Medical students’ distress during the transition to the endemic phase of COVID-19 in China: The association with temperament traits and attachment styles

Carmenrita Infortuna; Xiaolin Yang; Ray Wang; Gianluca Pandolfo; Ilona Cazorla; Julian Dupont; Veolette Hanna; Valerie Iosim; Mirai Mikhail; Alex Yu; Stanley R. Terlecky; Florian P. Thomas; Jing Ren; Wenhua Cao; Zhiyong Han; Fortunato Battaglia

doi:10.3934/publichealth.2025001

Medical students’ distress during the transition to the endemic phase of COVID-19 in China: The association with temperament traits and attachment styles

Carmenrita Infortuna, Xiaolin Yang, Ray Wang, Gianluca Pandolfo, Ilona Cazorla, Julian Dupont, Veolette Hanna, Valerie Iosim, Mirai Mikhail, Alex Yu, Stanley R. Terlecky, Florian P. Thomas, Jing Ren, Wenhua Cao, Zhiyong Han, Fortunato Battaglia

School of Medicine

Hackensack Meridian School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: The transition of COVID-19 into the endemic phase in China has posed additional challenges to medical student’s well-being, and increased the odds of mental distress. Although affective temperament traits and adult attachment styles accompany crisis-induced stress, whether this applies to medical students in the endemic phase has yet to be determined. The aim of present study is to test if temperament traits and adult attachment style can predict stress in Chinese medical students. Methods: Medical students (N = 402) enrolled in the undergraduate medical program at the Southern Medical University, Guangdong, China completed an online survey in May 2022. Most participants were female (62.4%), with a mean age of (21.3 ±3.1). The individual temperament traits and adult attachment styles were assessed using the Chinese version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-auto-questionnaire short version (TEMPS-A), and the Attachment Style Questionnaire (ASQ). Results: The participants showed significant distress as assessed with the K10: 19 (15–24) (median, Q1, Q3). Furthermore, a multiple linear regression analysis indicated that cyclothymic (β = 2.1, p = 0.048) and depressive (β = 1.2, p = 0.001) temperament traits and an insecure attachment (ASQ-anxious: β = 0.19, p = 0.006; ASQ-avoidant: β = 0.07, p < 0.001) predicted pandemic-related distress. Conclusions: Dimensions of both affective temperaments and attachment styles were associated with stress in the medical students during the transition to the endemic phase. The investigations of these psychological variables provided new information regarding risk factors for endemic-related distress, and pointed to potential targets for counseling and developing programs to support the medical students’ mental health.

Original language	English
Pages (from-to)	1-15
Number of pages	15
Journal	AIMS Public Health
Volume	12
Issue number	1
DOIs	https://doi.org/10.3934/publichealth.2025001
State	Published - 2025

ASJC Scopus subject areas

Health Informatics
Public Health, Environmental and Occupational Health

Keywords

attachment styles
endemic
medical students
stress
temperament

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3934/publichealth.2025001

Cite this

Infortuna, C., Yang, X., Wang, R., Pandolfo, G., Cazorla, I., Dupont, J., Hanna, V., Iosim, V., Mikhail, M., Yu, A., Terlecky, S. R., Thomas, F. P., Ren, J., Cao, W., Han, Z., & Battaglia, F. (2025). Medical students’ distress during the transition to the endemic phase of COVID-19 in China: The association with temperament traits and attachment styles. AIMS Public Health, 12(1), 1-15. https://doi.org/10.3934/publichealth.2025001

@article{d8e9ee85b72140038b4e097c41618559,

title = "Medical students{\textquoteright} distress during the transition to the endemic phase of COVID-19 in China: The association with temperament traits and attachment styles",

abstract = "Objective: The transition of COVID-19 into the endemic phase in China has posed additional challenges to medical student{\textquoteright}s well-being, and increased the odds of mental distress. Although affective temperament traits and adult attachment styles accompany crisis-induced stress, whether this applies to medical students in the endemic phase has yet to be determined. The aim of present study is to test if temperament traits and adult attachment style can predict stress in Chinese medical students. Methods: Medical students (N = 402) enrolled in the undergraduate medical program at the Southern Medical University, Guangdong, China completed an online survey in May 2022. Most participants were female (62.4%), with a mean age of (21.3 ±3.1). The individual temperament traits and adult attachment styles were assessed using the Chinese version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-auto-questionnaire short version (TEMPS-A), and the Attachment Style Questionnaire (ASQ). Results: The participants showed significant distress as assessed with the K10: 19 (15–24) (median, Q1, Q3). Furthermore, a multiple linear regression analysis indicated that cyclothymic (β = 2.1, p = 0.048) and depressive (β = 1.2, p = 0.001) temperament traits and an insecure attachment (ASQ-anxious: β = 0.19, p = 0.006; ASQ-avoidant: β = 0.07, p < 0.001) predicted pandemic-related distress. Conclusions: Dimensions of both affective temperaments and attachment styles were associated with stress in the medical students during the transition to the endemic phase. The investigations of these psychological variables provided new information regarding risk factors for endemic-related distress, and pointed to potential targets for counseling and developing programs to support the medical students{\textquoteright} mental health.",

keywords = "attachment styles, endemic, medical students, stress, temperament",

author = "Carmenrita Infortuna and Xiaolin Yang and Ray Wang and Gianluca Pandolfo and Ilona Cazorla and Julian Dupont and Veolette Hanna and Valerie Iosim and Mirai Mikhail and Alex Yu and Terlecky, {Stanley R.} and Thomas, {Florian P.} and Jing Ren and Wenhua Cao and Zhiyong Han and Fortunato Battaglia",

note = "Publisher Copyright: {\textcopyright} 2025 the Author(s), licensee AIMS Press.",

year = "2025",

doi = "10.3934/publichealth.2025001",

language = "English",

volume = "12",

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issn = "2327-8994",

publisher = "American Institute of Mathematical Sciences",

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Infortuna, C, Yang, X, Wang, R, Pandolfo, G, Cazorla, I, Dupont, J, Hanna, V, Iosim, V, Mikhail, M, Yu, A, Terlecky, SR , Thomas, FP, Ren, J, Cao, W, Han, Z & Battaglia, F 2025, 'Medical students’ distress during the transition to the endemic phase of COVID-19 in China: The association with temperament traits and attachment styles', AIMS Public Health, vol. 12, no. 1, pp. 1-15. https://doi.org/10.3934/publichealth.2025001

TY - JOUR

T1 - Medical students’ distress during the transition to the endemic phase of COVID-19 in China

T2 - The association with temperament traits and attachment styles

AU - Infortuna, Carmenrita

AU - Yang, Xiaolin

AU - Wang, Ray

AU - Pandolfo, Gianluca

AU - Cazorla, Ilona

AU - Dupont, Julian

AU - Hanna, Veolette

AU - Iosim, Valerie

AU - Mikhail, Mirai

AU - Yu, Alex

AU - Terlecky, Stanley R.

AU - Thomas, Florian P.

AU - Ren, Jing

AU - Cao, Wenhua

AU - Han, Zhiyong

AU - Battaglia, Fortunato

PY - 2025

Y1 - 2025

N2 - Objective: The transition of COVID-19 into the endemic phase in China has posed additional challenges to medical student’s well-being, and increased the odds of mental distress. Although affective temperament traits and adult attachment styles accompany crisis-induced stress, whether this applies to medical students in the endemic phase has yet to be determined. The aim of present study is to test if temperament traits and adult attachment style can predict stress in Chinese medical students. Methods: Medical students (N = 402) enrolled in the undergraduate medical program at the Southern Medical University, Guangdong, China completed an online survey in May 2022. Most participants were female (62.4%), with a mean age of (21.3 ±3.1). The individual temperament traits and adult attachment styles were assessed using the Chinese version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-auto-questionnaire short version (TEMPS-A), and the Attachment Style Questionnaire (ASQ). Results: The participants showed significant distress as assessed with the K10: 19 (15–24) (median, Q1, Q3). Furthermore, a multiple linear regression analysis indicated that cyclothymic (β = 2.1, p = 0.048) and depressive (β = 1.2, p = 0.001) temperament traits and an insecure attachment (ASQ-anxious: β = 0.19, p = 0.006; ASQ-avoidant: β = 0.07, p < 0.001) predicted pandemic-related distress. Conclusions: Dimensions of both affective temperaments and attachment styles were associated with stress in the medical students during the transition to the endemic phase. The investigations of these psychological variables provided new information regarding risk factors for endemic-related distress, and pointed to potential targets for counseling and developing programs to support the medical students’ mental health.

AB - Objective: The transition of COVID-19 into the endemic phase in China has posed additional challenges to medical student’s well-being, and increased the odds of mental distress. Although affective temperament traits and adult attachment styles accompany crisis-induced stress, whether this applies to medical students in the endemic phase has yet to be determined. The aim of present study is to test if temperament traits and adult attachment style can predict stress in Chinese medical students. Methods: Medical students (N = 402) enrolled in the undergraduate medical program at the Southern Medical University, Guangdong, China completed an online survey in May 2022. Most participants were female (62.4%), with a mean age of (21.3 ±3.1). The individual temperament traits and adult attachment styles were assessed using the Chinese version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-auto-questionnaire short version (TEMPS-A), and the Attachment Style Questionnaire (ASQ). Results: The participants showed significant distress as assessed with the K10: 19 (15–24) (median, Q1, Q3). Furthermore, a multiple linear regression analysis indicated that cyclothymic (β = 2.1, p = 0.048) and depressive (β = 1.2, p = 0.001) temperament traits and an insecure attachment (ASQ-anxious: β = 0.19, p = 0.006; ASQ-avoidant: β = 0.07, p < 0.001) predicted pandemic-related distress. Conclusions: Dimensions of both affective temperaments and attachment styles were associated with stress in the medical students during the transition to the endemic phase. The investigations of these psychological variables provided new information regarding risk factors for endemic-related distress, and pointed to potential targets for counseling and developing programs to support the medical students’ mental health.

KW - attachment styles

KW - endemic

KW - medical students

KW - stress

KW - temperament

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U2 - 10.3934/publichealth.2025001

DO - 10.3934/publichealth.2025001

M3 - Article

SN - 2327-8994

VL - 12

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EP - 15

JO - AIMS Public Health

JF - AIMS Public Health

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Medical students’ distress during the transition to the endemic phase of COVID-19 in China: The association with temperament traits and attachment styles

Abstract

ASJC Scopus subject areas

Keywords

UN SDGs

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