Stressors and mental health in Chinese medical students: the mediating roles of positive and negative affect and moderating role of positive coping

This study investigated the relationship between stressors and mental health issues, such as anxiety and depression, among Chinese medical graduate students, examining the mediating roles of positive affect (PA) and negative affect (NA) and the moderating role of positive coping. Using a cross-sectional design, 1,216 participants from 16 medical colleges across 13 provinces was completed validated questionnaires (Stressors Scale, HSCL-25, PANAS, and TCSQ). Data were analyzed using the PROCESS macro for SPSS, and adjusting for demographic confounders. The results revealed that stressors showed a significant positive association with mental health problems (β = 0.406, p < 0.001). Both NA and PA partially mediated this relationship, with the indirect effect through NA being particularly strong (effect = 0.461, 95% CI [0.388, 0.542]), and the effect via PA smaller but significant (effect = 0.045, 95% CI [0.022, 0.072]). Positive coping significantly moderated the model. It attenuated both the direct effect of stressors on mental health (interaction β = -0.377, p < 0.001) and the first stage of the indirect pathway through NA (the path from stressors to NA; interaction β = -0.264, p < 0.001). These results suggest that stressors are linked to mental health primarily through NA, with PA playing a secondary protective role. Positive coping, defined as adaptive, approach-oriented strategies, may serves as a buffer that potentially reduces the negative effects of stressors. The study provides evidence-based recommendations for developing targeted medical education programs to improve student well-being.