Psychological Resilience Among Vocational Medical Students in China: The Mediating Role of Professional Identity in the Relationship With Ideological and Political Education Experience

Abstract

Objective

This study aimed to examine the current status of psychological resilience among students in medical vocational colleges and its associations with professional identity, perceived stress, self-efficacy, and social support, and to test a mediation model involving professional identity.

Methods

A cross-sectional survey was conducted among 2,274 medical vocational college students. Standardized scales were used for measurement. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation, multiple linear regression, and structural equation modeling.

Results

The average psychological resilience score among participants was moderate. Significant differences were observed across gender, grade level, and family background (p < 0.05). Psychological resilience showed significant associations with professional identity, self-efficacy, social support, and perceived stress. Multiple regression analysis revealed that self-efficacy and social support were the strongest predictors of resilience. Structural equation modeling further showed that professional identity partially mediated the association between ideological and political education experience and psychological resilience, with acceptable model fit (χ²/df = 2.47, RMSEA = 0.053, GFI = 0.926, CFI = 0.938).

Conclusion

Psychological resilience among medical vocational college students is influenced by individual, professional, and social factors. Targeted interventions to strengthen professional identity, self-efficacy, and social support may effectively improve students’ resilience, thus promoting better mental health and academic performance.

Keywords

psychological resilience vocational medical students professional identity perceived stress social support structural equation modeling

1. Introduction

Medical students frequently encounter considerable psychological stress due to academic pressure, clinical training, and uncertain career prospects.¹ These stressors may undermine mental health and reduce learning efficiency. Psychological resilience—the ability to adapt to stress, recover from adversity, and maintain psychological stability—has been identified as a protective factor against emotional exhaustion and depression.²

In recent years, research on resilience has expanded from clinical populations to medical students.^2-7 Existing studies have shown that resilience is associated with self-efficacy, perceived stress, social support, and professional identity in health-professions education,^8-11 but important knowledge gaps remain. In the Chinese context, most evidence has focused on general university students or traditional undergraduate medical students, whereas vocational medical students have received far less attention. This group has distinct educational and career characteristics, including earlier skills-oriented training, stronger employment orientation toward primary-level health services, and greater exposure to family, economic, and academic pressures. As a result, it remains unclear whether the factors associated with resilience in other student populations operate similarly among vocational medical students in China, and little is known about how educational experiences linked to professional identity formation may shape their resilience. By focusing specifically on vocational medical students and incorporating ideological and political education (IPE) experience into an integrative analytical framework, this study aims to extend the current literature and provide new empirical evidence on educational and psychosocial determinants of resilience in this understudied population.

From a theoretical perspective, resilience is not only an individual coping capacity but also a developmental outcome shaped by meaning systems, values, and socialization processes. Based on these perspectives, we constructed a conceptual model in which IPE experience influences psychological resilience both directly and indirectly through professional identity. IPE experience may therefore be relevant to resilience because it provides students with value-based interpretation frameworks, reinforces a sense of professional mission, and strengthens their understanding of the social role of healthcare work. These processes are also consistent with identity formation perspectives, which suggest that educational experiences can foster professional identity by enhancing students’ recognition of occupational value, responsibility, and commitment. In this sense, IPE experience may contribute to psychological resilience both directly, by promoting adaptive meaning-making, and indirectly, by strengthening professional identity.

Accordingly, this study used a structural equation model (SEM) to test a conceptual framework linking IPE experience, professional identity, and psychological resilience among vocational medical students in China. Specifically, the study addressed the following questions: (1) What is the level of psychological resilience among vocational medical students in China? (2) Is IPE experience positively associated with professional identity and psychological resilience? (3) Does professional identity positively predict psychological resilience? and (4) Does professional identity mediate the relationship between IPE experience and psychological resilience? Based on the proposed model, we hypothesized that IPE experience would positively predict professional identity and psychological resilience, that professional identity would positively predict psychological resilience, and that professional identity would partially mediate the association between IPE experience and psychological resilience.

Understanding these relationships may provide practical implications for medical education by informing strategies to strengthen students’ professional identity and psychological resilience, which are essential for sustaining motivation, coping with academic and clinical pressures, and preparing a resilient healthcare workforce.

2. Methods

2.1. Participants and Design

A cross-sectional online survey using a convenience sampling approach was conducted from September to October 2025 at Cangzhou Medical College and approved by the Ethical Review Board of the institution (Approval No. 20251127). The survey link and study information were distributed to eligible full-time students through the college’s online communication channels, and participation was voluntary and anonymous. A total of 2,454 students were approached and 2,274 valid questionnaires were returned (response rate = 92.7%, Table 1), which presents the detailed demographic characteristics and corresponding psychological resilience scores of the participants.

Table 1.

Psychological Resilience Scores of Vocational Medical Students by Demographic Characteristics (n = 2,274)

Characteristic	Category	n	Proportion (%)	Score (x̄ ± s)
Gender	Male	504	22.16	33.85 ± 5.12
Gender	Female	1,770	77.84	34.86 ± 4.79
Grade	Class 3	291	12.8	36.21 ± 4.53
	Class 2	779	34.26	35.17 ± 4.68
	Class 1	1,204	52.95	33.78 ± 5.01
Major	Clinical Medicine	492	21.64	34.52 ± 4.93
	Nursing	521	22.91	35.07 ± 4.67
	Stomatology	169	7.43	34.18 ± 5.21
	Traditional Chinese Medicine	320	14.07	35.32 ± 4.58
	Other Majors	772	33.95	33.86 ± 5.15
Place of Origin	Urban	478	21.02	34.21 ± 4.98
Place of Origin	Rural	1,796	78.98	34.79 ± 4.82
Student Cadre	Yes	504	22.16	36.58 ± 4.32
Student Cadre	No	1,770	77.84	34.03 ± 4.95
Parental Occupation	Farming	1,286	56.55	34.92 ± 4.76
	Self-employed/Laborer	644	28.32	34.51 ± 4.93
	Government/Enterprise Staff	119	5.23	33.87 ± 5.04
	Others	225	9.89	34.26 ± 5.11
Perceived Academic Stress	Low (1-2 points)	615	27.05	37.24 ± 4.15
	Moderate (3 points)	711	31.27	35.13 ± 4.56
	High (4-5 points)	948	41.68	32.36 ± 5.27
Self-rated Health Status	Poor	52	2.29	31.64 ± 5.38
	Fair	860	37.82	33.97 ± 4.92
	Good	821	36.1	35.42 ± 4.65
	Excellent	541	23.79	36.89 ± 4.31

Inclusion criteria were: (1) full-time medical students, (2) voluntary consent to participate, and (3) completion of the questionnaire.

Exclusion criteria were: (1) questionnaires with substantial missing data or logical inconsistencies, (2) duplicate submissions, and (3) respondents who did not provide informed consent.

Before accessing the questionnaire, students reviewed an online information sheet describing the study aims, data processing procedures, and instructions, and then provided informed consent electronically. Because the study used a single-college online voluntary sample rather than probability sampling, some degree of self-selection bias cannot be excluded, and the representativeness of the sample should be interpreted with caution.

The reporting of this cross-sectional study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement¹²; the completed STROBE checklist is provided as Supplementary File S1.

2.2. Measures

• The full questionnaire used in this study, including all measurement scales and demographic items, is provided as Supplementary File S2. Demographic information included 8 items: grade, major, gender, place of origin, whether serving as a student cadre, parents’ occupational status, self-reported academic stress^13-15 (assessed with a 5-point Likert scale: 1 = Strongly disagree to 5 = Strongly agree), and self-reported general health status (measured using a 4-point scale: 1 = Poor to 4 = Excellent).

• Resilience: Assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), originally validated by Campbell-Sills and Stein,¹⁶ rated on a 5-point Likert scale (0-4).⁶ The Cronbach’s α coefficient is 0.867.

• Perceived Stress: Evaluated using the 14-item Perceived Stress Scale (PSS-14), originally developed by Cohen, Kamarck, and Mermelstein.¹⁷ The Cronbach’s α coefficient is 0.853.

• The WHO-5 Well-Being Index: consisting of 5 items, uses a 6-point scale (0 = None to 5 = All the time) with a total score ranging from 0 to 25. Higher scores indicate stronger subjective well-being.^18,19 The Cronbach’s α coefficient is 0.821.

• The Self-Designed Occupational Identity Scale is a 27-item instrument rated on a 5-point Likert scale (1 = Strongly disagree to 5 = Strongly agree), comprising seven dimensions: resilience-related cognition (5 items), occupational identity (4 items), willingness to practice medicine (4 items), recognition of occupational value (3 items), social support (2 items), recognition of policies (2 items), and experience of ideological and political courses (7 items). The items were developed based on relevant literature and educational context and were reviewed by faculty members with experience in medical education to ensure content relevance and clarity. In the present sample, the total Cronbach’s α coefficient was 0.924, and the Cronbach’s α coefficients for the seven dimensions ranged from 0.786 to 0.893, indicating good internal consistency. This study primarily provides evidence of internal consistency reliability, while further psychometric validation such as confirmatory factor analysis and external validation should be conducted in future research.

2.3. Statistical Analysis

Data were analyzed using SPSS 26.0 and AMOS 24.0. Descriptive statistics, Pearson’s correlation, and multiple regression were conducted.²⁰ The distribution of variables was evaluated using descriptive indicators including skewness and kurtosis. Given the large sample size, skewness and kurtosis were examined to assess approximate normality prior to parametric analyses. Missing values accounted for less than 3% overall and were handled using expectation–maximization imputation. Sample size adequacy was determined following Kline’s recommendation, ensuring N > 200 for SEM reliability. Structural equation modeling was performed in AMOS using maximum likelihood estimation. Latent variables were identified by fixing one factor loading for each latent construct, and model fit was evaluated using multiple commonly reported indices, including χ²/df, RMSEA, GFI, and CFI. Acceptable model fit was defined a priori as χ²/df < 3, RMSEA < 0.08, and GFI and CFI > 0.90. The significance level was set at p < 0.05.

3. Results

3.1. Descriptive Analysis

As shown in Table 1, the psychological resilience scores of vocational medical students varied across different demographic characteristics. Among the 2,274 participants, females accounted for 77.84% and students from rural areas accounted for 78.98%. Resilience scores differed across subgroups. Grade 3 students had the highest mean resilience score (36.21 ± 4.53), student cadres scored higher than non-cadres (36.58 ± 4.32 vs. 34.03 ± 4.95). Students with low perceived academic stress had the highest score (37.24 ± 4.15), and those with high stress had the lowest (32.36 ± 5.27). Students reporting good or excellent health had higher resilience score than those with poor health; and Traditional Chinese Medicine majors showed relatively higher resilience (35.32 ± 4.58) than several other specialty groups.

As presented in Table 2, the descriptive statistics and reliability coefficients of the major study variables indicate satisfactory internal consistency.

Table 2.

Descriptive Statistics and Reliability of Major Variables (n = 2,274)

Variable	Items	Score range	Observed range	Mean ± SD	Cronbach’s α
Psychological Resilience (CD-RISC-10)	10	0-40	12-40	34.62 ± 4.87	0.867
Perceived Stress (PSS-14)	14	0-56	8-42	26.35 ± 7.28	0.853
Subjective Well-Being (WHO-5)	5	0-25	5-25	17.86 ± 4.32	0.821
Professional Identity	27	27-140	45-138	102.68 ± 15.73	0.924
Resilience-related Subscale	5	5-25	8-25	19.75 ± 3.68	0.842
Occupational Identity	4	4-20	6-20	16.32 ± 2.87	0.815
Willingness to Practice Medicine	4	4-20	5-20	15.87 ± 3.12	0.836
Recognition of Professional Value	3	3-15	5-15	12.46 ± 2.15	0.786
Social Support	2	2-10	3-10	8.23 ± 1.64	0.793
Policy Identity	2	2-10	3-10	8.57 ± 1.48	0.801
Ideological and Political Course Experience	7	7-35	10-35	27.42 ± 4.85	0.893

Note. SD = standard deviation.

3.2. Correlation Analysis

As shown in Table 3, significant differences in psychological resilience scores were observed among different subgroups.

Table 3.

Comparison of Psychological Resilience Scores Among Subgroups (n = 2,274)

Variable	Group	Score (mean ± SD)*	t/F-value	Effect size (η²/Cohen’s d)
Gender	Male	33.85 ± 5.12	4.283	0.008
Gender	Female	34.86 ± 4.79
Grade	Class 3	36.21 ± 4.53	28.651	0.024
	Class 2	35.17 ± 4.68
	Class 1	33.78 ± 5.01
Major	Traditional Chinese Medicine	35.32 ± 4.58	12.374	0.011
	Nursing	35.07 ± 4.67
	Other Majors	33.86 ± 5.15
Student Cadre	Yes	36.58 ± 4.32	12.765	0.022
Student Cadre	No	34.03 ± 4.95
Perceived Academic Stress	Low (1-2 points)	37.24 ± 4.15	118.326	0.098
	Moderate (3 points)	35.13 ± 4.56
	High (4-5 points)	32.36 ± 5.27
Self-rated Health Status	Poor	31.64 ± 5.38	62.59	0.076
	Fair	33.97 ± 4.92
	Good	35.42 ± 4.65
	Excellent	36.89 ± 4.31
Ideological and Political Course Experience	High (≥28 points)	36.87 ± 4.21	23.892	0.105
Ideological and Political Course Experience	Low (≤20 points)	31.52 ± 5.34

Note. *p-value<0.001 for all comparisons.

Social support was another significant predictor of resilience (β = 0.154, p < 0.001), functioning as an emotional and instrumental buffer against stress. Student cadres also showed higher resilience scores than non-cadres in the subgroup analysis. This pattern may reflect greater opportunities for leadership practice, peer interaction, and problem-solving, which could help strengthen adaptive coping resources. In addition, the gradient observed across self-rated health categories suggests that better perceived health may coexist with stronger psychological resources and more effective stress adaptation. Given that nearly 79% of participants were from rural backgrounds, many students may experience limited family proximity and insufficient access to campus resources. Therefore, establishing a family-school-internship triadic support network is essential to enhance emotional well-being and psychological security.

As shown in Table 4, resilience was significantly and positively correlated with professional identity (r = 0.632, p < 0.01) and subjective well-being (r = 0.587, p < 0.01), while negatively correlated with perceived stress (r = -0.413, p < 0.01).

Table 4.

Pearson Correlation Matrix Among Variables

Variables	1	2	3	4	5	6	7	8
Psychological Resilience	1
Perceived Stress	-0.413^**	1
Subjective Well-being	0.587^**	-0.386^**	1
Professional Identity	0.632^**	-0.357^**	0.498^**	1
Professional Recognition	0.594^**	-0.329^**	0.472^**	0.826^**	1
Career Intention	0.568^**	-0.315^**	0.453^**	0.789^**	0.694^**	1
Social Support	0.524^**	-0.287^**	0.436^**	0.753^**	0.672^**	0.635^**	1
Ideological-Political Experience	0.478^**	-0.263^**	0.412^**	0.728^**	0.651^**	0.618^**	0.597^**	1

Note. **P < 0.001.

3.3. Regression Analysis

As shown in Table 5, multiple regression showed that professional identity (β = 0.318, p < 0.001) and ideological and political course experience (β = 0.182, p < 0.001) were the strongest positive predictors of resilience, with the model explaining 60.1% of the total variance (R² = 0.601).

Table 5.

Multiple Linear Regression Analysis of Factors Influencing Psychological Resilience (n = 2,274)

Independent variable	β coefficient	SE	t-value	p-value	VIF
Perceived Stress	–0.212	0.023	–9.217	< 0.001	1.335
Subjective Well-being	0.081	0.027	3.003	0.003	1.426
Professional Identity	0.318	0.031	10.258	< 0.001	1.598
Social Support	0.149	0.029	5.136	< 0.001	1.372
Policy Identity	0.069	0.032	2.156	0.031	1.461
Ideological and Political Course Experience	0.182	0.025	7.28	< 0.001	1.534
Student Cadre (Yes = 1)	0.059	0.028	2.107	0.035	1.298
Academic Stress (High vs. Low)	–0.091	0.03	–3.033	0.002	1.415
Self-rated Health (Fair vs. Poor)	0.074	0.034	2.176	0.03	1.286
Self-rated Health (Good vs. Poor)	0.132	0.035	3.771	< 0.001	1.293
Self-rated Health (Excellent vs. Poor)	0.186	0.036	5.167	< 0.001	1.301
Constant	8.692	1.235	7.038	< 0.001	—

Note. R²=0.601 adjusted R²=0.596 F=348.57 P<0.001.

To identify the independent predictors of psychological resilience among medical vocational college students, a multiple linear regression analysis was performed with psychological resilience scores as the dependent variable, and demographic characteristics, psychological status, and cognitive experience indicators as independent variables (only the predictors finally entering the model are presented in the table). The model showed good overall fit, and the Variance Inflation Factor (VIF) of all predictors was less than 2, indicating no serious multicollinearity issues.

A mediation effect model was constructed with psychological resilience as the endogenous latent variable (observed indicators: scores of each item in the CD-RISC-10 scale), Ideological and Political Education (IPE) Experience as the exogenous latent variable (observed indicators: each item of the IPE experience dimension), and professional identity as the mediating latent variable (observed indicators: scores of dimensions such as professional recognition and willingness to practice medicine). This SEM was designed to evaluate the specific mechanism hypothesized a priori, namely whether IPE experience influences resilience directly and indirectly through professional identity. Variables such as perceived stress and social support were retained in the regression framework as relevant associated factors, but were not incorporated into the SEM so as to avoid unnecessary model complexity and overlap between observed and latent constructs. The visualized path of the model is presented in Figure 1.

Figure 1.

Mediation Model Path Diagram of the Impact of Ideological and Political Education (IPE) Experience on Psychological Resilience (Note: n=2274; Ellipses denote latent variables, rectangles denote observed variables; Standardized path coefficients are shown beside arrows, ***P<0.001)

The model fit results were as follows: χ²/df=2.47, RMSEA=0.053, GFI=0.926, and CFI=0.938. These indices met the prespecified criteria for acceptable model fit, indicating that the model showed a good fit to the data.

The path analysis results revealed that:

• IPE experience had a direct positive effect on professional identity (β=0.68, P<0.001);

• Professional identity had a direct positive effect on psychological resilience (β=0.43, P<0.001);

• IPE experience had a direct positive effect on psychological resilience (β=0.27, P<0.001);

• Professional identity played a partial mediating role between IPE experience and psychological resilience. The indirect effect was 0.292, accounting for 52.0% of the total effect (0.562). The significance of the indirect effect should be further confirmed using bootstrap 95% confidence intervals. Bootstrapping with 5,000 resamples showed that the indirect effect was 0.292 (95% CI [0.21, 0.38]), indicating a significant partial mediation effect because the confidence interval did not include zero.

4. Discussion

4.1. Current Status of Psychological Resilience Among Vocational Medical Students

The findings of this study revealed a declining trend across cohorts, with the highest scores among class 3 students and the lowest among those in class 1. This downward pattern may be related to greater academic and clinical demands across training stages,²¹ although this interpretation should be considered exploratory given the cross-sectional design.

Female students exhibited higher resilience than males. This difference may reflect variations in educational experiences or social expectations across health-related specialties, although the present data do not allow further explanation.^7,22,23 Student leaders also demonstrated significantly higher resilience, which may be associated with differences in campus engagement, responsibility, and social connectedness.

Academic stress showed a significant negative correlation with resilience: the high-stress group scored markedly lower than the low-stress group. This finding is consistent with an inverse association between academic stress and resilience, suggesting that students facing intensive clinical training or certification pressure may warrant greater attention.^21,23-25

4.2. Mechanisms of Association Among Variables

Correlation analysis indicated a strong positive association between psychological resilience and professional identity (r = 0.632, p < 0.001). Regression results further confirmed that professional identity was the strongest predictor of resilience (β = 0.318, p < 0.001). The professional identity of vocational medical students encompasses recognition of occupational value and willingness to practice medicine. Students with stronger recognition of the social value of healthcare work and greater willingness to engage in medical practice also tended to report higher resilience,²⁵ although the direction of this relationship cannot be determined in the present design. This finding is consistent with previous research showing that professional identity is closely related to adaptation in the face of adversity.²⁶ From a theoretical perspective, the results also align with multidimensional resilience frameworks that emphasize both internal resources and external support structures. By examining vocational medical students—a population less frequently represented in resilience research—this study extends existing models by highlighting the potential role of professional identity formation within vocational medical education contexts.

Experience in ideological and political courses (IPEC) was moderately and positively correlated with resilience (r = 0.478, p < 0.001), and exerted a partial mediating effect through professional identity (indirect effect accounting for 52.0%). IPE experience was positively associated with both professional identity and psychological resilience. This pattern suggests that educational experiences related to values, professional meaning, and role understanding may be relevant to resilience, partly through their association with professional identity.

Social support was also significantly associated with resilience (β = 0.154, p < 0.001), indicating that students reporting greater support also tended to report higher resilience. Similar associations have been reported in international studies of health and allied health students, where resilience is often conceptualized as the result of interactions among individual psychological resources, professional identity development, and social support systems. Our findings are broadly consistent with this perspective, suggesting that these factors may also be relevant among vocational medical students. Student cadres also showed higher resilience scores than non-cadres in the subgroup analysis. This pattern may reflect greater opportunities for leadership practice, peer interaction, and problem-solving, which could help strengthen adaptive coping resources. In addition, the gradient observed across self-rated health categories suggests that better perceived health may coexist with stronger psychological resources and more effective stress adaptation. Given that nearly 79% of participants were from rural backgrounds, differences in available support resources may be relevant when interpreting these findings. More broadly, the results underscore the potential importance of supportive interpersonal and educational environments for student well-being.

The findings indicate that psychological resilience among vocational medical students is associated with professional identity, perceived stress, social support, and self-rated health. Professional identity also partially mediated the relationship between ideological and political course experience and resilience. These results highlight several psychological and social correlates of resilience; however, due to the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects.

4.3. Limitations

Several limitations should be acknowledged.

First, the use of convenience sampling limits the generalizability of the findings, as participants were drawn from only one vocational medical college within a specific regional, institutional, and cultural context in China; therefore, the results may not be fully applicable to students from other regions, educational settings, or cultural backgrounds.

Second, the cross-sectional design prevents causal inferences; future longitudinal studies should track changes in resilience over time.

Third, the exclusive reliance on self-reported instruments may introduce response bias and potential common method bias, which could inflate the observed associations among the study variables. Additionally, one of the key instruments was self-designed and lacked external psychometric validation, which may limit the interpretability and generalizability of findings derived from that measure.

Finally, although the proposed model explained 58.3% of the variance, unmeasured variables such as personality traits and coping styles may also contribute to resilience and merit further investigation.

5. Conclusion

Vocational medical students in China exhibit a moderate-to-high level of psychological resilience, associated with multiple factors such as gender, academic year, academic stress, professional identity, ideological and political education experience, and social support.²⁷

Among these, professional identity, IPEC experience, and social support emerged as the strongest positive predictors, whereas perceived stress acted as the primary negative factor.

Moreover, professional identity served as a partial mediator between ideological and political education experience and psychological resilience.²⁸

Based on the observed associations, a four-dimensional framework may be used by institutions to organize resilience-support efforts, including:

(1) Tiered intervention,

(2) Professional empowerment,

(3) Ideological-political integration, and

(4) Comprehensive support enhancement.

Institutions may prioritize students with higher academic stress or poorer self-rated health, and monitor whether changes in professional identity, perceived stress, social support, and resilience scores accompany implementation. Because this was a cross-sectional study, these findings should be interpreted as associations rather than causal effects.

Supplemental Material

Supplemental Material - Psychological Resilience Among Vocational Medical Students in China: The Mediating Role of Professional Identity in the Relationship With Ideological and Political Education Experience

Supplemental Material for Psychological Resilience Among Vocational Medical Students in China: The Mediating Role of Professional Identity in the Relationship With Ideological and Political Education Experience by Xiaodong Xu, Guoming Wang, Ying Liu and Xu Li in Journal of Medical Education and Curricular Development.

Supplemental Material

Supplemental Material - Psychological Resilience Among Vocational Medical Students in China: The Mediating Role of Professional Identity in the Relationship With Ideological and Political Education Experience

Supplemental Material

Supplemental Material - Psychological Resilience Among Vocational Medical Students in China: The Mediating Role of Professional Identity in the Relationship With Ideological and Political Education Experience

Footnotes

ORCID iD

Xu Li

Ethical Considerations

Ethics statement: This study was approved by the Ethical Review Board of Cangzhou Medical College (Ethics approval No. 20251127), and informed consent was obtained from all participants.

Consent to Participate

Written informed consent was obtained from all participants prior to participation. All participants in this study were adults and provided their own informed consent electronically.

Author Contributions

Xiaodong Xu: Manuscript drafting. Guoming Wang: Data collection. Ying Liu: Data analysis. Xu Li: Manuscript drafting, Manuscript critical revision. All authors have read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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