Medical students often face heavy pressure, which can contribute to mental health problems. This study examined the association between perceived stress and social anxiety, with sleep quality and affective empathy as mediators. A total of 1065 medical students completed the Perceived Stress Scale (PSS), the Chinese version of the Social Anxiety Questionnaire-Adults (CSAQ-A), the Pittsburgh Sleep Quality Index (PSQI), and the Interpersonal Reactivity Index (IRI). The results revealed that perceived stress was positively associated with social anxiety, and this association was jointly mediated by sleep quality and affective empathy. These findings provide empirical evidence for the development of interventions to reduce social anxiety among medical students.
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