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

## TL;DR

This study explores how medical students in China experienced mental distress during the endemic phase of COVID-19, and how traits like temperament and attachment styles influenced their stress levels.

## Contribution

The study identifies affective temperament traits and attachment styles as predictors of pandemic-related distress in Chinese medical students.

## Key findings

- Cyclothymic and depressive temperament traits predicted increased pandemic-related distress.
- Insecure attachment styles (anxious and avoidant) were significantly associated with higher distress levels.
- The findings suggest psychological traits could be targeted in mental health support programs for medical students.

## Abstract

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.

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).

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.

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.