How do stressful life events affect medical students' academic adjustment? Parallel mediating mechanisms of anxiety and depression.

BACKGROUND: Medical students frequently face challenges in academic adjustment, necessitating effective support and intervention. This study aimed to investigate the impact of stressful life events on medical students' academic adjustment, focusing on the mediating roles of depression and anxiety. It also differentiated the impacts between at-risk students (those with academic failures) and their peers respectively. METHODS: This case-control study involved 320 at-risk medical students and 800 other students from a university in western China. Participants anonymously completed the scales of stressful life events, depression, anxiety, and academic adjustment. T-tests, ANOVA, Pearson correlation, and structural equation modeling were employed for statistical analysis. RESULTS: Depression and anxiety were significantly more prevalent in at-risk students (46.8% and 46.1%, respectively) than in controls (34.0% and 40.3%, respectively). Notably, at-risk students had poorer academic adjustment (t = 5.43, p < 0.001). The structural equation modeling had good fit indices and the results indicated that depression and anxiety fully mediated the effects of stressful life events on academic adjustment. For at-risk students, stressful life events significantly decreased academic adjustment through increased depression and anxiety (p < 0.001). Conversely, anxiety had a positive effect on academic adjustment in other students. CONCLUSION: Targeted interventions focusing on depression and anxiety could reduce the negative impact of stressful life events on medical students' academic adjustment. However, educators have to distinguish the differences between at-risk students and others.

Discrimination Experiences of Orphans and Left-Behind Children in China as Predictors of Suicidal Thoughts and Behaviors.

Background: Suicide has been recognized as a serious problem in orphans and left-behind children. It is important to examine the differences in the factors affecting suicidal thoughts and behaviors between the two groups. Aims: To compare the lifetime rates of suicidal thoughts and behaviors between orphans, left-behind children, and other children, and to assess the impact of discrimination experiences and the mediating role of self-esteem. Methods: A total of 2,413 children from middle schools in China completed standardized anonymous questionnaires that assessed child type, suicidal thoughts and behaviors, discrimination experiences, and self-esteem. Data analysis employed χ2 test, Pearson correlation test, and structural equation modeling (SEM). Results: Left-behind children had a significantly higher lifetime rates of suicidal ideation than orphans and other children (χ2 = 9.35, p < .05). Discrimination experiences significantly and positively predicted suicidal thoughts and behaviors through the mediating effect of self-esteem in orphaned children, and there was no self-esteem mediating effect found for left-behind children. Discrimination experiences had a greater impact on suicidal thoughts and behaviors for orphans than for left-behind children. Limitations: Cross-sectional studies based on self-report might lead to biased results and mean that causality cannot be inferred. Conclusions: Attention should be paid to suicidal thoughts and behaviors among vulnerable groups, especially left-behind children. Reducing discrimination and improving orphans' self-esteem can be considered as targets of prevention and intervention for suicidal thoughts and behaviors.