The relationship between stress and anxiety among Chinese college students during the COVID-19 pandemic from a nationwide cross-sectional study: Exploring the moderated mediation of family health and self-efficacy.

Publication date: Jun 18, 2026

The emergence of COVID-19 disrupted the normal daily lives of individuals. Isolation measures particularly affected college students, with many reporting elevated anxiety symptoms. Factors such as family health and self-efficacy are believed to be crucial in mitigating mental health issues, although their complex interplay remains understudied. A national cross-sectional study was conducted in China in 2021. Questionnaires were used to collect data from 1193 college students to assess their stress situation, anxiety degree, family health, and self-efficacy. Bivariate correlations were used to analyze the relationships among the study variables. The mediation and moderated mediation models were examined using structural equation modeling to explore the mediating role of family health and the moderating effect of self-efficacy. During the COVID-19 pandemic, 47. 28% of the students experienced anxiety. After adjusting for demographic factors, a significant positive association was observed between stressors and anxiety. Family health partially mediated this relationship. Additionally, self-efficacy was negatively associated with anxiety. Self-efficacy moderated the indirect pathways in the mediation model (stress-family health: β = -0. 100, 95%CI: -0. 140, -0. 060; family health-anxiety: β = -0. 110, 95%CI: -0. 157, -0. 06), whereas it exhibited no significant moderating effect on the direct path from stress to anxiety. The conditional indirect effect was significant only for individuals with moderate to high self-efficacy, but not for those with low self-efficacy. Family health partially mediated the relationship between stress and anxiety among college students during COVID-19. The indirect pathway through family health was moderated by self-efficacy, although alternative theoretical models remain plausible within this cross-sectional framework. Future studies should focus on strengthening family health resources and developing self-efficacy interventions to help alleviate anxiety-related mental health disorders among university students.

Semantics

Original Article