Family Functioning and Academic Adjustment in Medical Students: Coping Styles as Mediators and Differences in At-Risk Students

Abstract

Objective: Academic adjustment is essential for medical students facing rigorous academic demands. While individual and instructional factors have been well-studied, the role of family functioning remains underexplored. This study examined the association between family functioning and academic adjustment, explored the mediating role of coping styles, and compared these pathways between at-risk students (those who had failed at least one final examination) and controls.

Methods: A cross-sectional study was conducted using validated scales for assessment of academic adjustment, family functioning, and coping styles. Structural equation modeling and bootstrap analyses were used to test mediation effects.

Results: 1022 Chinese medical students (293 at-risk, 729 controls) were included. Family functioning was significantly and positively associated with academic adjustment (p < 0.001). Positive coping mediated this relationship in both groups (at-risk: β = 0.13, 95% confidence interval [CI] [0.068, 0.218]; controls: β = 0.21, 95% CI [0.182, 0.243]), while negative coping mediated the effect only in at-risk students (β = 0.12, 95% CI [0.090, 0.167]). At-risk students showed significantly lower academic adjustment (t = –6.56, p < 0.001, Cohen's d = –0.45) and relied on distinct coping mechanisms compared to controls.

Conclusions: This study reveals distinct mediating pathways of coping styles between at-risk and other students, deepening our understanding of family influences and providing practical guidance for targeted interventions in medical education.

Keywords

academic adjustment / at-risk students / comparative analysis / coping styles / family functioning

RIGHTS & PERMISSIONS

2026 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.