{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:14Z","timestamp":1790146874654,"version":"4.0.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Critical-care nurses (CCNs) are exposed to intense emotional demands that may impair work engagement, particularly in the presence of alexithymia. However, the mechanisms that link alexithymia to work engagement remain unclear. This study aimed to determine how organizational trust and social support mediate the relationship between alexithymia and work engagement among CCNs in Hail, Northwest Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional correlational study involved 308 CCNs in Hail from August to November 2025. Data were collected using the Toronto Alexithymia Scale (TAS-20), Oslo Social Support Scale (OSSS-3), Organizational Trust Scale, and Utrecht Work Engagement Scale (UWES). Data were analyzed using AMOS 24.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      More than half of the CCNs (52.3%) exhibited a high level of alexithymia, followed by moderate (36%) and low (11.7%) levels. Higher alexithymia levels were significantly associated with lower levels of social support (\u03b2 = \u22120.229,\n                      <jats:italic>p =<\/jats:italic>\n                      0.001), organizational trust (\u03b2 = \u22120.286,\n                      <jats:italic>p =<\/jats:italic>\n                      0.001), and work engagement (\u03b2 = \u22120.287,\n                      <jats:italic>p =<\/jats:italic>\n                      0.001). By contrast, work engagement was positively impacted by social support (\u03b2 = 0.185,\n                      <jats:italic>p =<\/jats:italic>\n                      0.002) and organizational trust (\u03b2 = 0.236,\n                      <jats:italic>p =<\/jats:italic>\n                      0.001). Alexithymia negatively impacted work engagement via social support (indirect effect = \u22120.044, 95% CI: \u22120.140 to \u22120.011,\n                      <jats:italic>p =<\/jats:italic>\n                      0.014) and organizational trust (indirect effect = \u22120.070, 95% CI: \u22120.158 to \u22120.028,\n                      <jats:italic>p =<\/jats:italic>\n                      0.001). Overall, alexithymia significantly decreased work engagement (\u03b2 = \u22120.401,\n                      <jats:italic>p =<\/jats:italic>\n                      0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for practice<\/jats:title>\n                    <jats:p>Enhancing organizational trust and strengthening social support may buffer the negative effects of alexithymia on work engagement. Interventions such as leadership development, peer support programs, and emotional skills training may help promote psychological well-being and sustained engagement among CCNs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alexithymia is a significant psychological barrier to work engagement among CCNs. Organizational trust and social support can effectively mitigate this impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1942846","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:16:11Z","timestamp":1790144171000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unraveling the pathways from alexithymia to work engagement among critical care nurses: the mediating effects of social support and organizational trust"],"prefix":"10.3389","volume":"17","author":[{"given":"Sameer A.","family":"Alkubati","sequence":"first","affiliation":[{"name":"Department of Medical-Surgical Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naif F.","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhafith","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Department of Psychiatric and Mental Health Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh Z.","family":"Alhetar","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galal F.","family":"Albani","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham S.","family":"Moqbel","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman Mohamed","family":"El-Ashry","sequence":"additional","affiliation":[{"name":"Department of Nursing, College of Applied Medical Sciences, Jouf University","place":["Al-Qurayyat, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdan M.","family":"Albaqawi","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesam T.","family":"Almagharbeh","sequence":"additional","affiliation":[{"name":"Medical Surgical Nursing Department, College of Nursing, University of Tabuk","place":["Tabuk, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habib","family":"Alrashedi","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layla","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Nursing, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bandar S.","family":"Alsaif","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Public Health and Health Informatics, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziza Z.","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Nursing Administration, College of Nursing, University of Hail","place":["Hail, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/j.ijnss.2025.08.002","article-title":"Prevalence of workplace violence against nurses in Saudi Arabia: A systematic review and meta-analysis.","volume":"12","author":"Abdelmalik","year":"2025","journal-title":"Int. J. Nurs. Sci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1419855","DOI":"10.3389\/fpsyg.2024.1419855","article-title":"The role of psychological factors on improving work engagement among nurses.","volume":"15","author":"Abualruz","year":"2024","journal-title":"Front. Psychol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1330720","DOI":"10.3389\/fpsyg.2024.1330720","article-title":"Social support and mental health: The mediating role of perceived stress.","volume":"15","author":"Acoba","year":"2024","journal-title":"Front. Psychol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1186\/s12912-025-03482-2","article-title":"Relationship between nursing work environment and clinical decision-making among Saudi nurses: Psychological empowerment as mediator.","volume":"24","author":"Alharbi","year":"2025","journal-title":"BMC Nurs."},{"key":"B5","doi-asserted-by":"publisher","first-page":"101064","DOI":"10.1016\/j.aucc.2024.04.008","article-title":"The influence of anxiety and depression on critical care nurses\u2019 performance: A multicenter correlational study.","volume":"38","author":"Alkubati","year":"2025","journal-title":"Aus. Crit. Care"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-026-15170-1","article-title":"Organizational support and motivation associated with nurse work engagement: Evidence from Saudi Arabia.","author":"Alotaibi","year":"2026","journal-title":"BMC Health Serv. Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e6938783","DOI":"10.1155\/jonm\/6938783","article-title":"Psychological capital and work engagement among mental health nurses in Saudi Arabia: The mediation role of motivation at work.","volume":"2026","author":"Alqhtani","year":"2026","journal-title":"J. Nurs. Manag."},{"key":"B8","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3390\/nursrep11020038","article-title":"Challenges facing the nursing profession in Saudi Arabia: An integrative review.","volume":"11","author":"Alsadaan","year":"2021","journal-title":"Nurs. Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1186\/s12912-024-02018-4","article-title":"Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: A mixed method study.","volume":"23","author":"Alshammari","year":"2024","journal-title":"BMC Nurs."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1272500","DOI":"10.3389\/fpsyg.2023.1272500","article-title":"The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: A cross-sectional correlational design.","volume":"14","author":"Alshammari","year":"2023","journal-title":"Front. Psychol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"208","DOI":"10.3390\/nursrep15060208","article-title":"The mediating role of burnout in the relationship between emotional intelligence and work engagement among hospital nurses: A structural equation modeling approach.","volume":"15","author":"Alshammari","year":"2025","journal-title":"Nurs. Rep."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2331","DOI":"10.1002\/nop2.843","article-title":"Burnout and job satisfaction among critical care nurses in Saudi Arabia and their contributing factors: A scoping review.","volume":"8","author":"Alzailai","year":"2021","journal-title":"Nurs. Open"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2158244020988726","DOI":"10.1177\/2158244020988726","article-title":"Exploring factor validity of 20-Item Toronto Alexithymia Scale (TAS-20) in Albanian clinical and nonclinical samples.","volume":"11","author":"Arenliu","year":"2021","journal-title":"Sage Open"},{"key":"B14","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/0022-3999(94)90005-1","article-title":"The twenty-item Toronto Alexithymia Scale\u2013I. Item selection and cross-validation of the factor structure.","volume":"38","author":"Bagby","year":"1994","journal-title":"J. Psychosom. Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13054-024-04844-z","article-title":"Violence against healthcare professionals in intensive care units: A systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures.","volume":"28","author":"Berger","year":"2024","journal-title":"Crit. Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1177\/2319510x1200800314","article-title":"Psychometric evaluation of utrecht work engagement scale in an indian sample.","volume":"8","author":"Chaudhary","year":"2012","journal-title":"Asia-Pacific J. Manag. Res. Innov."},{"key":"B17","volume-title":"A Study on the Relationship Among Organizational Trust, Organizational Justice, and Organizational Citizenship Behavior of the State-Owned Enterprises Employees.","author":"Chen","year":"2006"},{"key":"B18","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.apnu.2022.12.020","article-title":"The relationship between alexithymia, communication skills and mental well-being of nurses\u2019 in Turkey: A cross-sectional study.","volume":"43","author":"Dalokay","year":"2023","journal-title":"Arch. Psychiatric Nurs."},{"key":"B19","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","article-title":"The job demands-resources model of burnout.","volume":"86","author":"Demerouti","year":"2001","journal-title":"J. Appl. Psychol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1186\/s12912-025-02903-6","article-title":"Understanding the relationship between professional values and caring behavior among nurses in intensive care units: A cross-sectional study from Palestine.","volume":"24","author":"Ejheisheh","year":"2025","journal-title":"BMC Nurs."},{"key":"B21","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.paid.2017.03.017","article-title":"Cross-validation of the 20-item Toronto Alexithymia Scale: Results from an Arabic multicenter study.","volume":"113","author":"El Abiddine","year":"2017","journal-title":"Personal. Individ. Differ."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2827","DOI":"10.3390\/ejihpe13120195","article-title":"Social support and its impact on job satisfaction and emotional exhaustion.","volume":"13","author":"Garmendia","year":"2023","journal-title":"Eur. J. Investig. Health Psychol. Educ."},{"key":"B23","first-page":"127","article-title":"Conservation of Resources Theory: Its Implication for Stress, Health, and Resilience","volume-title":"The Oxford Handbook of Stress, Health, and Coping","author":"Hobfoll","year":"2011"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2049627","DOI":"10.1155\/2024\/2049627","article-title":"Organizational culture and trust affect the team-basedpractice and job satisfaction of nurse practitioners in acute care hospitals: A national survey.","volume":"2024","author":"Huang","year":"2024","journal-title":"J. Nurs. Manag."},{"key":"B25","doi-asserted-by":"publisher","first-page":"583786","DOI":"10.3389\/fpsyg.2021.583786","article-title":"Alexithymia and sensory processing sensitivity: Areas of overlap and links to sensory processing styles.","volume":"12","author":"Jakobson","year":"2021","journal-title":"Front. Psychol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"154","DOI":"10.5001\/omj.2018.28","article-title":"Nurses\u2019 perceptions of spirituality and spiritual care at five tertiary care hospitals in Riyadh, Saudi Arabia: A cross-sectional study.","volume":"33","author":"Kaddourah","year":"2018","journal-title":"Oman. Med. J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"284","DOI":"10.14744\/phd.2020.98700","article-title":"Alexithymia in nurses and its relationship with burnout, anger, and somatization.","volume":"11","author":"Korkmaz","year":"2020","journal-title":"J. Psychiatric Nurs. Psikiyatri Hemsireleri Dernegi"},{"key":"B28","doi-asserted-by":"publisher","first-page":"104086","DOI":"10.1016\/j.iccn.2025.104086","article-title":"Workload in ICU nurses: A systematic review and meta-analysis of the Nursing Activities Score.","volume":"91","author":"Li","year":"2025","journal-title":"Intens. Crit. Care Nurs."},{"key":"B29","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1186\/s12888-025-06742-2","article-title":"Unravelling the link between alexithymia and psychological distress in nurses: A multi-hospital cross-sectional study exploring the mediating roles of workplace conflict and emotional exhaustion.","volume":"25","author":"Li","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1080\/10705511.2017.1401932","article-title":"Review of principles and practice of structural equation modeling.","volume":"25","author":"Martynova","year":"2018","journal-title":"Struct. Equat. Model. Multidiscipl. J."},{"key":"B31","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.paid.2010.03.038","article-title":"Taxometric analysis of alexithymia in a general population sample from Finland.","volume":"49","author":"Mattila","year":"2010","journal-title":"Personal. Individ. Differ."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2235819","DOI":"10.1080\/23311975.2023.2235819","article-title":"The role of work engagement and organizational commitment in improving job performance.","volume":"10","author":"Nabhan","year":"2023","journal-title":"Cogent Bus. Manag."},{"key":"B33","doi-asserted-by":"publisher","first-page":"4471","DOI":"10.1002\/nop2.1689","article-title":"Prevalence and associated factors of alexithymia in intensive care unit nurses.","volume":"10","author":"Nan","year":"2023","journal-title":"Nurs. Open"},{"key":"B34","first-page":"208","article-title":"Confirmatory factor analysis of 20-item toronto alexithymia scale in spanish patients with substance use disorder.","volume":"50","author":"Palma-\u00c1lvarez","year":"2022","journal-title":"Actas Esp. Psiquiatr."},{"key":"B35","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/s12912-021-00702-3","article-title":"Alexithymia, social support, depression, and burnout among emergency nurses in China: A structural equation model analysis.","volume":"20","author":"Pei","year":"2021","journal-title":"BMC Nurs."},{"key":"B36","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: A critical review of the literature and recommended remedies.","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J. Appl. Psychol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1023\/A:1015630930326","article-title":"The measurement of engagement and burnout: A two sample confirmatory factor analytic approach.","volume":"3","author":"Schaufeli","year":"2002","journal-title":"J. Happ. Stud. Interdiscipl. Forum Subjective Well-Being"},{"key":"B38","first-page":"179","article-title":"Chapter Five - Workplace Engagement and Motivation","volume-title":"Advances in Motivation Science","author":"Taris","year":"2023"},{"key":"B39","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511526831","volume-title":"Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness.","author":"Taylor","year":"1997"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1016\/j.neubiorev.2013.07.008","article-title":"Neural correlates of alexithymia: A meta-analysis of emotion processing studies.","volume":"37","author":"van der Velde","year":"2013","journal-title":"Neurosci. Biobehav. Rev."},{"key":"B41","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1016\/j.ijnss.2023.09.010","article-title":"The associations among nurse work engagement, job satisfaction, quality of care, and intent to leave: A national survey in the United States.","volume":"10","author":"Wei","year":"2023","journal-title":"Int. J. Nurs. Sci."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1186\/s12889-021-11544-8","article-title":"The influence of personality, alexithymia and work engagement on burnout among village doctors in China: A cross-sectional study.","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Public Health"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1505641","DOI":"10.3389\/fpubh.2024.1505641","article-title":"The relationship between organizational trust and voice behavior among neonatal intensive care unit nurses in tertiary A hospitals in Sichuan Province: The mediating role of career resilience [Original Research].","volume":"12","author":"Zhang","year":"2024","journal-title":"Front. Public Health"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1111\/jocn.16982","article-title":"The impact of nurses\u2019 experiences of hospital violence on resilience: A mediated moderation model.","volume":"33","author":"Zheng","year":"2024","journal-title":"J. Clin. Nurs."},{"key":"B45","doi-asserted-by":"publisher","first-page":"9731","DOI":"10.1038\/s41598-023-35981-0","article-title":"Disparities in insecurity, social support, and family relationships in association with poor mental health among US adults during the COVID-19 pandemic.","volume":"13","author":"Zhu","year":"2023","journal-title":"Sci. Rep."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1942846\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:16:13Z","timestamp":1790144173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1942846\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":45,"alternative-id":["10.3389\/fpsyg.2026.1942846"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1942846","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"1942846"}}