The effect of interpersonal relationship and epidemic attention on negative emotion among medical students: the mediating role of social satisfaction

The occurrence of sudden public health events increases the negative emotion of the masses, and depression and anxiety are common psychological reactions [1]. Studies found that after the incidents, most respondents have negative emotional reactions such as anxiety and depression [2]. An online survey of the general population in China showed that more than 30% of the population suffered from psychological distress such as anxiety, depression, cognitive changes, etc. [3]. A survey conducted in Hong Kong found that 19% had depression and 14% had anxiety of the segregated respondents included [4]. While in Europe, studies sampling from UK showed that 22.12% had depression and 21.63% had anxiety among its samples during the early stages of the pandemics [5]. Research carried out in Ireland found that there are 20% of participants who had Generalized Anxiety Disorder (GAD) and 22.8% experienced depression [6]. Moreover, there was a research showed that individuals who feel less emotionally secure, become less satisfying and show more emotional reactivity as they behave more consciously and positively [7].

Medical students, as a special group of students, bear a heavier burden of schoolwork and face greater pressure, making them more susceptible to experiencing negative emotions, such as depression and anxiety [8, 9]. Previous surveys found that the student population of medical schools has a higher rate of emotional disorders than non-medical schools during the SARS epidemic [1], while the detection rate of depression and anxiety symptoms in medical students was higher during the new coronary pneumonia epidemic [10]. What is more, study conducted in Jordan found that pharmacy students had a higher level of depression and anxiety during the epidemics quarantine period [11].Negative emotions such as depression and anxiety easily lead to sleep disturbances, mood disorders, and abnormal activities, which affect social relationships and quality of life. Medical students are the main future frontline workforces in the hospitals, so they take more important and urgent responsibilities to reduce their own negative emotion levels not only for themselves but also for the future development of the medical industry.

During the epidemics, due to the strong contagious power of the virus, it was suggested that individuals should avoid close contact to reduce the probability of contracting the virus, which can easily lead to social isolation [12]. Some studies believe that social isolation mainly refer to loose interpersonal relationships that lack contact and communication [13, 14], which significantly affect the mental health of the individuals after the epidemic [15, 16]. Its impact, which some researches has manifested, could enhance the individual’s sense of fear of related events and over-solve the external world, triggering avoidance behavior and negative emotions [17]. Some surveys showed that more than half of the individuals believe that during the epidemics, social interpersonal relationships tended to be tense, interpersonal vigilance was increased, and trust was lacking [18].However, interpersonal relationship significantly affects individuals’ mental health levels. Poor interpersonal relationships play an important role in generating negative emotions such as depression and anxiety [19].

Public health emergencies refer to situations characterized by uncertainty, instability and insecurity. During crisis events, individuals often seek to gain a sense of control and alleviate anxiety by obtaining, disseminating, evaluating and utilizing information related to epidemics from different channels [20]. Research has found that uncertainty can lead to stress. During epidemics, smartphones become the primary source of information. Individuals who isolated and heavily rely on their smartphones to gain information can experience a sense of control that helps alleviate stress [21]. A study has shown that the degree and core of public regarding the epidemic has a significantly impact on public panic and mental health [22].

Therefore, it is essential to investigate the influencing factors, particularly interpersonal relationships and epidemic attention, on depression and anxiety during the period of epidemics and understand their underlying mechanisms of interaction with negative emotions.

A cross-sectional survey was used to investigate the influence of interpersonal relationships and epidemic attention on negative emotions among university students, using convenience sampling and simple random sampling. A total of 1,500 questionnaires were distributed, 1,451 valid questionnaires were returned and the effective response rate was 96.7%. Epidata 3.1 was used for double entry of data, and structural equation models were constructed and tested using AMOS 23.0 software. The bias-corrected non-parametric percentile confidence interval Bootstrap method was used to test the mediating effect of social satisfaction between interpersonal relationships, epidemic concern and depression and anxiety using 1000 replicate samples.

According to the theory of interpersonal relationship promoting growth model, good interpersonal relationships promoted individuals to actively respond to trauma-related events, encourage individuals to think positively, rebuild cognition, reduce individual psychological stress levels, and overcome negative psychological experiences [14]. Higher satisfaction in interpersonal relationships, to a certain extent, signify having good social support [28], and social support buffer the emotional response triggered by stressful events correspondingly [29]. During the epidemics, individuals tend to be socially isolated, and it is difficult to maintain satisfactory interpersonal relationships. Good interpersonal relationships effectively alleviate negative emotions such as depression and anxiety that are generated in the environment of the epidemics, and bad, broken, and loose interpersonal relationships exacerbate negative emotions.

H1: Interpersonal relationships positively predict depression and anxiety levels.

Various risk events exposed in the public’s vision during the epidemic made individuals feel threats from the external environment and were more likely to trigger negative emotions such as anxiety, depression, and panic [30, 31]. In an environment where risk events such as emergent public health events occur frequently, the more serious the threat perceived by the masses, the more frequent and more intense information searching behaviors are likely to occur [30]. The Audience-centric theory state that audiences are actively looking for the information they want [32]. Negative information, compared with positive or neutral information, bring a larger amount of information, thereby attracting more attention from the crowd [33]. Ecosystem theory and interpretation level theory also put forward similar views [34, 35]. However, paying attention to the epidemic information for a long time is more likely to trigger negative emotions [36]. Due to the peculiarities of the epidemic environment, most information about the epidemic spread through the Internet. Internet information are mixed and difficult to distinguish between false and true, which might cause psychological stress to netizens and affect their mental health [37]. Excessive time are spent focusing on epidemic information interferes with normal life and rest, manifested by a lack of necessary recreational activities or exercise, and exacerbates symptoms of depression and anxiety. Studies show that the increased frequency and intensity of epidemic information bring a large number of stimuli, resulting in perceptual deactivation and a weakened ability to regulate and process emotions. When facing with a sudden epidemic, individuals tend to behave as a decrease in processing capabilities, leading to an increase and accumulation of negative emotions [38]. Therefore, this study assumes that the degree of attention to the epidemic negatively predicts the level of depression and anxiety.

H2: Epidemic attention negatively predicts depression and anxiety levels.

Satisfaction refers to a state of mind that describes a person’s subjective evaluation of the quality of a relationship[39]. Depression and anxiety are closely related to satisfaction. Research on depression and anxiety emotions and satisfaction, from job satisfaction [40] to physical satisfaction [41] to nurse-patient relationship satisfaction etc., these results show that satisfaction negatively affects the level of anxiety and depression, and the increase in satisfaction is beneficial to reduce negative emotion. Among them, there are many surveys on negative emotions and life satisfaction, and it is found that the generation of anxiety and depression is negatively correlated with life satisfaction [42, 43]. In addition, satisfaction is also affected in many ways. In terms of interpersonal relationships, life satisfaction, job satisfaction, and community satisfaction are equal to interpersonal problems and are negatively correlated [44]. At the level of information attention, the public’s expectations and attention are positively affecting official media satisfaction[45].

Social satisfaction is a kind of satisfaction, and it is an important social psychological index, which refers to the perception and experience that individuals show to the social environment in work and life [46]. During the epidemics, due to the peculiarities of the environment, individuals’ interpersonal relationships, information attention, and negative emotion levels fluctuated, and social satisfaction also change. Social satisfaction plays a vital role in social harmony, social construction, and social development. However, there are few related studies on the influencing factors of social satisfaction and its relationship with negative emotions. Because of this, this study proposes the following hypotheses: social satisfaction negatively predicts depression and anxiety; interpersonal disturbance negatively affects social satisfaction; epidemic attention positively affects social satisfaction; social satisfaction is in interpersonal relationship disturbance and epidemic concern; the degree plays a partially mediating role in the influence of depression and anxiety levels.

H3: Social satisfaction negatively predicts depression and anxiety.

H4: Interpersonal disturbance negatively predicts social satisfaction.

H5: Epidemic attention positively predicts social satisfaction.

H6: Social satisfaction plays a partially mediating role in the influence of interpersonal relationships and epidemic attention on depression and anxiety levels.

The means, standard deviations, and correlation coefficients among the study variables are presented in Table 1. Additionally, Fig. 1 displays the correlation heat map.

During the pandemic, Pearson’s correlations showed that gender was significantly negatively correlated with epidemic attention (r = -0.076, p < 0.001) but positively correlated with social satisfaction (r = 0.112, p < 0.001). Grade was significantly negatively correlated with epidemic attention (r = -0.054, p < 0.05) and relationship (r = -0.057, p < 0.05) but positively with social satisfaction (r = 0.133, p < 0.001). Epidemic attention was significantly negatively correlated with social satisfaction (r = -0.098, p < 0.001) but positively correlated with anxiety (r = 0.078, p < 0.001). Social Satisfaction was significantly positively correlated with relationship (r = 0.129, p < 0.001), depression (r = 0.140, p < 0.001) and anxiety (r = 0.120, p < 0.001). Relationship was significantly positively correlated with depression (r = 0.519, p < 0.001) and anxiety (r = 0.497, p < 0.001). There was a significant positive correlation between depression and anxiety (r = 0.77, p < 0.001).

The scale was tested for reliability (Table 3) and descriptive statistical analysis (Table 4) using SPSS 24.0 software, and the total scale had a Cronbach’s alpha value of 0.839, which was greater than 0.8 and had some reliability. The Cronbach’s α value of each dimension fluctuates between 0.60 and 0.86, which were all greater than 0.6, indicating that the reliability of the scale was relatively good. Besides, the KMO value and Bartlett’s sphere test were performed on the scale. The KMO value of the total scale and each dimension fluctuated between 0.654 and 0.878, all greater than 0.6, and the t-test values were also significant at the 0.05 level, indicating the structural model of performance’s validity was good.

To explore the relationship and action path of the negative emotions of college students during the epidemics, we used AMOS22.0 software to build a structural equation model and used the maximum likelihood method to estimate the initial model. The initial model was shown in Fig. 3.

After the initial model simulation, the results showed that the correction index MI value between the four latent variables of anxiety, depression, social satisfaction and interpersonal relationship was relatively large. The relevant path could be added to modify the model, and increased [e9-e10], [e14 -e15] equal residual path. The p-value of each path after the correction was less than 0.05, which was statistically significant. The final model was shown in Fig. 4. Due to the large sample size in this study, the CMIN/DF index was too large, but the fitting results of other fitness indexes were good. The fitting results were shown in Table 5.

Interpersonal relationships positively predicted the level of anxiety and depression, which was consistent with the hypothesis of this study, and also verified the results of previous studies. The more serious the interpersonal relationship is, the more likely it is to trigger and aggravate depression and anxiety. During the epidemics, the fear of pandemics among the masses led to social isolation, the face-to-face contact between individuals decreases and interpersonal relationships tend to loosen. Therefore, a negative interpersonal atmosphere was easily created, which intensified negative emotional experiences. To a certain extent, poor interpersonal relationships also represent a lack of social support, inhibiting individuals’ positive thinking about the epidemic environment, increasing the level of internal stress, and causing anxiety, depression and other emotions.

The degree of epidemic attention positively predicted the level of anxiety and depression, which is consistent with the hypothesis of this study, and also verify the results of previous studies. Paying attention to the increase in the frequency and intensity of epidemic information is an individual’s normal objective behavior in the new risk environment [33, 34]. However, the increase in the degree of attention to the epidemic points to an increase in negative emotional experience. This was manifested in the undesirable results brought about by the behavior of overly paying attention to the epidemic information and the negative effects brought about by the negative information. Focusing on the phone for a long time is prone to the feeling of emptiness [47].

Excessive attention to information easily diminishes the ability to regulate emotions and cognitive processing. Increased focus on the epidemic also contributes to a decline in overall quality of life, resulting in a lack of recreational and sports activities, which further exacerbate negative emotions. Network information is diverse and mixed. Compared with positive information, negative information is more likely to attract the attention of the crowd. When individuals are exposed to an abundance of negative information, they become susceptible to perceiving higher levels of risk, leading to feelings of panic and anxiety. With an excessive amount of negative information received, a more intense sense of fear could be triggered [48] due to a reduced sense of control, which is at the core of anxiety generation and maintenance [49].

Social satisfaction negatively predicted the level of anxiety and depression, which is consistent with the hypothesis of this study, that is, the higher the social satisfaction, the lower the level of anxiety and depression, and the weaker the negative emotional experience. McMillan and Chavez once proposed that when individuals’ community satisfaction is higher, the individual’s sense of attachment and belonging to the community is stronger [50]. A society is a collection of several communities. When individuals are more satisfied with society, they are more likely to have a sense of trust and security, thereby reducing the generation of negative emotions.

The university’s efforts to enhance outbreak science may be a breakthrough in reducing negative emotional experiences. Firstly, teachers reaching out more to students and building social support from teachers to students. Secondly, promoting epidemic prevention policies and knowledge as a school will not only reduce rumor generation and achieve disbelief and disinformation, but will also increase the authority and trust of the school and improve university students’ satisfaction at school, which in turn will improve social satisfaction and thus reduce the likelihood of depression and anxiety.

Interpersonal disturbance negatively predicts social satisfaction, that is, the higher the degree of interpersonal disturbance, the lower social satisfaction, which is consistent with the hypothesis of this research. The fear of pandemics among masses during the epidemic forbid unnecessary face-to-face close contact and communication between individuals such as parties which undergraduate students like very much, and individuals may be more inclined to extend the negative emotions brought about by interpersonal distancing into dissatisfaction with social policies.

The degree of epidemic attention positively predicts social satisfaction, that is, the higher the degree of epidemic attention, the higher the social satisfaction, which is consistent with the hypothesis of this study. During the epidemic, the public had higher expectations for the performance of government departments. As the main source of propagating correct epidemic information and effective epidemic prevention knowledge, the official media has become one of the directions for the public to maintain high attention. The masses maintain a high attention to the epidemic while also experiencing the quality of services provided by the government during the epidemic, to obtain A sense of security, more trust in the government [51].

In addition, the pandemic outbreak is a global public health emergency. As individuals focus on more information about the domestic outbreak, they will also receive information about other countries’ preparedness measures and their effectiveness. Government prevention and control of the outbreak has controlled the increase in domestic infections, and China has provided assistance to other countries in their prevention and control of the outbreak. These initiatives have led to an increased sense of security among university students, which in turn has led to increased social satisfaction.

Interpersonal problems can not only directly affect negative emotion levels but also indirectly affect negative emotion levels through social satisfaction. This shows that individuals with bad interpersonal relationships are more likely to be dissatisfied with their social environment, and are more likely to feel helpless and induce the development and escalation of anxiety and depression.

Epidemic attention indirectly predicted negative emotion levels by influencing social satisfaction, that was when individuals spend more time and attention in using correct and credible information channels to obtain real epidemic news and rationally recognize government decisions. When they understand the quality of service and other aspects, with social satisfaction increasing, the experience of depression and anxiety will decrease.

The pathognomonic features of anxiety disorders and anxiety symptoms are generally believed to be the unconscious conflicts in the psychodynamic theory [52]. On the other hand, depression symptoms are often triggered by disruption of profit and avoid loss avoidance mechanism, as well as the obstruction of the safety path and the value path [53]. Those conflicts and destruction not only come from inside, but also happens between people and within families, groups, and systems [52]. Conflicts which direct anxiety symptoms manifest themselves in the battle between inner desire and standard imposed by society or environment [52]. After perceiving the negative stimulus which is imminent to the psychological limit, individuals are prone to experience anxiety [53]. During the period of epidemics, the strong desire to go out with friends clashed with the strict social requirement to isolate oneself at home, leading to lower social satisfaction and aggravate anxiety. However, due to the control of negative epidemic information and the dissemination of positive information, it can not only enhance the public’s awareness of social management during the epidemic and increase social satisfaction, but also reduce the threat to life. This declines the conflict between survival instinct and the danger of the epidemic helps decrease the level of anxiety.

Depression begins with the breaking of psychological limits, which refers to minimum expectations in life. When limits are breached, negative experiences become intensify, and attention becomes more focused on negative information [53]. Negative events predict distress in the form of negative mood and depression symptoms [54, 55]. Therefore, it is necessary to control the dissemination of negative epidemic information. During pandemics, the general population tended to be more sensitive to epidemics. However, due to the effective information management, social satisfaction rose as the level of epidemic attention become higher, leading to a reduction in depression experiences. Whereas individuals were prone to experience depression when interpersonal disturbances worsened because of the necessity of isolation, resulting in reduced social satisfaction.

Therefore, the government should create a more accessible information platform for the public, publish immediate information, pay attention to the direction of public opinion, and be attentive to the expectations and voices of the public to increase their social satisfaction and avoid a negative emotional climate during the critical period of the epidemic.