Adverse childhood experiences and learning engagement in medical students: the mediating role of negative emotions

Learning engagement has become a pivotal indicator in higher medical education, garnering substantial research attention. However, the negative impact of adverse childhood experiences (ACEs) on learning engagement has rarely been discussed, and the underlying psychological mechanisms remain unclear. This study investigated the associations between ACEs and learning engagement among medical students and the mediating role of negative emotions (NEs). Participants were selected via random cluster sampling, using a cross-sectional study design. A total of 1004 medical students completed questionnaires about their adverse childhood experiences, learning engagement, perceived stress, depression, and anxiety. To examine the mediating role of NEs in the relationship between ACEs and learning engagement, a multiple mediation model was utilized. A total of 43.2% of the study participants self-reported experiencing ACEs. Significant pairwise correlations were observed among ACEs, NEs (depression, perceived stress, and anxiety), and learning engagement. According to the mediation analysis, perceived stress (-0.444, 95% CI -0.706, -0.208), depression ( -0.855, 95% CI -1.197, -0.322), and anxiety (0.294, 95% CI 0.004, 0.600) mediated the relationship between ACEs and learning engagement after adjusting for covariates, with a total mediating effect of 85.8% of the total effect. These findings underscore the critical need to examine the interactions among ACEs, learning engagement, and NEs and extend existing research on the psychological determinants of medical students’ academic engagement. Medical universities and educators should implement systematic ACEs and NEs screening and provide timely monitoring and evidence-based psychological interventions to enhance students’ learning engagement.