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.

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 (R2 = 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.