Dual Pressure of Low Income and High Workload: Impact on Mental Health and Sleep Quality Among Chinese Medical Residents, and the Buffering Role of Social Support

Objective: This study aimed to assess the mental health status (depression, anxiety, stress, insomnia) of Chinese medical residents facing a unique "low income + high workload" dual pressure, identify key influencing factors, and explore the differential buffering effects of emotional and practical social support. Methods: A cross-sectional survey was conducted among 469 medical residents (28.26% from internal medicine, 19.8% from surgery, 17.5% from emergency medicine, and 34.4% from other departments) using standardized scales (DASS-21, ISI, MSPSS, WHOQOL-BREF). Descriptive statistics, factor analysis, multiple linear regression, interaction effect tests, and structural equation modeling (SEM) were performed using SPSS 26.0, AMOS 24.0, and R 4.3.0 (packages: ggplot2 3.4.4, lavaan 0.6-16, factoextra 1.0.7). Results: The prevalence of moderate-to-severe anxiety, depression, and clinical insomnia was 15.8%, 11.9%, and 6.1%, respectively. Weekly working hours (β=0.193, p=0.007), monthly on-call frequency (β=0.126, p=0.015), and monthly consumption (β=0.143, p=0.003) were independent risk factors for insomnia. Social support significantly buffered the negative impact of work stress on mental health (interaction term β=-0.089, p<0.05), with emotional and practical support exerting similar protective effects (family support: β=-0.062; friend support: β=-0.058). The SEM showed good fit (χ²/df=2.371, RMSEA=0.054, CFI=0.928, TLI=0.917, SRMR=0.048), confirming the paths: work stress→mental health (β=0.412, p<0.001), social support→mental health (β=-0.326, p<0.001), and mental health→quality of life (β=0.684, p<0.001). Conclusion: Chinese medical residents face severe mental health challenges driven by dual pressure. Reducing work burden, improving economic support, and constructing multi-dimensional social support systems are crucial for workplace mental health promotion, providing actionable empirical evidence for optimizing China’s resident standardized training system and public health policy-making.