*Strength and Limitations of this Study*

The present study has several drawbacks that should be acknowledged. First, the cross-sectional nature of this study does not allow to establish causal interferences, making it difficult to determine if alexithymia increases the incidence of depression among medical students or whether other risk factors are responsible. Secondly, the study participants (medical students) were recruited from a single medical institution; therefore, the findings cannot be generalized to the whole country. Thus, conducting a multi-centric study with an adequate sample size would enhance the generalizability of the results and could lead to significant improvements in other characteristics related to alexithymia. Finally, due to the self-report nature of the assessments utilized in this study, social desirability and reporting biases from the respondents may occur. Despite these, this study has a number of potential benefits. This was one of the first studies to assess the relationship between alexithymia and depression among medical students in Saudi Arabia. These results would add evidence to the existing body of literature, and serve as baseline data for policymakers, mental health professionals, and clinicians to assist with the development and implementation of evidence-based interventions and initiatives to improve alexithymia and mental health among medical students in Saudi Arabia. Moreover, methodological and analytical approaches represent another strength of this study.

#### **5. Conclusions**

This study reported nearly half of the participants (47.3%) had alexithymia, and several sociodemographic (such as being female, having chronic health problems, and income status) and psychological factors (depression) were found to be significantly associated with alexithymia. The findings imply the necessity for thorough screening for depression and alexithymia before the commencement of the first semester in order to prevent the usually harmful repercussions that come from it. Additionally, it is highly recommended to set up training, awareness programs, and psychological interventions for students who have alexithymia so that they can accurately identify and express their emotions and feelings. Since psychological factors such as depression are linked to alexithymia, students should be routinely monitored by mental health practitioners to prevent any psychological distress. Further longitudinal, follow-up, or interventional studies that may incorporate large and diverse samples are warranted to better understand the causal interactions between alexithymia and psychological distress such as stress, anxiety, and depression.

**Supplementary Materials:** The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/healthcare10091703/s1, The study questionnaire.

**Author Contributions:** Conceptualization, M.A.A.; methodology, M.A.A., M.R.A. and N.Z.A.; software, M.A.A., A.A.A.A., J.A.J.A. and M.R.A.; validation, M.A.A., N.S.A. and N.Z.A.; formal analysis, M.A.A.; investigation, M.A.A., M.R.A. and N.Z.A.; resources, M.A.A., N.S.A., A.A.A.A., J.A.J.A. and M.R.A.; data curation, M.A.A.; writing—original draft preparation, M.A.A.; writing—review and editing, M.A.A., N.S.A., M.R.A. and N.Z.A.; visualization, N.Z.A.; supervision, N.S.A. and N.Z.A.; project administration, M.A.A.; funding acquisition, M.A.A. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** This study was approved by the ethics and research committee at King Khalid University, with number (HAPO-06-B-001).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** Not applicable.

**Acknowledgments:** The authors would like to thank Bharti Rishi and Fatima Riaz for their fruitful advice and their efforts in statistics consultation in preparing this manuscript.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

