# Perceived stigma, emotional resilience, and depressive/anxiety symptoms across school stages: a cross-sectional study

## TL;DR

This study explores how stigma, stress, and emotional resilience affect depression and anxiety in students across different school stages.

## Contribution

The study identifies emotional resilience as a key mediator linking stigma to mental health outcomes, with stage-specific effects.

## Key findings

- Junior high students showed the highest levels of depression/anxiety and stigma.
- Emotional resilience mediates the relationship between stigma and mental health symptoms.
- Stigma's direct effect on mental health varies by school stage.

## Abstract

Adolescent psychological distress rises sharply. Stigma may inflict harms that exceed the disorders themselves; stress and emotional resilience is pivotal for mental health. Yet how perceived stigma, stress, resilience, and symptoms interact across school stages remains underexplored. We therefore examined stage-specific prevalence and interrelations of perceived stigma, perceived stress, emotional resilience, depression, and anxiety.

We conducted a cross-sectional, school-based online survey from November 2024 to February 2025 among students in Chongqing, Sichuan, and Hubei. All students in participating schools were invited without sex or age restrictions. The scales included the Perceived Devaluation and Discrimination (PDD), the Stress Numerical Rating Scale–11 (SNRS-11), the Adolescents’ Emotional Resilience Questionnaire (AERQ), the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7(GAD-7). Analyses comprised descriptive statistics (for stigma, stress, resilience, and mental-health), Pearson and partial correlations (age/sex-adjusted), and mediation modeling.

A total of 86,513 students were included. Clear stage gradients emerged: junior high showed the highest prevalence of PHQ-9/GAD-7 ≥10 and greater stigma and stress, whereas university showed the lowest levels; girls, especially in junior high, bore the greatest burden. In mediation models, stigma was associated with lower resilience, and lower resilience was linked to higher depressive and anxiety symptoms; indirect pathways were significant for both outcomes. The direct effect of stigma was negative overall, with stage-dependent variations: positive in junior/senior high and negative in university, suggesting heterogeneous effects by school stage.

Findings highlight emotional resilience as a principal pathway linking stigma to depressive and anxiety symptoms, with stronger mediation at later school stages. This supports a dual-track approach to school mental health: anti-stigma and help-seeking initiatives alongside resilience-enhancement embedded in curricula and school climate. Limitations include the cross-sectional design, reliance on self-report, potential selection/nonresponse bias from voluntary online participation, and under-representation of out-of-school youth. Prospective longitudinal or intervention studies with causal-mediation frameworks and broader sampling are warranted to clarify mechanisms across developmental stages.