Perceived stress and coping styles in medical students: the dual mediating effects of resilience and perceived social support

Abstract Objectives This study aimed to explore the association between perceived stress and coping styles among medical students, focusing on the mediating roles of resilience and perceived social support, based on the Transactional Theory of Stress and Coping (TTSC). Methods A cross-sectional online survey was conducted among medical students in Xinjiang, China, from August 20 to September 23, 2022. Measurements for perceived stress, resilience, perceived social support, and coping styles were obtained using the Perceived Stress Scale (PSS), the Connor–Davidson Resilience Scale (CD-RISC), the Multi-dimensional Scale of Perceived Social Support (MSPSS), and the Simplified Coping Styles Questionnaire (SCSQ). Statistical analyses were performed using SPSS 25.0 and the PROCESS macro for SPSS (version 3.5, Model 4) developed by Hayes to test the parallel indirect associations of resilience and perceived social support. Results Significant correlations existed among perceived stress, resilience, perceived social support, and coping styles. Statistical results indicated that perceived stress was positively associated with resilience ( r = 0.268, p < 0.01) and positively associated with perceived social support ( r = 0.165, p < 0.01). Moreover, perceived stress, resilience, and perceived social support were all significantly positively associated with coping styles, with correlation coefficients of r = 0.208, r = 0.489, and r = 0.419 (all p < 0.01), respectively. Mediation analysis further demonstrated that resilience ( B = 0.094, 95% CI [0.059, 0.139]) functioned as an independent partial mediator in the association between perceived stress and coping styles. Similarly, perceived social support ( B = 0.032, 95% CI [0.013, 0.064]) also served as a distinct partial mediator in this linkage. When both mediators were simultaneously incorporated into the same analytical model, the total indirect effect was 0.126 (95% CI [0.081, 0.180]), and the total effect of perceived stress in relation to coping styles was 0.208 (95% CI [0.151, 0.265]). The two indirect pathways jointly represented approximately 60.6% of the total statistical association, with the indirect association through resilience representing a larger proportion than that through perceived social support (45.1% vs. 15.5%). Conclusions The findings indicate significant associations among perceived stress, resilience, perceived social support, and coping styles in medical students. Resilience and perceived social support showed significant parallel indirect associations between perceived stress and the coping-style index, with a larger indirect association observed through resilience. These findings provide a correlational framework for understanding the links between perceived stress and coping styles and highlight the relevance of intrapersonal and interpersonal resources for future longitudinal and intervention research.