalent in Mansoura medical students. Gender differences show males with higher resilience, while the MMPME program students exhibit better resilience than those in the integrated program. Resilience is positively correlated with extraversion and conscientiousness and negatively correlated with neuroticism and alexithymia. Our results can help develop strategies to increase the resilience of medical students to qualify them as future healthcare providers. Additional improvements to the educational systems and mental health programs can also be provided. We encourage participation in extracurricular activities and implementation of stress management strategies to improve student well-being and resilience.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Science\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCD-RISC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConnor Davidson Resilience Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eToronto Alexithymia Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDIF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDifficulty identifying feelings\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDDF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDifficulty describing feelings\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEOT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExternally-oriented thinking\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNEO-FFI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch4\u003e\u003cstrong\u003eSupplementary information\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eWe thank Mansoura Manchester Research Society (MMRS), a student non-profit research association, for providing this research opportunity and facilitating communication between authors and faculty professors. We also acknowledge its efforts in providing a research environment and research workshops and resources that helped authors a lot to conduct and publish this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contribution of Mohamed Elmekkawi, Rahma M. Almetwaly, Samaa T. Hassan, Nada E. Mokhtar, \u0026nbsp; \u0026nbsp; Omar Reisha, and Hesham Helmy in completing the process of data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.M.A.I, H.A, K.A, M.H. contributed to conception and design. All authors contributed to the data collection process. H.A, A.H.A, M.E, M.H.N conducted statistical analysis. H.A prepared tables and figures. H.A, K.A, M.E, M.N, M.E.E wrote the manuscript. I.M.A.I supervised the work. H.A finalized and prepared the manuscript for submission. All authors revised and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no funding resources available; the study was self-funded.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe data are available from the corresponding author upon request .\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe study protocol followed the latest version of the Declaration of Helsinki and was approved by the Institutional Research Board (IRB) at Faculty of Medicine, Mansoura University (R.23.11.2394). A written informed consent was obtained from participants at the beginning of the questionnaire and they were allowed to refuse to participate or proceed till the end of the questionnaire. We ensured voluntary participation, anonymity and confidentiality for all participants and the collected data were used for research purposes only.\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe authors reported no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZeng W, Chen R, Wang X, Zhang Q, Deng W. Prevalence of mental health problems among medical students in China: A meta-analysis. 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Association between Alexithymia and Depression among King Khalid University Medical Students: An Analytical Cross-Sectional Study. Healthcare (Basel) 2022;10. https://doi.org/10.3390/healthcare10091703.\u003c/li\u003e\n \u003cli\u003eHamaideh SH. Alexithymia among Jordanian university students: Its prevalence and correlates with depression, anxiety, stress, and demographics. Perspect Psychiatr Care 2018;54:274\u0026ndash;80. https://doi.org/10.1111/ppc.12234.\u003c/li\u003e\n \u003cli\u003eHemming L, Taylor P, Haddock G, Shaw J, Pratt D. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord 2019;254:34\u0026ndash;48. https://doi.org/10.1016/j.jad.2019.05.013.\u003c/li\u003e\n \u003cli\u003eAljaffer MA, Almadani AH, Alghamdi SA, Alabdulkarim IM, Albabtain MA, Altameem RM, et al. Prevalence and associated factors of alexithymia among medical students: A cross-sectional study from Saudi Arabia. Neurosciences (Riyadh) 2022;27:257\u0026ndash;62. https://doi.org/10.17712/nsj.2022.4.20220049.\u003c/li\u003e\n \u003cli\u003eAlzahrani SH, Coumaravelou S, Mahmoud I, Beshawri J, Algethami M. Prevalence of alexithymia and associated factors among medical students at King Abdulaziz University: a cross-sectional study. Ann Saudi Med 2020;40:55\u0026ndash;62. https://doi.org/10.5144/0256-4947.2020.55.\u003c/li\u003e\n \u003cli\u003eCosta PT, McCrae RR. The Five-Factor Model of Personality and Its Relevance to Personality Disorders. J Pers Disord 1992;6:343\u0026ndash;59. https://doi.org/10.1521/pedi.1992.6.4.343.\u003c/li\u003e\n \u003cli\u003ePitanupong J, Sa-I A, Sathaporn K, Jiraphan A, Ittasakul P, Karawekpanyawong N. The personality traits with depression and suicidal ideation among Thai medical students: a university-based multiregional study. BMC Psychol 2024;12:223. https://doi.org/10.1186/s40359-024-01707-8.\u003c/li\u003e\n \u003cli\u003eOshio A, Taku K, Hirano M, Saeed G. Resilience and Big Five personality traits: A meta-analysis. Pers Individ Dif 2018;127:54\u0026ndash;60. https://doi.org/10.1016/j.paid.2018.01.048.\u003c/li\u003e\n \u003cli\u003eKlinger-K\u0026ouml;nig J, Hertel J, Terock J, V\u0026ouml;lzke H, Van der Auwera S, Grabe HJ. Predicting physical and mental health symptoms: Additive and interactive effects of difficulty identifying feelings, neuroticism and extraversion. J Psychosom Res 2018;115:14\u0026ndash;23. https://doi.org/10.1016/j.jpsychores.2018.10.003.\u003c/li\u003e\n \u003cli\u003eSfeir E, El Othman R, Barakat M, Hallit S, Obeid S. Personality Traits and Mental Health among Lebanese Medical Students: The Mediating Role of Emotional Intelligence. Healthcare (Basel) 2022;10. https://doi.org/10.3390/healthcare10122516.\u003c/li\u003e\n \u003cli\u003eNieto M, Visier ME, Silvestre IN, Navarro B, Serrano JP, Mart\u0026iacute;nez-Vizca\u0026iacute;no V. Relation between resilience and personality traits: The role of hopelessness and age. Scand J Psychol 2023;64:53\u0026ndash;9. https://doi.org/10.1111/sjop.12866.\u003c/li\u003e\n \u003cli\u003eOpenEpi:Sample Size for X-Sectional,Cohort,and Clinical Trials n.d. https://www.openepi.com/SampleSize/SSCohort.htm (accessed September 11, 2024).\u003c/li\u003e\n \u003cli\u003eVaishnavi S, Connor K, Davidson JRT. An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials. Psychiatry Res 2007;152:293\u0026ndash;7. https://doi.org/10.1016/j.psychres.2007.01.006.\u003c/li\u003e\n \u003cli\u003eBagby RM, Taylor GJ, Parker JD. The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity. J Psychosom Res 1994;38:33\u0026ndash;40. https://doi.org/10.1016/0022-3999(94)90006-x.\u003c/li\u003e\n \u003cli\u003eMcCrae RR, Costa PT. Updating Norman\u0026rsquo;s \u0026ldquo;Adequate Taxonomy\u0026rdquo;: intelligence and personality dimensions in natural language and in questionnaires. J Pers Soc Psychol 1985;49:710\u0026ndash;21.\u003c/li\u003e\n \u003cli\u003eAl Omari O, Al Yahyaei A, Wynaden D, Damra J, Aljezawi M, Al Qaderi M, et al. Correlates of resilience among university students in Oman: a cross-sectional study. BMC Psychol 2023;11:2. https://doi.org/10.1186/s40359-022-01035-9.\u003c/li\u003e\n \u003cli\u003eKim SM, Kim HR, Min KJ, Yoo S-K, Shin Y-C, Kim E-J, et al. Resilience as a Protective Factor for Suicidal Ideation among Korean Workers. Psychiatry Investig 2020;17:147\u0026ndash;56. https://doi.org/10.30773/pi.2019.0072.\u003c/li\u003e\n \u003cli\u003eSeo EH, Yang H-J, Kim S-G, Yoon H-J. Ego-resiliency moderates the risk of depression and social anxiety symptoms on suicidal ideation in medical students. Ann Gen Psychiatry 2022;21:19. https://doi.org/10.1186/s12991-022-00399-x.\u003c/li\u003e\n \u003cli\u003eHan J, Wong I, Christensen H, Batterham PJ. Resilience to suicidal behavior in young adults: a cross-sectional study. Sci Rep 2022;12:11419. https://doi.org/10.1038/s41598-022-15468-0.\u003c/li\u003e\n \u003cli\u003eAlc\u0026aacute;ntara C, Molina KM, Kawachi I. Transnational, social, and neighborhood ties and smoking among Latino immigrants: does gender matter? Am J Public Health 2015;105:741\u0026ndash;9. https://doi.org/10.2105/AJPH.2014.301964.\u003c/li\u003e\n \u003cli\u003eChoi D, Minote N, Sekiya T, Watanuki S. Relationships between Trait Empathy and Psychological Well-Being in Japanese University Students. PSYCH 2016;07:1240\u0026ndash;7. https://doi.org/10.4236/psych.2016.79126.\u003c/li\u003e\n \u003cli\u003eRan L, Wang W, Ai M, Kong Y, Chen J, Kuang L. Psychological resilience, depression, anxiety, and somatization symptoms in response to COVID-19: A study of the general population in China at the peak of its epidemic. Soc Sci Med 2020;262:113261. https://doi.org/10.1016/j.socscimed.2020.113261.\u003c/li\u003e\n \u003cli\u003eFoong CC, Bashir Ghouse NL, Lye AJ, Pallath V, Hong W-H, Vadivelu J. Differences between high- and low-achieving pre-clinical medical students: a qualitative instrumental case study from a theory of action perspective. Ann Med 2022;54:195\u0026ndash;210. https://doi.org/10.1080/07853890.2021.1967440.\u003c/li\u003e\n \u003cli\u003eOrsolini L, Latini R, Pompili M, Serafini G, Volpe U, Vellante F, et al. Understanding the Complex of Suicide in Depression: from Research to Clinics. Psychiatry Investig 2020;17:207\u0026ndash;21. https://doi.org/10.30773/pi.2019.0171.\u003c/li\u003e\n \u003cli\u003eDe Berardis D, Fornaro M, Valchera A, Rapini G, Di Natale S, De Lauretis I, et al. Alexithymia, resilience, somatic sensations and their relationships with suicide ideation in drug na\u0026iuml;ve patients with first-episode major depression: An exploratory study in the \u0026ldquo;real world\u0026rdquo; everyday clinical practice. Early Interv Psychiatry 2020;14:336\u0026ndash;42. https://doi.org/10.1111/eip.12863.\u003c/li\u003e\n \u003cli\u003eRomano L, Buonomo I, Callea A, Fiorilli C. Alexithymia in Young people\u0026rsquo;s academic career: The mediating role of anxiety and resilience. J Genet Psychol 2019;180:157\u0026ndash;69. https://doi.org/10.1080/00221325.2019.1620675.\u003c/li\u003e\n \u003cli\u003eTomaszek A, Wr\u0026oacute;blewska A, Zdankiewicz-Ścigała E, Rzońca P, Gałązkowski R, Gozdowska J, et al. Post-Traumatic Growth among Patients after Living and Cadaveric Donor Kidney Transplantation: The Role of Resilience and Alexithymia. Int J Environ Res Public Health 2021;18. https://doi.org/10.3390/ijerph18042164.\u003c/li\u003e\n \u003cli\u003eMei X, Wang H, Wang X, Wu X, Wu J, Ye Z. Associations among neuroticism, self-efficacy, resilience and psychological distress in freshman nursing students: a cross-sectional study in China. BMJ Open 2022;12:e059704. https://doi.org/10.1136/bmjopen-2021-059704.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eBaseline characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"480\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe studied group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 598)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMin-Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e21.79 \u0026plusmn; 2.27\u003c/p\u003e\n \u003cp\u003e16-26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e264 (44.1 %)\u003c/p\u003e\n \u003cp\u003e334 (55.9 %)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eAcademic Year\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eAcademic years\u003c/p\u003e\n \u003cp\u003e1st year\u003c/p\u003e\n \u003cp\u003e2nd year\u003c/p\u003e\n \u003cp\u003eClinical years\u003c/p\u003e\n \u003cp\u003e3rd year\u003c/p\u003e\n \u003cp\u003e4th year\u003c/p\u003e\n \u003cp\u003e5th year\u003c/p\u003e\n \u003cp\u003eInterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e155 (25.9 %)\u003c/p\u003e\n \u003cp\u003e72 (12 %)\u003c/p\u003e\n \u003cp\u003e83 (13.9 %)\u003c/p\u003e\n \u003cp\u003e257 (43 %)\u003c/p\u003e\n \u003cp\u003e74 (12.4 %)\u003c/p\u003e\n \u003cp\u003e98 (16.4 %)\u003c/p\u003e\n \u003cp\u003e85 (14.2 %)\u003c/p\u003e\n \u003cp\u003e186 (31.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eProgram\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eIntegrated\u003c/p\u003e\n \u003cp\u003eConventional\u003c/p\u003e\n \u003cp\u003eMMPME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e343 (57.4 %)\u003c/p\u003e\n \u003cp\u003e54 (9 %)\u003c/p\u003e\n \u003cp\u003e201 (33.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eNationality\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eEgyptian\u003c/p\u003e\n \u003cp\u003eNon-Egyptians\u003c/p\u003e\n \u003cp\u003eBritain\u003c/p\u003e\n \u003cp\u003eBahrain\u003c/p\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003cp\u003eJordan\u003c/p\u003e\n \u003cp\u003eKuwait\u003c/p\u003e\n \u003cp\u003eMalaysia\u003c/p\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003cp\u003ePalestine\u003c/p\u003e\n \u003cp\u003eSaudi Arabia\u003c/p\u003e\n \u003cp\u003eSaudan\u003c/p\u003e\n \u003cp\u003eSyria\u003c/p\u003e\n \u003cp\u003eYemen\u003c/p\u003e\n \u003cp\u003eSingapore\u003c/p\u003e\n \u003cp\u003eSomalia\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e435 (72.7 %)\u003c/p\u003e\n \u003cp\u003e163 (27.3 %)\u003c/p\u003e\n \u003cp\u003e1 (0.2 %)\u003c/p\u003e\n \u003cp\u003e23 (3.8 %)\u003c/p\u003e\n \u003cp\u003e1 (0.2 %)\u003c/p\u003e\n \u003cp\u003e9 (1.5 %)\u003c/p\u003e\n \u003cp\u003e1 (0.2 %)\u003c/p\u003e\n \u003cp\u003e21 (3.5 %)\u003c/p\u003e\n \u003cp\u003e1 (0.2 %)\u003c/p\u003e\n \u003cp\u003e26 (4.3 %)\u003c/p\u003e\n \u003cp\u003e8 (1.3 %)\u003c/p\u003e\n \u003cp\u003e19 (3.2 %)\u003c/p\u003e\n \u003cp\u003e27 (4.5 %)\u003c/p\u003e\n \u003cp\u003e7 (1.2 %)\u003c/p\u003e\n \u003cp\u003e1 (0.2 %)\u003c/p\u003e\n \u003cp\u003e3 (0.5 %)\u003c/p\u003e\n \u003cp\u003e15 (2.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e449 (75.1 %)\u003c/p\u003e\n \u003cp\u003e142 (23.7 %)\u003c/p\u003e\n \u003cp\u003e7 (1.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEngaged\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e580 (97 %)\u003c/p\u003e\n \u003cp\u003e12 (2 %)\u003c/p\u003e\n \u003cp\u003e6 (1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eThe present history of Psychiatric disorders\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePast history of Psychiatric disorders\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFamily history of Psychiatric disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e25 (4.2 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52 (8.7 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e521 (87.1 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (4.5 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51 (8.5 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e520 (87 %)\u003c/p\u003e\n \u003cp\u003e56 (9.4 %)\u003c/p\u003e\n \u003cp\u003e470 (78.6 %)\u003c/p\u003e\n \u003cp\u003e72 (12 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eMMPME: Mansoura Manchester Program for Medical Education\u003c/p\u003e\n \u003cp\u003eData are presented as numbers and % calculated by column\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eMean scores for the questionnaires used in the study\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe studied group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 598)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCD-RISC \u0026nbsp;score /40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e24.9 \u0026plusmn; 5.8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eResilience class\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eHigh (\u0026gt;25.5/40)\u003c/p\u003e\n \u003cp\u003eLow (\u0026lt;25.5/40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e294 (49.2 %)\u003c/p\u003e\n \u003cp\u003e304 (50.8 %)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eTAS total score\u003c/p\u003e\n \u003cp\u003eDDF\u003c/p\u003e\n \u003cp\u003eDIF\u003c/p\u003e\n \u003cp\u003eEOT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e53.1 \u0026plusmn; 10.8\u003c/p\u003e\n \u003cp\u003e14.27 \u0026plusmn; 4.21\u003c/p\u003e\n \u003cp\u003e18.1 \u0026plusmn; 5.92\u003c/p\u003e\n \u003cp\u003e20.7 \u0026plusmn; 4.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eAlexithymia classes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eAlexithymia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePossible Alexithymia\u003c/p\u003e\n \u003cp\u003eNo Alexithymia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e151 (25.3 %)\u003c/p\u003e\n \u003cp\u003e176 (29.4 %)\u003c/p\u003e\n \u003cp\u003e271 (45.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eNEO-FFI classes\u003c/p\u003e\n \u003cp\u003eNeuroticism T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eExtraversion T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOpenness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAgreeableness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eConscientiousness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e41 (6.9 %)\u003c/p\u003e\n \u003cp\u003e265 (44.3 %)\u003c/p\u003e\n \u003cp\u003e260 (43.5 %)\u003c/p\u003e\n \u003cp\u003e32 (5.4 %)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e39 (6.5 %)\u003c/p\u003e\n \u003cp\u003e272 (45.5 %)\u003c/p\u003e\n \u003cp\u003e247 (41.3 %)\u003c/p\u003e\n \u003cp\u003e40 (6.7 %)\u003c/p\u003e\n \u003cp\u003e3 (0.5 %)\u003c/p\u003e\n \u003cp\u003e40 (6.7 %)\u003c/p\u003e\n \u003cp\u003e273 (45.7 %)\u003c/p\u003e\n \u003cp\u003e246 (41.1 %)\u003c/p\u003e\n \u003cp\u003e36 (6 %)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e41 (6.9 %)\u003c/p\u003e\n \u003cp\u003e247 (41.3 %)\u003c/p\u003e\n \u003cp\u003e276 (46.2 %)\u003c/p\u003e\n \u003cp\u003e34 (5.7 %)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e44 (7.4 %)\u003c/p\u003e\n \u003cp\u003e271 (45.3 %)\u003c/p\u003e\n \u003cp\u003e245 (41 %)\u003c/p\u003e\n \u003cp\u003e38 (6.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u0026nbsp;CD-RISC: Connor Davidson Resilience Scale; TAS: Toronto Alexithymia Scale; DIF: Difficulty identifying feelings; DDF: Difficulty describing feelings; EOT: Externally-oriented thinking; NEO-FFI: Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory\u003c/p\u003e\n \u003cp\u003eData are presented as number and % calculated by column\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eFactors Affecting Resilience\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 294px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh resilience\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e( n=294 )\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow resilience\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e( n=304 )\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e21.83 \u0026plusmn; 2.27\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e21.75 \u0026plusmn; 2.27\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e148 (56.1 %)\u003c/p\u003e\n \u003cp\u003e146 (43.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e116 (43.9 %)\u003c/p\u003e\n \u003cp\u003e188 (56.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eAcademic years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eClinical years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eInterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1st year\u003c/p\u003e\n \u003cp\u003e2nd year\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3rd year\u003c/p\u003e\n \u003cp\u003e4th year\u003c/p\u003e\n \u003cp\u003e5th year\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e75 (48.4 %)\u003c/p\u003e\n \u003cp\u003e32 (44.4 %)\u003c/p\u003e\n \u003cp\u003e43 (51.8 %)\u003c/p\u003e\n \u003cp\u003e128 (49.8 %)\u003c/p\u003e\n \u003cp\u003e32 (43.2 %)\u003c/p\u003e\n \u003cp\u003e54 (55.1 %)\u003c/p\u003e\n \u003cp\u003e42 (49.4 %)\u003c/p\u003e\n \u003cp\u003e91 (48.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e80 (51.6 %)\u003c/p\u003e\n \u003cp\u003e40 (55.6 %)\u003c/p\u003e\n \u003cp\u003e40 (48.2 %)\u003c/p\u003e\n \u003cp\u003e129 (50.2 %)\u003c/p\u003e\n \u003cp\u003e42 (56.8 %)\u003c/p\u003e\n \u003cp\u003e44 (44.9 %)\u003c/p\u003e\n \u003cp\u003e43 (50.6 %)\u003c/p\u003e\n \u003cp\u003e95 (51.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eProgram\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eIntegrated\u003c/p\u003e\n \u003cp\u003eConventional\u003c/p\u003e\n \u003cp\u003eMMPME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e154 (44.9 %)\u003c/p\u003e\n \u003cp\u003e31 (57.4 %)\u003c/p\u003e\n \u003cp\u003e109 (54.2 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e189 (55.1 %)\u003c/p\u003e\n \u003cp\u003e23 (42.6 %)\u003c/p\u003e\n \u003cp\u003e92 (45.8 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.05*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eNationality\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eEgyptians\u003c/p\u003e\n \u003cp\u003eNon-Egyptians\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e205 (47.1 %)\u003c/p\u003e\n \u003cp\u003e89 (54.6 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e230 (52.9 %)\u003c/p\u003e\n \u003cp\u003e74 (45.4 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e225 (50.1 %)\u003c/p\u003e\n \u003cp\u003e65 (45.8 %)\u003c/p\u003e\n \u003cp\u003e4 (57.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e224 (49.9 %)\u003c/p\u003e\n \u003cp\u003e77 (54.2 %)\u003c/p\u003e\n \u003cp\u003e3 (42.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEngaged\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e286 (49.3 %)\u003c/p\u003e\n \u003cp\u003e5 (41.7 %)\u003c/p\u003e\n \u003cp\u003e3 (50 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e294 (50.7 %)\u003c/p\u003e\n \u003cp\u003e7 (58.3 %)\u003c/p\u003e\n \u003cp\u003e3 (50 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003ePresent history of psychiatric disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e7 (28 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (34.6 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e269 (51.6 ℅)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e18 (72℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (65.4 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e252 (48.4 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003ePast history\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e13 (48.1 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (33.3 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e264 (50.8 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e14 (51.9 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (66.7 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e256 (49.2 ℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eFamily hx\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e20(35.7℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34(47.2℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e240(51.1℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e36(64.3℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38(52.8℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e230(48.9℅)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eTAS total score\u003c/p\u003e\n \u003cp\u003eDDF\u003c/p\u003e\n \u003cp\u003eDIF\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e50.44 \u0026plusmn; 10.86\u003c/p\u003e\n \u003cp\u003e13.6 \u0026plusmn; 4.35\u003c/p\u003e\n \u003cp\u003e16.68 \u0026plusmn; 5.9\u003c/p\u003e\n \u003cp\u003e20.17 \u0026plusmn; 4.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e55.66 \u0026plusmn; 10.14\u003c/p\u003e\n \u003cp\u003e14.92 \u0026plusmn; 3.97\u003c/p\u003e\n \u003cp\u003e19.49 \u0026plusmn; 5.61\u003c/p\u003e\n \u003cp\u003e21.25 \u0026plusmn; 4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eAlexithymia class\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAlexithymia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePossible\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo Alexithymia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e53 (35.1 %)\u003c/p\u003e\n \u003cp\u003e82 (46.6 %)\u003c/p\u003e\n \u003cp\u003e159 (58.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e98 (64.9 %)\u003c/p\u003e\n \u003cp\u003e94 (53.4 %)\u003c/p\u003e\n \u003cp\u003e112 (41.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eNEO-FFI\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNeuroticism T scores\u003c/p\u003e\n \u003cp\u003eExtraversion T scores\u003c/p\u003e\n \u003cp\u003eOpenness T scores\u003c/p\u003e\n \u003cp\u003eAgreeableness T scores\u003c/p\u003e\n \u003cp\u003eConscientiousness T scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46.37 \u0026plusmn; 9.22\u003c/p\u003e\n \u003cp\u003e52.68 \u0026plusmn; 9.02\u003c/p\u003e\n \u003cp\u003e50.19 \u0026plusmn; 9.69\u003c/p\u003e\n \u003cp\u003e50.84 \u0026plusmn; 10.31\u003c/p\u003e\n \u003cp\u003e52.70 \u0026plusmn; 9.67\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53.51 \u0026plusmn; 9.47\u003c/p\u003e\n \u003cp\u003e47.41 \u0026plusmn; 10.23\u003c/p\u003e\n \u003cp\u003e49.81 \u0026plusmn; 10.3\u003c/p\u003e\n \u003cp\u003e49.19 \u0026plusmn; 9.64\u003c/p\u003e\n \u003cp\u003e47.39 \u0026plusmn; 9.63\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eNEO-FFI classes\u003c/p\u003e\n \u003cp\u003eNeuroticism\u0026nbsp;T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e4 (9.8 %)\u003c/p\u003e\n \u003cp\u003e102 (38.5 %)\u003c/p\u003e\n \u003cp\u003e162 (62.3 %)\u003c/p\u003e\n \u003cp\u003e26 (81.3 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e37 (90.2 %)\u003c/p\u003e\n \u003cp\u003e163 (61.5 %)\u003c/p\u003e\n \u003cp\u003e98 (37.7 %)\u003c/p\u003e\n \u003cp\u003e6 (18.8 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp; \u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eExtraversion T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e26 (66.7 %)\u003c/p\u003e\n \u003cp\u003e164 (60.3 %)\u003c/p\u003e\n \u003cp\u003e97 (39.3 %)\u003c/p\u003e\n \u003cp\u003e7 (17.5 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e13 (33.3 %)\u003c/p\u003e\n \u003cp\u003e108 (39.7 %)\u003c/p\u003e\n \u003cp\u003e150 (60.7 %)\u003c/p\u003e\n \u003cp\u003e33 (82.5 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eOpenness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e1 (33.3 %)\u003c/p\u003e\n \u003cp\u003e21 (52.5 %)\u003c/p\u003e\n \u003cp\u003e140 (51.3 %)\u003c/p\u003e\n \u003cp\u003e116 (47.2 %)\u003c/p\u003e\n \u003cp\u003e16 (44.4 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e2 (66.7 %)\u003c/p\u003e\n \u003cp\u003e19 (47.5 %)\u003c/p\u003e\n \u003cp\u003e133 (48.7 %)\u003c/p\u003e\n \u003cp\u003e130 (52.8 %)\u003c/p\u003e\n \u003cp\u003e20 (55.6 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eAgreeableness T scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e28 (68.3 %)\u003c/p\u003e\n \u003cp\u003e124 (50.2 %)\u003c/p\u003e\n \u003cp\u003e123 (44.6 %)\u003c/p\u003e\n \u003cp\u003e19 (55.9 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e13 (31.7%)\u003c/p\u003e\n \u003cp\u003e123 (49.8 %)\u003c/p\u003e\n \u003cp\u003e153 (55.4 %)\u003c/p\u003e\n \u003cp\u003e15 (44.1 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eConscientiousness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eVery high\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e32 (72.7 %)\u003c/p\u003e\n \u003cp\u003e156 (57.6 %)\u003c/p\u003e\n \u003cp\u003e99 (40.4 %)\u003c/p\u003e\n \u003cp\u003e7 (18.4 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e12 (27.3 %)\u003c/p\u003e\n \u003cp\u003e115 (42.4 %)\u003c/p\u003e\n \u003cp\u003e146 (59.6 %)\u003c/p\u003e\n \u003cp\u003e31 (81.6 %)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 625px;\"\u003e\n \u003cp\u003e*Significant\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMMPME: Mansoura Manchester Program for Medical Education; TAS: Toronto Alexithymia Scale; DIF: Difficulty identifying feelings; DDF: Difficulty describing feelings; EOT: Externally-oriented thinking; NEO-FFI: Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eCorrelation between continuous variables and resilience scores\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eStudents\u0026rsquo; characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 271px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eCD-RISC scores\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 271px;\"\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eTAS sum scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDDF\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDIF\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 271px;\"\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.32\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e-0.19\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e-0.19\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e-0.2\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eNEO-FFI personality traits\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNeuroticism T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eExtraversion T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOpenness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAgreeableness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eConscientiousness T scores\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 271px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003cp\u003eCorrelation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-0.41\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003cp\u003e0*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 587px;\"\u003e\n \u003cp\u003e*Significant\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCD-RISC: Connor Davidson Resilience Scale; TAS: Toronto Alexithymia Scale; DIF: Difficulty identifying feelings; DDF: Difficulty describing feelings; EOT: Externally-oriented thinking; NEO-FFI: Neuroticism (N), Extraversion (E), Openness (O), Five-Factor Inventory\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eLogistic regression, predictors of high resilience\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1.64 (1.187 - 2.274)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00* \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e1.151 (.770 - 1.722)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eMMPME\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eConventional\u003c/p\u003e\n \u003cp\u003eIntegrated\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1.45 (1.03 - 2.06)\u003c/p\u003e\n \u003cp\u003e1.65 (0.93 \u0026ndash; 2.95)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e1.436 (.953 - 2.165)\u003c/p\u003e\n \u003cp\u003e1.742 (.890 - 3.413)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent history\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e0.364 (.150 - .887)\u003c/p\u003e\n \u003cp\u003e0.496 (.273 - .901)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e0.377 (.138 - 1.031)\u003c/p\u003e\n \u003cp\u003e0.628 (.317 - 1.246)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAlexithymia\u003c/p\u003e\n \u003cp\u003ePossible\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo Alexithymia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.381 (0.25 \u0026ndash; 0.58)\u003c/p\u003e\n \u003cp\u003e0.614 (0.42 \u0026ndash; 0.90)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.736 (0.451 - 1.202)\u003c/p\u003e\n \u003cp\u003e0.887 (0.574 - 1.370)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeuroticism\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.025 (0.01 \u0026ndash; 0.10)\u003c/p\u003e\n \u003cp\u003e0.114 (0.06 \u0026ndash; 0.36)\u003c/p\u003e\n \u003cp\u003e0.381 (0.15 \u0026ndash; 0.96)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e0.051 (0.012 - 0.220)\u003c/p\u003e\n \u003cp\u003e0.230 (0.084 - 0.631)\u003c/p\u003e\n \u003cp\u003e0.497 (0.184 - 1.341)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtraversion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery low\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e9.43 (3.29 \u0026ndash; 27.02)\u003c/p\u003e\n \u003cp\u003e7.16 (3.06 \u0026ndash; 16.77)\u003c/p\u003e\n \u003cp\u003e3.05 (1.297 \u0026ndash; 7.17)\u003c/p\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.003 (1.286 - 12.463)\u003c/p\u003e\n \u003cp\u003e4.133 (1.675 - 10.200)\u003c/p\u003e\n \u003cp\u003e2.201 (.894 - 5.416)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAgreeableness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eAverage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.700 (0.662 - 4.370)\u003c/p\u003e\n \u003cp\u003e0.796 (0.387 - 1.637)\u003c/p\u003e\n \u003cp\u003e0.635 (0.310 - 1.300)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.685 (.225 - 2.079)\u003c/p\u003e\n \u003cp\u003e0.407 (0.172 - .963)\u003c/p\u003e\n \u003cp\u003e0.439 (0.190 - 1.015)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConscientiousness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;High\u003c/p\u003e\n \u003cp\u003eAverage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e11.810 (4.112 - 33.914)\u003c/p\u003e\n \u003cp\u003e6.007 (2.555 - 14.123)\u003c/p\u003e\n \u003cp\u003e3.003 (1.272 - 7.089)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8.203 (2.576 - 26.126)\u003c/p\u003e\n \u003cp\u003e4.274 (1.726 - 10.583)\u003c/p\u003e\n \u003cp\u003e2.875 (1.162 - 7.112)\u003c/p\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003e*Significant\u003c/p\u003e\n \u003cp\u003eCOR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; MMPME: Mansoura Manchester program for Medical Education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Resilience, Alexithymia, Personality Traits, Medical Students, Psychological Well-being","lastPublishedDoi":"10.21203/rs.3.rs-5510628/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5510628/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Mental health issues among medical students are increasingly prevalent. Resilience, the ability to positively adapt in the face of adversity, is crucial for reducing psychological distress and enhancing overall well-being. About half of students in Egypt have low resilience. Alexithymia, the difficulty in identifying and describing emotions, alongside personality traits, influences resilience. This study aims to assess the level of resilience in medical students at Mansoura University and to explore the effects of alexithymia and personality traits on resilience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A uni-centre descriptive cross-sectional study with an analytical component was conducted at the Faculty of Medicine, Mansoura University from December 2023 to May 2024. A sample of 598 students was selected using a convenience method. Our survey consisted of the Connor-Davidson Resilience Scale (CD-RISC-10), the Toronto Alexithymia Scale (TAS-20), and the NEO Five-Factor Inventory (NEO-FFI). IBM SPSS version 25 software was used for data analysis. Significance was set at \u003cem\u003ep\u003c/em\u003e≤ 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Almost half of the students showed low resilience (50.8%). Alexithymia was present in 25.3%. Significant associations were found between resilience and gender (\u003cem\u003ep\u003c/em\u003e = 0.003), academic program (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05), and alexithymia (\u003cem\u003ep\u003c/em\u003e = 0). Multivariate analysis revealed that positive predictors of high resilience were high levels of extraversion [ AOR= 4; CI= 1.29 – 12.46; \u003cem\u003ep\u003c/em\u003e= 0.02] and conscientiousness (AOR= 8.203; CI= 2.58 – 26.13; \u003cem\u003ep\u003c/em\u003e= 0.00), while high neuroticism was a negative predictor of high resilience (AOR= 0.5; 95℅CI= 0.01– 0.22; \u003cem\u003ep\u003c/em\u003e= 0.00).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The majority of medical students exhibited low resilience, associated with higher levels of alexithymia and neuroticism and lower levels of extraversion and conscientiousness. Gender and the academic program also influenced resilience levels. Future research should examine the long-term relationship between resilience, alexithymia, and personality traits, and assess the effectiveness of resilience-building strategies. Strategies to enhance resilience and mental health programs are needed.\u003c/p\u003e","manuscriptTitle":"Resilience and its relation to Alexithymia and personality traits in Egyptian medical students: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-03 04:20:19","doi":"10.21203/rs.3.rs-5510628/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7f2093f-d8d3-4931-8191-ccd7401e0b4f","owner":[],"postedDate":"February 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T04:20:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-03 04:20:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5510628","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5510628","identity":"rs-5510628","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}