Department of Psychology, Faculty of Humanities, University of Kashan, Iran
10.22062/sdme.2026.201529.1631
Abstract
Background: Medical students often face considerable psychological challenges, jeopardizing their well-being. Character strengths and resilience are key constructs in positive psychology that may enhance flourishing, yet their underlying mechanisms require further investigation in medical education contexts. Objectives: This study aimed to examine the relationship between character strengths and flourishing among Iranian medical students, focusing on the mediating role of resilience. Methods: A total of 387 medical students were selected through multi-stage cluster sampling. Participants completed the Brief Strengths Test (BST), the Connor-Davidson Resilience Scale (CD-RISC-10), and Rashid & Seligman flourishing inventory. Data were analyzed using structural equation modeling (SEM) and bootstrapping procedures. Results: SEM revealed that character strengths had a significant direct effect on flourishing (β = 0.425, P < 0.01) and an indirect effect through resilience. Bootstrapped analyses confirmed a significant partial mediation, indicating that resilience accounts for a meaningful portion of the link between character strengths and flourishing (indirect effect β = 0.204, P < 0.01). Conclusion: These findings underscore the dual role of character strengths in promoting flourishing directly and indirectly by enhancing resilience. Strengths-based educational interventions and resilience-building programs may foster sustainable well-being in medical students, especially within demanding academic environments.
Frajerman A, Morvan Y, Krebs MO, Gorwood P, Chaumette B. Burnout in medical students before residency: a systematic review and meta-analysis. Eur Psychiatry. 2019; 55:36-42. doi: 1016/j.eurpsy.2018.08.006. PMID: 30384110
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016; 316(21): 2214-2236. doi: 1001/jama.2016.17324. PMID: 27923088 PMCID: PMC5613659
Lu L, Ye C, Xu R, Feng H, Liu B. Psychological resilience and perceived stress among Chinese medical students: mediation between optimistic intelligence quotient and adversity quotient. BMC Med Educ. 2024; 24(1):1358. doi: 1186/s12909-024-06287-0. PMID: 39587588 PMCID: PMC11590519
Peng P, Hao Y, Liu Y, Chen S, Wang Y, Yang Q, et al. The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis. J Affect Disord. 2023; 321:167-181. doi: 1016/j.jad.2022.10.040. PMID: 36341802 PMCID: PMC9613786
Aghajani Liasi G, Mahdi Nejad S, Sami N, Khakpour S, Ghorbani Yekta B. The prevalence of educational burnout, depression, anxiety, and stress among medical students of the Islamic Azad University in Tehran, Iran. BMC Med Educ. 2021;21(1):471. doi: 1186/s12909-021-02874-7. PMID: 34482821 PMCID: PMC8418739
Ashrafi A, Kadhum M, Molodynski A, Bhugra D. Mental health and wellbeing among Iranian medical students: a descriptive study. Int J Soc Psychiatry. 2022;68(6):1248-1252. doi: 1177/00207640211047880. PMID: 34553630
Almutairi H, Alsubaiei A, Abduljawad S, Alshatti A, Fekih-Romdhane F, Husni M, et al. Prevalence of burnout in medical students: A systematic review and meta-analysis. Int J Soc Psychiatry. 2022; 68(6): 1157-1170. doi: 1177/00207640221106691. PMID: 35775726
Yee LY, Yusoff MSB. Prevalence and sources of stress among medical students in Universiti Sains Malaysia and Universiteit Maastricht. Education in Medicine Journal. 2013;5(4): 34-41. doi: 5959/eimj.v5i4.190.
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-49. doi: 1111/medu.12927. PMID: 26695473
Pokhrel NB, Khadayat R, Tulachan P. Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: a cross-sectional study. BMC Psychiatry. 2020; 20(1):298. doi: 1186/s12888-020-02645-6. PMID: 32539732 PMCID: PMC7294639
Jaafari Z, Farhadi A, Lari FA, Mousavi FS, Moltafet H, Dashti E, et al. Prevalence of depression in Iranian college students: A systematic review and meta-analysis. Iranian Journal of Psychiatry and Behavioral Sciences. 2021;15(1):e101524. doi: 5812/ijpbs.101524.
Seligman MEP, Csikszentmihalyi M. Positive Psychology: An Introduction. In: Csikszentmihalyi M. Flow and the Foundations of Positive Psychology. Dordrecht: Springer; 2014. doi: 1007/978-94-017-9088-8_18.
Butler J, Kern ML. The PERMA-Profiler: A brief multidimensional measure of flourishing. International Journal of Wellbeing. 2016;6(3): 1-48. doi: 5502/ijw.v6i3.526.
Slavin SJ. Resilience and mental health: How we can help medical students flourish. Med Teach. 2023; 45(1):3-5. doi: 1080/0142159X.2022.2136930. PMID: 36306378
Slavin S. Reimagining well-being initiatives in medical education: shifting from promoting wellness to increasing satisfaction. Acad Med. 2021; 96(5):632-634. doi: 1097/ACM.0000000000004023. PMID: 33635840
Maurana CA, Fritz JD, Witten AA, Williams SE, Ellefson KA. Advancing flourishing as the north star of medical education: A call for personal and professional development as key to becoming physicians. Med Teach. 2024;46(12):1539-1543. doi: 1080/0142159X.2024.2412791. PMID: 39481004
Kelly-Hedrick M, Iuliano K, Tackett S, Chisolm MS. Medical student flourishing before and during the COVID-19 pandemic at one US institution. MedEdPublish. 2023;12:28. doi: 12688/mep.19094.2. PMID: 36974117 PMCID: PMC10039319
Lebares CC, Greenberg AL, Shui A, Boscardin C, van der Schaaf M. Flourishing as a measure of global well-being in first year residents: a pilot longitudinal cohort study. J Med Educ Curric Dev. 2021; 8: 23821205211020758. doi: 1177/23821205211020758. PMID: 34104793 PMCID: PMC8170288
Tang X, Li Y, Duan W, Mu W, Cheng X. Character strengths lead to satisfactory educational outcomes through strength use: A longitudinal analysis. Front Psychol. 2019; 10:1829. doi: 3389/fpsyg.2019.01829. PMID: 31507473 PMCID: PMC6718633
Wagner L, Holenstein M, Wepf H, Ruch W. Character strengths are related to students’ achievement, flow experiences, and enjoyment in teacher-centered learning, individual, and group work beyond cognitive ability. Front Psychol. 2020; 11:1324. doi: 3389/fpsyg.2020.01324. PMID: 32765332 PMCID: PMC7378955
Park N, Peterson C, Seligman ME. Strengths of character and well-being. Journal of Social and Clinical Psychology. 2004;23(5):603-19. doi: 1521/jscp.23.5.628.50749.
Lavy S. A review of character strengths interventions in twenty-first-century schools: Their importance and how they can be fostered. Applied Research in Quality of Life. 2020;15(2): 573-96. doi: 1007/s11482-018-9700-6.
Hausler M, Strecker C, Huber A, Brenner M, Höge T, Höfer S. Associations between the application of signature character strengths, health and well-being of health professionals. Front Psychol. 2017; 8:1307. doi: 3389/fpsyg.2017.01307. PMID: 28824492 PMCID: PMC5534439
Harzer C, Ruch W. The relationships of character strengths with coping, work-related stress, and job satisfaction. Front Psychol. 2015; 6:165. doi: 3389/fpsyg.2015.00165. PMID: 25767452 PMCID: PMC4341515
Littman-Ovadia H, Niemiec RM. Character Strengths and Mindfulness as Core Pathways to Meaning in Life. In: Russo-Netzer P, Schulenberg S, Batthyany A. (eds) Clinical Perspectives on Meaning. Cham: Springer; 2016. doi: 1007/978-3-319-41397-6_19.
Martin AJ, Marsh HW. Academic resilience and its psychological and educational correlates: A construct validity approach. Psychology in the Schools. 2006;43(3):267-81. doi: 1002/pits.20149.
Wang Q, Sun W, Wu H. Associations between academic burnout, resilience and life satisfaction among medical students: a three-wave longitudinal study. BMC Med Educ. 2022;22(1):248. doi: 1186/s12909-022-03326-6. PMID: 35382810 PMCID: PMC8980514
Blanchard T, McGrath, R. E., & Jayawickreme, E. Resilience in the face of interpersonal loss: The role of character strengths. Appl Psychol Health Well Being. 2021;13(4):817-34. doi: 1111/aphw.12273. PMID: 33876863
Karris Bachik MA, Carey G, Craighead WE. VIA character strengths among US college students and their associations with happiness, well-being, resiliency, academic success and psychopathology. The Journal of Positive Psychology. 2021;16(4):512-25. doi: 1080/17439760.2020.1752785.
Shoshani A, Slone M. The resilience function of character strengths in the face of war and protracted conflict. Front Psychol. 2016; 6:2006. doi: 3389/fpsyg.2015.02006. PMID: 26793139 PMCID: PMC4709440
Martínez-Martí ML, Theirs CI, Pascual D, Corradi G. Character strengths predict an increase in mental health and subjective well-being over a one-month period during the COVID-19 pandemic lockdown. Front Psychol. 2020; 11:584567. doi: 3389/fpsyg.2020.584567. PMID: 33192913 PMCID: PMC7609545
De la Fuente J, Urien B, Luis EO, González-Torres MC, Artuch-Garde R, Balaguer A. The proactive-reactive resilience as a mediational variable between the character strength and the flourishing in undergraduate students. Front Psychol. 2022; 13:856558. doi: 3389/fpsyg.2022.856558. PMID: 35664176 PMCID: PMC9159511
Ungar M. The social ecology of resilience: A handbook of theory and practice. New York: Springer Science & Business Media; 2011.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78. doi: 1037//0003-066x.55.1.68. PMID: 11392867
Neufeld A, Malin G. How medical students’ perceptions of instructor autonomy-support mediate their motivation and psychological well-being. Med Teach. 2020;42(6):650-656. doi: 1080/0142159X.2020.1726308. PMID: 32074464
Neufeld A, Malin G. Exploring the relationship between medical student basic psychological need satisfaction, resilience, and well-being: a quantitative study. BMC Med Educ. 2019; 19(1):405. doi: 1186/s12909-019-1847-9. PMID: 31690292 PMCID: PMC6833185
Quinlan D, Swain N, Vella-Brodrick DA. Character strengths interventions: Building on what we know for improved outcomes. Journal of Happiness Studies. 2012;13(6):1145-63. doi: 1007/s10902-011-9311-5.
Hobfoll SE. Conservation of resources: a new attempt at conceptualizing stress. Am Psychol. 1989;44(3):513-24. doi: 1037//0003-066x.44.3.513. PMID: 2648906
Jackson DL. Revisiting sample size and number of parameter estimates: Some support for the N: q hypothesis. Structural Equation Modeling. 2003;10(1):128-41. doi: 1207/S15328007SEM1001_6.
Khanjani M, Shahidi S, Fathabadi J, Mazaheri M, Shokri O. Factor structure and psychometric properties of the positive psychotherapy inventory (PPTI). Journal of Applied Psychology. 2014;8(1):29. [In Persian].
Peterson C, Seligman MEP. Character strengths and virtues: A handbook and classification. New York: Oxford University Press; American Psychological; 2004.
Jabbari M, Shahidi S, Panaghi L, Mazaheri MA, Oberle E. Examining the link between character strengths and positive and negative mental health indicators in Iranian adolescents. Journal of Psychoeducational Assessment. 2021;39(5):610-22. doi: 1177/07342829211005300.
Connor KM, Davidson JR. Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depress Anxiety. 2003;18(2):76-82. doi: 1002/da.10113. PMID: 12964174
Campbell‐Sills L, Stein MB. Psychometric analysis and refinement of the connor–davidson resilience scale (CD‐RISC): Validation of a 10‐item measure of resilience. J Trauma Stress. 2007;20(6):1019-28. doi: 1002/jts.20271. PMID: 18157881
Rezaeipandari H, Mohammadpoorasl A, Morowatisharifabad MA, Shaghaghi A. Psychometric properties of the Persian version of abridged Connor-Davidson Resilience Scale 10 (CD-RISC-10) among older adults. BMC Psychiatry. 2022;22(1):493. doi: 1186/s12888-022-04138-0. PMID: 35869455 PMCID: PMC9308300
Schafer JL, Graham JW. Missing Data: Our view of the state of the art. Psychol Methods. 2002;7(2):147-77. PMID: 12090408
Little RJA, Rubin DB. Statistical analysis with missing data. New York, NY: Wiley; 2002.
Kunnan AJ. An introduction to structural equation modelling for language assessment research. Language Testing. 1998;15(3): 295-332. doi: 1191/026553298675279428.
Meyers LS, Gamst G, Guarino AJ. Applied multivariate research: Design and interpretation. Los Angeles: Sage Pub; 2016. doi: 4135/9781071802687.
Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: a Multidisciplinary Journal. 1999;6(1):1-55. doi: 1080/10705519909540118.
Fredrickson BL. The role of positive emotions in positive psychology: The broaden and build theory of positive emotions. Am Psychol. 2001; 56(3): 218-26. doi: 1037//0003-066x.56.3.218. PMID: 11315248 PMCID: PMC3122271
Kobau R, Seligman ME, Peterson C, Diener ED, Zack MM, Chapman D, et al. Mental health promotion in public health: Perspectives and strategies from positive psychology. Am J Public Health. 2011; 101(8): e1-9. doi: 2105/AJPH.2010.300083. PMID: 21680918 PMCID: PMC3134513
Sadoughi, M. (2026). How Character Strengths Promote Flourishing in Medical Students: The Mediating Role of Resilience. (e93051). Strides in Development of Medical Education, 23(1), e93051 https://doi.org/10.22062/sdme.2026.201529.1631
MLA
Sadoughi, M. "How Character Strengths Promote Flourishing in Medical Students: The Mediating Role of Resilience" .e93051 , Strides in Development of Medical Education, 23, 1, 2026, e93051. doi: 10.22062/sdme.2026.201529.1631
HARVARD
Sadoughi, M. (2026). 'How Character Strengths Promote Flourishing in Medical Students: The Mediating Role of Resilience', Strides in Development of Medical Education, 23(1), e93051. doi: 10.22062/sdme.2026.201529.1631
CHICAGO
Sadoughi, M., "How Character Strengths Promote Flourishing in Medical Students: The Mediating Role of Resilience." Strides in Development of Medical Education, 23 1 (2026): e93051, doi: 10.22062/sdme.2026.201529.1631
VANCOUVER
Sadoughi M. How Character Strengths Promote Flourishing in Medical Students: The Mediating Role of Resilience. Strides Dev Med Educ. 2026;23(1):e93051. doi: 10.22062/sdme.2026.201529.1631