Resilience, insomnia and anxiety linked in Chinese medical students

Researchers surveyed 4,219 medical students at two universities in Heilongjiang Province, China. The cross-sectional study assessed anxiety symptoms, insomnia severity, psychological resilience and academic stress using standardized questionnaires, including the DASS-21, Insomnia Severity Index and CD-RISC-10. The analysis examined whether insomnia mediated the association between resilience and anxiety and whether academic stress altered that mediation.

Overall, 24.3% of participants screened positive for anxiety symptoms. Higher resilience was associated with lower insomnia severity (B = −0.119) and lower anxiety (B = −0.111), while greater insomnia severity was associated with higher anxiety (B = 0.834); all associations had P < 0.001. The indirect association between resilience and anxiety through insomnia was −0.099 (95% CI, −0.114 to −0.084), accounting for 47.24% of the total effect. This indirect association was stronger among students reporting severe rather than mild academic stress.

The findings identify co-occurring sleep problems and academic stress as potential targets for further research on student mental health. However, the cross-sectional design cannot establish temporal order or causality, and the results do not demonstrate that interventions addressing sleep or stress reduce anxiety. Findings from two universities in one Chinese province may not generalize to other student populations.