Does Academic Stress Heighten Medical Students' Anxiety and Depression Risk? A Comparative Analysis of Varied Influencing Mechanisms on Interpersonal Relationship, Sleep quality and Academic Stress across Medical Majors

Background With the rapid development of Chinese medical education, the increasing requirements for medical students has raised the bar for their knowledge proficiency, clinical skills, scientific research innovation and professional ethics, resulting in heightened academic stress, interpersonal challenges and a spotlight on their psychological well-being. This study aims to investigate the influencing factors on medical students' mental health and compare the different influencing mechanisms across varied medical majors. Methods A cross-sectional survey was conducted among 1514 undergraduate medical students (514 clinical medicine students, 488 nursing students and 512 students from other medical majors) from seven universities in China using stratified random sampling. An e-questionnaire was used to collect self-assessment data on participants' interpersonal relationships, academic stress, sleep quality, anxiety and depression levels. Results (1) Sleep quality mediated the effect of interpersonal relationship on anxiety and depression. (2) Academic stress varied across majors, with nursing and clinical medicine students generally experiencing higher levels(35.2%, 37.5%). (3) Academic stress played a significant moderating role in the latter part of the mediation model, exacerbated anxiety and depression (nursing: β _−anxiety  = 0.197, β _{−depression}  = 0.172; clinical: β _−anxiety  = 0.144, β _{−depression}  = 0.077; p  < 0.05) among nursing and clinical medicine students. (4) Conversely, academic stress in other medical students was relatively lower (29.5%) with no contribution to the mediation model. Conclusions Enhancing interpersonal relationships among medical students can lead to better sleep quality, which in turn may alleviate anxiety and depression. Notably, there is heterogeneity in the impact of academic stress across different medical majors, which can interact with sleep disturbance and exacerbate mental disorders. This not only reflects the differentiation and developmental changes in the priorities of various medical professions but also offers new insights for cultivating globally competent medical talents from both physical and psychological healthy pathway.