Emotion regulation, academic resilience, and perceived stress in health professions students: a cross-sectional analysis of indirect associations

Background Health professions students face substantial academic and clinical demands that may increase perceived stress. Previous studies have examined emotion regulation and academic resilience separately, but little is known about whether academic resilience is related to the association between emotion regulation and perceived stress. Academic resilience was examined because students who regulate their emotions more effectively may be better able to cope with academic difficulties, and greater resilience may in turn be associated with lower perceived stress. This study examined the associations of emotion regulation with academic resilience and perceived stress, as well as their indirect associations with perceived stress through academic resilience. Methods A cross-sectional study was conducted among 180 health professions students recruited from a medical university in Taiwan using convenience sampling. Participants completed measures of emotion regulation, academic resilience, and perceived stress. Cognitive reappraisal and expressive suppression were analyzed separately. Pearson correlation analyses and PROCESS Model 4 were used to examine the proposed associations and statistical indirect associations. Results Cognitive reappraisal was positively associated with academic resilience (B = 1.04, p < .001), whereas expressive suppression was not significantly associated with academic resilience (B = −0.14, p = .402). Academic resilience was negatively associated with perceived stress in the cognitive reappraisal model (B = −0.15, p < .001). The statistical indirect association between cognitive reappraisal and perceived stress through academic resilience was significant (effect = −0.16, 95% percentile bootstrap CI [−0.24, −0.07]), whereas the corresponding indirect association for expressive suppression was not significant (effect = 0.02, 95% percentile bootstrap CI [−0.04, 0.10]). Conclusion Cognitive reappraisal was positively associated with academic resilience and showed a significant statistical indirect association with perceived stress through academic resilience, whereas expressive suppression showed no significant indirect association. These findings suggest that different emotion regulation strategies may have different associations with academic resilience and perceived stress. However, because participants were recruited by convenience sampling from a single university, the findings may not be generalizable to students in other institutions or settings. Longitudinal and multi-institutional studies are needed to further examine these associations.