The Impact of Negative Life Events on Psychological Capital, Perceived Social Support and Prosocial Behavior in Medical Students: A Moderated Mediation Model

The Impact of Negative Life Events on Psychological Capital, Perceived Social Support and Prosocial Behavior in Medical Students: A Moderated Mediation Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Negative Life Events on Psychological Capital, Perceived Social Support and Prosocial Behavior in Medical Students: A Moderated Mediation Model Nana Liu, Xinyan Zhuang, Yanjun Cao, Huihui Hu, Haibo Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6200207/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 May, 2025 Read the published version in BMC Medical Education → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Prosocial behavior is an essential quality for medical students and reflects the development of future professional values. This study aims to investigate the roles of perceived social support and psychological capital in the prosocial behaviors of medical students while also testing the moderating effect of negative life events. Methods: A cross-sectional survey was conducted from July to October 2023 among 1940 medical students in Jiangsu Province, using a questionnaire composed of the Prosocial Tendencies Measurement Scale, the Perceived Social Support Scale, the Psychological Capital Questionnaire, and the Adolescent Life Events Scale. SPSS 25.0 was used for the preliminary analysis, and M-plus 8.3 was performed to examine the moderated mediation effect. Results: Perceived social support ( β = 0.248, 95% CI [0.178, 0.321]) and psychological capital ( β = 0.414, 95% CI [0.334, 0.495]) positively predicted medical students' prosocial behavior. Perceived social support positively predicted psychological capital ( β = 0.458, 95% CI [0.401, 0.518]). Psychological capital mediated their relationship. The first half of the mediating pathway of "perceived social support → psychological capital → prosocial behavior" was moderated by negative life events. Specifically, due to the negative moderating effect of negative life events, the indirect effect of psychological capital on the relationship between perceived social support and prosocial behavior increased from 33.5% to 50.6%. Conclusions: Perceived social support directly predicts medical students' prosocial behavior and may do so indirectly via psychological capital. It's a stronger positive predictor of psychological capital in medical students with lower negative life events. Findings help develop targeted mental health courses and interventions for medical students' prosocial behaviors. Clinical trial number: Not applicable. Prosocial behavior Perceived social support Psychological capital Negative life events Medical students Figures Figure 1 Figure 2 Figure 3 Introduction Prosocial behavior is a fundamental aspect of human interaction, characterized by actions intended to benefit others, such as helping, sharing, and cooperating [ 1 ]. This concept holds particular relevance within medical education., where fostering prosocial behaviors among medical students can enhance their interpersonal skills and improve patient care outcomes [ 2 ]. Unlike altruism, which often emphasizes selfless acts performed solely for the benefit of others, prosocial behavior encompasses a broader range of actions that balance individual interests with societal needs [ 3 ]. Recent studies indicate that engaging in prosocial behaviors can mitigate the moral dilemmas associated with self-sacrifice, which is often emphasized in traditional medical training [ 4 ]. Furthermore, prosocial behavior serves as a protective factor against antisocial tendencies, thus promoting a healthier psychological state among medical students [ 5 ]. Despite the importance of prosocial behavior, research indicates that levels of such behavior among medical students are moderate, suggesting significant potential for growth in this area [ 6 ]. Understanding the factors that influence prosocial behavior is crucial for developing effective educational interventions. Historically, research has focused primarily on emotional and personality traits as determinants of prosocial behavior [ 7 , 8 ], with limited exploration of individual resources from the perspective of the Conservation of Resources (COR) theory. The present study aims to investigate the mechanisms of how social support and psychological capital, as composite individual resources, predict prosocial behaviors through the lens of COR. Additionally, it will examine the role of negative life events among these three variables based on the stress-vulnerability hypothesis. Through this exploration, the study expects to provide valuable insights for developing interventions designed to promote prosocial behaviors in higher education institutions. Perceived social support refers to people’s beliefs about the extent and quality of support available from their social contacts [ 9 ]. This concept is a critical dimension of social support, which encompasses the interactions and relationships that provide individuals with actual assistance and embed them within a social system that offers love, caring, and a sense of belonging to valued groups [ 10 ]. Received social support and perceived social support are the two primary dimensions of social support that have long been the focus of research. Received social support refers to the number of supportive behaviors an individual has received [ 11 ], while perceived social support reflects both the satisfaction with and the availability of support [ 12 ]. In the context of COR theory, perceived social support is considered a valuable resource [ 13 ], playing a crucial role in reducing depression, alleviating stress, improving mental health, and enhancing overall well-being [ 14 , 15 ]. This aspect of support is particularly vital for medical students, who encounter various challenges within their academic environment, including resource limitations, extended school terms, and overwhelming learning demands. These factors can adversely affect their mental health and social development [ 16 ]. According to the cumulative risk hypothesis [ 17 ], the accumulation of risk factors intensifies negative impacts on psychological adjustment; therefore, the greater the number of risk factors, the higher the incidence of maladjustment. The absence of social support can exacerbate these difficulties, contributing negatively to other risk factors [ 18 ], particularly among the medical student population. Conversely, social support can protect individuals from the detrimental effects of these risks and encourage positive behavioral changes. COR theory posits that adequate psychological resources can inspire individuals to engage in more constructive behaviors, such as self-sacrifice, helpfulness, sharing, cooperation, and humility [ 19 ]. Research indicates that social support from parents, peers, and educational institutions significantly influences prosocial development in adolescents [ 20 ]. Moreover, perceived social support is a positive predictor of individuals’ prosocial behaviors. When individuals recognize that they have strong interpersonal relationships, they often develop a robust sense of belonging, which fosters altruistic behaviors [ 21 ]. Despite these insights, current research investigating the relationship between perceived social support and prosocial behavior remains limited, necessitating further exploration of this connection. Drawing on the aforementioned theories and literature, this study proposes Hypothesis 1 : Perceived social support directly predicts prosocial behavior in medical students. Psychological Capital (PsyCap) is defined as a positive psychological state that individuals exhibit during their growth and development, comprising four core components: self-efficacy, optimism, hope, and resilience [ 22 ]. Within the framework of COR theory, PsyCap is considered a valuable individual resource [ 13 ]. Research has shown that individuals with high levels of PsyCap typically experience positive transformations in their attitudes and behaviors, even surpassing the influence of other factors such as physical, human, and social capital [ 23 ]. A recent systematic review indicated that PsyCap positively predicts prosocial behavior; individuals endowed with higher levels of PsyCap tend to exhibit better service behaviors and greater consideration of others. This emphasis on PsyCap is further justified by the observation that researchers frequently treat PsyCap and perceived social support as a composite resource when examining their impact on various individual behaviors, including bullying and volunteering behavior. According to COR theory, individuals rich in resources are better able to leverage existing resources to acquire additional ones [ 24 ]. PsyCap can be nurtured and enhanced through social mechanisms, such as social support, constructive relationships, and close interpersonal contact. Although the relationship between perceived social support and PsyCap has been established among nursing students and general college populations, the interplay of perceived social support and PsyCap as a composite coping resource in influencing prosocial behavior remains unexplored. Given that previous research has indicated a mediating role for PsyCap in the effects of various psychological factors—such as mindfulness and meaning in life, on prosocial behavior [ 25 , 26 ], we propose Hypothesis 2 : PsyCap mediates the relationship between perceived social support and prosocial behavior in medical students. Negative life events are defined as situations or occurrences that disrupt an individual's psychological balance, potentially resulting in adverse effects on physical health [ 27 ]. Our focus on negative life events is particularly relevant in the context of medical students, who experience significantly higher stress levels due to rigorous curricula, prolonged academic cycles, and demanding internships compared to their peers in other disciplines. This group is recognized as one of the most distressed within the undergraduate population. Previous studies have highlighted those medical students frequently encounter a variety of stressful life events, including illness and bereavement, financial difficulties, challenging interpersonal interactions, and high workloads. Research indicates that such negative life events can substantially impact the mental health of medical students [ 28 ], with an accumulation of these stresses often associated with poor psychological adjustment [ 29 ]. According to the loss spiral hypothesis in the COR theory, individuals can deplete their resources in managing stress and negative emotions arising from these life events, which can hinder their ability to acquire new resources given their diminished reserves. Furthermore, the stress-vulnerability hypothesis posits that positive psychological qualities may lose their protective effects in high-stress environments, suggesting that an individual's adaptive capacity diminishes rapidly when confronted with numerous or severe negative life events [ 30 ]. Empirical studies have shown that Psycap such as resilience, gratitude, and emotional intelligence can significantly counteract risk; however, its efficacy is markedly reduced, or even negated, in the face of larger or more severe negative life events [ 30 , 31 ]. Consequently, we can hypothesize that the predictive effect of perceived social support on PsyCap may be diminished when individuals encounter a greater number of negative life events. In essence, negative life events could modulate the relationship between perceived social support and PsyCap. Based on this reasoning, we propose Hypothesis 3 : The first-stage path of the indirect effect of perceived social support through PsyCap is moderated by negative life events. Based on COR theory, the stress susceptibility hypothesis, and the above research literature, a mediated model (Fig. 1 ) was constructed to evaluate the effects of PsyCap and negative life events on the relationship between perceived social support and prosocial behavior among medical students. Methods Participants and Procedures Data collection was completed between July and October 2023. Medical students from four medical schools in Jiangsu Province were recruited using a whole cluster stratified sampling method. Initially, college students from each school were categorized into four strata based on their academic year: freshmen, sophomores, juniors, and seniors. At least one complete class was selected from each stratum. To maximize participation, the survey was scheduled during the free time when the students were more likely to gather. Counselors facilitated access for researchers by entering classes, where they explained the purpose of the study. Following the explanation and after obtaining informed consent from participants, the questionnaires were distributed through the online survey tool "Wenjuanxing" ( https://www.wjx.cn/ ), including four scales (see measures) and general demographic characteristics (such as gender, grade, and family). We excluded 560 questionnaires that were not answered seriously and those with suspected extreme values. In total, 1940 valid questionnaires were collected with an effective rate of 77.6%. A post hoc power analysis was performed using G * Power 3.1 to assess the effective sample size for the correlation analysis. The result included 1,940 participants, with a significance level established at α = 0.001 and an effect size of r = 0.10. This yielded a statistical power of 0.87 [ 32 ]. Measures Prosocial behavior. The Prosocial Tendencies Measurement Scale (PTM) developed by Carlo et al. [ 33 ] was used to assess prosocial behavior among medical students. The scale consists of 26 items that encompass six dimensions: openness, anonymity, altruism, compliance, emotion, and urgency. Responses were collected using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The Chinese version of the PTM has demonstrated good reliability among Chinese university students [ 26 ]. In this study, the PTM exhibited a high level of internal consistency, with a Cronbach's α coefficient of 0.949. Perceived Social Support The Perceived Social Support Scale (PSSS) developed by Zimet et al. [ 9 ] was employed to measure perceived social support among medical students. The scale consists of 12 items that are structured around three dimensions: family support, friend support, and other support. A seven-point Likert scale was utilized, where responses ranged from 1 (totally disagree) to 7 (totally agree). The Chinese version of the PSSS has demonstrated good reliability among Chinese university students [ 34 ]. Higher scores indicate a greater level of perceived social support. In this study, the PSSS demonstrated excellent internal consistency, with a Cronbach's α coefficient of 0.962. Psychological Capital The Psychological Capital Questionnaire (PCQ-24) developed by Luthans et al. [ 23 ] was employed to measure the PsyCap of medical students. The questionnaire consists of 24 items across four dimensions. Respondents rated each item on a six-point Likert scale, where higher scores reflect increased levels of PsyCap. The Chinese version has proven reliable in previous studies among Chinese university students [ 35 ] and showed strong internal consistency in this study, with a Cronbach's α coefficient of 0.928. Negative Life Events The Adolescent Life Events Scale (ASLEC) compiled by Liu et al. [ 36 ] was utilized to assess the occurrence of negative life events among medical students over the past year. The scale consists of 27 items categorized into six dimensions: interpersonal relationships, health adaptation, study stress, punishment, loss, and others. Responses were measured on a five-point Likert scale, with higher scores indicating a greater impact from negative life events. The Chinese version has proven reliable in previous studies among Chinese adolescents [ 37 ]. The ASLEC achieved a Cronbach's α coefficient of 0.947 in this study. Data Analysis Data analysis was performed using SPSS 25.0 for descriptive statistics and correlation analyses, while the moderated mediation model [ 38 ] was tested through the latent moderated structural equations (LMS) approach in M-plus 8.3. In constructing structural equation models (SEM), perceived social support, psychological capital, prosocial behaviors, and negative life events were treated as latent variables, their dimensions serving as observed indicators. Additionally, age and grade were included as control variables in the data processing. Due to the absence of frequently used model fit indices such as CFI, TLI, RMSEA, and SRMR in the LMS framework, the first step of our analysis involved creating a baseline SEM that excluded the latent interaction term to assess initial model fit. Upon confirming that the baseline model met the satisfactory fit criteria, we proceeded to introduce the latent interaction between perceived social support and negative life events, thus establishing the moderated mediation model. Next, a log-likelihood ratio test was performed to assess whether this moderated mediation model provided a better fit to the data. In the third step, we investigate indirect effects at varying levels of family socioeconomic status (SES), using bias-corrected bootstrap confidence intervals derived from 5000 bootstrap samples to determine the significance of these indirect effects. Finally, we characterized the moderating effect through a simple slope analysis at two levels of negative life events (− 1 SD, + 1 SD) and examined the moderating effect using the Johnson-Neyman technique [ 39 , 40 ]. Ethics Approval and Consent to Participate The procedures in this study adhered to the Declaration of Helsinki and received approval from the Institutional Review Board at Xuzhou Medical University. Results Common Method Bias Test Harman’s single-factor test was utilized to evaluate the influence of common method bias on the study findings [41]. The results indicated that the first factor accounted for 23.79% of the variance, falling below the 40% threshold. This suggests that the common-method bias did not significantly impact the results of the research. Descriptive statistics As shown in Table 1, the sample comprised 581 (29.95%) men and 1359 (70.01%) females with an average age of 19.81 years (SD = 1.53). Among them, 803 participants (41.39%) were only children and 1137 (58.61%) had siblings. Only a small proportion of 160 (8.25%) were from single-parent families. 48 (2.47%) had a religious affiliation. The grade composition of the participants was 478 (24.64%) freshmen, 390 (20.10%) sophomores, 522 (26.91%) juniors, and 550 (28.35%) seniors. Table 1 Sociodemographic characteristics and differences of medical students' prosocial behavior (N=1940) Variables N (%) M±SD t/F p Gender Male 581(29.95) 94.59±13.44 1.668 0.095 Female 1359(70.05) 93.51±12.85 Ages (years) ＜20 868(44.74) 94.87±13.04 3.154 0.002 ≥20 1072(55.26) 92.99±12.99 Grade Freshmen 478(24.64) 94.93±13.11 3.999 0.008 Sophomores 390(20.10) 94.79±12.96 Juniors 522(26.91) 93.57±13.07 Seniors 550(28.35) 93.83±13.03 Home location Rural areas 1147(59.12) 93.97±13.45 0.576 0.565 Urban areas 793(40.88) 93.63±12.42 Only child Yes 803(41.39%) 93.33±13.23 -1.436 0.151 No 1137(58.61) 94.19±12.87 Single-parent family Yes 160(8.25) 93.53±13.01 -0.303 0.762 No 1780(91.75) 93.86±13.04 Ethnic minority Yes 105(5.41) 92.85±11.17 -0.794 0.427 No 1835(94.59) 93.89±13.13 Religious belief Yes 48(2.47) 92.75±13.47 -0.581 0.561 No 1892(97.53) 93.86±13.03 Abbreviation: M, mean; SD, standard deviation. Testing for Moderated Mediation Effects The LMS method was used to examine whether negative life events moderate the indirect effect of perceived social support on prosocial behavior through PsyCap among medical students, in order to provide a comprehensive understanding of how the incentive effects of perceived social support vary between different levels of negative life events. Following the three-step procedure [38,42] the first step was to estimate the structural equation model without the latent interaction term (Model 0). It showed that Model 0 fit the data well, with satisfactory fit indices: χ 2 /df = 4.75, TLI = 0.972, CFI = 0.977, RMSEA = 0.044, SRMR = 0.032. The second step was to estimate the structural equation model with a latent interaction term (Model 1) and use a log-likelihood ratio test to determine whether Model 1 fits better than Model 0. The statistic of a log-likelihood ratio test, called D, was calculated by multiplying −2 by the difference subtracting the log-likelihood value for Model 1 (-41202.290) from Model 0 (-41222.855), yielding a D value of 41.13 that was greater than the χ 2 critical value of 6.63 (df = 1, p < 0.01), which indicated that the moderated mediation model fit better. The specific unstandardized path coefficients are shown in Figure 2 . The paths from perceived social support to PsyCap ( β = 0.458, 95% CI [0.401, 0.518]) and prosocial behavior ( β = 0.248, 95% CI [0.178, 0.321]) were statistically significant; and the path from PsyCap to prosocial behavior was positive and significant ( β = 0.414, 95% CI [0.334, 0.495]). The path from negative life events to PsyCap was negative and significant ( β = -0.157, 95% CI [-0.191, -0.123]). Moreover, there was a significant latent interaction effect of perceived social support and negative life events on PsyCap ( β = -0.156, 95% CI [−0.207, −0.108]). The third step was to estimate the conditional indirect effect of perceived social support on prosocial behavior through PsyCap at two levels of negative life events ( Table 2 ). When negative life events were one standard deviation above the mean (+1 SD), the indirect effect was significant, with a value of 0.125 (95% CI [0.089, 0.166]), representing 33.5% of the total effect of 0.373. When negative life events were one standard deviation below the mean (-1 SD), the indirect effect was more significant with a value of 0.254 (95% CI [0.202, 0.314]), representing 50.6% of the total effect of 0.502. Then, the present study further examined the statistical significance of the unstandardized simple main effect of perceived social support on PsyCap at two levels of negative life events to illustrate the nature of the moderating effects [39]. The simple slope test showed that when negative life events were one standard deviation above the mean (+1 SD), the effect of perceived social support on PsyCap was statistically significant ( β = 0.302, 95% CI [0.230, 0.378]); When negative life events were one standard deviation below the mean (−1 SD), the effect of perceived social support on PsyCap was more statistically significant ( β = 0.614, 95% CI [0.541, 0.699]). Figure 3 shows that the lower the level of negative life events, the greater the role perceived social support plays in the promotion of PsyCap. Table 2 Moderation effect of negative life events Negative Life Events Effect SE 95% CI +1SD 0.125 0.020 [0.089, 0.166] Mean 0.190 0.021 [0.149, 0.234] -1SD 0.254 0.028 [0.202, 0.314] Discussion In the context of medical education, cultivating the future professional values of medical students is crucial. Compared to the traditional method of imposing altruism, fostering prosocial behavior represents a more balanced and realistic approach to instilling medical virtue within medical education. The present study identified significant differences in prosocial behavior among medical students based on age and grade. Prosocial behavior decreases with the increase of students' age and academic level. This observation aligns with a previous review that highlighted a trend in which medical students exhibit decreasing prosocial values as they progress through their education [43]. This decline may be attributed to the fact that, during medical training, students often encounter increasingly heavy workloads and face strenuous demands, becoming more familiar with the non-humanistic informal practices that can characterize the medical culture [43]. These cumulative challenges can lead to emotional suppression, detachment from patients, and symptoms of burnout, with other negative consequences possibly arising as a means of self-preservation. This finding reinforces the importance of developing prosocial behaviors within the medical student population. This study thoroughly examines the effects of perceived social support and PsyCap as individual composite resources on the prosocial behaviors of medical students. The findings reveal that both perceived social support and PsyCap positively predict medical students' prosocial behaviors. Furthermore, PsyCap was found to mediate the relationship between perceived social support and prosocial behaviors. In particular, negative life events were identified as a moderating factor that affected the initial phase of this mediated model. This study not only identifies protective factors that contribute to the development of prosocial behavior among medical students but also elucidates the conditions under which the relationship between perceived social support and prosocial behavior is more significant. First, this study found that perceived social support positively predicts prosocial behavior among medical students, thus validating Hypothesis 1. These findings suggest that individuals are more inclined to engage in prosocial behavior when they believe that they are supported by others, aligning with previous research [44,45]. Perceived social support serves as a crucial psychological resource, providing individuals with a sense of being cared for and accepted [46]. According to COR theory, individuals are motivated to allocate and utilize their resources efficiently. The availability of an initial resource surplus encourages individuals to maximize the utility of these resources and invest them in subsequent activities [47]. Since the execution of prosocial behaviors requires the consumption of certain resources, an individual's assessment of the adequacy of social support as a resource significantly influences their display of prosocial behaviors. An environment characterized by strong social support facilitates the practice and development of prosocial behaviors [48]. When individuals perceive their interpersonal relationships and organizational connections as supportive, they are likely to experience a heightened sense of belonging [49], as well as promote their empathy [50], thereby promoting altruistic behaviors. Conversely, individuals who lack adequate social support are more susceptible to emotional and behavioral issues. They may prioritize their thoughts and feelings in interpersonal interactions, centering relationships around themselves. Consequently, a deficiency in emotional resonance with their community and peers can hinder the expression of altruistic motivations, leading to diminished sharing behaviors and a lack of cooperation [51]. As such, providing adequate social support within educational and training environments for medical students is essential to promote their engagement in prosocial behaviors. Educational institutions should focus on cultivating supportive environments by fostering strong teacher-student relationships, facilitating peer support groups, and encouraging family involvement. These initiatives can enhance the sense of social support and contribute to the development of healthcare professionals who are more compassionate and actively involved in social services. This will ultimately improve their prosocial behavior and strengthen future doctor-patient relationships. Second, this study demonstrates that PsyCap serves as an intrinsic mediating mechanism that links perceived social support to the prosocial behaviors of medical students, thus validating Hypothesis 2. Both PsyCap and perceived social support are crucial psychological resources for individuals, and the significant positive relationship between these two constructs has been examined in various studies. Specifically, heightened perceptions of social support are known to enhance PsyCap, while increased PsyCap can further boost perceived social support, creating a beneficial feedback loop [15,52]. This interaction aligns with COR theory, which posits that access to one resource facilitates access to additional resources [24]. Thus, PsyCap and perceived social support are often viewed as a composite individual resource that can be used to investigate their effects on various behaviors [53,54]. In addition, research across diverse populations has indicated that PsyCap plays a vital role in promoting the development of prosocial behaviors [55,26]. Individuals who are more confident/efficacy, hopeful, resistant to setbacks, and inclined toward optimism show more altruistic behavior [56,57]. Those with elevated PsyCap tend to exhibit positive attitudes towards life events, attribute distress to external factors, and demonstrate a greater willingness to assist others, even strangers, compared to their counterparts with lower PsyCap [26]. In contrast, people with low levels of PsyCap are associated with a decrease in prosocial behaviors, higher levels of emotional symptoms, and increased tendencies to impairments such as hyperactivity, impulsivity, and difficulties in peer interactions [58]. This suggests that enhancing medical students’ self-efficacy, resilience, optimism, and hope to foster PsyCap is crucial for cultivating prosocial behavior. These factors should be considered when developing intervention programs to promote such behaviors among medical students in the future. Third, the results of this study indicate that among the various pathways through which perceived social support mediates prosocial behavior through PsyCap, the initial pathway is moderated by negative life events, thus validating Hypothesis 3. Consistent with the stress-vulnerability hypothesis, our findings reveal that perceived social support serves as a stronger positive predictor of PsyCap for individuals with low levels of negative life events compared to those with high levels. Additionally, the mediating role of PsyCap between perceived social support and prosocial behavior is more pronounced among medical students who experience fewer negative life events. In other words, high levels of stressful life events decrease the relationship between perceived social support, PsyCap, and prosocial behavior by weakening the link between perceived social support and PsyCap. Medical students often face a unique set of challenges, including intense academic demands, employment pressures, and career direction uncertainties. These challenges can lead to negative life events that significantly impact their mental health and overall well-being [59]. Furthermore, the prevalence of burnout among medical students has been documented, with studies indicating that nearly half of medical students experience moderate to high levels of burnout, which can be exacerbated by negative life events [60,61]. These findings underscore the importance of recognizing the specific challenges faced by medical students and the potential for negative life events to hinder their ability to leverage perceived social support effectively. Similar patterns have been observed in adolescent populations, where only those who experience fewer negative life events derive benefits from gratitude, indicating that negative life events can moderate the relationships between gratitude and various psychological outcomes [31]. A clinical psychologist noted that many of the adolescent suicide victims in China expressed gratitude to others in their suicide notes despite the overwhelming stress they faced. However, such expressions of gratitude do not mitigate the harmful effects of severe stress [31]. A study conducted among adolescents showed that negative life events significantly reduced the contribution of perceived social support to life satisfaction, thus revealing that perceived social support is a stress vulnerability factor [62]. Our results also suggest that perceived social support, much like other personal attributes, may not be sufficient to protect individuals from maladaptation in high-stress situations. This phenomenon may arise from the observation that people in less stressful environments exhibit greater resilience and are more adept at effectively utilizing their psychological resources. In these contexts, perceived social support is more likely to promote prosocial behaviors through PsyCap. Thus, negative life events function as risk factors that weaken PsyCap enhancement by perceived social support, underscoring perceived social support as a factor of stress vulnerability and further substantiating the stress-vulnerability hypothesis [31,63]. This finding highlights the importance for educators to consider the impact of negative life events on medical students when designing interventions to promote prosocial behavior in medical students, ultimately guiding the development of more effective intervention strategies. Limitation There are several limitations to consider when interpreting these results. First, the cross-sectional design employed in this study restricts our ability to infer directionality, temporal sequences, and causal relationships among variables. Future longitudinal or experimental studies are necessary to explore potential causal links in more depth. Second, our sample was drawn exclusively from Jiangsu Province, China. Therefore, the generalizability of our findings to students from other provinces or cultures remains uncertain. Future research should aim to recruit a larger and more diverse sample to enhance the representativeness of the findings. Third, this study was primarily based on self-reported measures of prosocial behavior. Subsequent research should consider examining the relationship between perceived social support and various forms of prosocial behavior to provide a more comprehensive understanding. Conclusion In summary, perceived social support and PsyCap, as individual composite resources, exhibit a positive correlation with prosocial behavior. Medical students reporting higher levels of perceived social support and PsyCap are more inclined to engage in prosocial behaviors. Additionally, PsyCap mediates the relationship between perceived social support and prosocial behavior, while negative life events act as a moderating factor in the link between perceived social support and PsyCap. These findings offer significant insights for the design of mental health initiatives aimed at promoting prosocial behaviors among medical students. Initiatives to enhance psychological resources, such as perceived social support and PsyCap, can notably boost the prosocial behaviors of medical students. Simultaneously, it is of great importance to accord greater attention to those who encounter a higher frequency of negative life events. Our results suggest that perceived social support may yield reduced benefits for medical students under elevated stress. Declarations Ethics approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethical Committee at Xuzhou Medical University. The consent process was facilitated digitally, with participants confirming their understanding and voluntary agreement via an online consent mechanism consistent with the Declaration of Helsinki principles. The study design explicitly guaranteed participants the right to withdraw without penalty. Consent for publication Not applicable. Availability of data and materials The data used in this study is available from the corresponding author on request. Competing Interests The authors report no conflicts of interest in this work. Funding This study was funded by the Special subject key project "Jiangsu Higher Education" of Jiangsu Higher Education Association (2022JSGJKT008) and Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province (2024SJYB0815). Authors’ contributions HX contributed to the conception and design of the study, the manuscript preparation, and the final revision. NL investigated the data and established the databases, performed the data analysis, and drafted the initial manuscript. HH and XZ performed the data analysis. NL , YC, and HX revised the manuscripts. All authors contributed to the article and approved the submitted version. Acknowledgments The authors would like to share their appreciation for all college students in this study. References Davidov M, Vaish A, Knafo-Noam A, Hastings PD. The motivational foundations of prosocial behavior from a developmental perspective–evolutionary roots and key psychological mechanisms: Introduction to the special section. Child Dev. 2016;87(6):1655–67. https://doi.org/10.1111/cdev.12639 . Zhou P, Xie Y, Liang C, Zhu J, Zhao S. The effect of prosocial behavior and its intensity on doctors’ performance in an online health community. Hum Soc Sci Commun. 2024;11(1):1–11. https://doi.org/10.1057/s41599-024-03420-8 . Bishop JP, Rees CE. Hero or has-been: is there a future for altruism in medical education? Adv Health Sci Educ. 2007;12:391–9. https://doi.org/10.1007/s10459-007-9064-4 . Shin Y, Kim S, Kim D-H, Lee S, Cho M, Ihm J. The effect of deliberative process on the self-sacrificial decisions of utilitarian healthcare students. BMC Med Ethics. 2022;23(1):28. https://doi.org/10.1186/s12910-022-00769-w . Maiya S, Gülseven Z, Killoren SE, Carlo G, Streit C. The intervening role of anxiety symptoms in associations between Self-Regulation and prosocial behaviors in US Latino/a college students. J Am Coll Health. 2023;71(2):584–92. https://doi.org/10.1080/07448481.2021.1899187 . Wang Y, Zhang H, Hu Z, Ma Y, Sun Y, Zhang J, et al. Perceived social support and prosocial behavior in medical students: Mediating effect of empathy and moderating role of moral identity. Acta Psychol. 2024;250:104543. https://doi.org/10.1016/j.actpsy.2024.104543 . Gao M, Qiu X, Zhu H. The Relationship Between Awe and Prosocial Behavior: A Three-Level Meta-Analysis. Basic Appl Soc Psychol. 2024:1–15. https://doi.org/10.1080/01973533.2024.2433721 Schindler S, Pfattheicher S. When it really counts: Investigating the relation between trait mindfulness and actual prosocial behavior. Curr Psychol. 2023;42(7):5357–65. https://doi.org/10.1007/s12144-021-01860-y . Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41. Hobfoll SE. The ecology of stress. NY: Hemisphere Publishing Corporation; 1988. Haber MG, Cohen JL, Lucas T, Baltes BB. The relationship between self-reported received and perceived social support: A meta-analytic review. Am J Community Psychol. 2007;39:133–44. https://doi.org/10.1007/s10464-007-9100-9 . Sarason BR, Sarason IG, Pierce GR, editors. Social support: An interactional view. Wiley; 1990. Hobfoll SE. Conservation of resources: A new attempt at conceptualizing stress. Am Psychol. 1989;44(3):513–24. https://doi.org/10.1037/0003-066X.44.3.513 . Grey I, Arora T, Thomas J, Saneh A, Tohme P, Abi-Habib R. The role of perceived social support on depression and sleep during the COVID-19 pandemic. Psychiatry Res. 2020;293:113452. https://doi.org/10.1016/j.psychres.2020.113452 . Huang L, Zhang T. Perceived social support, psychological capital, and subjective well-being among college students in the context of online learning during the COVID-19 pandemic. Asia-Pacific Educ Res. 2022;31(5):563–74. https://doi.org/10.1007/s40299-021-00608-3 . Yogeswaran V, El Morr C. Effectiveness of online mindfulness interventions on medical students’ mental health: a systematic review. BMC Public Health. 2021;21:1–12. https://doi.org/10.1186/s12889-021-12341-z . Sameroff AJ. Developmental systems and psychopathology. Dev Psychopathol. 2000;12(3):297–312. https://doi.org/10.1017/S0954579400003035 . Yao Z, Li Y. The influence of social support on low-income adolescents’ prosocial behavior: The mediating role of social goals. Child Youth Serv Rev. 2023;155:107201. https://doi.org/10.1016/j.childyouth.2023.107201 . Van Lange PA, Joireman J, Parks CD, Van Dijk E. The psychology of social dilemmas: A review. Organ. Behav Hum Decis Process. 2013;120(2):125–41. https://doi.org/10.1016/j.obhdp.2012.11.003 . Lai FH, Siu AM, Shek DT. Individual and social predictors of prosocial behavior among Chinese adolescents in Hong Kong. Front Pediatr. 2015;3:39. https://doi.org/10.3389/fped.2015.00039 . Wang H, Wu S, Wang W, Wei C. Emotional intelligence and prosocial behavior in college students: A moderated mediation analysis. Front Psychol. 2021;12:713227. https://doi.org/10.3389/fpsyg.2021.713227 . Luthans F, Youssef C, Avolio B. Psychological capital. New York: Oxford University Press; 2007. Luthans F, Avolio BJ, Avey JB, Norman SM. Positive psychological capital: Measurement and relationship with performance and satisfaction. Pers Psychol. 2007;60(3):541–72. https://doi.org/10.1111/j.1744-6570.2007.00083.x . Hobfoll SE, Halbesleben J, Neveu JP, Westman M. Conservation of Resources in the Organizational Context: The Reality of Resources and Their Consequences. Annu Rev Organ Psychol Organ Behav. 2018;5(1):103–28. https://doi.org/org/10.1146/annurev-orgpsych-032117-104640 . Liu N, Cao Y, Xu H. Prosocial behavior associated with trait mindfulness, psychological capital and moral identity among medical students: a moderated mediation model. Front Psychol. 2024;15:1431861. https://doi.org/10.3389/fpsyg.2024.1431861 . Zhang S, Fu Y, Liu Q, Turel O, He Q. Psychological capital mediates the influence of meaning in life on prosocial behavior of university students: A longitudinal study. Child Youth Serv Rev. 2022;140:106600. https://doi.org/10.1016/j.childyouth.2022.106600 . Huang Q, Guo J, Peng H, Li L, Wu L, Zhou H, et al. Relationship between life events and anxiety in adolescents: A moderate mediation model. China J Health Psychol. 2021;29(12):1892–6. https://doi.org/10.13342/j.cnki.cjhp.2021.12.029 . Peng L, Zhang J, Li M, Li P, Zhang Y, Zuo X, et al. Negative life events and mental health of Chinese medical students: the effect of resilience, personality and social support. Psychiatry Res. 2012;196(1):138–41. Sandin B, Chorot P, Santed MA, Valiente RM, Joiner TE Jr. Negative life events and adolescent suicidal behavior: A critical analysis from the stress process perspective. J Adolesc. 1998;21(4):415–26. https://doi.org/10.1006/jado.1998.0172 . Fu Q, Ye B, Wen Z. The impact mechanism of stressful life events on adolescents' subjective well-being. Psychol Dev Educ. 2012;28(05):516–. https://doi.org/10.16187/j.cnki.issn1001-4918.2012.05.007 . 23. Li D, Zhang W, Li X, Li N, Ye B. Gratitude and suicidal ideation and suicide attempts among Chinese adolescents: Direct, mediated, and moderated effects. J Adolesc. 2012;35(1):55–66. https://doi.org/10.1016/j.adolescence.2011.06.005 . Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60. https://doi.org/10.3758/BRM.41.4.1149 . Carlo G, Randall BA. The development of a measure of prosocial behaviors for late adolescents. J Youth Adolesc. 2002;31:31–44. https://doi.org/10.1023/A:1014033032440 . Dong S, Ge H, Su W, Guan W, Li X, Liu Y, et al. Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles. BMC Psychol. 2024;12(1):393. https://doi.org/10.1186/s40359-024-01902-7 . Xu H, Peng L, Wang Z, Zeng P, Liu X. Interpersonal sensitivity on college freshmen’s depression: a moderated moderation model of psychological capital and family support. Front Psychiatry. 2022;13:921045. https://doi.org/https://doi.org/10.3389/fpsyt.2022.921045 . Liu X, Liu L, Yang J, Chai F, WANG A, Sun L et al. Reliability and Validity Tests of the Adolescent Life Events Scale. Chin J Clin Psychol. 1997;(01):39–41. Hua Y, Jiang W, He Y, Zheng X, Huang C, Guo L, et al. Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning. Eur J Psychotraumatol. 2024;15(1):2337577. https://doi.org/10.1080/20008066.2024.2337577 . Cheung GW, Lau RS. Accuracy of parameter estimates and confidence intervals in moderated mediation models: A comparison of regression and latent moderated structural equations. Organ Res Methods. 2017;20(4):746–69. https://doi.org/10.1177/1094428115595869 . Cheung GW, Cooper-Thomas HD, Lau RS, Wang LC. Testing moderation in business and psychological studies with latent moderated structural equations. J Bus Psychol. 2021;36:1009–33. https://doi.org/10.1007/s10869-020-09717-0 . Johnson PO, Neyman J. Tests of certain linear hypotheses and their application to some educational problems. Stat Res Mem. 1936;1:57–93. Podsakoff PM, Mackenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879–903. https://doi.org/10.1037/0021-9010.88.5.879 . Klein A, Moosbrugger H. Maximum likelihood estimation of latent interaction effects with the LMS method. Psychometrika. 2000;65(4):457–74. https://doi.org/10.1007/bf02296338 . Burks DJ, Kobus AM. The legacy of altruism in health care: the promotion of empathy, prosociality and humanism. Med Educ. 2012;46(3):317–25. https://doi.org/10.1111/j.1365-2923.2011.04159.x . Zhang S, Li H, Li H, Zhao S. The effect of autistic traits on prosocial behavior: the chain mediating role of received social support and perceived social support. Autism. 2024;28(3):600–15. https://doi.org/10.1177/13623613231177776 . Liu W, Jiang R, Hu L. College Students' Understanding of the Relationship Between Social Support and Prosocial Behavior: The Mediating Role of Gratitude and the Moderating Role of Belief in a Just World. Rev High Educ. 2024;12(2):38–44. https://doi.org/10.3969/j.issn.2095-6800.2024.02.006 . Dreyer J, Schwartz-Attias I. Nursing care for adolescents and young adults with cancer: literature review. Acta Haematol. 2014;132(3–4):363–74. https://doi.org/10.1159/000360213 . Hobfoll SE. Conservation of resource caravans and engaged settings:Conservation of resource caravans. J Occup Organ Psychol. 2011;84(1):116–22. 10.1111/j.2044-8325.2010.02016.x . https://doi.org/https://doi.org/ . Guzman MRd, Jung E, Do K-AT. Perceived social support networks and prosocial outcomes among Latino/a youth in the United States. Child Youth Fam Stud Fac Publ 2012;98. https://doi.org/http://digitalcommons.unl.edu/famconfacpub/98 Wei S, Sun W, Chen J, Sun J. Family environment and prosocial behavior in college students: A moderated mediation model. Chin J Clin Psychol. 2017;25(4):743–6. Zhang W, Li X, Chen G, Cao Y. The relationship between positive parenting and adolescent prosocial behavior: The mediating role of empathy and the moderating role of the oxytocin receptor gene. Acta Psychol Sin. 2021;53(9):976. https://doi.org/10.3724/SP.J.1041.2021.00976 . Fu W, Wang C, Chai H, Xue R. Examining the relationship of empathy, social support, and prosocial behavior of adolescents in China: A structural equation modeling approach. Hum Soc Sci Commun. 2022;9(1):1–8. https://doi.org/10.1057/s41599-022-01296-0 . Khan A, Zeb I, Zhang Y, Fazal S, Ding J. Relationship between psychological capital and mental health at higher education: Role of perceived social support as a mediator. Heliyon. 2024;10(8):e29472. https://doi.org/10.1016/j.heliyon.2024.e29472 . Ahmadboukani S, Fathi D, Karami M, Bashirgonbadi S, Mahmoudpour A, Molaei B. Providing a health-promotion behaviors model in elderly: Psychological capital, perceived social support, and attitudes toward death with mediating role of cognitive emotion regulation strategies. Health Sci Rep. 2022;6(1):e1020. https://doi.org/https://doi.org/10.1002/hsr2.1020 . Ding X, Yang L, Huang Y, Yang H, Zhao X, Jiang Q, et al. The Relationship between Perceived Social Support and Bullying Behavior in Nursing Education among Nursing Students: The Mediating Role of Positive Psychological Capital. Perspect Psychiatr Care. 2024;2024(1):6642262. https://doi.org/10.1155/2024/6642262 . Liang X, Qin X. The Influence Mechanism of Sports Participation on Prosocial Behavior of College students. Adv Educ Technol Psychol. 2022;6(8):126–36. https://doi.org/10.23977/aetp.2022.060820 . Li M, Zhou M. Volunteer’s psychological capital and altruistic behaviors: the mediating effect of volunteer role identity. Chin J Appl Psychol. 2017;23:248–57. Xu LP, Wu YS, Yu JJ, Zhou J. The influence of volunteers’ psychological capital: mediating role of organizational commitment, and joint moderating effect of role identification and perceived social support. Front Psychol. 2020;11:673. https://doi.org/10.3389/fpsyg.2020.00673 . Zhu C, Yin X, Li Z, Zhou L. Psychological capital differs among rural left-behind children and is associated with emotional and behavioral problems. Front Psychol. 2021;12:1–7. https://doi.org/10.3389/fpsyg.2021.565385 . Kendler KS, Gardner CO. Depressive vulnerability, stressful life events and episode onset of major depression: a longitudinal model. Psychol Med. 2016;46(9):1865–74. https://doi.org/10.1017/S0033291716000349 . Zaidi TH, Zafar M, Ilyas A, Khan M, Ghani R, Naz R, et al. Association of Burnout and Depression symptoms and their prevalence among medical students in Karachi, Pakistan. Russ Open Med J. 2023;12(1):104. Gupta A, Salunkhe LR, Hameed S, Halappanavar A. Study of association between psychological stress and depression among medical students in Mangalore. Int J Community Med Public Health. 2018;5(10):4398–402. https://doi.org/10.18203/2394-6040.ijcmph20183982 . Yang Q, Ye B. The Effect of Gratitude on Adolescents' Life Satisfaction: The Mediating Role of Perceived Social Support and the Moderating Role of Stressful Life Events. J Psychol Sci. 2014;37(3):610–6. Wang J, Li D, Zhang W. Adolescence's Family Financial Difficulty and Social Adaptation: Coping efficacy of compensatory, mediation, and moderation effects. J Beijing Normal Univ (Soc Sci). 2010;(4):11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 31 May, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 05 May, 2025 Reviews received at journal 30 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviewers invited by journal 01 Apr, 2025 Editor assigned by journal 21 Mar, 2025 Submission checks completed at journal 21 Mar, 2025 First submitted to journal 11 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6200207","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443486201,"identity":"8194ccf3-dfdb-4fea-8ce2-24b2286c58d8","order_by":0,"name":"Nana Liu","email":"","orcid":"","institution":"Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Nana","middleName":"","lastName":"Liu","suffix":""},{"id":443486205,"identity":"bc20da60-c67b-48cd-b541-3d1b610a2109","order_by":1,"name":"Xinyan Zhuang","email":"","orcid":"","institution":"Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinyan","middleName":"","lastName":"Zhuang","suffix":""},{"id":443486206,"identity":"36dcbd88-6bc0-463e-ac0e-47c2ccbe7425","order_by":2,"name":"Yanjun Cao","email":"","orcid":"","institution":"Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Yanjun","middleName":"","lastName":"Cao","suffix":""},{"id":443486209,"identity":"03354111-c568-41fc-9fe0-cd89387b9c68","order_by":3,"name":"Huihui Hu","email":"","orcid":"","institution":"Xuzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huihui","middleName":"","lastName":"Hu","suffix":""},{"id":443486210,"identity":"75d44946-d649-4a67-93c7-67b45e3d391b","order_by":4,"name":"Haibo Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYDACCR7GBwwMByBsYrUwG5CshU2CNC0Gt3uPVfP8uRNtcID54G0eBrs8glok55xLuzmD51nuhgNsydY8DMnFBLXwS+SY3fggcRiohcdMmofhQGIDIS1sQC0FCQYgLfzfiNMCsoXhQwLYFjbitEjOyEuWnHHgcO7Mw2zGlnMMkglrMbiRe/Azz5/DuX3Hmx/eeFNhR1gLAjCDTSBe/SgYBaNgFIwCPAAARpM88X3/wagAAAAASUVORK5CYII=","orcid":"","institution":"Xuzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Haibo","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-03-11 05:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6200207/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6200207/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07410-5","type":"published","date":"2025-05-31T15:57:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81178938,"identity":"43437b4e-0b26-4b4e-9a3d-5c61380e21da","added_by":"auto","created_at":"2025-04-23 06:58:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36658,"visible":true,"origin":"","legend":"\u003cp\u003eA moderated mediation model framework\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6200207/v1/aa6216133cae926d5f281e11.jpg"},{"id":81178896,"identity":"c69d492e-8d30-4546-b77d-5d1f8b6bdcfd","added_by":"auto","created_at":"2025-04-23 06:58:06","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46126,"visible":true,"origin":"","legend":"\u003cp\u003eA\u003cstrong\u003e \u003c/strong\u003emoderated mediation model (\u003cem\u003eN \u003c/em\u003e= 1940).\u003c/p\u003e\n\u003cp\u003eNotes: The control variables age and grade are not presented to simplify the model; the values shown are unstandardized coefficients. \u003csup\u003e***\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001. Age and grade are controlled but not shown.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6200207/v1/25a157d40c6e2755e5fb1e06.jpg"},{"id":81178919,"identity":"6a1a6f14-6f07-408d-96fc-ce69d53d0b76","added_by":"auto","created_at":"2025-04-23 06:58:07","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24817,"visible":true,"origin":"","legend":"\u003cp\u003eUnstandardized effects of perceived social support on PsyCap at various levels of negative life events\u003c/p\u003e\n\u003cp\u003eNote: High and low levels of life events represent one standard deviation above and below the mean\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6200207/v1/4eb8a3fadfc81ad712d3b6ba.jpg"},{"id":83782959,"identity":"d91c14bc-a548-4507-bee6-cf24a8d65192","added_by":"auto","created_at":"2025-06-02 16:09:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":928917,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6200207/v1/625ee59f-9024-4f7a-a9cf-5d4595277c38.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Negative Life Events on Psychological Capital, Perceived Social Support and Prosocial Behavior in Medical Students: A Moderated Mediation Model","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProsocial behavior is a fundamental aspect of human interaction, characterized by actions intended to benefit others, such as helping, sharing, and cooperating [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This concept holds particular relevance within medical education., where fostering prosocial behaviors among medical students can enhance their interpersonal skills and improve patient care outcomes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Unlike altruism, which often emphasizes selfless acts performed solely for the benefit of others, prosocial behavior encompasses a broader range of actions that balance individual interests with societal needs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recent studies indicate that engaging in prosocial behaviors can mitigate the moral dilemmas associated with self-sacrifice, which is often emphasized in traditional medical training [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, prosocial behavior serves as a protective factor against antisocial tendencies, thus promoting a healthier psychological state among medical students [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite the importance of prosocial behavior, research indicates that levels of such behavior among medical students are moderate, suggesting significant potential for growth in this area [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Understanding the factors that influence prosocial behavior is crucial for developing effective educational interventions. Historically, research has focused primarily on emotional and personality traits as determinants of prosocial behavior [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], with limited exploration of individual resources from the perspective of the Conservation of Resources (COR) theory. The present study aims to investigate the mechanisms of how social support and psychological capital, as composite individual resources, predict prosocial behaviors through the lens of COR. Additionally, it will examine the role of negative life events among these three variables based on the stress-vulnerability hypothesis. Through this exploration, the study expects to provide valuable insights for developing interventions designed to promote prosocial behaviors in higher education institutions.\u003c/p\u003e \u003cp\u003ePerceived social support refers to people\u0026rsquo;s beliefs about the extent and quality of support available from their social contacts [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This concept is a critical dimension of social support, which encompasses the interactions and relationships that provide individuals with actual assistance and embed them within a social system that offers love, caring, and a sense of belonging to valued groups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Received social support and perceived social support are the two primary dimensions of social support that have long been the focus of research. Received social support refers to the number of supportive behaviors an individual has received [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], while perceived social support reflects both the satisfaction with and the availability of support [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the context of COR theory, perceived social support is considered a valuable resource [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], playing a crucial role in reducing depression, alleviating stress, improving mental health, and enhancing overall well-being [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This aspect of support is particularly vital for medical students, who encounter various challenges within their academic environment, including resource limitations, extended school terms, and overwhelming learning demands. These factors can adversely affect their mental health and social development [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to the cumulative risk hypothesis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the accumulation of risk factors intensifies negative impacts on psychological adjustment; therefore, the greater the number of risk factors, the higher the incidence of maladjustment. The absence of social support can exacerbate these difficulties, contributing negatively to other risk factors [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], particularly among the medical student population. Conversely, social support can protect individuals from the detrimental effects of these risks and encourage positive behavioral changes. COR theory posits that adequate psychological resources can inspire individuals to engage in more constructive behaviors, such as self-sacrifice, helpfulness, sharing, cooperation, and humility [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Research indicates that social support from parents, peers, and educational institutions significantly influences prosocial development in adolescents [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Moreover, perceived social support is a positive predictor of individuals\u0026rsquo; prosocial behaviors. When individuals recognize that they have strong interpersonal relationships, they often develop a robust sense of belonging, which fosters altruistic behaviors [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Despite these insights, current research investigating the relationship between perceived social support and prosocial behavior remains limited, necessitating further exploration of this connection. Drawing on the aforementioned theories and literature, this study proposes \u003cb\u003eHypothesis 1\u003c/b\u003e: Perceived social support directly predicts prosocial behavior in medical students.\u003c/p\u003e \u003cp\u003ePsychological Capital (PsyCap) is defined as a positive psychological state that individuals exhibit during their growth and development, comprising four core components: self-efficacy, optimism, hope, and resilience [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Within the framework of COR theory, PsyCap is considered a valuable individual resource [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Research has shown that individuals with high levels of PsyCap typically experience positive transformations in their attitudes and behaviors, even surpassing the influence of other factors such as physical, human, and social capital [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A recent systematic review indicated that PsyCap positively predicts prosocial behavior; individuals endowed with higher levels of PsyCap tend to exhibit better service behaviors and greater consideration of others. This emphasis on PsyCap is further justified by the observation that researchers frequently treat PsyCap and perceived social support as a composite resource when examining their impact on various individual behaviors, including bullying and volunteering behavior. According to COR theory, individuals rich in resources are better able to leverage existing resources to acquire additional ones [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. PsyCap can be nurtured and enhanced through social mechanisms, such as social support, constructive relationships, and close interpersonal contact. Although the relationship between perceived social support and PsyCap has been established among nursing students and general college populations, the interplay of perceived social support and PsyCap as a composite coping resource in influencing prosocial behavior remains unexplored. Given that previous research has indicated a mediating role for PsyCap in the effects of various psychological factors\u0026mdash;such as mindfulness and meaning in life, on prosocial behavior [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], we propose \u003cb\u003eHypothesis 2\u003c/b\u003e: PsyCap mediates the relationship between perceived social support and prosocial behavior in medical students.\u003c/p\u003e \u003cp\u003eNegative life events are defined as situations or occurrences that disrupt an individual's psychological balance, potentially resulting in adverse effects on physical health [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Our focus on negative life events is particularly relevant in the context of medical students, who experience significantly higher stress levels due to rigorous curricula, prolonged academic cycles, and demanding internships compared to their peers in other disciplines. This group is recognized as one of the most distressed within the undergraduate population. Previous studies have highlighted those medical students frequently encounter a variety of stressful life events, including illness and bereavement, financial difficulties, challenging interpersonal interactions, and high workloads. Research indicates that such negative life events can substantially impact the mental health of medical students [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], with an accumulation of these stresses often associated with poor psychological adjustment [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. According to the loss spiral hypothesis in the COR theory, individuals can deplete their resources in managing stress and negative emotions arising from these life events, which can hinder their ability to acquire new resources given their diminished reserves. Furthermore, the stress-vulnerability hypothesis posits that positive psychological qualities may lose their protective effects in high-stress environments, suggesting that an individual's adaptive capacity diminishes rapidly when confronted with numerous or severe negative life events [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Empirical studies have shown that Psycap such as resilience, gratitude, and emotional intelligence can significantly counteract risk; however, its efficacy is markedly reduced, or even negated, in the face of larger or more severe negative life events [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Consequently, we can hypothesize that the predictive effect of perceived social support on PsyCap may be diminished when individuals encounter a greater number of negative life events. In essence, negative life events could modulate the relationship between perceived social support and PsyCap. Based on this reasoning, we propose \u003cb\u003eHypothesis 3\u003c/b\u003e: The first-stage path of the indirect effect of perceived social support through PsyCap is moderated by negative life events.\u003c/p\u003e \u003cp\u003eBased on COR theory, the stress susceptibility hypothesis, and the above research literature, a mediated model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was constructed to evaluate the effects of PsyCap and negative life events on the relationship between perceived social support and prosocial behavior among medical students.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Procedures\u003c/h2\u003e \u003cp\u003eData collection was completed between July and October 2023. Medical students from four medical schools in Jiangsu Province were recruited using a whole cluster stratified sampling method. Initially, college students from each school were categorized into four strata based on their academic year: freshmen, sophomores, juniors, and seniors. At least one complete class was selected from each stratum. To maximize participation, the survey was scheduled during the free time when the students were more likely to gather. Counselors facilitated access for researchers by entering classes, where they explained the purpose of the study. Following the explanation and after obtaining informed consent from participants, the questionnaires were distributed through the online survey tool \"Wenjuanxing\" (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn/\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), including four scales (see measures) and general demographic characteristics (such as gender, grade, and family).\u003c/p\u003e \u003cp\u003eWe excluded 560 questionnaires that were not answered seriously and those with suspected extreme values. In total, 1940 valid questionnaires were collected with an effective rate of 77.6%. A post hoc power analysis was performed using G\u003csup\u003e*\u003c/sup\u003ePower 3.1 to assess the effective sample size for the correlation analysis. The result included 1,940 participants, with a significance level established at α\u0026thinsp;=\u0026thinsp;0.001 and an effect size of r\u0026thinsp;=\u0026thinsp;0.10. This yielded a statistical power of 0.87 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e \u003cem\u003eProsocial behavior.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe Prosocial Tendencies Measurement Scale (PTM) developed by Carlo et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] was used to assess prosocial behavior among medical students. The scale consists of 26 items that encompass six dimensions: openness, anonymity, altruism, compliance, emotion, and urgency. Responses were collected using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The Chinese version of the PTM has demonstrated good reliability among Chinese university students [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In this study, the PTM exhibited a high level of internal consistency, with a Cronbach's α coefficient of 0.949.\u003c/p\u003e\n\u003ch3\u003ePerceived Social Support\u003c/h3\u003e\n\u003cp\u003eThe Perceived Social Support Scale (PSSS) developed by Zimet et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] was employed to measure perceived social support among medical students. The scale consists of 12 items that are structured around three dimensions: family support, friend support, and other support. A seven-point Likert scale was utilized, where responses ranged from 1 (totally disagree) to 7 (totally agree). The Chinese version of the PSSS has demonstrated good reliability among Chinese university students [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Higher scores indicate a greater level of perceived social support. In this study, the PSSS demonstrated excellent internal consistency, with a Cronbach's α coefficient of 0.962.\u003c/p\u003e\n\u003ch3\u003ePsychological Capital\u003c/h3\u003e\n\u003cp\u003eThe Psychological Capital Questionnaire (PCQ-24) developed by Luthans et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] was employed to measure the PsyCap of medical students. The questionnaire consists of 24 items across four dimensions. Respondents rated each item on a six-point Likert scale, where higher scores reflect increased levels of PsyCap. The Chinese version has proven reliable in previous studies among Chinese university students [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and showed strong internal consistency in this study, with a Cronbach's α coefficient of 0.928.\u003c/p\u003e\n\u003ch3\u003eNegative Life Events\u003c/h3\u003e\n\u003cp\u003eThe Adolescent Life Events Scale (ASLEC) compiled by Liu et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] was utilized to assess the occurrence of negative life events among medical students over the past year. The scale consists of 27 items categorized into six dimensions: interpersonal relationships, health adaptation, study stress, punishment, loss, and others. Responses were measured on a five-point Likert scale, with higher scores indicating a greater impact from negative life events. The Chinese version has proven reliable in previous studies among Chinese adolescents [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The ASLEC achieved a Cronbach's α coefficient of 0.947 in this study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using SPSS 25.0 for descriptive statistics and correlation analyses, while the moderated mediation model [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] was tested through the latent moderated structural equations (LMS) approach in M-plus 8.3. In constructing structural equation models (SEM), perceived social support, psychological capital, prosocial behaviors, and negative life events were treated as latent variables, their dimensions serving as observed indicators. Additionally, age and grade were included as control variables in the data processing.\u003c/p\u003e \u003cp\u003eDue to the absence of frequently used model fit indices such as CFI, TLI, RMSEA, and SRMR in the LMS framework, the first step of our analysis involved creating a baseline SEM that excluded the latent interaction term to assess initial model fit. Upon confirming that the baseline model met the satisfactory fit criteria, we proceeded to introduce the latent interaction between perceived social support and negative life events, thus establishing the moderated mediation model. Next, a log-likelihood ratio test was performed to assess whether this moderated mediation model provided a better fit to the data. In the third step, we investigate indirect effects at varying levels of family socioeconomic status (SES), using bias-corrected bootstrap confidence intervals derived from 5000 bootstrap samples to determine the significance of these indirect effects. Finally, we characterized the moderating effect through a simple slope analysis at two levels of negative life events (\u0026minus;\u0026thinsp;1 SD, +\u0026thinsp;1 SD) and examined the moderating effect using the Johnson-Neyman technique [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe procedures in this study adhered to the Declaration of Helsinki and received approval from the Institutional Review Board at Xuzhou Medical University.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCommon Method Bias Test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHarman\u0026rsquo;s single-factor test was utilized to evaluate the influence of common method bias on the study findings [41]. The results indicated that the first factor accounted for 23.79% of the variance, falling below the 40% threshold. This suggests that the common-method bias did not significantly impact the results of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive statistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 1, the sample comprised 581 (29.95%) men and 1359 (70.01%) females with an average age of 19.81 years (SD = 1.53). Among them, 803 participants (41.39%) were only children and 1137 (58.61%) had siblings. Only a small proportion of 160 (8.25%) were from single-parent families. 48 (2.47%) had a religious affiliation. The grade composition of the participants was 478 (24.64%) freshmen, 390 (20.10%) sophomores, 522 (26.91%) juniors, and 550 (28.35%) seniors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Sociodemographic characteristics and differences of medical students\u0026apos; prosocial behavior (N=1940)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e581(29.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e94.59\u0026plusmn;13.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1359(70.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.51\u0026plusmn;12.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAges (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e＜20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e868(44.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e94.87\u0026plusmn;13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026ge;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1072(55.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e92.99\u0026plusmn;12.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eFreshmen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e478(24.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e94.93\u0026plusmn;13.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eSophomores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e390(20.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e94.79\u0026plusmn;12.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eJuniors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e522(26.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.57\u0026plusmn;13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eSeniors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e550(28.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.83\u0026plusmn;13.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eRural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1147(59.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.97\u0026plusmn;13.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eUrban areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e793(40.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.63\u0026plusmn;12.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnly child\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e803(41.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.33\u0026plusmn;13.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-1.436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1137(58.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e94.19\u0026plusmn;12.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle-parent family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e160(8.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.53\u0026plusmn;13.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1780(91.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.86\u0026plusmn;13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnic minority\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e105(5.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e92.85\u0026plusmn;11.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1835(94.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.89\u0026plusmn;13.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious belief\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e48(2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e92.75\u0026plusmn;13.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1892(97.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93.86\u0026plusmn;13.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation:\u003c/strong\u003e M, mean; SD, standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTesting for Moderated Mediation Effects\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe LMS method was used to examine whether negative life events moderate the indirect effect of perceived social support on prosocial behavior through PsyCap among medical students, in order to provide a comprehensive understanding of how the incentive effects of perceived social support vary between different levels of negative life events. Following the three-step procedure [38,42] the first step was to estimate the structural equation model without the latent interaction term (Model 0). It showed that Model 0 fit the data well, with satisfactory fit indices: \u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e/df = 4.75, TLI = 0.972, CFI = 0.977, RMSEA = 0.044, SRMR = 0.032.\u003c/p\u003e\n\u003cp\u003eThe second step was to estimate the structural equation model with a latent interaction term (Model 1) and use a log-likelihood ratio test to determine whether Model 1 fits better than Model 0. The statistic of a log-likelihood ratio test, called D, was calculated by multiplying \u0026minus;2 by the difference subtracting the log-likelihood value for Model 1 (-41202.290) from Model 0 (-41222.855), yielding a D value of 41.13 that was greater than the \u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e critical value of 6.63 (df = 1, p \u0026lt; 0.01), which indicated that the moderated mediation model fit better. The specific unstandardized path coefficients are shown in \u003cstrong\u003eFigure 2\u003c/strong\u003e. The paths from perceived social support to PsyCap (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.458, 95% CI [0.401, 0.518]) and prosocial behavior (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.248, 95% CI [0.178, 0.321]) were statistically significant; and the path from PsyCap to prosocial behavior was positive and significant (\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= 0.414, 95% CI [0.334, 0.495]). The path from negative\u0026nbsp;life events to PsyCap was negative and significant (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.157, 95% CI [-0.191, -0.123]). Moreover, there was a significant latent interaction effect of perceived social support and negative life events on PsyCap (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.156, 95% CI [\u0026minus;0.207, \u0026minus;0.108]).\u003c/p\u003e\n\u003cp\u003eThe third step was to estimate the conditional indirect effect of perceived social support on prosocial behavior through PsyCap at two levels of negative\u0026nbsp;life events (\u003cstrong\u003eTable 2\u003c/strong\u003e). When negative\u0026nbsp;life events were one standard deviation above the mean (+1 SD), the indirect effect was significant, with a value of 0.125 (95% CI [0.089, 0.166]), representing 33.5% of the total effect of 0.373. When negative\u0026nbsp;life events were one standard deviation below the mean (-1 SD), the indirect effect was more significant with a value of 0.254 (95% CI [0.202, 0.314]), representing 50.6% of the total effect of 0.502.\u003c/p\u003e\n\u003cp\u003eThen, the present study further examined the statistical significance of the unstandardized simple main effect of perceived social support on PsyCap at two levels of negative\u0026nbsp;life events to illustrate the nature of the moderating effects [39]. The simple slope test showed that when negative\u0026nbsp;life events were one standard deviation above the mean (+1 SD), the effect of perceived social support on PsyCap was statistically significant (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.302, 95% CI [0.230, 0.378]); When negative life events were one standard deviation below the mean (\u0026minus;1 SD), the effect of perceived social support on PsyCap was more statistically significant (\u003cem\u003e\u0026beta;\u003c/em\u003e = 0.614, 95% CI [0.541, 0.699]). \u003cstrong\u003eFigure 3\u003c/strong\u003e shows that the lower the level of negative life events, the greater the role perceived social support plays in the promotion of PsyCap.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Moderation effect of negative life events\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative Life Events\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e+1SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.125\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e[0.089, 0.166]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e[0.149, 0.234]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e-1SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e[0.202, 0.314]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the context of medical education, cultivating the future professional values of medical students is crucial. Compared to the traditional method of imposing altruism, fostering prosocial behavior represents a more balanced and realistic approach to instilling medical virtue within medical education. The present study identified significant differences in prosocial behavior among medical students based on age and grade. Prosocial behavior decreases with the increase of students\u0026apos; age and academic level. This observation aligns with a previous review that highlighted a trend in which medical students exhibit decreasing prosocial values as they progress through their education [43]. This decline may be attributed to the fact that, during medical training, students often encounter increasingly heavy workloads and face strenuous demands, becoming more familiar with the non-humanistic informal practices that can characterize the medical culture [43]. These cumulative challenges can lead to emotional suppression, detachment from patients, and symptoms of burnout, with other negative consequences possibly arising as a means of self-preservation. This finding reinforces the importance of developing prosocial behaviors within the medical student population.\u003c/p\u003e\n\u003cp\u003eThis study thoroughly examines the effects of perceived social support and PsyCap as individual composite resources on the prosocial behaviors of medical students. The findings reveal that both perceived social support and PsyCap positively predict medical students\u0026apos; prosocial behaviors. Furthermore, PsyCap was found to mediate the relationship between perceived social support and prosocial behaviors. In particular, negative life events were identified as a moderating factor that affected the initial phase of this mediated model. This study not only identifies protective factors that contribute to the development of prosocial behavior among medical students but also elucidates the conditions under which the relationship between perceived social support and prosocial behavior is more significant.\u003c/p\u003e\n\u003cp\u003eFirst, this study found that perceived social support positively predicts prosocial behavior among medical students, thus validating Hypothesis 1. These findings suggest that individuals are more inclined to engage in prosocial behavior when they believe that they are supported by others, aligning with previous research [44,45]. Perceived social support serves as a crucial psychological resource, providing individuals with a sense of being cared for and accepted [46]. According to COR theory, individuals are motivated to allocate and utilize their resources efficiently. The availability of an initial resource surplus encourages individuals to maximize the utility of these resources and invest them in subsequent activities [47]. Since the execution of prosocial behaviors requires the consumption of certain resources, an individual\u0026apos;s assessment of the adequacy of social support as a resource significantly influences their display of prosocial behaviors.\u0026nbsp;An environment characterized by strong social support facilitates the practice and development of prosocial behaviors [48]. When individuals perceive their interpersonal relationships and organizational connections as supportive, they are likely to experience a heightened sense of belonging [49], as well as promote their empathy [50], thereby promoting altruistic behaviors. Conversely, individuals who lack adequate social support are more susceptible to emotional and behavioral issues. They may prioritize their thoughts and feelings in interpersonal interactions, centering relationships around themselves. Consequently, a deficiency in emotional resonance with their community and peers can hinder the expression of altruistic motivations, leading to diminished sharing behaviors and a lack of cooperation [51]. As such, providing adequate social support within educational and training environments for medical students is essential to promote their engagement in prosocial behaviors. Educational institutions should focus on cultivating supportive environments by fostering strong teacher-student relationships, facilitating peer support groups, and encouraging family involvement. These initiatives can enhance the sense of social support and contribute to the development of healthcare professionals who are more compassionate and actively involved in social services. This will ultimately improve their prosocial behavior and strengthen future doctor-patient relationships.\u003c/p\u003e\n\u003cp\u003eSecond, this study demonstrates that PsyCap serves as an intrinsic mediating mechanism that links perceived social support to the prosocial behaviors of medical students, thus validating Hypothesis 2. Both PsyCap and perceived social support are crucial psychological resources for individuals, and the significant positive relationship between these two constructs has been examined in various studies. Specifically, heightened perceptions of social support are known to enhance PsyCap, while increased PsyCap can further boost perceived social support, creating a beneficial feedback loop [15,52]. This interaction aligns with COR theory, which posits that access to one resource facilitates access to additional resources [24]. Thus, PsyCap and perceived social support are often viewed as a composite individual resource that can be used to investigate their effects on various behaviors [53,54]. In addition, research across diverse populations has indicated that PsyCap plays a vital role in promoting the development of prosocial behaviors [55,26]. Individuals who are more confident/efficacy, hopeful, resistant to setbacks, and inclined toward optimism show more altruistic behavior [56,57]. Those with elevated PsyCap tend to exhibit positive attitudes towards life events, attribute distress to external factors, and demonstrate a greater willingness to assist others, even strangers, compared to their counterparts with lower PsyCap [26]. In contrast, people with low levels of PsyCap are associated with a decrease in prosocial behaviors, higher levels of emotional symptoms, and increased tendencies to impairments such as hyperactivity, impulsivity, and difficulties in peer interactions [58]. This suggests that enhancing medical students\u0026rsquo; self-efficacy, resilience, optimism, and hope to foster PsyCap is crucial for cultivating prosocial behavior. These factors should be considered when developing intervention programs to promote such behaviors among medical students in the future.\u003c/p\u003e\n\u003cp\u003eThird, the results of this study indicate that among the various pathways through which perceived social support mediates prosocial behavior through PsyCap, the initial pathway is moderated by negative life events, thus validating Hypothesis 3. Consistent with the stress-vulnerability hypothesis, our findings reveal that perceived social support serves as a stronger positive predictor of PsyCap for individuals with low levels of negative life events compared to those with high levels. Additionally, the mediating role of PsyCap between perceived social support and prosocial behavior is more pronounced among medical students who experience fewer negative life events. In other words, high levels of stressful life events decrease the relationship between perceived social support, PsyCap, and prosocial behavior by weakening the link between perceived social support and PsyCap. Medical students often face a unique set of challenges, including intense academic demands, employment pressures, and career direction uncertainties. These challenges can lead to negative life events that significantly impact their mental health and overall well-being\u0026nbsp;[59]. Furthermore, the prevalence of burnout among medical students has been documented, with studies indicating that nearly half of medical students experience moderate to high levels of burnout, which can be exacerbated by negative life events [60,61]. These findings underscore the importance of recognizing the specific challenges faced by medical students and the potential for negative life events to hinder their ability to leverage perceived social support effectively. Similar patterns have been observed in adolescent populations, where only those who experience fewer negative life events derive benefits from gratitude, indicating that negative life events can moderate the relationships between gratitude and various psychological outcomes [31]. A clinical psychologist noted that many of the adolescent suicide victims in China expressed gratitude to others in their suicide notes despite the overwhelming stress they faced. However, such expressions of gratitude do not mitigate the harmful effects of severe stress [31]. A study conducted among adolescents showed that negative life events significantly reduced the contribution of perceived social support to life satisfaction, thus revealing that perceived social support is a stress vulnerability factor [62].\u0026nbsp;Our results also suggest that perceived social support, much like other personal attributes, may not be sufficient to protect individuals from maladaptation in high-stress situations. This phenomenon may arise from the observation that people in less stressful environments exhibit greater resilience and are more adept at effectively utilizing their psychological resources. In these contexts, perceived social support is more likely to promote prosocial behaviors through PsyCap. Thus, negative life events function as risk factors that weaken PsyCap enhancement by perceived social support, underscoring perceived social support as a factor of stress vulnerability and further substantiating the stress-vulnerability hypothesis [31,63]. This finding highlights the importance for educators to consider the impact of negative life events on medical students when designing interventions to promote prosocial behavior in medical students, ultimately guiding the development of more effective intervention strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are several limitations to consider when interpreting these results. First, the cross-sectional design employed in this study restricts our ability to infer directionality, temporal sequences, and causal relationships among variables. Future longitudinal or experimental studies are necessary to explore potential causal links in more depth. Second, our sample was drawn exclusively from Jiangsu Province, China. Therefore, the generalizability of our findings to students from other provinces or cultures remains uncertain. Future research should aim to recruit a larger and more diverse sample to enhance the representativeness of the findings. Third, this study was primarily based on self-reported measures of prosocial behavior. Subsequent research should consider examining the relationship between perceived social support and various forms of prosocial behavior to provide a more comprehensive understanding.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, perceived social support and PsyCap, as individual composite resources, exhibit a positive correlation with prosocial behavior. Medical students reporting higher levels of perceived social support and PsyCap are more inclined to engage in prosocial behaviors. Additionally, PsyCap mediates the relationship between perceived social support and prosocial behavior, while negative life events act as a moderating factor in the link between perceived social support and PsyCap. These findings offer significant insights for the design of mental health initiatives aimed at promoting prosocial behaviors among medical students. Initiatives to enhance psychological resources, such as perceived social support and PsyCap, can notably boost the prosocial behaviors of medical students. Simultaneously, it is of great importance to accord greater attention to those who encounter a higher frequency of negative life events. Our results suggest that perceived social support may yield reduced benefits for medical students under elevated stress.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethical Committee at Xuzhou Medical University. The consent process was facilitated digitally, with participants confirming their understanding and voluntary agreement via an online consent mechanism consistent with the Declaration of Helsinki principles. The study design explicitly guaranteed participants the right to withdraw without penalty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study is available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Special subject key project \u0026quot;Jiangsu Higher Education\u0026quot; of Jiangsu Higher Education Association (2022JSGJKT008) and Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province (2024SJYB0815).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHX\u003c/strong\u003e contributed to the conception and design of the study, the manuscript preparation, and the final revision. \u003cstrong\u003eNL\u003c/strong\u003e investigated the data and established the databases, performed the data analysis, and drafted the initial manuscript. \u003cstrong\u003eHH\u003c/strong\u003e and \u003cstrong\u003eXZ\u003c/strong\u003e performed the data analysis. \u003cstrong\u003eNL\u003c/strong\u003e, \u003cstrong\u003eYC,\u003c/strong\u003e and \u003cstrong\u003eHX\u0026nbsp;\u003c/strong\u003erevised the manuscripts. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to share their appreciation for all college students in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDavidov M, Vaish A, Knafo-Noam A, Hastings PD. The motivational foundations of prosocial behavior from a developmental perspective\u0026ndash;evolutionary roots and key psychological mechanisms: Introduction to the special section. Child Dev. 2016;87(6):1655\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/cdev.12639\u003c/span\u003e\u003cspan address=\"10.1111/cdev.12639\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou P, Xie Y, Liang C, Zhu J, Zhao S. The effect of prosocial behavior and its intensity on doctors\u0026rsquo; performance in an online health community. Hum Soc Sci Commun. 2024;11(1):1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1057/s41599-024-03420-8\u003c/span\u003e\u003cspan address=\"10.1057/s41599-024-03420-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBishop JP, Rees CE. Hero or has-been: is there a future for altruism in medical education? Adv Health Sci Educ. 2007;12:391\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10459-007-9064-4\u003c/span\u003e\u003cspan address=\"10.1007/s10459-007-9064-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin Y, Kim S, Kim D-H, Lee S, Cho M, Ihm J. The effect of deliberative process on the self-sacrificial decisions of utilitarian healthcare students. BMC Med Ethics. 2022;23(1):28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12910-022-00769-w\u003c/span\u003e\u003cspan address=\"10.1186/s12910-022-00769-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaiya S, G\u0026uuml;lseven Z, Killoren SE, Carlo G, Streit C. The intervening role of anxiety symptoms in associations between Self-Regulation and prosocial behaviors in US Latino/a college students. J Am Coll Health. 2023;71(2):584\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/07448481.2021.1899187\u003c/span\u003e\u003cspan address=\"10.1080/07448481.2021.1899187\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Zhang H, Hu Z, Ma Y, Sun Y, Zhang J, et al. Perceived social support and prosocial behavior in medical students: Mediating effect of empathy and moderating role of moral identity. Acta Psychol. 2024;250:104543. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.actpsy.2024.104543\u003c/span\u003e\u003cspan address=\"10.1016/j.actpsy.2024.104543\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao M, Qiu X, Zhu H. The Relationship Between Awe and Prosocial Behavior: A Three-Level Meta-Analysis. Basic Appl Soc Psychol. 2024:1\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/01973533.2024.2433721\u003c/span\u003e\u003cspan address=\"10.1080/01973533.2024.2433721\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchindler S, Pfattheicher S. When it really counts: Investigating the relation between trait mindfulness and actual prosocial behavior. Curr Psychol. 2023;42(7):5357\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12144-021-01860-y\u003c/span\u003e\u003cspan address=\"10.1007/s12144-021-01860-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHobfoll SE. The ecology of stress. NY: Hemisphere Publishing Corporation; 1988.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaber MG, Cohen JL, Lucas T, Baltes BB. The relationship between self-reported received and perceived social support: A meta-analytic review. Am J Community Psychol. 2007;39:133\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10464-007-9100-9\u003c/span\u003e\u003cspan address=\"10.1007/s10464-007-9100-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarason BR, Sarason IG, Pierce GR, editors. Social support: An interactional view. Wiley; 1990.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHobfoll SE. Conservation of resources: A new attempt at conceptualizing stress. Am Psychol. 1989;44(3):513\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0003-066X.44.3.513\u003c/span\u003e\u003cspan address=\"10.1037/0003-066X.44.3.513\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrey I, Arora T, Thomas J, Saneh A, Tohme P, Abi-Habib R. The role of perceived social support on depression and sleep during the COVID-19 pandemic. Psychiatry Res. 2020;293:113452. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.psychres.2020.113452\u003c/span\u003e\u003cspan address=\"10.1016/j.psychres.2020.113452\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang L, Zhang T. Perceived social support, psychological capital, and subjective well-being among college students in the context of online learning during the COVID-19 pandemic. Asia-Pacific Educ Res. 2022;31(5):563\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40299-021-00608-3\u003c/span\u003e\u003cspan address=\"10.1007/s40299-021-00608-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYogeswaran V, El Morr C. Effectiveness of online mindfulness interventions on medical students\u0026rsquo; mental health: a systematic review. BMC Public Health. 2021;21:1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-021-12341-z\u003c/span\u003e\u003cspan address=\"10.1186/s12889-021-12341-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSameroff AJ. Developmental systems and psychopathology. Dev Psychopathol. 2000;12(3):297\u0026ndash;312. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0954579400003035\u003c/span\u003e\u003cspan address=\"10.1017/S0954579400003035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao Z, Li Y. The influence of social support on low-income adolescents\u0026rsquo; prosocial behavior: The mediating role of social goals. Child Youth Serv Rev. 2023;155:107201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.childyouth.2023.107201\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2023.107201\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Lange PA, Joireman J, Parks CD, Van Dijk E. The psychology of social dilemmas: A review. Organ. Behav Hum Decis Process. 2013;120(2):125\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.obhdp.2012.11.003\u003c/span\u003e\u003cspan address=\"10.1016/j.obhdp.2012.11.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai FH, Siu AM, Shek DT. Individual and social predictors of prosocial behavior among Chinese adolescents in Hong Kong. Front Pediatr. 2015;3:39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fped.2015.00039\u003c/span\u003e\u003cspan address=\"10.3389/fped.2015.00039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Wu S, Wang W, Wei C. Emotional intelligence and prosocial behavior in college students: A moderated mediation analysis. Front Psychol. 2021;12:713227. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2021.713227\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2021.713227\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuthans F, Youssef C, Avolio B. Psychological capital. New York: Oxford University Press; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuthans F, Avolio BJ, Avey JB, Norman SM. Positive psychological capital: Measurement and relationship with performance and satisfaction. Pers Psychol. 2007;60(3):541\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1744-6570.2007.00083.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1744-6570.2007.00083.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHobfoll SE, Halbesleben J, Neveu JP, Westman M. Conservation of Resources in the Organizational Context: The Reality of Resources and Their Consequences. Annu Rev Organ Psychol Organ Behav. 2018;5(1):103\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/org/10.1146/annurev-orgpsych-032117-104640\u003c/span\u003e\u003cspan address=\"10.1146/annurev-orgpsych-032117-104640\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu N, Cao Y, Xu H. Prosocial behavior associated with trait mindfulness, psychological capital and moral identity among medical students: a moderated mediation model. Front Psychol. 2024;15:1431861. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2024.1431861\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2024.1431861\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang S, Fu Y, Liu Q, Turel O, He Q. Psychological capital mediates the influence of meaning in life on prosocial behavior of university students: A longitudinal study. Child Youth Serv Rev. 2022;140:106600. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.childyouth.2022.106600\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2022.106600\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Q, Guo J, Peng H, Li L, Wu L, Zhou H, et al. Relationship between life events and anxiety in adolescents: A moderate mediation model. China J Health Psychol. 2021;29(12):1892\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13342/j.cnki.cjhp.2021.12.029\u003c/span\u003e\u003cspan address=\"10.13342/j.cnki.cjhp.2021.12.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng L, Zhang J, Li M, Li P, Zhang Y, Zuo X, et al. Negative life events and mental health of Chinese medical students: the effect of resilience, personality and social support. Psychiatry Res. 2012;196(1):138\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandin B, Chorot P, Santed MA, Valiente RM, Joiner TE Jr. Negative life events and adolescent suicidal behavior: A critical analysis from the stress process perspective. J Adolesc. 1998;21(4):415\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1006/jado.1998.0172\u003c/span\u003e\u003cspan address=\"10.1006/jado.1998.0172\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu Q, Ye B, Wen Z. The impact mechanism of stressful life events on adolescents' subjective well-being. Psychol Dev Educ. 2012;28(05):516\u0026ndash;. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.16187/j.cnki.issn1001-4918.2012.05.007\u003c/span\u003e\u003cspan address=\"10.16187/j.cnki.issn1001-4918.2012.05.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u0026thinsp;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi D, Zhang W, Li X, Li N, Ye B. Gratitude and suicidal ideation and suicide attempts among Chinese adolescents: Direct, mediated, and moderated effects. J Adolesc. 2012;35(1):55\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.adolescence.2011.06.005\u003c/span\u003e\u003cspan address=\"10.1016/j.adolescence.2011.06.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3758/BRM.41.4.1149\u003c/span\u003e\u003cspan address=\"10.3758/BRM.41.4.1149\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlo G, Randall BA. The development of a measure of prosocial behaviors for late adolescents. J Youth Adolesc. 2002;31:31\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1023/A:1014033032440\u003c/span\u003e\u003cspan address=\"10.1023/A:1014033032440\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong S, Ge H, Su W, Guan W, Li X, Liu Y, et al. Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles. BMC Psychol. 2024;12(1):393. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40359-024-01902-7\u003c/span\u003e\u003cspan address=\"10.1186/s40359-024-01902-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu H, Peng L, Wang Z, Zeng P, Liu X. Interpersonal sensitivity on college freshmen\u0026rsquo;s depression: a moderated moderation model of psychological capital and family support. Front Psychiatry. 2022;13:921045. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/10.3389/fpsyt.2022.921045\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2022.921045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, Liu L, Yang J, Chai F, WANG A, Sun L et al. Reliability and Validity Tests of the Adolescent Life Events Scale. Chin J Clin Psychol. 1997;(01):39\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHua Y, Jiang W, He Y, Zheng X, Huang C, Guo L, et al. Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning. Eur J Psychotraumatol. 2024;15(1):2337577. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/20008066.2024.2337577\u003c/span\u003e\u003cspan address=\"10.1080/20008066.2024.2337577\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung GW, Lau RS. Accuracy of parameter estimates and confidence intervals in moderated mediation models: A comparison of regression and latent moderated structural equations. Organ Res Methods. 2017;20(4):746\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1094428115595869\u003c/span\u003e\u003cspan address=\"10.1177/1094428115595869\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung GW, Cooper-Thomas HD, Lau RS, Wang LC. Testing moderation in business and psychological studies with latent moderated structural equations. J Bus Psychol. 2021;36:1009\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10869-020-09717-0\u003c/span\u003e\u003cspan address=\"10.1007/s10869-020-09717-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson PO, Neyman J. Tests of certain linear hypotheses and their application to some educational problems. Stat Res Mem. 1936;1:57\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePodsakoff PM, Mackenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879\u0026ndash;903. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0021-9010.88.5.879\u003c/span\u003e\u003cspan address=\"10.1037/0021-9010.88.5.879\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlein A, Moosbrugger H. Maximum likelihood estimation of latent interaction effects with the LMS method. Psychometrika. 2000;65(4):457\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/bf02296338\u003c/span\u003e\u003cspan address=\"10.1007/bf02296338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurks DJ, Kobus AM. The legacy of altruism in health care: the promotion of empathy, prosociality and humanism. Med Educ. 2012;46(3):317\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2923.2011.04159.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2923.2011.04159.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang S, Li H, Li H, Zhao S. The effect of autistic traits on prosocial behavior: the chain mediating role of received social support and perceived social support. Autism. 2024;28(3):600\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/13623613231177776\u003c/span\u003e\u003cspan address=\"10.1177/13623613231177776\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu W, Jiang R, Hu L. College Students' Understanding of the Relationship Between Social Support and Prosocial Behavior: The Mediating Role of Gratitude and the Moderating Role of Belief in a Just World. Rev High Educ. 2024;12(2):38\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.2095-6800.2024.02.006\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.2095-6800.2024.02.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDreyer J, Schwartz-Attias I. Nursing care for adolescents and young adults with cancer: literature review. Acta Haematol. 2014;132(3\u0026ndash;4):363\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000360213\u003c/span\u003e\u003cspan address=\"10.1159/000360213\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHobfoll SE. Conservation of resource caravans and engaged settings:Conservation of resource caravans. J Occup Organ Psychol. 2011;84(1):116\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.2044-8325.2010.02016.x\u003c/span\u003e\u003cspan address=\"10.1111/j.2044-8325.2010.02016.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/\u003c/span\u003e\u003cspan address=\"https://doi.org/https://doi.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuzman MRd, Jung E, Do K-AT. Perceived social support networks and prosocial outcomes among Latino/a youth in the United States. Child Youth Fam Stud Fac Publ 2012;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/http://digitalcommons.unl.edu/famconfacpub/98\u003c/span\u003e\u003cspan address=\"https://doi.org/http://digitalcommons.unl.edu/famconfacpub/98\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei S, Sun W, Chen J, Sun J. Family environment and prosocial behavior in college students: A moderated mediation model. Chin J Clin Psychol. 2017;25(4):743\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang W, Li X, Chen G, Cao Y. The relationship between positive parenting and adolescent prosocial behavior: The mediating role of empathy and the moderating role of the oxytocin receptor gene. Acta Psychol Sin. 2021;53(9):976. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3724/SP.J.1041.2021.00976\u003c/span\u003e\u003cspan address=\"10.3724/SP.J.1041.2021.00976\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu W, Wang C, Chai H, Xue R. Examining the relationship of empathy, social support, and prosocial behavior of adolescents in China: A structural equation modeling approach. Hum Soc Sci Commun. 2022;9(1):1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1057/s41599-022-01296-0\u003c/span\u003e\u003cspan address=\"10.1057/s41599-022-01296-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan A, Zeb I, Zhang Y, Fazal S, Ding J. Relationship between psychological capital and mental health at higher education: Role of perceived social support as a mediator. Heliyon. 2024;10(8):e29472. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.heliyon.2024.e29472\u003c/span\u003e\u003cspan address=\"10.1016/j.heliyon.2024.e29472\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmadboukani S, Fathi D, Karami M, Bashirgonbadi S, Mahmoudpour A, Molaei B. Providing a health-promotion behaviors model in elderly: Psychological capital, perceived social support, and attitudes toward death with mediating role of cognitive emotion regulation strategies. Health Sci Rep. 2022;6(1):e1020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.org/10.1002/hsr2.1020\u003c/span\u003e\u003cspan address=\"10.1002/hsr2.1020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing X, Yang L, Huang Y, Yang H, Zhao X, Jiang Q, et al. The Relationship between Perceived Social Support and Bullying Behavior in Nursing Education among Nursing Students: The Mediating Role of Positive Psychological Capital. Perspect Psychiatr Care. 2024;2024(1):6642262. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2024/6642262\u003c/span\u003e\u003cspan address=\"10.1155/2024/6642262\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang X, Qin X. The Influence Mechanism of Sports Participation on Prosocial Behavior of College students. Adv Educ Technol Psychol. 2022;6(8):126\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.23977/aetp.2022.060820\u003c/span\u003e\u003cspan address=\"10.23977/aetp.2022.060820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi M, Zhou M. Volunteer\u0026rsquo;s psychological capital and altruistic behaviors: the mediating effect of volunteer role identity. Chin J Appl Psychol. 2017;23:248\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu LP, Wu YS, Yu JJ, Zhou J. The influence of volunteers\u0026rsquo; psychological capital: mediating role of organizational commitment, and joint moderating effect of role identification and perceived social support. Front Psychol. 2020;11:673. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2020.00673\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2020.00673\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu C, Yin X, Li Z, Zhou L. Psychological capital differs among rural left-behind children and is associated with emotional and behavioral problems. Front Psychol. 2021;12:1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2021.565385\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2021.565385\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKendler KS, Gardner CO. Depressive vulnerability, stressful life events and episode onset of major depression: a longitudinal model. Psychol Med. 2016;46(9):1865\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0033291716000349\u003c/span\u003e\u003cspan address=\"10.1017/S0033291716000349\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaidi TH, Zafar M, Ilyas A, Khan M, Ghani R, Naz R, et al. Association of Burnout and Depression symptoms and their prevalence among medical students in Karachi, Pakistan. Russ Open Med J. 2023;12(1):104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta A, Salunkhe LR, Hameed S, Halappanavar A. Study of association between psychological stress and depression among medical students in Mangalore. Int J Community Med Public Health. 2018;5(10):4398\u0026ndash;402. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18203/2394-6040.ijcmph20183982\u003c/span\u003e\u003cspan address=\"10.18203/2394-6040.ijcmph20183982\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Q, Ye B. The Effect of Gratitude on Adolescents' Life Satisfaction: The Mediating Role of Perceived Social Support and the Moderating Role of Stressful Life Events. J Psychol Sci. 2014;37(3):610\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Li D, Zhang W. Adolescence's Family Financial Difficulty and Social Adaptation: Coping efficacy of compensatory, mediation, and moderation effects. J Beijing Normal Univ (Soc Sci). 2010;(4):11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prosocial behavior, Perceived social support, Psychological capital, Negative life events, Medical students","lastPublishedDoi":"10.21203/rs.3.rs-6200207/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6200207/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eProsocial behavior is an essential quality for medical students and reflects the development of future professional values. This study aims to investigate the roles of perceived social support and psychological capital in the prosocial behaviors of medical students while also testing the moderating effect of negative life events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional survey was conducted from July to October 2023 among 1940 medical students in Jiangsu Province, using a questionnaire composed of the Prosocial Tendencies Measurement Scale, the Perceived Social Support Scale, the Psychological Capital Questionnaire, and the Adolescent Life Events Scale. SPSS 25.0 was used for the preliminary analysis, and M-plus 8.3 was performed to examine the moderated mediation effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003ePerceived social support (\u003cem\u003eβ\u003c/em\u003e = 0.248, 95% CI [0.178, 0.321]) and psychological capital (\u003cem\u003eβ\u003c/em\u003e= 0.414, 95% CI [0.334, 0.495]) positively predicted medical students' prosocial behavior. Perceived social support positively predicted psychological capital (\u003cem\u003eβ\u003c/em\u003e = 0.458, 95% CI [0.401, 0.518]). Psychological capital mediated their relationship. The first half of the mediating pathway of \"perceived social support → psychological capital → prosocial behavior\" was moderated by negative life events. Specifically, due to the negative moderating effect of negative life events, the indirect effect of psychological capital on the relationship between perceived social support and prosocial behavior increased from 33.5% to 50.6%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ePerceived social support directly predicts medical students' prosocial behavior and may do so indirectly via psychological capital. It's a stronger positive predictor of psychological capital in medical students with lower negative life events. Findings help develop targeted mental health courses and interventions for medical students' prosocial behaviors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"The Impact of Negative Life Events on Psychological Capital, Perceived Social Support and Prosocial Behavior in Medical Students: A Moderated Mediation Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-23 06:58:00","doi":"10.21203/rs.3.rs-6200207/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-05T09:15:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-30T04:04:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145250262697783348002712682807087023618","date":"2025-04-24T01:54:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T22:54:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297369260418355484191497057418700123556","date":"2025-04-01T14:18:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T14:10:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-21T04:08:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-21T04:08:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-11T05:03:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"da5a8909-837e-4ed3-90d0-1a07bf0cf773","owner":[],"postedDate":"April 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:03:04+00:00","versionOfRecord":{"articleIdentity":"rs-6200207","link":"https://doi.org/10.1186/s12909-025-07410-5","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-05-31 15:57:07","publishedOnDateReadable":"May 31st, 2025"},"versionCreatedAt":"2025-04-23 06:58:00","video":"","vorDoi":"10.1186/s12909-025-07410-5","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07410-5","workflowStages":[]},"version":"v1","identity":"rs-6200207","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6200207","identity":"rs-6200207","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}