Association between anxiety and aggression among students at a medical college in China: a cross-sectional analysis of indirect associations involving physical activity motivation and self-regulatory fatigue

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Background Anxiety and aggression are important concerns for college students’ mental health and campus adjustment. However, motivational and self-regulatory correlates of this association remain insufficiently examined. Objective This study examined the anxiety–aggression association among students at one medical college in China, tested separate and serial statistical indirect associations involving physical activity motivation (PAM) and self-regulatory fatigue (SRF), and examined the reverse ordering of PAM and SRF. Methods A cross-sectional questionnaire survey was conducted among 1,773 students at Shangqiu Medical College, Henan Province, China. Measures included a GAD-7-derived anxiety item set with five-point agreement responses and no two-week recall period, a BAQ-derived aggression item set with five rather than seven response categories, and PAM and SRF scales. Pearson correlations, regression analyses, and PROCESS Model 6 with 5,000 percentile bootstrap samples were used. Gender and three age-group indicator variables were included as covariates; reverse-order and outlier sensitivity analyses were also conducted. Results Anxiety showed modest correlations with aggression ( r = 0.260), SRF ( r = 0.254), and PAM ( r = −0.257; all p < 0.001). The adjusted aggression model explained 14.5% of the variance (R 2 = 0.145), and the direct anxiety–aggression association remained statistically distinguishable from zero ( B = 0.1101, 95% CI [0.0807, 0.1395]). Bootstrap confidence intervals excluded zero for the separate statistical indirect associations involving PAM and SRF and for the prespecified serial association. The serial association was small ( B = 0.0053, 95% bootstrap CI [0.0034, 0.0077]; completely standardized estimate = 0.0083, 95% bootstrap CI [0.0053, 0.0120]), and the reverse ordering yielded a similarly small serial association. The outlier sensitivity analysis did not materially alter the findings. Conclusion Among students at one medical college, anxiety, lower PAM, higher SRF, and aggression formed modest cross-sectional covariance patterns. Because both PAM–SRF orderings were compatible with the data and the serial association was small, the findings are hypothesis-generating and do not establish temporal or causal mechanisms.

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