The mediating role of perceived stress in the relationship between involvement and academic performance: a study on medical students

Although academic over-involvement has become widespread among Chinese students, its link to objective academic outcomes remains unclear. This study examined whether perceived stress mediates the relationship between perceived involution and academic performance, and whether social support and learning engagement moderate this relationship. In a cross-sectional survey with a longitudinal component, 393 third-year medical students completed validated scales measuring perceived involution, perceived stress, coping strategies, social support, and learning engagement. Academic performance was measured using standardized examination scores obtained across four semesters. T-tests, binary logistic regression, and moderated mediation modelling were performed using Mplus 8.3. Perceived Involution indirectly lowered academic performance by increasing perceived stress. Social support and learning engagement moderated this pathway: family and peer support buffered the effect of stress, and learning engagement directly improved students’ performance. Rather than a pure “scarcity-mindset trap” involution appears to act through perceived stress, which vigilance and support can partly offset. These findings point to stress management and peer/family support as practical targets for mental health programmes in medical education.