Positive childhood experiences on flourishing mediated by meaning in life in Chinese undergraduate nursing students: A cross-sectional study

Aim: To examine the associations of positive childhood experiences (PCEs) with positive mental well-being (i.e. meaning in life and flourishing) in Chinese undergraduate nursing students. The mediation effect of meaning in life on the association between PCEs and flourishing was investigated.Background: Mental health problems, such as high stress, have been prevalent in nursing students. Less is known about positive well-being that could be independent of mental health problems.Design: This was a cross-sectional study in Chinese nursing students of age & GE; 18 years enrolled in either three-year associate degree or four-year bachelor's degree program at 25 different universities across mainland China.Methods: PCEs were measured using the 10-item Benevolent Childhood Experiences scale on perceived relational and internal safety and security, positive and predictable quality of life, and interpersonal support by age 18. Measures of positive mental well-being included the Secure Flourish Index on flourishing and the Meaning in Life Questionnaire on presence of meaning and searching for meaning. Associations were analyzed using multivar-iable linear regression adjusting for perceived stress.Results: Of 2105 participants, 87.7% were female, the mean [SD] age was 19.8 [1.6] years. More PCEs were associated with higher flourishing (adjusted b=6.82, 95% CI 6.23, 7.41, 13 = 0.44), presence of meaning (adjusted b=0.91, 95% CI 0.75, 1.06, 13 = 0.24), and searching for meaning (adjusted b=0.67, 95% CI 0.49, 0.84, 13 = 0.17). Presence of meaning (indirect effect: adjusted b=1.57, 95% CI 1.27, 1.89) and searching for meaning (indirect effect: adjusted b=0.84, 95% CI 0.60, 1.08) partially mediated 23% and 12% of the association between PCEs and flourishing, respectively.Conclusions: PCEs showed dose-response associations with meaning in life and flourishing in Chinese under-graduate nursing students, and the associations remained independent of perceived stress. The association be-tween PCEs and flourishing was mediated through meaning in life. Higher meaning of life and flourishing associated with more PCEs highlighted the importance of increasing awareness and early screening of PCEs in nursing schools. The mediation effects of meaning in life warranted targeted interventions for helping students with fewer PCEs to flourish.