Anger and Anxiety as Sequential Predictors of Fatigue: A Two-Wave Longitudinal Study

Fatigue occurs at a high rate among college students. Anger and anxiety are thought to be important triggers for fatigue. The mechanisms underlying the association between anger and fatigue remain unclear. The objective of this longitudinal study was to examine a sequential predictive pathway in which anger prospectively predicts fatigue through anxiety among Chinese university students.

The participants in this current study were 3475 college students (2686 females and 789 males, 15-42 years old, M = 19.78 years, SD = 1.96) from a university in Xinxiang City, Henan province, mainland China. Data for this two-wave longitudinal study were collected via online surveys at two timepoints: October 2023 (T1) and April 2024 (T2). The Patient-Reported Outcomes Measurement Information System (PROMIS) Anger scale, Anxiety scale, and Fatigue scale were used to assess state-like emotional functioning (anger and anxiety assessed over the past 7 days) at each wave. These week-based assessments were conceptualized as indicators of participants' proximal emotional conditions at each timepoint rather than emotions persisting across the entire 6-month interval.

In longitudinal structural equation models, T1 anger significantly predicted higher anxiety at follow-up (β = 0.314, 95% CI [0.267,0.362], p < 0.001). The autoregressive effect of T1 anxiety on T2 anxiety was also significant (β = 0.315, 95% CI [0.264, 0.368], p < 0.001). Likewise, T1 anxiety significantly predicted increases in T2 fatigue (β = 0.267, 95% CI [0.225,0.310], p < 0.001) even after accounting for the autoregressive effect of T1 fatigue (β = 0.339, 95% CI [0.296,0.382], p < 0.001). To enhance transparency, a supplementary structural model was estimated to assess the direct predictive effect of T1 anger on T2 fatigue. After controlling for T1 fatigue, T1 anger showed a significant direct association with T2 fatigue (β = 0.396, 95% CI [0.316,0.477], p < 0.001). Overall, the findings support a sequential prediction pattern in which earlier anger predicts later increases in anxiety, which subsequently predict increases in fatigue.

This study provides evidence for a sequential predictive pathway linking anger to fatigue via anxiety in college students. These findings suggest that baseline state-like emotional functioning-rather than enduring traits-can initiate longer-term psychological processes. Interventions that reduce anger and anxiety at their point of emergence may help interrupt this temporal chain and ultimately alleviate fatigue.