# The mediating role of self-esteem in the link between attachment relationships and stress among Vietnamese nursing students: a cross-sectional survey

## TL;DR

This study shows that self-esteem helps explain how parent and peer relationships affect stress in Vietnamese nursing students, suggesting ways to improve their mental health.

## Contribution

The study identifies self-esteem as a mediator in the relationship between attachment and stress in nursing students, offering new insights for mental health interventions.

## Key findings

- Self-esteem fully mediates the relationship between parental attachment and stress in nursing students.
- Self-esteem partially mediates the relationship between peer attachment and stress.
- Stronger parent and peer attachments are associated with lower stress levels among students.

## Abstract

Managing stress is crucial for the success and well-being of undergraduate nursing students, yet little is known about how interpersonal relationships influence their stress levels. This study explores the impact of parent and peer attachments on stress, focusing on the mediating role of self-esteem. Understanding these dynamics can help educators and counselors develop targeted strategies to support students’ mental health and academic performance.

A cross-sectional survey was conducted from August to November 2023 at three medical institutions in Ho Chi Minh City, Vietnam. Using a structured self-reported questionnaire, we collected data from 612 nursing students on sociodemographic characteristics, attachments to parents and peers (Inventory of Parent and Peer Attachment), self-esteem (Rosenberg Self-Esteem Scale), and stress levels (Student Nurse Stress Index). Descriptive statistics, correlation analyses, and mediation modeling were employed to examine relationships between these factors.

Pearson’s correlation analyses showed significant associations between parental attachment, peer attachment, self-esteem, and stress, with stress negatively correlated with parental attachment (r = -0.42, p < 0.001), peer attachment (r = -0.38, p < 0.001), and self-esteem (r = -0.56, p < 0.001). Mediation analysis indicated that self-esteem fully mediated the relationship between parental attachment and stress (Sobel test: Z = -2.36, p < 0.05) and partially mediated the relationship between peer attachment and stress (Sobel test: Z = -3.41, p < 0.001).

Counselors and school officials could promote parental attachment, peer attachment, and self-esteem in nursing students to reduce stress and improve students’ psychological well-being during their training. Educators should also identify students with insecure attachments to parents or peers to provide timely and appropriate interventions.

Fostering strong parent and peer attachments, along with promoting self-esteem, can serve as a protective factor against stress in nursing students. Educational institutions should implement interventions that enhance supportive relationships and self-worth among students. Identifying those with insecure attachments early on can enable timely psychological support, ultimately improving well-being and academic success in nursing education.