Introduction

Anxiety (ANX) refers to a series of subjective and unpleasant feelings experienced by an individual when facing stressful events or persistent stimuli1. As a prevalent mental health challenge, ANX can manifest across various educational pathways, such as higher education, vocational training, and medical education—due to differences in the types of stressors individuals face. It poses a threat to students’ learning effectiveness and vocational adaptability2,3. A global epidemiological survey conducted by the World Health Organization involving 4,178 college students from 1,527 different countries and 21 African university students revealed that ANX are the most common mental health issue across all groups (11.7–14.7%)4. Focusing on the higher education population, a 2024 survey of Chinese college students revealed that 24.6% of them were diagnosed with ANX5. ANX represents a significant mental health issue for students in higher education, substantially influencing their social connections, overall well-being, and involvement in academic activities, with severe instances leading to suicidal risk6,7,8. In this context, improving mental health literacy (MHL) among college students is considered an essential approach to promoting their mental well-being (Pan et al., 2025). Furthermore, research has shown that psychological resilience (PR) and physical exercise (PE) are related to college students’ ANX and can help alleviate ANX levels9,10.

Although previous studies have explored the relationships among MHL, PR, and ANX, most have focused on direct or simple mediating effects between variables, lacking in-depth examination of the underlying complex interactive mechanisms. In particular, the selection of moderating variables has largely centered on static background factors (e.g., subjective socioeconomic status, gender)11, with limited attention to modifiable, intervention-targetable behavioral factors. Grounded in Conservation of Resources Theory, this study proposes that MHL, as a cognitive resource, can alleviate ANX by enhancing PR—an internal psychological resource. Uniquely, this study introduces PE as a moderator, examining its moderating effects not only on the direct path from MHL to ANX but also on the mediating pathway via PR. In contrast to prior research that treats PE as a predictor or mediator12, this study offers a novel perspective and integrative model in both its path design and theoretical framing. This approach not only enriches the explanatory power of Conservation of Resources Theory in the context of college students’ mental health but also provides theoretical and practical support for integrated interventions that combine MHL education with physical activity in higher education settings.

MHL and ANX

MHL is the awareness and understanding that enable individuals to recognize, address, and prevent mental health problems13. Existing research suggests that low levels of MHL are associated with various mental disorders, including ANX. Two cross-sectional studies on Chinese college students indicate that insufficient mental health knowledge is closely linked to the high prevalence of ANX symptoms14,15. This relationship primarily manifests in college students’ difficulties in recognizing mental disorder symptoms and their often unscientific or inaccurate beliefs about handling psychological distress. Many college students fail to recognize that ANX can be effectively alleviated through professional help, instead believing they can “resolve” emotional issues on their own. This misconception may exacerbate ANX16. For instance, Huang, et al.17 found that both insufficient physical activity and low MHL are key factors contributing to ANX in college students. People with higher MHL levels are more capable of recognize early symptoms of mental disorders, and tend to improve their overall mental health18. According to the Vulnerability-Stress Model, protective factors help mitigate the impact of stressful life events19. Consequently, an elevated degree of MHL allows individuals to recognize mental health problems sooner, helping to diminish the social stigma tied to mental health issues, and enhances the willingness to seek professional help. This, in turn, facilitates early intervention for mental health problems and lowers the risk of developing ANX20,21. A meta-analysis of 14 intervention studies on MHL conducted between 2000 and 2015 by Brijnath, et al.22 showed that high levels of MHL can improve mental health outcomes and reduce the incidence of ANX. These studies suggest that MHL not only helps individuals identify symptoms of ANX and other mental disorders early, but also reduces the occurrence of ANX by enhancing individuals’ knowledge and management skills regarding mental health issues. Therefore, exploring the relationship between MHL and ANX is of significant theoretical and practical importance. Building on the previous analysis, this study hypothesizes:

H1: MHL is significantly negatively correlated with ANX.

The mediating role of PR

PR refers to an individual’s ability to self-regulate and positively adapt to their environment when facing setbacks or adversity in order to cope with complex and changing challenges23. Findings consistently highlight the substantial role of PR in promoting mental health, with higher levels of resilience helping individuals better cope with stress and reduce negative emotions related to ANX24,25. According to the Dynamic Model of Psychological Resilience, resilience is an acquirable skill26. Similarly, according to the Resilience Model put forward by Dray, et al.27 individuals with high resilience are more capable of facing difficulties, adopt optimistic coping strategies, actively reach out for help, and find practical solutions to challenges. For instance, a study using a cross-sectional approach by Cai, et al.28 on 4,038 college students found a significant negative correlation between PR and ANX. That is, students with higher PR scores are prone to maintaining good mental health and experience a lower incidence of ANX9. In contrast, individuals with low resilience are more prone to ANX in stressful environments due to a lack of effective emotional regulation and coping strategies, making it difficult to alleviate feelings of ANX. Therefore, PR is considered an important factor in managing ANX and can help reduce an individual’s ANX levels to some extent.

Current research shows that MHL has a significant positive predictive effect on an individual’s psychological capital29. MHL enhances individuals’ understanding of psychological issues, enabling them to maintain a higher sense of self-efficacy and confidence in solving problems when facing adversity. This confidence and coping ability, in turn, enhances their PR when confronted with stress and challenges30. A study on the latent categories of MHL and PR in college students found that MHL levels lead to differences in PR, with students who have higher MHL exhibiting stronger resilience31. Moreover, high levels of MHL help individuals better understand the sources and characteristics of psychological distress, thereby improving their ability to adapt to challenges and stress11,32. For instance, Zhang, et al.11 examined the mediating role of PR in the relationship between MHL and psychological distress among Chinese adolescents. The results indicated that MHL positively predicted PR and negatively predicted psychological distress, with PR playing a mediating role in this relationship. Therefore, research proposes that MHL directly influences ANX in college students, and may also have an indirect effect on the emergence and development of ANX through the enhancement of their PR. Based on the above analysis, this study hypothesizes:

H2: PR acts as a mediator in the connection between MHL and ANX.

The moderating role of PE

PE refers to any activity involving physical movement and skills aimed at enhancing physical health and fitness, including organized sports, fitness training, yoga, running, and more33. As a behavioral factor, PE may act as a moderating influence in the connection between MHL, PR, and ANX levels. According to the Biopsychosocial Model, PE not only promotes emotional regulation by improving individuals’ physical health but also enhances PR by increasing self-efficacy, thereby effectively reducing ANX34. Moreover, the extent of this effect varies depending on the individual’s level of exercise engagement35,36. Individuals who engage in regular PE generally exhibit stronger emotional regulation abilities and better resilience in coping with stress, which helps reduce ANX levels37,38. For example, Peng, et al.12 explored how PE enhances the PR of college students and found that exercise not only promotes social connections but also improves emotional regulation, thereby boosting PR. Additionally, Zheng, et al.39 explored the impact of social support and PR on the connection between PE and ANX, revealing that PE reduces ANX levels by enhancing PR. This suggests that regular PE helps individuals more effectively translate their MHL into PR when facing challenges, ultimately reducing ANX40. Research has pointed out that PE can indirectly affect negative emotions by enhancing PR36,38. For instance, Zhang, et al.38 explored the moderating role of PE between PR and negative emotions. The analysis revealed that PE played a crucial role in influencing the link between PR and adverse emotional states. Specifically, exercise not only improves individuals’ physical state but also helps them cope with ANX by modulating their psychological responses10,41. Individuals with higher PR are more capable of alleviating ANX through positive coping strategies, and PE may promote this process by enhancing their resilience42. Building on the previous analysis, this research puts forward the following hypotheses:

H3: PE significantly moderates the direct and indirect relationship between MHL and ANX.

The proposed theoretical framework of this study is depicted in Fig. 1.

Fig. 1
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Research model.

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Research methods

Sample and data collection procedure

This study adopted a cross-sectional research design and utilized convenience sampling. Data were collected through an online questionnaire distributed via the Wenjuanxing platform (www.sojump.com) to college students at Xi’an Peihua University (Approval Number:2024-0014). To enhance the external validity and generalizability of the results, the research team collaborated with department heads, who outlined the goals and relevance of the questionnaire to the students and invited their participation. All students participated voluntarily and filled out the questionnaires independently. Data collection took place from November 2024 to February 2025, and the survey was conducted anonymously and confidentially. According to the sample calculation method proposed by Kline43, at least 10 respondents are needed for each survey item. The questionnaire in this study included 62 items, and considering a 20% sample attrition rate, the required sample size was calculated to be 744 participants (43 items × 10 respondents + 20% × 43 items × 10 respondents). The study distributed a total of 760 questionnaires, with 757 returning the completed surveys. During the screening process, questionnaires with duplicate IP addresses, those where over 95% of participants selected the same answer, those with completion times exceeding three standard deviations, and those missing age information were excluded. The final analysis included 752 valid questionnaires from 752 participants (376 males), the participants’ average age was recorded at 19.88 years (see Table 1). All participants completed the questionnaire after providing informed consent, ensuring that the study adhered to ethical standards and respected participants’ privacy and autonomy.

Table 1 Descriptive statistics.
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Measurements

MHL

The research employed the Adolescent Mental Health Literacy Assessment Questionnaire (AMHLAQ), which was created by Chinese scholars Li, et al.44, to assess college students’ MHL. The AMHLAQ consists of 22 items across four dimensions: knowledge, recognition, attitude, and behavior. With a grade 5 rating, in which higher scores are indicative of a stronger grasp of MHL. The scale was designed based on the cultural norms of China and has demonstrated good reliability, having been widely applied in Chinese educational settings45. In this research, the scale demonstrated a Cronbach’s α of 0.760, a KMO measurement of 0.906, and a statistically significant outcome in Bartlett’s sphericity test (P < .001), suggesting that the scale has strong reliability and validity.

PR

PR in this study was assessed using the Chinese revised version of the Connor–Davidson Resilience Scale (CD-RISC)46, as updated by Yu and Zhang47. The scale consists of 25 items across three dimensions: perseverance, self-reliance, and optimism. Using the Likert 5-level scale, greater values correspond to a higher degree of PR. The scale has been tested and proven effective within Chinese educational settings, showing strong consistency and accuracy, and providing reliable and valid results48. The overall Cronbach’s α of 0.869, the KMO measurement of 0.897, and the Bartlett’s test of sphericity is significant (P < .001), suggesting that the scale possesses strong reliability and validity.

PE

This study utilized the revised version of the Physical Activity Rating Scale (PARS-3) developed by Liang and Liu49 to measure Chinese college students’ PE. The scale consists of three items, assessing the intensity, duration, and frequency of physical activity, each rated on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Following the original scoring method and its widespread application among Chinese university students, the total PE score was calculated using the formula: intensity × (time − 1) × frequency, which provides a comprehensive measure of an individual’s overall activity load. Based on the total score, PE levels are categorized into three groups: low (≤ 19), moderate (20–42), and high (≥ 43). The scale has been validated in Chinese college populations and has demonstrated good reliability and validity50. In the present study, the scale yielded a Cronbach’s α of 0.712, slightly above the commonly accepted threshold of 0.70 for social science research. As noted by Cortina51, Cronbach’s α is closely related to the number of items in a scale; given that this scale contains only three items, this reliability level is considered acceptable for a brief measure. Additionally, the KMO value was 0.719, and Bartlett’s test of sphericity was significant (P < .001), indicating good structural validity.

ANX

ANX was measured using the Chinese version of the Depression, Anxiety, and Stress Scale (DASS-21), a tool initially developed by Lovibond and Lovibond52 and subsequently modified by Gong53. The full scale contains 21 items across three subscales: depression, ANX, and stress1. This measurement tool includes 7 questions, utilizing a 5-level rating system, higher scores reflect greater levels of ANX. This scale, validated in Chinese college students, shows excellent reliability and validity1. The reliability and validity of the scale are supported by a Cronbach’s α of 0.806, a KMO statistic of 0.877, and a statistically significant result in Bartlett’s sphericity test (P < .001) in this scale.

Data analysis

Statistical analysis was carried out utilizing the SPSS 27.0. First, normality tests were performed, following Kim54 guidelines that suggest a normal distribution if the skewness is below 2 and kurtosis is under 7. The primary variables (MHL, PR, PE, ANX) exhibited normal distribution, and descriptive statistics, including the mean and standard deviation, were computed for these variables. Subsequently, Pearson correlation analysis was conducted to examine the relationships among the study variables. For the mediation and moderated mediation analyses, Hayes55 PROCESS macro was employed. Model 4 was used to test the mediating role of psychological resilience in the relationship between mental health literacy and anxiety, followed by Model 59 to examine the moderating effect of physical activity. Since all variables in this study were observed (manifest) variables, and the primary focus was on the significance of path effects and conditional indirect effects, the regression path estimates and bootstrap confidence intervals provided by PROCESS are widely regarded as appropriate for this type of analysis. The study employed 5,000 bootstrap resamples and reported 95% confidence intervals (95% CI) for each path. Effects were considered significant if the confidence interval did not include zero (α = 0.05). To enhance the clarity and interpretability of the model, key path coefficients and moderation effects are illustrated in the results section.

Results

Common variance bias test

To assess the potential for common method bias (CMB), the study utilized Harman’s single-factor test. The factor analysis uncovered 12 unique dimensions, all having eigenvalues above 1, with the first factor explaining 23.919% of the variance—far beneath the critical cutoff of 40%56, indicating no substantial CMB.

Correlation analysis

Table 2 provides the results from the correlation analysis. The analysis reveals a strong and positive relationship between MHL, PR (r = .625, p < .001), and PE (r = .133, p < .001). Additionally, MHL (r = -.546, p < .001) and PR (r = -.511, p < .001) are significantly negatively correlated with ANX, highlighting that the data set is fit for conducting further testing and model assessments. Therefore, H1 is supported.

Table 2 Descriptive statistics and correlation analysis.
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Confirmatory factor analysis (CFA)

CFA was conducted to evaluate the quality of the measurement model, specifically to examine whether the factor structure of the questionnaire aligns with theoretical expectations and to confirm that the instrument reliably measures the latent constructs. As shown in Table 3, the overall model demonstrated a good fit. Although the AGFI value was slightly below the recommended threshold of 0.90, the remaining indices met or exceeded commonly accepted standards, indicating that the proposed model fits the data well.

Table 3 Model fit indices.
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Mediation effect analysis

In H2, this research put forward the assumption that PR facilitates the link between MHL and ANX in college students. The results in Table 4 showed that MHL significantly boosts PR (b = 0.625, p < .001). Moreover, both MHL (b = -0.371, p < .001) and PR (b = -0.279, p < .001) have a significant negative effect on ANX. The study found a significant indirect effect of MHL on ANX through PR, with a value of -0.175 for the indirect effect, and the 95% CI = [-0.238, -0.113].

Table 4 Mediating role of PR between MHL and ANX.
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After introducing the moderator variable, the results show that MHL significantly influences PR (b = 0.609, p < .001) and ANX (b = -0.359, p < .001). PR also significantly affects ANX (b = -0.285, p < .001). Bootstrap tests revealed that the 95% CI = [-0.233, -0.116]. These results from Tables 4 and 5 indicate that PR partially mediates the relationship between MHL and ANX in university students. Therefore, H2 is supported.

Table 5 Testing the moderated mediation effects of MHL on ANX.
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Moderated mediation analysis

In H3, PE is hypothesized as a moderator influencing all paths in the mediation process. Participants were divided into low (M-1SD) and high PE (M + 1SD) subgroups. As shown in Table 5; Fig. 2, the interaction between MHL and PE significantly predicted PR (b = -0.078, p = .007), indicating that PE moderates the effect of MHL on PR. Simple slope analysis (Fig. 3) revealed that MHL had a stronger effect on PR in the low PE group (b simple = 0.687, p < .001) than in the high PE group (b simple = 0.532, p < .001). Specifically, low PE levels further weaken the relationship between MHL and PR. Additionally, the interaction between PR and PE significantly predicted ANX (b = 0.119, p = .002). Simple slope analysis (Fig. 4) reveals that PR has a weaker effect on ANX in the low PE group (b simple = -0.403, p < .001) compared to the high PE group (b simple = -0.166, p = .002). In other words, low PE levels may exacerbate the relationship between PR and ANX. However, bootstrapping results indicate that PE does not significantly moderate the direct effect of MHL on ANX. The moderation index was − 0.030, SE = 0.041, 95% CI = [-0.110, 0.051], suggesting that PE did not significantly moderate the direct effect of MHL on ANX. Therefore, H3 is partially supported.

Fig. 2
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Moderated mediation model.

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Fig. 3
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PE mediates the relationship between MHL and PR.

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Fig. 4
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PE mediates the relationship between PR and ANX.

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Discussion

The analysis revealed a significant negative connection between MHL and ANX in college students, echoing results from prior research20. According to the vulnerability-stress model, protective factors help mitigate the effects of stressful life events19. In this context, as a positive psychological trait, the improvement of MHL enables college students to recognize and challenge negative automatic thoughts, alter the negative interpretation of stressful events, and thus reduce the occurrence of ANX57. Furthermore, college students with higher MHL are better able to identify and manage ANX, adopting positive coping strategies to avoid emotional deterioration or accumulation, and thus maintaining lower ANX when facing academic and life stress17. This enhanced ability allows them to more effectively handle challenges and decrease the onset of ANX.

This study’s outcomes reveal that when PR functions as an intermediary variable, the association between MHL and ANX in university students continues to hold significance, with PR partially mediating this relationship. This result aligns with the findings of Zhang, et al.11which showed that PR mediates the relationship between adolescent MHL and psychological distress. College students with higher levels of MHL are generally better at recognizing and understanding their emotions while also acquiring effective coping strategies. This cognitive enhancement strengthens their PR58. A key characteristic of PR is the presence of positive emotions, which help individuals recover from stress and ANX9. According to the broaden-and-build theory of positive emotions, negative emotions tend to narrow attention and promote specific behavioral tendencies, such as aggression or avoidance. In contrast, positive emotions can suppress the self-arousal triggered by negative emotions, thereby broadening individuals’ attention, cognition, and behavioral capacities59. Consequently, MHL indirectly influences anxiety levels among college students by enhancing PR, further demonstrating the mediating role of PR in the relationship between MHL and ANX.

The results of this study partially supported the hypothesis regarding the moderating role of PE. Specifically, PE moderated the relationship between MHL and PR, as well as the relationship between PR and ANX. However, its moderating effect on the direct relationship between MHL and ANX was not significant. According to the Exercise–Cognition Integration Model60, moderate PE improves MHL. It also enhances the ability to cope with stress and challenges. This leads to stronger PR35,36 and lower ANX levels61. In the low-exercise group, the association between MHL and PR was stronger. This suggests that students who exercise less rely more on MHL to build PR. In the high-exercise group, the benefits of exercise itself, such as mood regulation, social support, and cognitive improvement62, may reduce the influence of MHL on PR. The negative effect of PR on ANX was stronger among students with low PE. This shows that PR is a key protective factor in this group. In the high-exercise group, this effect was weaker. PE may offer direct stress-relief effects, such as endorphin release or real-life challenge experiences63. These effects may reduce the need to rely on PR alone. Students with average PR levels can still manage ANX well if they exercise regularly. In contrast, students with low levels of exercise lack these physical resources. They depend more on internal strengths such as cognitive reappraisal and positive coping38. As a result, PR plays a stronger role in reducing ANX in this group. Some of these findings differ from previous theoretical expectations. Future research should explore the role of different types and intensities of PE. It should also consider personal traits such as stress sensitivity and neuroticism. This will help clarify how external behaviors and internal psychological traits work together in coping with ANX.

Impact and limitations

Impact

By establishing a moderated mediation framework, this study comprehensively investigated the pathways through which MHL, PR, and PE impact university students’ ANX levels, presenting a fresh theoretical approach to mental health research within academic settings. Firstly, the study confirmed the significant negative effect of MHL on ANX and revealed the partial mediating role of PR in this relationship. This finding helps improve the mechanism model between MHL and ANX, emphasizing that MHL not only directly affects emotional regulation but also indirectly reduces ANX by enhancing PR. Secondly, regarding the moderating effect of PE, the study found that PE can moderate the relationship between MHL and PR, as well as between PR and ANX under certain conditions, however, it did not significantly moderate the direct connection between MHL and ANX. This result suggests that PE can strengthen the relationship between MHL and PR, especially in the low exercise level group, where this relationship is more prominent. Moderate PE may enhance the positive effect of MHL on PR by improving both physical health and psychological regulation abilities, thus better helping individuals cope with ANX. PE can also moderate the relationship between PR and ANX, especially in the high PE level group. The physiological and psychological regulation effects brought about by exercise may enable these individuals to cope more effectively with ANX emotions, thereby alleviating ANX. This finding offers a fresh viewpoint for deeper investigation into the mechanism of PE as a psychological health intervention.

The practical implications of this study lie in offering clear operational recommendations for mental health interventions for college students, especially in improving MHL and promoting PE. First, universities can help students understand the core concepts of MHL and enhance their ability to recognize and manage emotions through systematic mental health education courses and activities. This education can be conducted through various formats such as lectures, workshops, and online learning platforms, equipping students with skills to recognize ANX, stress, and other emotional reactions. Improving MHL not only helps students identify and regulate negative emotions but also enhances their coping strategies when facing academic and life pressures. Therefore, universities can establish a supportive mental health service system that provides personalized emotional management and psychological counseling. Secondly, universities should encourage students to participate in PE, especially moderate PEs such as running, swimming, and yoga. Studies have demonstrated that PE not only boosts physical health but also promotes MHL and PR. By organizing campus sports events, fitness challenges, and club activities, students’ interest and participation in exercise can be stimulated. Engaging in regular exercise improves students’ physical health and also alleviates ANX through its beneficial emotional regulation effects. Finally, personalized mental health intervention programs should be designed for student groups with different levels of PE. For students with low exercise levels, the focus can be on training MHL and PR to help them improve their ability to cope with ANX. For students with high exercise levels, the focus can be on further strengthening PR, using the dual effects of exercise (physical and psychological) to help them cope with various life stresses. In PE interventions, attention can be given to how exercise enhances PR, which in turn helps students cope with ANX. Providing specific exercise guidance and psychological regulation skills will make PE an important tool for alleviating ANX.

Limitations and future research directions

This study offers new insights into the association between MHL and ANX, yet there are various limitations that need to be considered. Firstly, this study’s sample was limited to college students from Xi’an Peihua University, which may reduce the generalizability of the findings. Future research should include participants from different regions, types of institutions, and age groups such as adolescents, working adults, and older adults to examine the broader applicability and robustness of the model. Additionally, this research is cross-sectional and did not reveal causal links among the variables. Future studies could employ a longitudinal approach to gain a more detailed understanding of the causal pathways between MHL, PR, and ANX. Thirdly, the AMHLAQ and PARS-3 used in this study were developed in China. Although suitable for local use, they lack cross-cultural validation. This may limit the findings’ applicability in other cultural contexts. Future studies should consider translation and equivalence testing to improve global relevance. Lastly, this study also used the PARS-3 scale to assess PE, with scores calculated using the formula: intensity × (time − 1) × frequency. While this reflects overall exercise load, it may cause score skewness and complicate interpretation. The scale includes only three items, and although reliability (α = 0.712) was acceptable, it remains marginal. Future research should use more comprehensive tools and objective activity measures to improve accuracy and robustness.

Conclusion

This study constructed a moderated mediation model to examine the impact of MHL on ANX among Chinese college students. It tested the mediating role of PR and the moderating role of PR. The results showed that PR is a key mechanism linking MHL to ANX, and PE moderates this indirect path. Unlike previous studies that focused on either MHL or PR alone, this research integrated cognitive resources and behavioral factors. It revealed the interactive mechanisms between mental literacy, internal psychological resources, and lifestyle, enriching the application of Conservation of Resources Theory in college mental health research. Given the multiple pressures faced by university students, such as academic demands, social relationships, and career concerns, the findings highlight a dual-path intervention approach—enhancing both MHL and PR. Encouraging regular PE can further strengthen students’ psychological resources for coping with ANX. In sum, this study advances theoretical understanding and provides practical guidance for mental health promotion, curriculum development, and intervention planning in higher education.