Abstract
Background
Medical students have experienced increased anxiety symptoms during the pandemic of COVID-19. However, there is a paucity of investigation on the effect of academic procrastination, and personal resources (such as social support and resilience) on anxiety symptoms among this population.
Objective
The main objective of this research was to evaluate the link between academic procrastination and anxiety symptoms among medical students during the pandemic of COVID-19 and clarify how resilience and social support mediate or moderate the relations between academic procrastination and anxiety symptoms.
Methods
With a cross-sectional stratified sampling, 595 participants completed a self-administered questionnaire to assess anxiety symptoms and associated factors. The study used the Generalized Anxiety Disorder 7-item Scale (GAD-7 cutoff ≥ 10), the Academic Procrastination Scale (PASS), Connor Davidson Resilience Scale (CD-RISC),and Perception Social Support Scale for measurements.
Results
The results of the study showed that 26.4% (157/595) of medical students exhibited symptoms of anxiety. Regression analysis revealed an inverse relationship between resilience, social support, and anxiety symptoms (β = -0.058, P < 0.05). As revealed by the analysis results, the study found a total effect of 0.338, a direct effect of 0.270, and resilience exhibited a mediating effect of 0.068. The direct effect (0.270) accounted for 79.59% of the total effect (0.338), while the mediating effect (0.068) contributed to 20.12% of the total effect (0.338). This further supports the role of psychological resilience in mediating the link between academic procrastination and anxiety symptoms.
Conclusion
The study implies that promoting resilience may be an effective intervention to lessen the detrimental consequences of academic procrastination on anxiety symptoms, and social support might provide a defense against the negative influence of academic procrastination on anxiety symptoms.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-024-06202-3.
Keywords: Academic procrastination, Anxiety symptoms, Resilience, Social support, Moderated mediation analysis
Highlights
• The prevalence of anxiety symptoms among medical students in our study was high (26.4%).
• Academic procrastination is positively associated with anxiety symptoms among medical students, and mediating effects of resilience and moderating effect of social support on the relationship of academic procrastination and anxiety symptoms were found.
• Resilience and social support were found to play significant roles in mitigating the negative effects of procrastination on anxiety symptoms, suggesting that interventions targeting these factors may be effective in reducing anxiety among medical students.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-024-06202-3.
Introduction
The COVID-19 pandemics may negatively impact the mental health of college students. Research suggests that a lack of mental toughness in the face of emergencies may make college students more vulnerable to mental health problems. College students with higher levels of psychological resilience have been shown to be more capable of coping with challenges and adapting to stress [1]. Meanwhile the COVID-19 pandemic may have similar negative effects on the mental health of other groups, especially those who lacking in mental toughness and are more prone to symptoms of depression and anxiety [2]. Chinese medical students have turned to online teaching in response to the pandemic of COVID-19 [3, 4]. Although online teaching offers convenience, it can lead to negative impacts on academic procrastination [5], which is defined as putting off the completion of planned assignments despite negative consequences [6]. Studies indicate that academic procrastination has an adverse effect on students' academic achievement [7] and can have detrimental effects on the well-being of their bodies and minds, as well as their emotional experiences [8]. With the increasing prevalence of online teaching during the COVID-19 pandemic, academic procrastination has become a more serious issue affecting many students’ mental health.
Rothblum and Solomon [9] initially described academic procrastination as the "unnecessary procrastination of tasks to the point of experiencing subjective discomfort," Research by Anindyajati et al. [10] suggested that academic procrastination can lead to anxiety among medical students who worry about it and may disrupt their plans to pursue further academic study. Similarly, a study by [11] found that procrastinating students showed elevated anxiety levels, supporting the idea that higher levels of academic procrastination leads to more severe anxiety symptoms.
Resilience is the capacity to handle adverse circumstances and stressors, and to solve or prevent psychological problems in difficult situations [12]. Students with high resilience can actively adjust their mindset, change their cognition, and seek social support to alleviate anxiety symptoms when facing with difficulties [13]. Resilience can mediate the link between stress caused by COVID-19 and symptoms of depression [14], between emotion regulation and test anxiety [15], and between childhood negative emotional symptoms and trauma [16]. Furthermore, the association between work-related stress caused by COVID-19 ,manifestations of anxiety, and feelings of depression were found to be mediated by social support and resilience respectively [17]. Overall, the existing literature suggests that resilience can mitigate the detrimental consequences of academic procrastination on anxiety symptoms and act as a mediator between academic procrastination and anxiety symptoms, This idea has been carried out in a lot of literature, the statement that resilience can mitigate the adverse effects of academic procrastination on anxiety symptoms and act as a mediator in this relationship is supported by empirical research. For example, a study by Huang [18] examined the role of resilience in the relationship between academic procrastination and health outcomes. They found that higher levels of resilience were associated with lower levels of anxiety and depression, and high levels of academic procrastination, which suggests that resilient individuals are better able to cope with the stress and negative emotions arising from procrastination, thereby reducing anxiety symptoms.
Social support is how a person perceives the assistance that they could receive or desire from others [19]. Researches have shown that social support can moderate the link between negative emotions and psychological health. A recent study found that the relation between resilience and suicidal ideation was influenced by social support as a moderator, which exerted an indirect effect on suicidal ideation through loneliness [20]. Also, Yu et al. [21] revealed that online social support played a moderating role in the indirect effect of the mediation model linking parent-child attachment and college students' social anxiety, while resilience had a partial mediating effect on the link between parent-child attachment and college students' social anxiety.
Based on the above-mentioned theories and empirical studies [22, 23]. Three hypotheses were tested:
H1: There is a positive correlation between academic procrastination and anxiety symptoms (H1a), an inverse correlation between academic procrastination and resilience (H1b), and a negative correlation between resilience and anxiety symptoms (H1c).
H2: Academic procrastination and resilience predict anxiety symptoms, with higher resilience predicting lower anxiety symptoms (H2a), and higher academic procrastination predicting higher anxiety symptoms (H2b).
H3: Resilience and social support act as moderated mediators in the relationship between academic procrastination and anxiety symptoms. Resilience is expected to mediate the direct and indirect connections between academic procrastination and anxiety symptoms, with the moderating effect of social support.
Methods
Research design and participants
This cross-sectional survey employed a stratified random sampling method to test 595 medical students on academic procrastination, anxiety symptoms, resilience, and social support in a medical university in Shenyang. Data were collected using the widely used online survey tool "Questionnaire Star" (called "Wen Juanxing"in Chinese) . Prior to completing the questionnaire, all participants were required to give online informed consent. The criteria for inclusion were: (1) medical students aged between 18 and 35 years; (2) providing informed consent; and (3) having access to internet and the ability to use smartphones. Participants with mental illness, cognitive impairment, communication difficulties, or unwillingness to cooperate were excluded. After removing 105 incomplete questionnaires, the effective response rate was 85%.
Ethics statement
The study was conducted in accordance with ethical guidelines and approved by the China Medical University Committee on Human Experimentation (Ref no. 2020048).
Participant demographics
Demographic data of participants were collected, including age (categorized as <20 years or ≥20 years), gender, grade (freshman, sophomore, junior or above), major (clinical medicine or other), total monthly family income (categorized as <3000 yuan, 3000-6000 yuan, or >6000 yuan), and education level of parents (high school and below or college and above). The survey also included questions related to the closure management of schools owing to the outbreak of COVID-19.
Assessing anxiety symptoms
To assess anxiety symptoms among medical students, the study used the Generalized Anxiety Disorder 7-item Scale (GAD-7 cutoff ≥10), a reliable and valid tool that evaluates general anxiety symptoms [24]. The GAD-7 is a 7-item questionnaire that uses a Likert-type scale ranging from "not at all" to "nearly every day," and scores range from 0 to 3. Higher scores indicate more severe anxiety. The GAD-7 demonstrated good reliability, with a Cronbach's alpha of 0.941.
Assessing academic procrastination
This study employed the Academic Procrastination Scale (PASS), which was originally developed by Rothblum and Solomon [9] in 1984 and later translated and revised into Chinese by Guan Xuejing in 2010 [25]. The Chinese version of the scale has been validated to exhibit good reliability and validity [26]. The scale comprises 44 questions and is scored using a Likert 5 scale. This study used the first part, which consists of 18 questions to evaluate academic procrastination in six aspects. The scale used in this study was found to have a Cronbach's alpha of 0.862, indicating good internal consistency.
Measurement of resilience
To measure resilience, the study employed the chinese version of Connor Davidson Resilience Scale (CD-RISC) [27].The CD-RISC comprises 25 items. The scale uses a 5-level scoring method, where higher scores indicate greater levels of resilience. The reliability of the scale used in this study was demonstrated by Cronbach's alpha coefficient of 0.91.
Measurement of social support
To assess medical students' perception of social support, this study employed the Chinese version of the Revised Perception Social Support Scale [28, 29]. The scale comprises 12 items and is scored using a seven-level Likert scale ranging from "1(very inconsistent)" to "7(very consistent)." The internal consistency coefficient of the scale is 0.96, indicating good reliability.
Statistical analysis
To investigate the potential influence of demographic factors on anxiety symptoms, an independent samples t-test and Spearman correlation analysis were used in this study to detect potential correlations between variables. The study employed hierarchical linear regression analysis and conducted moderated mediation analyses using PROCESS Version 3.3, applying Model 4 for mediation analysis, and Model 59 for moderated medication analysis [30]. This model posited that anxiety symptoms (Y) were the dependent variable, with academic procrastination (X) as the independent variable, and resilience (M) as the mediator. Social support (W) was also included in the model as a moderator. The proposed moderated mediation model is visually represented in Figure 1. To determine the significance of effects, the study utilized the bootstrapping method with 5,000 samples and 95% confidence intervals, with effects considered significant if their 95% confidence interval did not include zero.
Fig. 1.
Moderated Mediation Model: Academic Procrastination on Anxiety symptoms Resilience as Mediator, Social Support as Moderator
Results
Demographic characteristics of anxiety symptoms
The demographic characteristics and corresponding anxiety symptom scores of study participants are shown in Table 1. Of the 595 participants, 85.2% (507) were younger than 20 years old, and 14.8% (88) were 20 years old and above. The sample was predominantly female, with women comprising 69.9% (416) of the participants. Additionally, 45.2% (269) of participants reported a family monthly income exceeding 6000 yuan (858.22 dollars), and 56.3% (355) were majoring in clinical medicine. Freshmen made up the largest proportion of participants 55.3%. The scores of anxiety symptoms among students in their junior year or above were higher than those of freshmen and sophomores, as indicated by an independent samples t-test (P<0.01).
Table 1.
Participant demographics and anxiety symptom distribution among medical students (N = 595)
| Variables | N(%) | Anxiety symptoms (Mean ± SD) |
|---|---|---|
| Age | ||
| < 20years old | 507(85.21) | 3.48 ± 4.66 |
| ≥ 20years old | 88(14.78) | 4.22 ± 4.83 |
| Gender | ||
| Man | 179(30.08) | 3.83 ± 4.88 |
| Female | 416(69.92) | 3.48 ± 4.61 |
| Grade | ||
| Freshman | 329(55.29) | 3.60 ± 4.66** |
| Sophomore | 181(30.42) | 2.82 ± 3.86 |
| Junior and above | 85(14.29) | 5.16 ± 5.90** |
| Profession | ||
| Clinical major | 335(56.30) | 3.63 ± 4.8 |
| Other | 260(43.70) | 3.53 ± 4.44 |
| Income | ||
| < 3000yuan | 110(18.49) | 4.03 ± 4.74 |
| 3000-6000yuan | 216(36.30) | 3.62 ± 4.47 |
| > 6000yuan | 269(45.21) | 3.38 ± 4.84 |
| The education of the father | ||
| High school and below | 340(57.14) | 3.54 ± 4.70 |
| College degree or above | 255(42.86) | 3.65 ± 4.69 |
| The education of the mother | ||
| High school and below | 355(59.66) | 3.76 ± 4.85 |
| College degree or above | 240(40.34) | 3.33 ± 4.44 |
**P < 0.01
Correlations between anxiety symptoms, academic procrastination, resilience and social support
Correlations between anxiety symptoms, academic procrastination, resilience and social support.
To investigate the correlations among the continuous variables, spearman correlation analysis was performed (H1). Table 2 displays the results, indicating a statistically marked positive correlation between academic procrastination (M = 52.29, SD = 14.751) and anxiety symptoms (M = 3.59, SD = 4.689). Moreover, a significant inverse relationship was found between academic procrastination and resilience in the study (M = 70.02, SD = 21.287),. Additionally, anxiety symptoms and resilience were found to have a statistically marked negative correlation.
Table 2.
The spearman correlations among anxiety symptoms and continuous variables
| M | SD | 1 | 2 | 3 | 4 | 5 | |
|---|---|---|---|---|---|---|---|
| 1. Anxiety symptoms | 3.59 | 4.689 | 1 | ||||
| 2. Age | 19.41 | 1.765 | 0.062 | 1 | |||
| 3. Academic procrastination | 52.29 | 14.751 | 0.347** | -0.007 | 1 | ||
| 4. Resilience | 70.02 | 21.287 | -0.469** | 0.001 | -0.295** | 1 | |
| 5.Social support | 64.39 | 15.263 | -0.308** | 0.027 | -0.141** | 0.574** | 1 |
**P < 0.01
The mediating influence of resilience in the association between academic procrastination and anxiety symptoms
The mediating influence of resilience in the association between academic procrastination and anxiety symptoms
Table 3 presents a summary of the analysis results. The anxiety symptoms of students in junior year or above were found to be higher than those of freshmen (β=0.404, P<0.001). Furthermore, academic procrastination had a negative impact on resilience (β=-0.188, P<0.001), whereas it had a positive influence on anxiety symptoms (β=0.269, P<0.001). Additionally, resilience had a negative impact on anxiety symptoms (β=-0.362, P<0.001). Table 4 revels the breakdown of the direct and total effect of academic procrastination on anxiety symptoms. As revealed by the analysis results, the study found a total effect of 0.338, a direct effect of 0.270, and esilience exhibited a mediating effect of 0.068. The direct effect (0.270) accounted for 79.59% of the total effect (0.338), and the mediating effect (0.068) contributed to 20.12% of the total effect (0.338).with a 95% confidence interval excluding zero,suggesting that resilience could predict anxiety symptoms both directly and indirectly (Fig. 2).
Table 3.
Examining the mediating role of academic procrastination in anxiety symptom developmen
| Predictors | Model 1 | Model 2 | ||||
|---|---|---|---|---|---|---|
| Resilience | Anxiety symptoms | |||||
| B (SE) | t | 95%CI | B (SE) | t | 95%CI | |
| Constant | -0.235(0.242) | -0.972 | (-0.71,0.240) | 0.032(0.216) | 0.147 | (-0.392,0.455) |
| Age | 0.011(0.055) | -0.208 | (-0.119,0.096) | -0.05(0.049) | -1.093 | (-0.149,0.042) |
| Gender | ||||||
| Male VS.Female | 0.087(0.088) | 0.987 | (-0.086,0.0.260) | -0.05(0.079) | -0.752 | (-0.213,0.095) |
| Grade | ||||||
| Sophomore VS.Freshman | 0.083 | 0.883 | -0.101,0.266 | -0.082 | -0.988 | (-0.246,0.081) |
| Junior and above VS.Freshman | 0.125 | 0.766 | -0.195,0.444 | 0.465 | 3.202** | (0.180,0.750) |
| Profession | ||||||
| Clinical VS.Non Clinical | -0.149(0.084) | -1.763 | (-0.314,0.017) | -0.04(0.075) | -0.543 | (-0.189,0.107) |
| Income | ||||||
| 3000-6000yuan VS.＜3000yuan | 0.248 | 2.153* | (0.022,0.474) | 0.004 | 0.036 | (-0.189,0.107) |
| ＞6000yuan VS.＜3000yuan | 0.448 | 3.766*** | (0.214,0.682) | 0.021 | 0.193 | (-0.199,0.206) |
| The education of the father | ||||||
| High school or below VS. College or above | -0.16(0.114) | -1.404 | (-0.385,0.064) | 0.114(0.102) | 1.118 | (-0.086,0.314) |
| The education of the mother | ||||||
| High school or below VS. College or above | 0.139(0.113) | 1.225 | (-0.084,0.361) | -0.06(0.101) | -0.616 | (-0.26,0.136) |
| Academic procrastination | -0.189(0.040) | -4.729*** | (-0.267,-0.11) | 0.269(0.036) | 7.428*** | (0.198,0.341) |
| Resilience | -0.36(0.037) | -9.826*** | (-0.435,-0.29) | |||
| R2 | 0.077 | 0.268 | ||||
| F | 4.873*** | 19.442*** | ||||
Note: *P < 0.05, **P < 0.01,***P < 0.001
Table 4.
Decomposition table of total effect, direct effect and medicating effect
| Effect | Boot SE | BootLLCI | BootULCI | Proportion of effects | |
|---|---|---|---|---|---|
| Total | 0.338 | 0.038 | 0.262 | 0.413 | |
| Direct | 0.270 | 0.036 | 0.198 | 0.341 | 79.59% |
| mediation effect of resilience | 0.068 | 0.028 | 0.022 | 0.131 | 20.12% |
Boot SE, Boot CI lower limit, and Boot CI upper limit refer to the standard error of indirect effects estimated using the deviation corrected percentile Bootstrap method, as well as the lower and upper limits of the 95% confidence interval
Fig. 2.
Results on resilience's mediating function in the link between academic procrastination and anxiety symptoms
The interaction between social support and the mediating effect of resilience in the association between academic procrastination and anxiety symptoms
The interaction between social support and the mediating effect of resilience in the association between academic procrastination and anxiety symptoms.
Table 5 presents the outcomes of the moderated mediation model, and Figure 3 illustrates the final model with statistical values. The results prove that the interaction impact of academic procrastination and social support significantly and negatively predicted both resilience and anxiety symptoms among medical students (β=-0.097, P<0.01; β=-0.059, P<0.05). However, the analysis revealed that the resilience × social support interaction was not significant, indicating that social support did not moderate the relationship between resilience and anxiety symptoms. These results support Hypothesis 3, which posits that social support moderates the main effect and the first half path of the model.
Table 5.
Examining how academic procrastination's mediating role in anxiety symptom development is moderated
| Predictors | Model 1 | Model 2 | ||||
|---|---|---|---|---|---|---|
| Resilience | Anxiety symptoms | |||||
| B (SE) | t | 95%CI | B (SE) | t | 95%CI | |
| Constant | 0.095 (0.198) | 0.482 | (-0.294,0.484) | 0.024(0.216) | 0.111 | (-0.400,0.448) |
| Age | -0.024 (0.045) | -0.53 | (-0.112,0.064) | -0.043(0.049) | -0.882 | (-0.139,0.053) |
| Gender | ||||||
| Male VS.Female | -0.060 (0.072) | -0.833 | (-0.202,0.082) | -0.051(0.079) | -0.64 | (-0.206,0.105) |
| Grade | ||||||
| Sophomore VS.Freshman | 0.050 (0.076) | 0.655 | (-0.100,0.200) | -0.088(0.083) | -1.06 | (-0.251,0.075) |
| Junior and above VS.Freshman | 0.002 (0.133) | 0.014 | (-0.26,0.264) | 0.434(0.145) | 2.988** | (0.149,0.720) |
| Profession | ||||||
| Clinical VS.Non Clinical | -0.036 (0.069) | -0.52 | (-0.171,0.100) | -0.044(0.075) | -0.578 | (-0.191,0.104) |
| Income | ||||||
| 3000-6000yuan VS. < 3000yuan) | 0.181 (0.094) | 1.925 | (-0.004,0.365) | -0.002(0.103) | -0.017 | (-0.204,0.200) |
| > 6000yuan VS. < 3000yuan | 0.300 (0.097) | 3.082** | (0.109,0.491) | 0.022(0.107) | 0.207 | (-0.188,0.232) |
| The education of the father | ||||||
| High school or below VS. college or above | 0.181 (0.093) | -1.206 | (-0.295,0.071) | 0.109(0.102) | 1.071 | (-0.091,0.309) |
| The education of the mother | ||||||
| High school or below VS. college or above | 0.300 (0.093) | -0.037 | (-0.185,0.178) | -0.057(0.101) | -0.564 | (-0.255,0.141) |
| Academic procrastination | -0.161 (0.033) | -4.933*** | (-0.226,-0.097) | 0.262(0.036) | 7.201*** | (0.191,0.334) |
| Resilience | -0.37(0.045) | -7.201*** | (-0.459,-0.282) | |||
| Social support | 0.532(0.034) | 15.561 | (0.465,0.599) | -0.023(0.044) | -0.516 | (-0.110,0.064) |
| Academic procrastination × Social support | -0.096(0.023) | -4.109 | (-0.142,-0.050) | -0.058(0.026) | -2.223* | (-0.108,-0.007) |
| R2 | 0.389 | 0.275 | ||||
| F | 30.884*** | 16.927*** | ||||
Model 1 regressed resilience on social support while controlling for demographic characteristics; Model 2 regressed anxiety symptoms on social support, resilience, academic procrastination × social support while controlling for demographic characteristics
*P < 0.05, **P < 0.01,***P < 0.001
Fig. 3.
The moderated mediation model. (The Relationship between Academic Procrastination and Anxiety Symptoms, Resilience as the mediator and Social Support as the moderator)
The simple slope diagram of social support moderation
To acquire a more holistic comprehension of how social support moderates the association between academic procrastination and anxiety symptoms, this study employed the slope analysis method [20]. On the premise that the variables are centered on the mean value. Figure 4(a) provides a visual representation of how medical students' anxiety symptoms and academic procrastination behavior are influenced by social support. The results demonstrated that at a high social support (βSimple=0.203, SE=0.047, P<0.001)academic procrastination positively predicted medical students’ anxiety symptoms. Academic procrastination may exert stronger effect on anxiety symptoms among medical students with lower levels of social support. This means that in the absence of social support, academic procrastination may be more likely to lead to increased anxiety symptoms among medical students. Figure 4(b) demonstrates that when the social support is low, the negative impact of academic procrastination on resilience is substantial. In the moderated mediation analysis, there was no indication that social support moderated the link between resilience and anxiety symptoms. Thus, H4 is also validated.
Fig. 4.
Through moderated mediation analysis, we graphed the effects of social support on the relationships between academic procrastination and anxiety symptoms, as well as between resilience and anxiety symptoms. The analysis presented two levels for each variable: 1 SD above and below the mean
Discussion
This study is the first to investigate the link between academic procrastination and anxiety symptoms within the medical student population during the outbreak of the COVID-19 pandemic, and also the first to examine whether this relationship is mediated by resilience and moderated by social support. In our study, the prevalence of anxiety symptoms among medical students was 26.4%, which was comparatively higher than that reported in a previous study conducted by Zhang(20.6%) [31] in China.The pandemic has presented unprecedented challenges for medical students, including the shift to online learning, social isolation, and increased academic demands, which can result in negative academic outcomes and psychological distress. It is closely related to feelings of guilt, anxiety, and stress, all of which can have negative effects on mental health [32]. Consistent with prior research, our results demonstrate that academic procrastination is positively linked with anxiety symptoms and negatively linked with resilience [33, 34]. In recent years, as people's awareness of attention to mental health increases, greater resilience has been linked to reduced anxiety symptoms [35]. A recent study indicated that resilience had a positive influence by being related with lower levels of academic stress and anxiety, and predicting improved academic achievement [36].
The study testified that social support moderated the direct and indirect relationships between academic procrastination and anxiety symptoms through resilience. This finding aligns with earlier research showing the beneficial impact of social support in moderating anxiety symptoms [37, 38].
Our research revealed that social support moderated the effect of academic procrastination on anxiety symptoms, which was in agreement with a research [39] found that social support moderated the association between anxiety and depression. Similarly, researchers [40, 41] found evidence to prove that social support could moderate the link between positive psychological factors, such as resilience and subjective happiness. There has also been research demonstrating that social support indirectly influenced academic burnout with the assistance of resilience as a mediator [42]. Angevaare et al. [43] have provided evidence that social support is highly significant in promoting resilience at the contextual level. This is in accordance with earlier investigations that high levels of resilience and social support can serve as valuable assets to address academic procrastination and mitigate anxiety symptoms [44–46]. Furthermore, a growing body of research has indicated that academic procrastination is more prevalent among people with poorer social support [47, 48].
Our results suggest that social support moderated the link between resilience and anxiety symptoms, as indicated by the moderated mediation analysis. Similarly, social support has been shown to moderate the influence of stress on depressive disorders [49] and the interaction between two variables (socical support and academic procrastination) have a statistically significant effect on anxiety symptoms [50]. Liabsuetrakul et al. [51] also demonstrated the moderating function of social support in the association between anxiety symptoms and positive psychological resources in a comparative epidemiological analysis. However, Balaban and Bilici [52] found no statistically marked differences in resilience scores based on social support in their study. Nonetheless, Zhao et al. [53] reported that social support moderated the bond between loneliness and depressive symptoms, with resilience playing a mediating role, which was in alignment with the present study. According to the above findings, interventions aimed at addressing academic procrastination in medical students with anxiety symptoms should consider the influence of resilience and social support individually, as well as the interplay between social support and resilience.
This study also demonstrated that students with higher resilience may be more capable of handling academic stress, thereby reducing the negative influence of academic procrastination on their mental health,which is consistent with prior investigations [54]. Our findings suggest that resilience and social support work together to minimize the negative bearing of academic procrastination on anxiety symptoms, as indicated by the moderated mediation model. Medical students who possess both higher resilience and stronger social support networks might be better equipped to deal with the challenges of academic procrastination and the pandemic. Resilience and social support may also reinforce each other, as students who feel supported may be more likely to develop and maintain resilience.
We also explored the potential mechanisms by which this relationship might exist. Based on the literature suggesting that the mediation role would benefit from providing information about the characteristics of resilience, various aspects such as emotion regulation and neuroplasticity should be taken into account [55] and neuroplasticity [56].
In the context of the COVID-19 pandemic, mental health problems have been widely reported. Nonetheless some resilience-related strategies can go a long way towards minimizing these kinds of psychological problems. For example, effortful control and constructive coping have been found to protect individuals from increasing or moderately high levels of anxiety symptoms during pandemic. These factors and especially the trainable constructive coping strategies could be possible targets for interventions focusing on adult mental health during the pandemic [57]. Another research also describes multiple coping strategies (such as behavioral activation, acceptance-based coping, mindfulness practice, loving-kindness practices) geared to decrease stress and promote resilience and recovery. These strategies may be especially effective because they help individuals make meaning, build distress tolerance, increase social support, gain deeper insights into human interconnectedness, and take goal-directed and value-driven actions in midst of the COVID-19 pandemic [58].
However, our study also has some limitations.There has been limited investigation into the direct or indirect buffering effects of social support on the positive influence of academic procrastination on anxiety symptoms among medical students. Also the data collection methodology of our research design may be subject to confounding bias.The survey instrument selection and the geographically restricted data collection may also affect the interpretation of the results.
Conclusion
The study revealed a high prevalence of anxiety symptoms among medical students during the COVID-19 pandemic. Resilience and social support are important contributors for reducing the effect of academic procrastination on anxiety symptoms among medical students. The construction of a moderated mediation model could offer valuable insights into the relationship and pathways between these factors. Interventions aimed at boosting social support and resilience may prove beneficial in mitigating the adverse influence of academic procrastination on students' mental health and overall well-being. To reduce anxiety symptoms, measures to enhance students' resilience, such as psychological training and self-regulation, are recommended. Furthermore, strengthening social support for medical students, such as building positive teacher-student relationships and promoting teamwork, can help to establish a robust social support network that assists students in managing stress and anxiety.
Supplementary Information
Acknowledgements
The authors are grateful to all of the study participants.
Code availability
The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. Be shared on reasonable request to the corresponding author.
Abbreviations
- COVID-19
The Coronavirus Disease-19.
- 95% CI
95% Confidence Interval
- B
The Unstandardized Path Coefficient
Authors’ contributions
Chong Liu and Xiaoshi Yang contributed to the acquisition and analysis of data, drafting and the revision of the Manuscript, Xinru Li and Gen Li were responsible for the conception, design, drafting and the revision of the manuscript. Yanyan Xu contributed to the acquisition and interpretation of data. Lingfang Ning, Xinyue Xie and Chunyu Shao contributed to the acquisition and analysis of data.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
This study was approved by ethics committee of China Medical University (Ref no. 2020048) and conducted in line with Helsinki Declaration principles.All subjects gave their informed consent for inclusion before they participated in the study.
Consent for publication
All participants agree to submit and publish the work in《BMC Psychiatry》.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
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Xinru Li, Yanyan Xu and Gen Li contributed equally to this work and should be regarded as co-first authors.
Contributor Information
Chong Liu, Email: liuc1@sj-hospital.org.
Xiaoshi Yang, Email: xsyang@cmu.edu.cn.
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Data Availability Statement
No datasets were generated or analysed during the current study.