Psychological resilience moderates the association between adverse academic events and probable anxiety disorder in Chinese clinical medicine postgraduates: a cross-sectional study

BACKGROUND: Clinical medicine postgraduates face a heightened risk for mental health problems, particularly anxiety disorder, which is largely due to a high-pressure training environment and prevalent adverse academic events. Psychological resilience, defined as the ability to adapt to adversity, is theorized to modify the association of external stressors with mental health problems. However, limited evidence exists regarding its moderating role in this specific population, particularly using rigorous interaction analysis. METHODS: In this cross-sectional study, 1182 clinical medicine postgraduates from a major Chinese medical school completed an anonymous online survey. Exposure to adverse academic events was assessed via an 8-item checklist. Anxiety symptoms were measured using the Generalized Anxiety Disorder scale (GAD-7), and psychological resilience was assessed with the Connor-Davidson Resilience Scale (CD-RISC-10). Hierarchical logistic regression was used to examine associations. The moderating role of psychological resilience was tested using the interaction contrast approach, reporting the Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP), and Synergy Index (SI). RESULTS: Reporting adverse academic events was strongly associated with probable anxiety disorder (OR = 3.157, 95% CI: 2.284-4.363, p < 0.001), and low psychological resilience was independently associated with higher odds (OR = 3.657, 95% CI: 2.546-5.253, p < 0.001). A significant additive interaction was observed (RERI = 5.308, 95% CI: 1.402-9.214; AP = 0.434, 95% CI: 0.218-0.650; SI = 1.897, 95% CI: 1.218-2.955). Stratified analysis revealed that the association of adverse academic events with probable anxiety disorder was substantially stronger among individuals with low resilience (OR = 12.226, 95% CI: 7.585-19.708) compared to those with high resilience (OR = 3.775, 95% CI: 2.043-6.975). CONCLUSIONS: Adverse academic events are positively associated with probable anxiety disorder among clinical medicine postgraduates. Psychological resilience is a potent factor that modifies this association. These findings highlight the importance of integrating resilience assessment and resilience‑building programs into postgraduate medical education to safeguard trainee mental well-being.