Neuroticism, perceived stress, psychological resilience, and pre-dive state anxiety in professional divers: a cross-sectional study

BACKGROUND: Professional divers work in safety-critical environments that require sustained attention, rapid judgment, and stable emotional control. Neuroticism is a vulnerability trait related to negative affectivity, perceived stress reflects appraisal of recent demands, and psychological resilience may be associated with weaker stress-related associations. This study examined how these factors were associated with pre-dive state anxiety in professional divers. METHODS: This cross-sectional study used a de-identified, code-linked, two-component survey design in China from January to February 2026. A total of 300 professional divers completed the baseline web-based questionnaire, and 277 were included in the final analysis after eligibility and data-quality screening. The baseline questionnaire assessed demographic characteristics, neuroticism, perceived stress, and psychological resilience. The State scale of the State-Trait Anxiety Inventory (STAI-S) was completed separately on the day of a scheduled diving task, shortly before the dive. Pearson correlations, adjusted linear regression models, and exploratory interaction analyses were conducted controlling for age, education, and years of diving experience. RESULTS: Neuroticism was positively correlated with state anxiety (r = 0.77, p < 0.001) and perceived stress (r = 0.29, p < 0.001), whereas resilience was negatively correlated with neuroticism (r = -0.49, p < 0.001) and state anxiety (r = -0.58, p < 0.001). After adjustment, neuroticism was strongly associated with state anxiety (B = 0.81, SE = 0.04, β = 0.78, p < 0.001), and perceived stress was also associated with state anxiety after accounting for neuroticism (B = 0.16, SE = 0.05, β = 0.13, p = 0.001). Resilience did not significantly moderate the direct neuroticism-state anxiety association (B ≈ 0.000, p = 0.837), but it moderated the neuroticism-perceived stress and perceived stress-state anxiety associations (both B = -0.011, p < 0.001). These associations were weaker at higher resilience. CONCLUSIONS: In this convenience sample of Chinese professional divers, higher neuroticism and perceived stress were associated with higher pre-dive state anxiety, whereas greater resilience was associated with lower state anxiety and with weaker selected stress-related associations. The mean STAI-S score was in a low-to-moderate range; therefore, the findings should not be interpreted as showing clinically elevated anxiety or as implying that all pre-dive arousal is maladaptive. Longitudinal and repeated-measures studies are needed to clarify temporal ordering, practical significance, and intervention implications.