Fig 1.
A Comprehensive Mediated-Moderation Model of Academic Stress.
Note: Solid black arrows indicate hypothesized direct effects; dashed arrows indicate hypothesized indirect/mediated effects. Red arrows denote hypothesized moderating (contextual) effects of sociodemographic variables on the indicated paths (i.e., the strength or direction of the PSY → mediator or PSY → academic stress relationships). Psychological distress (PSY) is hypothesized to exert direct and indirect effects on academic stress via behavioral mediators (sleep quality, self-esteem, internet addiction, coping). Sociodemographic variables are included as exogenous controls and, where indicated (red arrows), as moderators of key paths. Measurement indicators for Psychological distress PSY are depression and anxiety.
Fig 2.
Distribution of Depression, Anxiety, Insomnia, and Internet Addiction Scores by Academic Stress Status.
Note: Box-violin plots showing the distribution, median, interquartile range, and density of GAD-7 (anxiety), PHQ-9 (depression), ISI (insomnia), and IAT (internet addiction) scores among participants with and without academic stress (Absent vs Present).
Fig 3.
Academic Stress Subscale Medians by Depression Severity.
Note: Median scores for academic stress subscales are plotted across five depression severity categories (none/minimal, mild, moderate, moderately severe, severe).
Fig 4.
Structural equation model of psychological distress (latent PSY), behavioral mediators, and academic stress.
Caption: Path diagram showing the latent psychological distress factor PSY (defined by PHQ-9 and GAD-7) and its standardized path coefficients to behavioral mediators (insomnia [SQ_tt], self-esteem [SE_tt], internet addiction [IAT_tt], coping [SC_tt]) and the outcome academic stress (AS_tt). Coefficients displayed are standardized estimates; double-headed arrows indicate covariances. Abbreviations: PSY = psychological distress; PHQ_t = PHQ-9 total score; GAD_t = GAD-7 total score; AS_tt = Academic Stress total score; SE_tt = Self-Esteem total score; SC_tt = Stress Coping Style Inventory total score; SQ_tt = Insomnia Severity Index total score; IAT_tt = Internet Addiction Test total score.
Fig 5.
Network of partial correlations and node centrality for psychological and behavioral correlates of academic stress.
Caption: Left: partial-correlation network among variables (AS_ = Academic Stress; PHQ = PHQ-9 depression; GAD = GAD-7 anxiety; SQ_ = Insomnia Severity Index; IAT = Internet Addiction Test; SE_ = Rosenberg Self-Esteem Scale; SC_ = Stress Coping Style Inventory). Edge color denotes sign (green = positive; red = negative) and edge thickness reflects the magnitude of the partial correlation. Right: standardized centrality indices for each node — Strength, Closeness, Betweenness, and Expected Influence — with higher values indicating greater importance; depressive symptoms, insomnia, and internet addiction are notable central nodes.
Table 1.
Distribution of Academic Stress Levels by Sociodemographic Factors (N = 1072).
Table 2.
Psychological and Behavioral Factors of Academic Stress among Medical Students (N = 1072).
Table 3.
Sociodemographic, Psychological, and Behavioral Predictors of Academic Stress (N = 1072).
Table 4.
Convergence of findings across methods: logistic regression, latent-only SEM, and network centrality (N = 1,072). [Table 3, Fig 4, Fig 5].