Mediating effect of self-esteem on the relationship between academic self-efficacy and depression symptoms among nursing students participating in blended learning

Background: Blended learning, which comprises a combination of online and classroom-based activities, in nursing education can cause significant academic stress and depression symptoms among students. However, self-esteem may mediate the relationship between academic self efficacy and depression symptoms. Studies of the relationship between academic self-efficacy, self-esteem, and depression symptoms among nursing students participating in blended learning are limited.Objectives: To examine the determinants of depression symptoms and the mediating effect of selfesteem on the relationship between academic self-efficacy and depression symptoms among nursing students who participate in blended learning.Design: Cross-sectional study using convenience sampling.Settings: Ten universities across five provinces and two major Indonesian islands.Participants: A total of 534 undergraduate nursing students with a mean age of 20.30 years (standard deviation, +/- 1.36 years).Methods: An online survey was conducted between April and August 2022 to collect data from 10 universities applying blended learning. The study instruments included the General Self-Efficacy Scale, Rosenberg Self-Esteem Scale, and a 9-item Patient Health Questionnaire. Data were analysed by hierarchical linear regression using PROCESS macro version 4.1.Results: Of the 534 participants, 213 (39.14 %) experienced moderate-to-severe depression symptoms. Two variables, online learning difficulties (beta = 0.10; p = .012) and self-esteem (beta = -0.40; p < .001), were significant determinants of depression symptoms. Self-esteem mediated the relationship between academic self-efficacy and depression symptoms.Conclusions: It is necessary to understand the online learning difficulties experienced by blended learning students and improve their self-esteem by maximising academic self-efficacy to prevent depression symptoms.