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Frontiers in Child and Adolescent Psychiatry ·

Volume 5 - 2026 | https://doi.org/10.3389/frcha.2026.1835372

The mediating role of psychological resilience and coping styles among Chinese medical students in the relationship between perceived social support and learning engagement among medical students

  • Yue Li1
  • Fan Zhang2
  • Mengran Zhang3
  • Hua Zhu4
  • Zhe Jin1*corresponding author
  1. 1Department of Social Medicine and Health Management, Shenyang Medical College, Shenyang, China
  2. 2Department of Clinical Medicine, Xingtai Medical College, Xingtai, China
  3. 3School of Medical and Health, Weifang Business Vocational College, Weifang, China
  4. 4Infection Control Department, Baotou Central Hospital, Baotou, China
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Abstract

To explore the relationship between college medical students' Perceived Social Support and learning engagement and the mediating role of psychological resilience and coping styles. The Perceived Social Support Scale (PSSS), the Simple Medical Coping Style Questionnaire (SCSQ), Ego-resiliency Scale (ER89), and the Undergraduate Work Engagement Scale (UWES-S) were selected to conduct a questionnaire survey of 2,375 medical students. The analysis showed that there was a significant positive relationship between perceived social support, psychological resilience, positive coping styles and learning engagement(r = 0.274∼0.973, P < 0.01);The results of the mediated effects test indicated that the mediated paths of perceived social support affecting learning engagement through psychological resilience and positive coping styles and their chain mediated effects all showed statistical significance respectively (β = 0.083,0.033,0.071). Medical students' perceived social support not only affects learning engagement directly, but also indirectly through the mediating role of psychological resilience and positive coping style and the chain mediating role of psychological resilience-positive coping style.

Keywords

1 Introduction

In today's world, medical education requires medical students not only to master excellent clinical skills but also to cultivate high professional ethics and a passion for lifelong learning (1). Because medical education is closely linked to future careers, many universities have strengthened and implemented measures to foster an academic culture that encourages students to study diligently, increase the time they devote to their studies, and shift the focus of higher education quality assessment from outcomes to the learning process (2). Learning engagement is an extension of the concept of work engagement into the realm of learning; it refers to a state of behavior characterized by positive emotions and high energy levels demonstrated during the learning process (3), encompassing three dimensions: vitality, dedication, and focus (4). Researchers have found (5, 6) that increasing learning engagement can effectively improve the learning experience and enhance learning outcomes. Learning engagement positively predicts academic performance and achievement; it serves as a core indicator for assessing the quality of higher education and the development of medical students, and is closely related to the quality of healthcare services these students will provide in the future. With the development of the healthcare sector and the growing health needs of individuals, the importance placed on the professional competence of healthcare personnel is also increasing (7). As most medical students are future healthcare professionals and a strong reserve force for future healthcare services, there is an urgent need to study medical students' learning engagement and its influencing factors to provide theoretical and practical foundations for improving the quality of medical education.

Adolescence is a unique stage of life, beginning with sexual maturation and characterised by cognitive, emotional and social maturation, ultimately leading to a transition towards independence and adulthood (8). Due to the indefinable nature of adolescence, scholars currently find it difficult to conceptualize, study, and reasonably interpret it in a unified manner. This study posits that adolescence is characterized by a series of physical developmental features and long-term neural changes, and defines the age range as 14–24 years (9). The group of medical students examined in this study—aged 18–24—fully meets the current academic definition of “extended adolescence,” and medical students in this age group are particularly vulnerable to difficulties when facing academic pressures and challenges (10). therefore, it is necessary to support and promote the healthy development of adolescents, particularly in the areas of education and career.

Perceived social support refers to an individual' s expectations and subjective evaluation of social support (10); adequate external support can help students adapt to and adjust to their academic environment, allowing them to devote more time and energy to their studies (11). According to social exchange theory (12), the attention, recognition, and sense of trust that individuals gain from social support can foster close emotional bonds, which in turn translate into motivation for learning. This, in turn, increases their commitment to learning, leading to better performance in their academic lives (13).

With the development of positive psychology (14), the role of positive psychological resources in the process of individual growth and development has received widespread attention (15). High levels of stress in medical education lead to negative effects on medical students, such as decreased attention, anxiety and depression, deteriorating interpersonal relationships, and aversion to studying. These are often regarded as risk factors for psychological distress among medical students (16, 17); however, many students experiencing the same level of stress do not develop related psychological problems, and these students are considered to possess psychological resilience (18). Psychological resilience refers to an individual's “capacity for endurance” to actively cope with adverse events, recover quickly from adversity, and achieve positive development (19). Research indicates that perceived social support positively predicts psychological resilience (11), and strong psychological resilience enables effective coping with complex learning environments and positively influences academic engagement (20); Positive coping styles, as a form of self-stabilizing factor, refer to a state of maintaining optimism, seeking change, and seeking support when facing stress (21). Research indicates that an individual's perceived social support influences the choice of coping strategies (22). When people receive sufficient social support, they face problems with a positive attitude, enjoy better health, maintain positive emotions under stress, adopt appropriate coping strategies, and enhance their academic engagement (23). Previous research indicates that psychological resilience influences positive coping strategies (24). Students with psychological resilience often possess positive psychological traits such as optimism, emotional stability, and perseverance; they tend to adopt positive approaches to find positive meaning in the problems they face, demonstrate unique differences in physiological adaptive capacity when coping with stress, and achieve good adaptation (25). On the other hand, individuals who adopt positive coping strategies successfully resolve difficulties in their academic and personal lives by tapping into their inner potential and mobilizing internal and external protective factors, thereby indirectly influencing academic engagement (26).

Although previous studies have focused on medical students' academic engagement (13, 23, 26), existing studies on mediating effects are largely limited to a single mediating variable. Research on the sequential mediating role of psychological resilience and positive coping strategies remains insufficient; this may reveal a gradual psychological development pathway (27) that warrants further in-depth investigation and explanation. This study aims to analyze the underlying psychological mechanisms through which perceived social support influences medical students' academic engagement, thereby enriching the empirical research in this field.

Based on this, this study proposes three hypotheses: Perceived social support influences medical students' academic engagement; psychological resilience and positive coping strategies mediate the relationship between perceived social support and academic engagement, respectively; and psychological resilience and positive coping strategies exert a chained mediation effect on the relationship between perceived social support and academic engagement.

2 Materials and methods

2.1 Participants and procedure

From May 8th to 15th, 2024, an anonymous questionnaire survey was conducted among freshmen to seniors at a medical college in Shenyang. The survey employed stratified cluster sampling, stratified by four grades, with classes as the smallest sampling unit. At least 5–6 classes were selected from each grade to ensure that the number of sampled respondents was no less than 200 in each grade. After undergoing unified training, counselors clearly explained the research purpose, content, and precautions to the students and guided them in completing the questionnaire. A total of 2,400 questionnaires were distributed, and 2,375 valid questionnaires were collected, with a valid response rate of 98.96%. This study was approved by the Review Committee of Shenyang Medical College, and all survey participants provided informed consent.

2.2 Measures

2.2.1 Perceived social support scale (PSSS)

The “Perceived Social Support Scale” revised by Jiang Qianjin (28, 29) was adopted. The scale consists of 12 items, covering family support, friend support, and other support. It adopts a Likert 7-point scoring system, ranging from “completely disagree” to “completely agree”, with scores ranging from 1 to 7. The total score ranges from 12 to 84, with higher scores indicating that the individual receives more social support. In this study, the Cronbach's α coefficient of this scale was 0.929.

2.2.2 Simplified coping style questionnaire (SCSQ)

This scale was developed by Xie Yaning in 1998 based on the characteristics of the Chinese population (30, 31). In this study, we selected the positive coping subscale (12 items) and used a Likert 4-point scoring system, ranging from “not adopting” to “often adopting” with scores of 0–3, for a total score of 0–36. The higher the score, the stronger the positive coping ability. The Cronbach's α coefficient for this subscale in this study was 0.929.

2.2.3 Ego-resiliency Scale (ER89)

ER89 was developed by BLOCK (32, 33) and other researchers (34, 35) based on the theory of psychological resilience. This scale employs a Likert 4-point scoring system, with “1” indicating “strongly disagree” and “4” indicating “strongly agree”. It consists of 14 items, with a total score ranging from 14 to 56. A higher score indicates a higher level of psychological resilience. This scale has a solid theoretical foundation, with simple and understandable items and a small number of items. It is often used in combination with other scales. In this study, the Cronbach's α coefficient for this scale was 0.874.

2.2.4 Utrecht work engagement scale-student (UWES-S)

This scale was carefully developed by Schaufeli (36, 37) and later revised by Fang Laitan, Shi Kan, and others (38, 39). It consists of 17 items, covering three dimensions: vigor, dedication, and focus. Using the Likert 5-point scoring system, “completely disagree” is scored as 1 point, “completely agree” is scored as 5 points, and the total score ranges from 17 to 85. A higher score indicates greater engagement in learning. The Cronbach's α coefficient of the scale is 0.825, indicating good reliability.

2.3 Statistical analysis

Data were analyzed using SPSS 26.0 and AMOS 24.0 (40). For quantitative data, normality and homogeneity of variance tests were conducted first. If the data met the normality and homogeneity of variance tests, they were described using mean ± standard deviation (x¯±s). Count data were described using proportion (%) composition. Difference analysis was conducted using t/F tests, and Pearson correlation analysis was used to explore the correlation between variables (41). The Harman's one-way ANOVA method was employed for the common method bias test. The non-parametric percentile Bootstrap method was employed for 5,000 repeated samplings to test whether the mediating effect was significant. The estimated effect size and 95% confidence interval were considered statistically significant with P < 0.05. A structural equation model was constructed using AMOS 24.0 software for verification.

3 Results

3.1 Common method bias test

The results of the Harman one-factor test (42) indicate that the unrotated principal component analysis identified seven factors with eigenvalues greater than 1. The first factor explained 34.59% of the variance, which is below the 40% threshold, suggesting that there is no significant common method bias in this study.

3.2 Participant characteristics

Among the respondents, there were 656 males (27.62%) and 1,719 females (72.38%); their average age was 18–24 (20.71 ± 1.88) years; 977 were freshmen (41.14%), 702 were sophomores (29.56%), 367 were juniors (15.45%), and 329 were seniors (13.85%); 978 were urban students (41.18%), and 1,397 were rural students (58.82%). See Table 1 for details.

Table 1. A comparison of scores on social support, psychological resilience, positive coping strategies, and learning engagement among medical students with different characteristics (x¯±s).

VariablenPSSSPsychological ResiliencePositive Coping StrategiesLearning Engagement
Scorest/FScorest/FScorest/FScorest/F
Sex−7.242***−2.030*−4.268***−2.368*
Male65655.35 ± 17.5839.79 ± 9.8434.16 ± 8.9264.83 ± 15.78
Female1,71960.56 ± 14.8940.58 ± 8.0335.66 ± 7.1266.31 ± 12.65
Grade5.951***0.5860.5010.401
Freshman97760.63 ± 5.18b,c,d40.34 ± 8.0735.37 ± 7.2365.54 ± 13.03
Sophomore70258.34 ± 14.96a40.61 ± 8.2435.05 ± 7.4666.30 ± 12.03
Junior year36757.43 ± 16.56a40.08 ± 9.3235.02 ± 8.2466.11 ± 14.49
Senior year32956.86 ± 17.49a40.75 ± 8.5735.52 ± 8.0166.04 ± 14.91
Place of origin1.7772.654**1.4870.500
Town97859.81 ± 16.6440.92 ± 8.8935.53 ± 8.0165.78 ± 13.21
Rural1,39758.63 ± 15.2539.97 ± 8.3335.05 ± 7.4566.06 ± 14.14

P < 0.05.

P < 0.05.

P < 0.001.

indicates P<0.05：Compared to Freshman.

indicates P<0.05：Compared to Sophomore.

indicates P<0.05：Compared to Junior year.

indicates P<0.05：Compared to Senior year.

3.3 Comparison of scores on social support, psychological resilience, positive coping strategies, and learning engagement among medical students with different characteristics

The study found that female students scored significantly higher than male students on the PSSS, ER89, positive coping strategies, and UWES-S scales. Urban students scored higher on the ER89 scale than rural students, and first-year students scored significantly higher on the PSSS scale than students in other years. All differences were statistically significant (P < 0.05), as shown in Table 1.

3.4 Descriptive statistics and correlation analysis

The results revealed significant positive correlations between pairs of the four variables—social support, psychological resilience, positive coping strategies, and academic engagement(r = 0.27–0.97, P < 0.01), as shown in Table 2.

Table 2. Descriptive statistics and correlation analysis.

Variable12345678910
1. PSSS1
2. Family Support0.956**1
3. Friends' Support0.970**0.884**1
4. Other Support0.969**0.881**0.925**1
5. Psychological Resilience0.529**0.499**0.520**0.513**1
6. Positive Coping Strategies0.556**0.523**0.546**0.540**0.802**1
7. Learning Engagement0.336**0.318**0.324**0.330**0.387**0.400**1
8. Vitality0.365**0.348**0.355**0.355**0.380**0.402**0.959**1
9. Dedication0.319**0.304**0.307**0.313**0.376**0.390**0.973**0.916**1
10. Focus0.284**0.266**0.274**0.283**0.361**0.363**0.955**0.851**0.901**1
x¯59.1219.8519.8719.4040.3635.2465.8923.8019.3622.73
s15.845.565.425.438.577.6813.604.904.284.95

P < 0.01.

3.5 Mediation effect analysis

After considering the influence of demographic factors such as gender, age, and grade, the chain mediation effect of psychological resilience and positive coping strategies between perceived social support and learning engagement among medical students was tested using model 6 of the SPSS macro program Process developed by Hayes (43). The research indicates that perceived social support significantly affects learning engagement (β = 0.126, t = 6.495**), and positively influences psychological resilience and positive coping strategies (β* = 0.533, t = 30.319***; β = 0.178, t = 12.602**). Psychological resilience can effectively influence positive coping strategies (β* = 0.706, t = 50.503**), and both psychological resilience and positive coping strategies positively predict learning engagement (β* = 0.156, t = 4.944***; β = 0.189, t = 5.872***). The results are presented in Table 3.

Table 3. Hierarchical regression analysis of Variable relationships in mediational models.

Recurrence relationOverall fit indexFSignificance of the regression coefficient
Outcome variablePredictor variablesRR2βt
Psychological ResiliencePSSS0.5350.284158.071***0.53330.319***
Positive Coping StrategiesPSSS0.8180.670685.464***0.17812.602***
Psychological Resilience0.70650.503***
Learning EngagementPSSS0.4400.19471.121***0.1266.495***
Psychological Resilience0.1564.944***
Positive Coping Strategies0.1895.872***

P < 0.001.

3.6 Chain mediation effect analysis

The results showed that the direct effect of perceived social support on academic engagement, the mediating effects of psychological resilience and positive coping strategies on the relationship between perceived social support and academic engagement, and the chained mediating effect of psychological resilience and positive coping strategies all reached statistical significance, as shown in Table 4. Psychological resilience accounted for 28.92% of the mediating effect, positive coping strategies accounted for 11.50%, and the chained mediating effect accounted for 24.74%. The indirect effect accounted for 56.10%, while the direct effect accounted for 43.90%. Based on these data, the authors developed the mediating effect model presented in this section (Figure 1).

Table 4. An analysis of the chain mediation effects of psychological resilience and positive coping strategies.

Patheffect sizestandard error95% CIProportion of effect size (%)
Psychological Resilience (a1b1)0.0830.019(0.044,0.123)28.92%
Positive Coping Strategies (a2b2)0.0330.006(0.020,0.048)11.50%
Psychological Resilience and Positive Coping Strategies (a1a3b2)0.0710.016(0.038,0.105)24.74%
Direct effect (c')0.1260.019(0.088,0.165)43.90%
Indirect effects0.1610.016(0.128,0.194)56.10%
Overall effect0.2870.016(0.255,0.320)100.00%
Diagram of the chain mediation effect model. This figure 1 was created by the first author.
Figure 1. Diagram of the chain mediation effect model. This figure 1 was created by the first author.

Finally, validation using AMOS 24.0 confirmed the validity of this model; the fit statistics are presented in Table 5.

Table 5. Fitting statistics for the chained mediation model.

Indicatorχ2/dfRMSEAGFIAGFINFIIFI
Criteria<5<0.05>0.9>0.9>0.9>0.9
Mediator model3.7560.0340.9940.9860.9970.998

4 Discussion

Medical curricula are highly challenging and involve relatively heavy academic workloads, requiring medical students to devote more time and effort (44). The results of the mediation analysis confirm that social support received during the learning process serves as an important protective factor for medical students' academic engagement. In other words, the more social support medical students perceive, the higher their level of academic engagement; establishing a multidimensional social support system can significantly improve academic engagement levels. According to the Resource Conservation Theory (45), changes in external and internal resources determine mental health status. Social support can compensate for the depletion of psychological resources caused by long-term academic stress, providing a theoretical explanation for how social support is transformed into internal psychological resources. Numerous studies have pointed out (11, 13) that support from friends and parents provides students with sufficient resources to cope with academic difficulties (46), thereby enhancing their academic engagement and enabling them to master solid medical professional skills. Therefore, providing medical students with adequate social support can enhance their academic engagement and help them acquire solid medical professional skills.

Previous studies (22, 24) have confirmed the association between psychological resilience and positive coping. Psychological resilience and positive coping strategies, acting as independent mediating variables, are influenced by perceived social support and, in turn, have a positive impact on academic engagement. According to the dynamic model of psychological resilience (47), adolescents have needs such as self-esteem, challenges, potential, and value during their development (19). If they can obtain sufficient support, understanding, and care from family, society, and school, this will help them develop a strong will and resilient traits. Research indicates that the more social support an individual perceives, the more conducive it is to developing a strong inner drive, enhancing psychological resilience, and promoting greater focus on studies (11). This is explained by the fact that both objectively available social support resources and subjectively experienced social support collectively constitute the internal and external protective factors of psychological resilience, thereby fostering psychological stability (48). At the same time, external support and psychological resilience can, to a certain extent, mitigate the impact of adverse situations, maintain consistency between inner thoughts and actions, and promote the development of strong adaptive abilities among medical students in both their academic and daily lives (49). This has a positive impact on their academic engagement, which in turn effectively reflects an individual's level of psychological resilience. Therefore, enhancing psychological resilience and fostering strong adaptive abilities can improve medical students' levels of academic engagement.

This study found that a positive coping style plays a partial mediating role in the relationship between perceived social support and academic engagement, acting as a “bridge.” When medical students with low levels of perceived social support face academic challenges, they often believe they are unable to overcome these difficulties (50). Conversely, if they adopt positive coping strategies, they can courageously accept challenges, continuously tap into their own potential, draw on favorable resources from all sources, mobilize protective factors, comprehensively explore diverse solutions to efficiently complete academic tasks, maintain proper learning motivation, rekindle their inner passion for learning, and enhance their academic engagement (45–47)—all of which are key to medical students achieving outstanding academic performance.

Positive coping strategies are crucial for enhancing academic engagement (26). In particular, medical students who lack sufficient social support need to focus on developing the ability to adopt positive and optimistic approaches to problem-solving, thereby fostering motivation and improving academic performance. Results indicate that psychological resilience plays a significant role in the selection of coping strategies (24, 51), and there is a significant positive correlation between psychological resilience and positive coping strategies. Medical students with low perceived social support can still engage effectively in their studies if they possess strong psychological resilience and adopt positive coping strategies. Having adequate social support resources is a key prerequisite for medical students to develop a high level of psychological resilience. A high level of psychological resilience not only fosters positive emotional states, enhances a sense of control over academic tasks, and significantly boosts enthusiasm for learning, but also helps medical students establish a healthy self-concept and develop excellent character traits (52, 53). Consequently, when facing challenges, they can fully utilize internal and external resources, adopt positive and reasonable measures to address problems, and exhibit sound psychological and behavioral patterns. Research indicates that individuals with high levels of psychological resilience are better able to perceive external support, mitigate maladaptive coping strategies and stress responses, and tend to adopt more positive coping strategies and behaviors when facing setbacks (24, 51, 52, 54), thereby promoting effective coping mechanisms. This is particularly true when rapidly adapting to a completely new learning environment during online learning. Therefore, with adequate social support, a high level of psychological resilience, and positive coping strategies, it is recommended that medical students increase their commitment to their studies to improve efficiency.

This study found that the overall learning engagement of medical students is at a relatively high level, which is consistent with the findings of Shida Q's survey (55). There is also a significant gender difference, with female students having an advantage, which is consistent with previous research findings (56), indicating that most medical students are relatively strict with themselves. Perceived social support has a significant positive impact on learning engagement, which is consistent with Xu Z's research findings on vocational students in China (57). Therefore, it is necessary for schools to cultivate classroom enthusiasm and enhance learning interest, as well as strengthen guidance and support in learning, so that medical students can more firmly commit to the medical profession.

This study has several limitations. First, there are limitations regarding the sample: the study surveyed only students at a single medical college in Shenyang, resulting in sampling bias (58). The grade composition within the sample obtained through stratified random sampling differs from that of the population (59), and there is room for improvement in terms of sample diversity and sample size; Second, there are limitations in variable selection (60). The study only examined the mediating roles of psychological resilience and positive coping strategies, failing to fully account for other important variables that may influence academic engagement (61); finally, academic engagement is a dynamic and evolving process, and the use of a cross-sectional design (62) limits the ability to accurately assess its developmental trajectory (56).

In future research, the sample size could be expanded and combined with qualitative interviews; subsequent studies should continue to examine the influence of other variables on the relationship between social support and medical students' academic engagement; longitudinal tracking, experimental methods, or case studies could be conducted to further refine the research; and more advanced and scientific statistical methods and theoretical models should be incorporated—from research design to data analysis—to explore other factors influencing academic engagement (63), while also considering the bidirectional interactions among variables.

5 Conclusion

Based on a theoretical hypothesis model, this study empirically examined the relationship between perceived social support and medical students' learning engagement, as well as its underlying mechanisms. All proposed hypotheses were validated (with each path coefficient P < 0.05). Specifically, the direct effect of perceived social support on learning engagement was significant. Both the independent mediating effect of psychological resilience and positive coping styles, as well as their chained mediating effect, reached a statistically significant level. The chained mediating effect accounted for 24.74% of the total effect, the indirect effect accounted for 56.10%, and the direct effect accounted for 43.90%. It is recommended that universities collaborate with families to improve the social support and security system for medical students, carry out targeted mental health interventions, enhance psychological resilience levels, and guide them to develop positive stress coping patterns, thereby effectively improving the overall quality and level of medical students' learning engagement.

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The author(s) declared that generative AI was not used in the creation of this manuscript.

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Footnotes

Edited by: Ann Dowker, University of Oxford, United Kingdom

Reviewed by: Carol Nash, University of Toronto, Canada

Hina Ghafoor, Riphah International University, Pakistan

Statements

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding

The authors declared that financial support was received for this research and its publication. This research was supported by the General Research Project approved by the Liaoning Provincial Education Science “14th Five-Year Plan” in 2022 (Project No. JG22DB665), the General Project of Education in the Liaoning Provincial Social Science Planning Fund in 2022 (Project No. L22BED018) and the Medical Scientific Research Project of Hebei Province in 2027 (Project No. 20271321).

Data availability

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Author contributions

YL: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Writing – original draft, Writing – review & editing. FZ: Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Writing – review & editing. MZ: Data curation, Methodology, Software, Writing – original draft, Writing – review & editing. HZ: Data curation, Investigation, Methodology. ZJ: Conceptualization, Funding acquisition, Project administration, Supervision, Validation, Writing – review & editing.

Acknowledgements

The authors thank all study participants. Thank you to all the organizations and personnel who participated in and assisted with the survey.

References

  1. 1. Arianpoor A, Taylor SCR, Huang P-H, Shulruf B. Fostering professionalism among health professionals: the essential role of self-regulated and self-directed aptitudes of learning. Korean J Med Educ. (2024) 36 (4): 445 – 7. doi:10.3946/kjme.2024.316
  2. 2. Li Y, Wu L, Li F, Fang P, Liu X, Wu S. Analysis of factors influencing medical students’ learning engagement and its implications for teaching work—a network analysis perspective. BMC Med Educ. (2024) 24 (1): 918. doi:10.1186/s12909-024-05908-y
  3. 3. Zhang G, Wu H, Xie A’N, Cheng H. The association between medical student research engagement with learning outcomes. Med Educ Online. (2022) 27 (1): 2100039. doi:10.1080/10872981.2022.2100039
  4. 4. Bravo REA, González DM, Navarro PI. Engaged to teach: vocational motivation and academic engagement among Pre-service teachers in distance higher education. Trends High Educ. (2026) 5 (1): 5. doi:10.3390/higheredu5010005
  5. 5. Xu X, Shi Z, Bos NA, Wu H. Student engagement and learning outcomes: an empirical study applying a four-dimensional framework. Med Educ Online. (2023) 28 (1): 2268347. doi:10.1080/10872981.2023.2268347
  6. 6. Wang Y, Zhang W. The relationship between college students’ learning engagement and academic self-efficacy: a moderated mediation model. Front Psychol. (2024) 15: 1425172. doi:10.3389/fpsyg.2024.1425172
  7. 7. Luo W, Fan W, Xia Y, Dou Y, Du J. Professional psychological qualities of Chinese medical students: theoretical models, questionnaire development, and relationship with mental health. Front Psychol. (2024) 15: 1411085. doi:10.3389/fpsyg.2024.1411085
  8. 8. Tervo-Clemmens B, Calabro FJ, Parr AC, Fedor J, Foran W, Luna B. A canonical trajectory of executive function maturation from adolescence to adulthood. Nat Commun. (2023) 14 (1): 6922. doi:10.1038/s41467-023-42540-8
  9. 9. Creighton Avery L, Lewis M. Emerging adolescence: current status and potential advances in bioarchaeology. Bioarchaeol Int. (2023) 7 (2): 103 – 10. doi:10.5744/bi.2023.0006
  10. 10. Andrade RR, Peralta Ramírez AA, López TS. Psychosocial factors associated with academic performance in medical students: a systematic review. BMC Med Educ. (2026) 26 (1): 451. doi:10.1186/s12909-026-08742-6
  11. 11. Liu Yue, Cao Zhe. The impact of social support and stress on academic burnout among medical students in online learning: the mediating role of resilience. Front Public Health. (2022) 10: 938132. doi:10.3389/fpubh.2022.938132
  12. 12. Zingnaa Iddrisu MA, Abdul-Karim M, Alidu M. The nexus between effective communication practices and employee engagement: integrating job demands-resources (JD-R) model and social exchange theory. SN Bus Econ. (2026) 6 (5): 133. doi:10.1007/s43546-026-01134-4
  13. 13. Yudhistira S, Gazadinda R, Medellu GI, Intana AN. Understanding academic engagement through psychosocial factors: evidence from Indonesian medical students. SHS Web Conf. (2025) 224: 07003. doi:10.1051/shsconf/202522407003
  14. 14. Zhang S, Ge S, Tian J, Li Q, Wang M, Wang X. A cross-sectional study of individual learning passion in medical education: understanding self-development in positive psychology. Front Psychol. (2022) 13: 758002. doi:10.3389/fpsyg.2022.758002
  15. 15. Cheung EO, Kwok I, Ludwig AB, Burton W, Wang X, Basti N. Development of a positive psychology program (LAVENDER) for preserving medical student well-being: a single-arm pilot study. Glob Adv Health Med. (2021) 10: 2164956120988481. doi:10.1177/2164956120988481
  16. 16. Yusefi AR, Beigzadeh A, Kaya F. Resilience as a predictor of mental health among medical students: a cross-sectional study using PLS-SEM. BMC Med Educ. (2025) 25 (1): 1476. doi:10.1186/s12909-025-08063-0
  17. 17. Sanjaya A, Mianto NA, Wijayanto KR, Edwin C. Resilience: a panacea for burnout in medical students during clinical training?: a narrative review. Medicine (Baltimore). (2024) 103 (49): e40794. doi:10.1097/MD.0000000000040794
  18. 18. Chen J, Chen F, Qiu S. The impact of multiple factors on medical students’ test anxiety: the mediating role of psychological resilience. Front Psychol. (2026) 17: 1802740. doi:10.3389/fpsyg.2026.1802740
  19. 19. Dariotis JK, Chen FR, Park YR, Nowak MK, French KM, Codamon AM. Parentification vulnerability, reactivity, resilience, and thriving: a mixed methods systematic literature review. Int J Environ Res Public Health. (2023) 20 (13): 6197. doi:10.3390/ijerph20136197
  20. 20. Guo W, Wang J, Li N, Wang L. The impact of teacher emotional support on learning engagement among college students mediated by academic self-efficacy and academic resilience. Sci Rep. (2025) 15 (1): 3670. doi:10.1038/s41598-025-88187-x
  21. 21. Li M, Chen L. The positive effects of positive coping on mental health in college students during the COVID-19 campus lockdown. Front Public Health. (2023) 11: 1267347. doi:10.3389/fpubh.2023.1267347
  22. 22. Li Z, Yi X, Zhong M, Li Z, Xiang W, Wu S. Psychological distress, social support, coping style, and perceived stress among medical staff and medical students in the early stages of the COVID-19 epidemic in China. Front Psychiatry. (2021) 12: 664808. doi:10.3389/fpsyt.2021.664808
  23. 23. McLeod E, Gupta S. The role of psychological safety in enhancing medical Students’ engagement in online synchronous learning. Med Sci Educ. (2023) 33 (2): 423 – 30. doi:10.1007/s40670-023-01753-8
  24. 24. Wu Y, Yu W, Wu X, Wan H, Wang Y, Lu G. Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study. BMC Psychol. (2020) 8 (1): 79. doi:10.1186/s40359-020-00444-y
  25. 25. Hartanto A, Kasturiratna KTAS, Soh XC. Cultivating positivity to achieve a resilient society: a critical narrative review from psychological perspectives. Knowledge. (2022) 2 (3): 443 – 51. doi:10.3390/knowledge2030026
  26. 26. Biaigo K, Ray S, Ahmed IS. Academic burnout and coping strategies in healthcare students: a scoping review. Med Educ Online. (2025) 30 (1): 2579392. doi:10.1080/10872981.2025.2579392
  27. 27. Pavlacic JM, Witcraft SM, Jones TO, Rheingold AA. Increasing psychological resilience in graduate programs and academic medical settings: developing a multimodal assessment and intervention model. Advers Resil Sci. (2024) 5 (2): 201 – 12. doi:10.1007/s42844-023-00120-1
  28. 28. Nie Y, Wang W, Wang T, Zhou F, Liu C, Gao J. The relationship between college Students’ perceived social support and life satisfaction: a chain mediation effect of physical activity and self-control. J Psychol. (2025) 160 (4): 405 – 20. doi:10.1080/00223980.2025.2585272
  29. 29. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. (1988) 52 (1): 30 – 41; Chinese version adapted by Jiang Qianjin (2001). doi:10.1207/s15327752jpa5201_2
  30. 30. Xie YN. Reliability and validity of the simplified coping style questionnaire. Chin J Clin Psychol. (1998) 6 (2): 114 – 5.
  31. 31. Ma H, Zou J, Zhong Y, Li J, He J. Perceived stress, coping style and burnout of Chinese nursing students in late-stage clinical practice: a cross-sectional study. Nurse Educ Pract. (2022) 62: 103385. doi:10.1016/j.nepr.2022.103385
  32. 32. Block J, Kremen AM. IQ And ego-resiliency: conceptual and empirical connections and separateness. J Pers Soc Psychol. (1996) 70 (2): 349 – 61. doi:10.1037/0022-3514.70.2.349
  33. 33. Badura-Brzoza K, Główczyński P, Dębski P, Dębska-Janus M. Ego-Resiliency, life satisfaction and symptoms of anxiety and depression among students of pro-health faculties during COVID-19 pandemic. Healthcare (Basel). (2025) 13 (9): 1008. doi:10.3390/healthcare13091008
  34. 34. Letzring TD, Block J, Funder DC. Ego-control and ego-resiliency: generalization of self-report scales based on personality descriptions from acquaintances, clinicians, and the self. J Res Pers. (2005) 39 (4): 395 – 422. doi:10.1016/j.jrp.2004.06.003
  35. 35. Seo EH, Yang H-J, Kim S-G, Yoon H-J. Ego-resiliency moderates the risk of depression and social anxiety symptoms on suicidal ideation in medical students. Ann Gen Psychiatry. (2022) 21: 19. doi:10.1186/s12991-022-00399-x
  36. 36. Schaufeli WB, Bakker AB, Salanova M. The measurement of workengagement with a short questionnaire: across-national study. Educ Psychol Meas. (2006) 66: 701 – 16. doi:10.1177/0013164405282471
  37. 37. Hamidkholgh G, Zare E, Mirzaei A, Nemati-Vakilabad R, Yousefian M. Investigating the mediating role of learning engagement in the relationship between self-efficacy for managing emotional challenges and subjective well-being among medical students. Sci Rep. (2026) 16 (1): 9418. doi:10.1038/s41598-026-40021-8
  38. 38. Fang L, Shi K, Zhang F. Research on reliability and validity of Utrecht work engagement scale-student. Chin J Clin Psychol. (2008) 16 (6): 618 – 20.
  39. 39. Huang R, Li Y, Gong M, Zhang W, Xian S, Tang J. Good learning environment of medical schools is an independent predictor for medical students’ study engagement. Front Med (Lausanne). (2024) 11: 1299805. doi:10.3389/fmed.2024.1299805
  40. 40. Yang H, Xu L, Malisa M, Xu M, Hu Q, Liu X. Analysing observed categorical data in SPSS AMOS: a Bayesian approach. Int J Quant Res Educ. (2022) 5 (4): 399 – 430. doi:10.1504/IJQRE.2022.129792
  41. 41. Azzam H, Omar YM, Awad K, Ata AH, Elagouz M, Nabih MH. Exploring the pathways between personality traits, alexithymia, and resilience among medical students and interns: a cross-sectional study in Egypt. Sci Rep. (2026) 16 (1): 20352. doi:10.1038/s41598-026-59508-5
  42. 42. Lu G-F, Luo Y, Huang M-Q, Geng F. The impact of career calling on learning engagement: the role of professional identity and need for achievement in medical students. BMC Med Educ. (2025) 25 (1): 238. doi:10.1186/s12909-025-06809-4
  43. 43. Ma W, Liang P, Wu B, Yu Y, Shi Q, Zhong R. Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults. BMC Public Health. (2024) 24 (1): 803. doi:10.1186/s12889-024-18255-w
  44. 44. Nahardani SZ, Sohrabi Z, Soltani Arabshahi SK, Rahimian N. Lived experiences of medical interns on the impact of medical curriculum on clinical skills: a phenomenological study. Med Educ Online. (2026) 31 (1): 2656829. doi:10.1080/10872981.2026.2656829
  45. 45. Chen G, Wang J, Huang Q, Sang L, Yan J, Chen R. Social support, psychological capital, multidimensional job burnout, and turnover intention of primary medical staff: a path analysis drawing on conservation of resources theory. Hum Resour Health. (2024) 22 (1): 42. doi:10.1186/s12960-024-00915-y
  46. 46. Wen HL, Feng C, Zhang SL, Li XW. Supportive psychological intervention on psychological disorders in clinical medicine students with English learning difficulties: a protocol of systematic review. Medicine (Baltimore). (2020) 99 (47): e23196. doi:10.1097/MD.0000000000023196
  47. 47. Fan J, Huang Y, Yang F, Cheng Y, Yu J. Psychological health status of Chinese university students: based on psychological resilience dynamic system model. Front Public Health. (2024) 12: 1382217. doi:10.3389/fpubh.2024.1382217
  48. 48. Zhang Y, Liu M, Yu W, Gao Z, Zhao D, Yan W. The mediation effects of smartphone addiction, negative emotion and psychological resilience in the relationship between social support and sleep quality among medical students. Front Psychiatry. (2026) 17: 1839572. doi:10.3389/fpsyt.2026.1839572
  49. 49. Yan Y, Mahdi M, He Y. Bridging cultural divides: family support and psychological resilience as catalysts for student adaptability in sino-foreign cooperative education. Front Psychol. (2025) 16: 1717876. doi:10.3389/fpsyg.2025.1717876
  50. 50. Park YS, Chun K, Lee TH. Exploring the psychosocial characteristics and systematic support of academically maladjusted students. Korean Med Educ Rev. (2022) 24 (3): 215 – 30. doi:10.17496/kmer.2022.24.3.215
  51. 51. Teh BL, Ang JK, Koh EB, Pang NT. Psychological resilience and coping strategies with anxiety among Malaysian medical students during the COVID-19 pandemic. Int J Environ Res Public Health. (2023) 20 (3): 1894. doi:10.3390/ijerph20031894
  52. 52. Kiss H, Pikó FB. Risk and protective factors of student burnout among medical students: a multivariate analysis. BMC Med Educ. (2025) 25 (1): 386. doi:10.1186/s12909-025-06956-8
  53. 53. Lyu FF, Ramoo V, Wang YX. Career maturity, psychological resilience, and professional self-concept of nursing students in China: a nationwide cross-sectional study. J Prof Nurs. (2022) 42: 58 – 66. doi:10.1016/j.profnurs.2022.06.003
  54. 54. Banerjee Y, Akhras A, Khamis AH, Alsheikh-Ali A, Davis D. Investigating the relationship between resilience, stress-coping strategies, and learning approaches to predict academic performance in undergraduate medical students: protocol for a proof-of-concept study. JMIR Res Protoc. (2019) 8 (9): e14677. doi:10.2196/14677
  55. 55. Shida Q. Mediating effects of achievement goal orientation on the relationship between growth mindset and learning engagement in medical students: a cross-sectional descriptive study. Medicine (Baltimore). (2024) 103 (21): e38158. doi:10.1097/MD.0000000000038158
  56. 56. Orozco-Jiménez KI, Samudio-Cruz MA, Baños-Chaparro J, Ocampo-Coronado E, Chávez-Maisterra I, Rodríguez-Baeza MMJ. Analysis of medical Students’ motivation: insights into the development of future health professionals. Behav Sci. (2026) 16 (1): 97. doi:10.3390/bs16010097
  57. 57. Xu Z, He Y. The relationship between perceived social support and learning engagement among Chinese vocational students: a moderated chain mediation model. Behav Sci. (2026) 16 (3): 426. doi:10.3390/bs16030426
  58. 58. Besse M, Signerski-Krieger J, Wiltfang J, Bartels C, Belz M. One year of digital teaching in psychiatry as a response to the COVID-19 pandemic: knowledge gain and content evaluation of medical students for two summer semesters in 2020 and 2021. PLoS One. (2022) 17 (10): e0276660. doi:10.1371/journal.pone.0276660
  59. 59. Lu L, Ye C, Xu R, Feng H, Liu B. Psychological resilience and perceived stress among Chinese medical students: mediation between optimistic intelligence quotient and adversity quotient. BMC Med Educ. (2024) 24 (1): 1358. doi:10.1186/s12909-024-06287-0
  60. 60. Stirling M, Hart J. The educational outcomes of medical student engagement in research projects: a scoping review. BMC Med Educ. (2026) 26 (1): 504. doi:10.1186/s12909-026-08787-7
  61. 61. He L, Li W, Zhang Y, Wang J, Yu Y, Li S. Academic stress and online learning engagement in medical students: the parallel mediating roles of sleep quality and positive academic emotions. BMC Med Educ. (2025) 26 (1): 54. doi:10.1186/s12909-025-08369-z
  62. 62. Flores V, Ríos H, González Gentili C, Donato M, Rapacioli M. Academic engagement and contextual factors associated with academic performance in first-year medical students: a cross-sectional study. Adv Med Educ Pract. (2026) 17: 1 – 14. doi:10.2147/AMEP.S622464
  63. 63. Ren J, Peng NQ, Luo J. Optimistic intelligence quotient: a factor that determines fate more than IQ and EQ[J]. Adv Psychol Sci. (2013) 21 (4): 571 – 80. doi:10.3724/SP.J.1042.2013.00571

Citation

Li, Y., et al. (2026). The mediating role of psychological resilience and coping styles among Chinese medical students in the relationship between perceived social support and learning engagement among medical students. Frontiers in Child and Adolescent Psychiatry, Volume 5. https://doi.org/
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5 - 2026

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© 2026 Li, Zhang, Zhang, Zhu and Jin.

License: https://creativecommons.org/licenses/by/4.0/

*Correspondence: Zhe Jin

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