Bedtime Procrastination and Attention as Serial Mediators Between Premenstrual Syndrome and Test Anxiety in Nursing...

Based on the Theory of Unpleasant Symptoms (TOUS), this study aimed to examine the relationship between premenstrual syndrome (PMS) and test anxiety among nursing college students, and to explore the serial mediating roles of bedtime procrastination and attention in this association.

A multicenter cross-sectional survey was conducted among 791 female nursing students from eight medical and health vocational colleges in China. Participants completed the General Information Questionnaire, Premenstrual Syndrome Scale (PSS), Bedtime Procrastination Scale (BPS), Multi-Dimensional Attention Rating Scale (MARS), and Test Anxiety Scale (TAS). Pearson correlation analysis, multiple linear regression, and structural equation modeling with 5,000 bootstrap resamples were performed.

Mean scores of PSS, BPS, MARS, and TAS were 6.26±4.85, 27.38 ± 6.022, 35.91±4.47, and 18.42±7.96, respectively. PMS was positively associated with bedtime procrastination and test anxiety and negatively associated with attention (all P<0.001). Multiple linear regression identified bottled drink intake frequency, menstrual cycle, thinking/feeling personality type, only-child status, PMS, bedtime procrastination, and attention as significant predictors of test anxiety (P<0.05). Structural equation modeling showed that PMS had a significant direct effect on test anxiety (β=0.20, 95% CI: 0.12-0.28). Bedtime procrastination and attention significantly mediated this association, including a serial mediation pathway (β=0.03, 95% CI: 0.01-0.06). The total indirect effect accounted for 50% of the total effect.

PMS was associated with test anxiety among nursing students, both directly and indirectly through the serial mediating roles of bedtime procrastination and attention. Within the TOUS framework, these findings advance understanding of the physiological-behavioral-cognitive pathway underlying test anxiety and suggest potential intervention targets for improving mental health among nursing students.