The indirect associations of academic self-efficacy and brief fear of negative evaluation in the relationship between neurotic personality traits and test anxiety of medical sciences students

Abstract

Background

Research on test anxiety has decreased in recent years, but the phenomenon of test anxiety has always been a major hazard that continuously plagues students’ academic performance. In recent years, with educational reforms, there have been more variables in examinations, and examinations have also become increasingly important in individual careers. Therefore, this study will continue to research test anxiety in the new era and continue to deepen the understanding of this issue. Moreover, existing studies mostly focus on the impact of general self-efficacy on anxiety, while there are fewer studies on the impact of academic self-efficacy on test anxiety, and currently, there are fewer studies that quantitatively research the relationship between individual personality and brief fear of negative evaluation. Therefore, this study aims to explore the indirect associations of academic self-efficacy and brief fear of negative evaluation between neurotic personality and test anxiety in medical sciences students.

Methods

By using the convenient sampling method, 420 medical sciences students studying in a medical college in Jinzhou City from October 2024 to March 2025 were selected as the research subjects. A questionnaire survey was conducted using the general information questionnaire, Eysenck Personality Questionnaire Short Scale, Academic Self-Efficacy Questionnaire, Brief Fear of Negative Evaluation Scale, and Test Anxiety Scale. The relationships between related variables were inspected through Spearman correlation analysis; The indirect association degree test was conducted using Model 6 of the SPSS macro program Process. Meanwhile, to verify the significance of the degree of indirect association, the Bootstrap method was used for repeated sampling 5,000 times to calculate the 95% confidence interval.

Results

The relevant analysis results show that neurotic personality is negatively correlated with academic self-efficacy (r = -0.313), positively correlated with fear of short-term negative evaluation (r = 0.382), and positively correlated with test anxiety (r = 0.348), with all P values less than 0.05. Academic self-efficacy and transient fear of negative evaluation play an indirect association role between neurotic personality and test anxiety of medical students, with an indirect association degree of 0.412, accounting for 66.58% of the total association degree.

Conclusions

Neurotic personality is not only directly associated with the test anxiety level of medical sciences students, but also indirectly related to the test anxiety level of medical sciences students through academic self-efficacy and the brief fear of negative evaluation.

Introduction

In an educational context, test anxiety is a manifestation of academic anxiety, generally characterized by an individual’s fear and concern over negative evaluations, along with the resultant negative behavioral, physiological, or emotional reactions [1]. As the future cornerstone of the national healthcare sector, medical sciences students hold significant importance in the educational institution’s training program. Distinguishing itself from other professional fields, the unique nature of the healthcare industry imposes elevated demands on medical sciences students regarding their professional skills, vocational ethics, and psychological resilience, thereby making them particularly susceptible to test anxiety. Estimates indicate that 10% to 40% of students experience varying degrees of test anxiety [2], with 15% to 22% exhibiting severe test anxiety [3, 4]. Research reveals that the prevalence of high test anxiety among medical sciences students stands at 52.3% [5]. Excessive test anxiety not only impairs academic performance but also adversely impacts cognitive functions such as attention and memory [6]. Furthermore, prolonged test anxiety can result in various detrimental physical outcomes, including bodily discomfort and weakened immunity [7]. Additionally, pertinent studies have shown that severe test anxiety can even precipitate suicidal behaviors in individuals with psychological disorders [8].

Neuroticism is a core personality trait characterized by feelings of inferiority, depression, shyness, mood swings, and anxiety. Research indicates that neuroticism is positively correlated with test anxiety [9–11]. There is a significant positive correlation between neuroticism and all forms of anxiety disorders. Among the myriad vulnerability factors contributing to anxiety, neuroticism is deemed to occupy the apex of the hierarchical model, ranging from general to specific factors, functioning as a universal higher-order factor for all anxiety disorders [12, 13].

Academic self-efficacy refers to an individual’s judgment and confidence in their ability to complete academic tasks [14], serving as a specific manifestation of competence in academic contexts. The primary cause of test anxiety is individuals’ belief that they lack the ability to handle exams, leading to an insufficient sense of competence, a finding supported by relevant empirical research. For instance, Krispenz et al. discovered that individuals with low academic self-efficacy frequently exhibit test anxiety when confronted with exams [15]. Furthermore, academic self-efficacy demonstrates a higher explanatory power in test anxiety compared to personality traits [16]. Consequently, Hypothesis 1: Academic self-efficacy has an indirect association between neurotic personality and test anxiety among medical sciences students.

Brief fear of negative evaluation refers to the apprehension and worry about receiving negative and pessimistic assessments from others, as well as the anticipation that others will hold negative views about oneself [17]. Among medical sciences students, those with higher levels of brief fear of negative evaluation tend to exhibit lower self-esteem and higher levels of test anxiety [18]. Personality traits are closely linked to the brief fear of negative evaluation; individuals with high neuroticism scores demonstrate a higher external locus of control, a more negative self-concept, increased sensitivity to negative stimuli in the environment, and a heightened brief fear of negative evaluation [19]. Research shows a significant positive correlation between neuroticism and the brief fear of negative evaluation [20]. Furthermore, there may be a causal relationship between the brief fear of negative evaluation and test anxiety, suggesting that the brief fear of negative evaluation from others could lead individuals to experience greater anxiety [21]. Therefore, Hypothesis 2: The brief fear of negative evaluation has an indirect association between neurotic personality and test anxiety among medical sciences students.

Methods

Participants

A total of 420 medical sciences students from a medical university in Jinzhou City were selected as research subjects using the convenience sampling method. Inclusion criteria: aged 18 years and above; full-time undergraduate or above Education Level students majoring in medical-related fields; providing informed Consents and voluntarily participating in this study. Exclusion criteria: students who are not in school but still have retention of student status due to special circumstances such as suspension of schooling or military service; students suffering from diseases related to this study, such as depression or other mental illnesses(Participants were screened using the Chinese version of the Patient Health Questionnaire − 9 items. Participants with a score of ≥ 10 were excluded from the final analysis.). According to Kendall [22]’s sample size estimation method, the sample size for descriptive studies should be 5 to 10 times the number of variables. This study involves 16 variables, considering a 20% questionnaire noncompliance rate, the estimated sample size is 100 to 200 cases. In addition, to meet the requirement of at least 200 cases for the structural equation model, the actual sample size included in this study was 420 cases. This study conducted data collection through an online questionnaire platform. First, the counselors of the target schools were contacted, and after obtaining consent, the counselors distributed the questionnaire links to the class groups. The data collection period was from October 2024 to March 2025. Before filling out the questionnaire, all participants executed the informed consent form online. A total of 460 questionnaires were recovered, and after excluding invalid questionnaires with regular responses and excessively short response time, 420 valid samples were obtained, with an effective recovery rate of 91.3%. This study has been reviewed and approved by the Ethics Committee of Jinzhou Medical University (JZMULL2025077).

Assessments

A general information questionnaire, the Eysenck Personality Questionnaire -Revised, Short Scale for Chinese(EPQ-RSC), the Academic Self-Efficacy Scale(ASS), the Brief Negative Evaluation Anxiety Scale(BFNES), and the Test Anxiety Scale(TAS) were employed in the questionnaire survey.

A general information questionnaire

Self-compiled, including gender, ethnicity, school, major, grade, place of home, whether an only child, average monthly living expenses, whether one likes the major, whether one will engage in the major after graduation, father’s educational background, and mother’s educational background.

Eysenck personality questionnaire -Revised, short scale for Chinese

Compiled by Eysenck and colleagues, and translated and revised by Qian Mingyi et al. [23]. This scale comprises four dimensions, totaling 48 items, each with two response options: “Yes” or “No.” A “Yes” response earns 1 point, while a “No” response earns 0 points. The total score ranges from 0 to 48, with higher scores indicating a more pronounced personality trait. For this study, the Neuroticism subscale was selected, and raw scores were converted into standard T scores using the national norm, calculated as T = 50 + 10 × (the subject’s raw score - the group mean)/the group’s standard deviation. The Cronbach’s α coefficient for this scale in our study is 0.856.

Academic self-efficacy scale

Compiled by Pintrich and DeGroot and translated and revised by Liang Yusong [6], this scale comprises 22 items, encompassing two dimensions: self-efficacy in learning ability and self-efficacy in learning behavior. It employs a 5-point Likert scale, where 1 represents “strongly disagree” and 5 represents “strongly agree.” Items 14, 16, and 17 are scored in reverse. The total score ranges from 1 to 110, with higher scores reflecting stronger academic self-efficacy. In this study, the Cronbach’s α coefficient for the scale is 0.828.

Brief fear of negative evaluation scale

Compiled by Leary and translated and revised by Chen Zhiyan [24], this scale comprises 12 items, each rated on a 5-point Likert scale ranging from 1 (“Not at all applicable”) to 5 (“Very applicable”). Items 2, 4, 7, and 10 are reverse-scored. The total score ranges from 1 to 60, with higher scores reflecting a greater fear of negative evaluation from others. In this study, the scale demonstrated a Cronbach’s α coefficient of 0.967.

Test anxiety scale

Compiled by Sarason and colleagues, and translated and revised by Wang Cai Kang [25], this scale comprises 37 items, employing a two-level rating system where “Yes” is assigned 1 point and “No” 0 points. Items 3, 15, 26, 27, 29, and 33 are reverse-scored. The total score is calculated by summing the points from all 37 items. Based on the widely used clinical cut-off points established by Wang Caikang et al., we classify the total scores as follows: A score below 12 indicates a low anxiety level, 12 to 20 indicates a moderate anxiety level, and over 20 indicates a severe anxiety level. In this study, the Cronbach’s α coefficient for the scale is 0.851.

Statistical analysis

In this study, all statistical analyses were performed using SPSS 25.0 and the PROCESS macro (Model 6) developed by Hayes. Normality tests were conducted for all continuous variables. Given the skewed distribution of the data, descriptive statistics are presented as median and interquartile range [M (P25, P75)]. To examine differences in key variables across groups, the Mann-Whitney U test (for two-group comparisons) or the Kruskal-Wallis H test (for multiple-group comparisons) was employed, depending on the number of groups. Given that the data were collected via self-reported questionnaires, Harman’s single-factor test was conducted to assess potential common method bias. Spearman rank correlation analysis was adopted to preliminarily explore the associations among independent variables, mediating variables and dependent variables, providing a basis for the subsequent construction of the indirect association model. The proposed indirect correlation model (Model 6) was evaluated using PROCESS v3.4. The significance of the indirect effect was determined through the Bootstrap method with 5,000 samples. If the 95% deviation-adjusted confidence interval does not include zero, the indirect association is considered statistically significant. For scales lacking clinical cut-off points, their consecutive scores are classified into three grades based on the terquels of this sample: “low” (≤ P33), “medium” (P33-P66), and “high” (≥ P66), to facilitate the presentation and interpretation of the results.

Results

Participant characteristics

A total of 460 medical sciences students participated in this study, of whom 420 completed and returned valid questionnaires, yielding an effective response rate of 91.3%. The sample comprised 218 female participants (51.9%) and 348 individuals of Han ethnicity (82.9%). Among the various medical specialties represented, clinical medicine had the highest representation with 84 students (20.0%). The majority of participants were in their third year of undergraduate study (26.2%), and most originated from urban areas (37.1%). Over half of the respondents were only children (53.8%). Monthly living expenses for the majority of students ranged between 800 and 2,000 yuan (72.9%). A substantial proportion of students reported liking their major (65.7%), and a higher percentage indicated their intention to pursue a career in the field (78.6%). With regard to parental education levels, 57.6% of fathers had attained either junior or senior high school education, while maternal educational attainment was slightly lower, with 56.7% of mothers having completed junior high school or less. The total scores of the 420 medical sciences students on the EPQ-RSC, ASS, BFNES, and TAS were 49.06 (43.19, 57.87), 72.00 (67.75, 76.00), 39.00 (34.00, 43.00), and 19.00 (15.00, 22.00) points, respectively. Detailed demographic characteristics are presented in Table 1.

Table 1.

Comparison of ASS, BFNES, and TAS scores among medical sciences students with various characteristics [N = 420, M(P25, P75)]

	Project	Number of Participants [n(%)]	ASS Score	BFNES Score	TAS Score
Gender	Male Female H/Z P	202(48.1%) 218(51.9%)	72.00(68.00,77.00) 71.00(67.00,76.00) −0.818 0.413	37.00(32.50,43.00) 40.00(34.00,43.00) −1.255 0.210	19.00(14.00,22.00) 19.00(16.00,22.00) −0.723 0.470
Ethnic group	Han ethnicity Others H/Z P	348(82.9%) 72(17.1%)	72.00(67.00,76.25) 73.00(70.00,76.00) −0.917 0.359	39.00(34.00,43.00) 38.50(32.25,43.00) −0.109 0.913	19.00(15.00,22.00) 19.50(14.25, 22.00) −0.074 0.941
Professional	Clinical Oral cavity Forensic expert Pharmacy Nursing Public health Others H/Z P	84(20.0%) 62(14.8%) 38(9.0%) 60(14.3%) 62(14.8%) 68(16.2%) 46(11.0%)	73.00(68.00,76.00) 73.00(71.00,77.00) 72.00(70.00,76.00) 74.50(67.50,80.00) 71.00(66.00,74.00) 70.00(65.50,75.25) 70.00(67.00,73.00) 9.533 0.146	41.00(34.00,43.25)d 39.00(32.00,43.00) 36.00(31.00,42.00)e 34.00(29.75,43.00)ae 42.00(36.00,45.00)cd 39.00(34.00,43.00) 38.00(34.00,43.00) 13.034 0.043	20.00(15.75,23.00) 21.00(14.00,24.00) 17.00(11.00,20.00) 17.00(13.75,20.00) 21.00(18.00,23.00) 19.50(15.25,22.00) 19.00(14.00,22.00) 11.588 0.072
Grade	Freshman Year Sophomore Junior year Senior year Senior Five Master’s degree H/Z P	48(11.4%) 92(21.9%) 110(26.2%) 80(19.0%) 26(6.2%) 64(15.2%)	69.50(64.00,72.00)bc 73.50(66.00,77.00)a 72.00(68.00,77.00)a 71.00(66.00,74.75) 72.00(68.00,76.50) 75.50(71.25,79.75)abcd 18.973 0.002	41.00(36.25,43.00) 37.50(32.75,44.00) 37.00(32.00,42.00) 39.00(34.00,43.00) 38.00(33.00,43.00) 38.50(32.50,44.00) 3.238 0.663	19.00(15.00,21.00) 18.00(14.00,22.25) 19.00(15.00,22.00) 22.00(17.25,24.00) 19.00(16.00,23.00) 18.00(14.00,21.00) 6.149 0.292
Residence	City Township Rural area H/Z P	156(37.1%) 146(34.8%) 118(28.1%)	73.00(68.75,78.25)b 71.00(66.00,75.50)a 71.00(68.00,75.00) 6.327 0.042	36.00(31.00,43.00)b 42.00(36.00,44.00)a 38.00(34.00,43.00) 11.171 0.004	18.00(13.00,21.00)bc 21.00(16.50,23.50)a 20.00(16.00,23.00)a 12.785 0.002
Singleton child	Yes No H/Z P	226(53.8%) 194(46.2%)	73.00(69.00,77.00) 71.00(66.00,75.00) −2.331 0.020	37.00(32.00,43.00) 40.00(34.50,44.50) −2.791 0.005	18.00(14.00,22.00) 21.00(17.00,23.00) −2.995 0.003
Living costs	≤ 800 800–1500 1500–2000 ≥ 2000 H/Z P	22(5.2%) 146(34.8%) 160(38.1%) 92(21.9%)	72.00(69.00,75.00) 72.00(67.00,77.00) 71.50(66.25,76.00) 73.00(70.00,78.00) 2.7730.428	40.00(36.00,45.00) 40.00(34.00,43.00) 38.00(32.00,43.00) 37.50(32.75,43.00) 2.018 0.569	20.00(17.00,22.00) 20.00(15.50,23.00) 18.50(15.00,21.00) 18.50(14.00,23.000 2.910 0.406
Enjoyingthe subject	Yes No H/Z P	276(65.7%) 144(34.3%)	72.00(68.00,77.00) 71.00(67.00,76.00) −0.8300.406	38.00(32.00,43.00) 41.00(34.00,44.00) −1.577 0.115	19.00(15.00,22.00) 20.00(15.25,22.750 −1.165 0.244
Engagingin this field	Yes No H/Z P	330(78.6%) 90(21.4%)	72.00(68.00,77.00) 71.00(67.00,76.00) −0.148 0.882	39.00(34.00,43.00) 39.00(33.50,43.00) −0.115 0.908	20.00(15.00,22.50) 18.00(13.50,22.00) −0.922 0.357
Father’s educational background	Prim. or below Jr. high Sr. high Assoc. Bach. Grad. or higher H/Z P	32(7.6%) 126(30.0%) 116(27.6%) 56(13.3%) 66(15.7%) 24(5.7%)	72.00(67.75,74.75) 71.00(65.00,75.00) 72.00(68.00,76.25) 72.00(70.00,80.00) 71.00(67.50,76.50) 75.00(73.00,78.75) 7.680 0.175	40.50(37.00,44.50)d 41.00(35.00,45.00)d 38.50(33.50,43.00)d 34.50(31.25,39.75)abc 38.00(34.00,43.00) 36.50(29.00,39.000ab 12.960 0.024	21.00(18.25,26.50)cd 20.00(16.00,23.00)d 20.00(14.75,23.00)ad 17.50(9.50,21.00)abce 19.00(15.00,22.00)d 14.50(11.25,18.50)abce 18.863 0.002
Maternal educational attainment	Prim. or below Jr. high Sr. high Assoc. Bach. Grad. or higher H/Z P	138(32.9%) 100(23.8%) 70(16.7%) 46(11.0%) 54(12.9%) 12(2.9%)	71.00(67.50,75.50) 71.00(64.75,75.25) 72.00(67.00,79.00) 72.00(66.00,77.00) 75.00(71.00,80.00) 73.50(71.00,78.25) 8.900 0.113	41.00(35.00,45.00)e 39.00(34.75,43.00)e 38.00(34.00,43.00)e 38.00(30.00,43.00) 36.00(29.00,39.00)abc 34.00(30.25,37.75)a 13.227 0.021	20.00(16.50,23.00) 21.00(14.75,23.25) 19.00(14.00,22.00) 17.00(13.00,22.00) 18.00(12.00,21.000 14.50(12.50,18.75) 10.921 0.053

(1) H represents the Kruskal - Wallis H test value; Z represents the Z value of the Mann - Whitney U test

(2) Post - hoc pairwise comparisons were carried out using Dunn's test, and Bonferroni correction was performed on the p values. There was a statistically significant difference between the groups that did not share the same letter superscripts (p < 0.05 after correction)

Check for common method bias

There are 15 factors with eigenvalues exceeding 1, with the first factor accounting for 13.22% of the variance, a figure below the 50% threshold, suggesting the absence of a significant common method bias in the present study [26].

Test the indirect correlation model

This study employed a sequential association model to investigate the indirect association between academic self-efficacy and brief fear of negative evaluation in the relationship between neuroticism and test anxiety among medical students. The analysis results support the proposed theoretical framework and reveal a unique psychological pathway: higher levels of neurotic traits are accompanied by higher levels of test anxiety, and by undermining academic self-efficacy, they further link to the brief fear of negative evaluation, ultimately associated with test anxiety. This sequential indirect correlation mechanism constitutes the main process by which neuroticism is associated with test anxiety. The specific research results are as follows:

The correlation between variables

Spearman correlation analysis showed that neuroticism was significantly positively correlated with test anxiety (r = 0.348, p < 0.05), laying the foundation for testing the indirect association. Neuroticism was negatively correlated with academic self-efficacy (r = −0.313, p < 0.05), and positively correlated with brief fear of negative evaluation (r = 0.382, p < 0.05). Academic self-efficacy is significantly negatively correlated with both brief fear of negative evaluation and test anxiety, supporting the rationality of the sequential association model hypothesis.

Test the sequence association model

After controlling for the relevant covariates, path analysis was used to test the sequence association model. The results show that neuroticism has a significant negative explanatory effect on academic self-efficacy (β = −0.155, p < 0.001), and a positive explanatory effect on brief fear of negative evaluation (β = 0.475, p < 0.001) and test anxiety (β = 0.207, p < 0.001).

Academic self-efficacy significantly negatively explains test anxiety (β = −0.923, p < 0.001) and brief fear of negative evaluation (β = −0.532, p < 0.001).

Brief fear of negative evaluations significantly positively explains test anxiety (β = 0.485, p < 0.001).

To assess the significance of the indirect effect, a Bootstrap program with 5,000 samples was conducted to estimate a 95% bias-corrected confidence interval. The results show that all three indirect effects are statistically significant because their confidence intervals do not include zero. Specifically:

• The indirect influence of neuroticism → academic self-efficacy → test anxiety is significant.

• Neuroticism → brief fear of negative evaluation → test anxiety have a significant indirect impact.

• The sequence of neuroticism → academic self-efficacy → brief fear of negative evaluation → test anxiety has a significant indirect effect.

The detailed estimates and confidence intervals of each path are shown in Table 2, and the complete model is shown in Fig. 1.

Table 2.

The indirect association of neurotic personality in the relationship between test anxiety and academic self-efficacy among medical sciences students focuses on the brief fear of negative evaluation

Path	Effect value	Boot SE	95%CI	Effect size(%)
Total Effect	0.619	0.113	0.395 ~ 0.842		100
Direct Effect Total Indirect Effect	0.207 0.412	0.101 0.082	0.008 ~ 0.405 0.259 ~ 0.578		33.4 66.6
Neurotic Personality → Academic Self-Efficacy → Exam Anxiety	0.143	0.048	0.060 ~ 0.246		23.1
Neurotic Personality → Brief Fear of Negative Evaluation → Exam Anxiety	0.230	0.060	0.116 ~ 0.352		37.2
Neurotic Personality → Academic Self-Efficacy → Brief Fear of Negative Evaluation → Exam Anxiety	0.039	0.019	0.004 ~ 0.081		6.3

Fig. 1.

Academic self-efficacy and brief fear of negative evaluation of medical sciences students: an indirect association model between neurotic personality and test anxiety

Discussion

Current status of neurotic personality and examination anxiety among medical sciences students

The results of this study show that the majority of medical students (63.3%) exhibit a moderate or higher level of neuroticism, which exceeds the findings of Zhang Li’s [11] investigation. This discrepancy may be attributed to the fact that the majority of the study participants are enrolled in clinical and related majors, which entail a broader curriculum and extensive practical training, coupled with escalating pressures from postgraduate entrance exams and job pursuits. Furthermore, based on the pre-set classification criteria, the descriptive statistics of the total TAS score show that the median is 19 points, corresponding to the range of “moderate test anxiety level”. However, classification analysis revealed that 41.4% of medical sciences students scored above 20 points and were classified as having a “severe test anxiety level”. This phenomenon highlights that relying solely on central trends (such as the median) may mask subgroups in the population with significant clinical problems. The boundary points we have adopted, revised based on the local cultural background, may be more sensitive than the internationally recognized boundary points in identifying individuals that need attention within this cultural context. These rates exceed those reported by Tsegay [5] and colleagues, potentially due to the prolonged duration of medical education, which heightens the risk of academic burnout and subsequently raises the prevalence of test anxiety. Additionally, disciplines such as anesthesiology and nursing, which demand deep involvement in clinical practice and high levels of practical proficiency, confront greater academic challenges and stringent exam requirements, thereby exacerbating test anxiety.

Correlation analysis of neurotic personality in medical sciences students with academic self-efficacy, brief fear of negative evaluation, and examination anxiety

The study findings reveal a negative correlation between neurotic personality traits in medical sciences students and their academic self-efficacy. This likely stems from the emotional instability of neurotic individuals, who are prone to mood swings, intense reactions, impulsivity, and can exhibit rigidity and obsessiveness, easily succumbing to negative emotions such as anxiety and worry. When faced with academic challenges, they are more likely to experience fear of difficulty, which can then generalize, leading to a denial of their own learning capabilities. Consequently, students with higher neurotic scores tend to exhibit lower academic self-efficacy [27, 28]. There is a positive correlation between neurotic personality traits in medical sciences students and brief fear of negative evaluation, consistent with the inference drawn by Stein et al. [29] from a comparative study of monozygotic twins sharing identical genomes. This suggests that the genetic factors promoting anxiety-related personality traits may also underlie the brief fear of negative evaluation. In other words, students who develop negative personality traits due to inherent or environmental factors are more likely to worry about others’ evaluations, feel distressed by negative feedback, and anticipate being negatively judged by others. Additionally, a positive correlation exists between neurotic personality traits in medical sciences students and test anxiety. This may be attributed to neurotic personality being the most closely linked trait to test anxiety. Individuals with high neuroticism experience more negative emotions in response to stressors, and thus may react more intensely to the stress of test failure, resulting in heightened test anxiety [11]. Neuroticism arises from the sensitivity of the autonomic nervous system, which readily responds to environmental and psychological stimuli. Those with high neuroticism are easily startled and prone to anxiety [30]. In line with this, neuroticism is the only personality trait that consistently and significantly predicts individual tension across all situations. High levels of neuroticism are associated with an increase in test anxiety, indicating that neurotic individuals tend to experience prolonged negative emotions and are less influenced by specific circumstances [31].

Academic self-efficacy plays an indirect association between neurotic personality traits and test anxiety of medical sciences students

The results of this study show that the indirect association degree between neurotic personality and academic self-efficacy of medical sciences students and test anxiety is 0.143. Personality traits are significantly correlated with academic self-efficacy, and personality traits have a positive explanatory effect on academic self-efficacy [32]. In addition, students with high neuroticism scores are more likely to experience negative emotions such as anxiety and worry, have a strong response to stimuli, and find it difficult to effectively control and regulate their emotions. This makes them more susceptible to the associated effects of exams and more prone to anxiety disorders [28]. Students with low academic self-efficacy often lack confidence in their abilities, are prone to self-denial, and are more likely to avoid or retreat when facing difficulties and challenges. They are unable to analyze problems objectively and are prone to “learned helplessness”, which makes them more susceptible to the associated effects of test anxiety and test fear [33]. The lower a medical sciences student’s academic self-efficacy, the fewer positive self-evaluations they have, and the less confident they are when facing exam pressure [34]. They are also more inclined to adopt negative behavioral strategies in bringing out their own potential and developing various social resources, which fails to alleviate the adverse effects of examinations but instead intensifies their anxiety.

Brief fear of negative evaluation plays an indirect association between neurotic personality and test anxiety in medical sciences students

This study found that the indirect association between brief fear of negative evaluation and neurotic personality and test anxiety among medical sciences students was 0.230. Students’ brief fear of negative evaluations is associated with their personality traits. Negative traits resulting from genetic inheritance or environmental factors can distort their emotional interpretation of others’ evaluations, thereby associating them with corresponding negative thoughts or emotions [35]. The onset of test anxiety stems partly from students’ apprehensions about exam failure, as test scores are affected by neuroticism and test anxiety [36]. Additionally, individuals who harbor a brief fear of negative evaluation are apprehensive about others’ adverse assessments. When confronted with stressful situations such as exams, they also experience heightened levels of tension. This is particularly true for medical sciences students, who are more concerned about their exam results being scrutinized and criticized by parents, teachers, and peers. This kind of interpersonal negative evaluation is associated with individuals experiencing test anxiety [37, 38].Given that college students are in a crucial phase of self-identity formation, those with fragile or underdeveloped self-esteem may be more susceptible to concerns about others’ criticism and evaluations [39]. The prevalence of social media has intensified college students’ tendencies to compare themselves and engage in self-presentation, thereby exacerbating the brief fear of negative evaluation [40, 41].

Academic self-efficacy and brief fear of negative evaluation may play an indirect association in the relationship between neurotic personality and test anxiety among medical sciences students

The results of this study show that the indirect association between academic self-efficacy and brief fear of negative evaluation between neurotic personality traits and test anxiety among medical sciences students is 0.039. Individuals with neurotic personality traits, due to their generally low self-efficacy, find it more difficult to adopt positive coping strategies when facing negative evaluations, thereby having a negative correlation with academic performance [42]. Self-efficacy is a crucial element of human agency and a robust resource that shields individuals from psychological stress. The primary source of anxiety is not the threatening event itself, but the absence of self-efficacy to mitigate it. This means that people with a high sense of self-efficacy will have a lower level of anxiety when facing exams [43]. Examinations, as a typical assessment scenario, make the temporary fear of negative evaluations an important related factor that cannot be ignored. Students with high academic self-efficacy exhibit greater confidence in their learning abilities, approach negative evaluations more rationally, and can accept them calmly without succumbing to fear. Meanwhile, individuals with low anxiety are less inclined to dwell on adverse aspects and can concentrate fully on the exam, whereas those with high anxiety tend to entertain numerous negative thoughts beyond the exam, such as outcomes, others’ judgments, and future prospects, thereby depleting more of their psychological resources [44]. This might imply that the brief fear of negative evaluation, as a negative risk factor, increasingly hinders the relief of test anxiety [45], while individuals with high academic self-efficacy have a positive impact on test anxiety by reducing this risk factor. Academic self-efficacy and temporary fear of negative evaluation may play an indirect association in this relationship. The higher the prediction of the exam result before the exam, the lower the perception of the importance of the exam, and the less the degree of exam anxiety. A deeper understanding of a person’s past successes can alleviate test anxiety.

Limitations and future directions

This study has several limitations. Firstly, the cross-sectional design hinders the inference of causal relationships among variables, and all findings should be interpreted as associations among the variables. Secondly, this study adopted convenience sampling, and the sample was only sourced from one medical university in Jinzhou, China. This might have limited the universal applicability of the results to medical sciences students from different cultural backgrounds and educational systems. Despite these limitations, this study has for the first time initially revealed the indirect association between academic self-efficacy and fear of negative evaluation in the relationship between neurotic personality and test anxiety among medical sciences students, providing valuable preliminary evidence for understanding the formation mechanism of test anxiety among medical sciences students. Future research should adopt longitudinal design and multi-center sampling strategies to verify the causal relationships of these associations and evaluate their universality across populations.

Conclusion

Academic self-efficacy and brief fear of negative evaluation play an indirect association role in the relationship between neurotic personality and test anxiety of medical sciences students, offering practical insights for developing effective interventions to alleviate test anxiety in this population. It is advisable for medical schools to provide specialized psychological support for students in clinical, nursing, and other front-line healthcare-related fields to address the mental health challenges stemming from test anxiety.

Abbreviations

EPQ-RSC

The Eysenck Personality Questionnaire-Revised, Short Scale for Chinese

ASS

The Academic Self-Efficacy Scale

BFNES

The Brief Negative Evaluation Anxiety Scale

TAS

The Test Anxiety Scale

Authors’ contributions

LL and YHY contributed to the development of the research design, reviewed the manuscript and analysis report, and drafted the initial version. JX and MY participated in the research design and data analysis. LZX and LTT were involved in data compilation. All authors reviewed and approved the final manuscript.

Funding

No fund supported the study.

Data availability

The dataset employed and analyzed in this study is not open to the public due to ethical considerations and data privacy protection. However, it may be provided by the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study has received approval from the Ethics Committee of Jinzhou Medical University (approval number: JZMULL2025077). All participants provided informed consent prior to the initiation of the study. Research involving human subjects adheres strictly to the guidelines of the Helsinki Declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.