Adverse childhood experiences and academic burnout among Chinese traditional medicine students: the serial mediating role of rumination, self-control, and resilience.

INTRODUCTION

Medical students are vulnerable to academic burnout, particularly those with a history of adverse childhood experiences (ACEs). Although early adversity has been linked to burnout, the precise psychological processes underlying this association remain insufficiently understood. This study examined whether rumination, self-control, and resilience were statistically associated with the relationship between ACEs and academic burnout among medical students.

METHODS

A cross-sectional questionnaire survey was conducted among 1,889 medical students from Heilongjiang University of Chinese Medicine. Measures included ACEs, academic burnout, rumination, self-control, and resilience. Pearson correlation analysis, and serial mediation analyses were performed. Sensitivity analyses were conducted using alternative ACE codings, and supplementary analyses were used to compare alternative mediator orderings.

RESULTS

ACEs were positively associated with academic burnout (β = 0.187, p < 0.001). Rumination, self-control, and resilience were each statistically linked to the ACEs-burnout association through significant indirect pathways. After inclusion of the mediators, the direct association between ACEs and academic burnout was no longer significant. The overall pattern was broadly consistent across continuous, binary, and ordinal ACE operationalizations. Supplementary analyses further indicated that several alternative mediator orderings were also statistically plausible.

CONCLUSION

These findings suggest that rumination, self-control, and resilience are statistically associated with the relationship between ACEs and academic burnout. However, because the study was cross-sectional, causal ordering cannot be established. Longitudinal studies are needed to clarify the temporal sequence of these psychological processes and to determine whether targeting them may help reduce academic burnout.