This study is a cross-sectional study that used cluster sampling to select 957 undergraduate students majoring in eldercare services from four provinces in China, Liaoning, Shandong, Guangxi, and Yunnan, from September to November 2024. The samples for this study were selected from four geographical regions in China: Liaoning Province represents the Northeast region, Shandong Province represents East China, Guangxi Province represents South China, and Yunnan Province represents the Southwest region. These provinces encompass a broad spectrum of geographical, economic, and social diversity, ranging from coastal to inland areas and from developed to developing regions, thereby reflecting the key geographical, economic, and social characteristics of China. A questionnaire survey was conducted on their academic burnout, self-efficacy, depression, and social support. This research was conducted using the “Questionnaire Star” platform. This platform is a widely popular, highly functional and personalized questionnaire design system that can be used to publish instructions and questionnaires. The researchers clearly explained the purpose of data collection, anonymity and confidentiality measures on the questionnaire’s homepage to the participants, and obtained their informed consent. In this study, questionnaires with incomplete responses, identical answer patterns, or response times shorter than 150 s were excluded. A total of 780 valid questionnaires were collected, resulting in a response rate of 81.5%.

This study employed SPSS 22.0 for statistical analysis. A P-value less than 0.05 in both tails indicated statistical significance. Using t-test to explore the scores and significant differences of depression, self-efficacy, academic burnout, and social support among undergraduate students majoring in eldercare services with different demographic factors. Pearson correlation analysis was used to explore the correlations. Using PROCESS Version 4.0 of SPSS for mediation effect analysis, Model 4 for mediation analysis, and Model 8 for moderated mediation effect analysis. Tooking academic burnout as the dependent variable, depression as the independent variable, self-efficacy as the mediating variable, and social support as the moderating variable to include them in the model for analysis. A total of 5,000 samples were simulated using the bootstrap method. If the 95% bias-corrected confidence interval did not include 0, the results were significant. The test standard α was set at 0.05.

This research complies with ethical standards and has been approved by the Ethics Committee of Shenyang Medical College.

Among the 780 students, 150 were male (19.20%), and 630 were female. The ratio of male to female was quite different. There were 457 students under the age of 20 (58.60%), and 323 students aged 20 or above (41.40%). Six hundred and twelve students (78.50%) were from medical colleges, and 168 students (21.50%) were from comprehensive colleges. A total of 358 students (45.90%) were freshmen, and 422 students (54.10%) were sophomores or above. A total of 358 students (31.00%) were the only child in the family, and 538 students (53.80%) were not. A total of 444 students (56.90%) had fathers with educational attainment of junior high school level or below, and 336 students (43.10%) had fathers with educational attainment above the middle school level. A total of 471 students (60.40%) had mothers with educational attainment of junior high school level or below, and 309 students (39.60%) had mothers with educational attainment above the junior high school level. A total of 125 students (16.00%) received scholarships, and 655 students (84.00%) did not receive scholarships. A total of 381 students (48.80%) exercised for less than 30 min a day, and 399 students (51.20%) exercised for more than 30 min. A total of 713 students (91.40%) slept for less than 6 h, and 67 students (8.60%) slept for more than 6 h. Only 40 students (5.10%) smoked. 622 students (84.90%) were raised by both parents.

Independent samples t-tests were conducted to examine differences in depression, self-efficacy, learning burnout, and perceived social support across various demographic variables. First, the results indicated that male students, those aged ≥ 20, students from medical universities, senior students, non-children, individuals with less than 30 min of daily exercise, and smokers were more likely to experience higher levels of depression (P < 0.05). The Cohen’s d ranged from 0.491 to 0.500, which falls within the range of a medium effect according to conventional benchmarks. This suggests that the aforementioned demographic variables do exert some influence on depression, although the magnitude of this effect is moderate. Second, the analysis revealed that students aged < 20, only children, those whose parents had a high school education or higher, scholarship recipients, and those engaging in 30 min or more of daily exercise exhibited higher levels of self-efficacy (P < 0.05). The Cohen’s d ranged from 0.663 to 0.671, which falls within the range of a moderately large effect according to standard effect size conventions. This indicates that the aforementioned demographic variables have a notable influence on self-efficacy, with a relatively strong effect.

Third, the findings showed that male students, those aged 20 or older, students from medical colleges, non-only children, individuals whose parents had a high school education or lower, those not raised by their parents, non-scholarship recipients, individuals with less than 30 min of daily exercise, and smokers were more prone to learning burnout (P < 0.05). The Cohen’s d ranged from 0.582 to 0.590, which falls within the range of a moderately large effect according to standard effect size criteria. This indicates that the aforementioned demographic variables have a significant impact on learning burnout, with a strong effect. Fourth, the results indicated that female students, those under 20 years old, students from comprehensive colleges, freshmen, only children, individuals whose parents had a high school education or above, those raised by their parents, scholarship recipients, individuals with 30 min or more of daily exercise, and non-smokers reported higher levels of perceived social support (P < 0.05). The Cohen’s d ranged from 1.084 to 1.096, which falls within the range of a large effect size according to established effect size benchmarks. This indicates that the aforementioned demographic variables have a substantial impact on social support, with a strong effect. The detailed findings are presented in Tables 1, 2.

Pearson correlation analysis was conducted on depression, self-efficacy, academic burnout, and social support. The results showed that depression was significantly negatively correlated with self-efficacy (r = −0.385, P < 0.01), depression was significantly positively correlated with academic burnout (r = 0.646, P < 0.01), and self-efficacy was significantly negatively correlated with academic burnout (r = −0.486, P < 0.01). The details are presented in Table 3.

The model 4 in the process macro compiled by Hayes was used to test the mediating effect of self-efficacy between depression and academic burnout. The results are shown in Tables 4, 5. The negative effect of daily exercise time on students’ academic burnout was significant (β = −0.075, P < 0.05). The positive effect of depression on the academic burnout of undergraduate students majoring in eldercare services was significant (β = 0.615, P < 0.001). After adding the mediating variable of self-efficacy, the positive predictive effect of depression on academic burnout remained significant (β = 0.498, P < 0.01), and depression showed a significant negative effect on self-efficacy (β = −0.367, P < 0.01), while self-efficacy also showed a significant negative effect on academic burnout (β = −0.319, P < 0.01). The research results showed that the total effect value was 0.731, the direct effect value was 0.592, and the mediating effect value of self-efficacy between depression and academic burnout was 0.139. The direct effect accounted for 80.98% of the total effect, and the mediating effect accounted for 19.02% of the total effect, with a 95% confidence interval of 0.100–0.183, not including zero, indicating that self-efficacy can directly and indirectly predict academic burnout (Figure 2).

The regulatory effect of social support was examined using Model 8 from the “process” macro developed by Hayes. The results are presented in Table 6 and Figure 3. After including social support in the model, the interaction term between depression and social support showed a significant negative predictive effect on self-efficacy (β = −0.203, P < 0.01), and a significant positive effect on academic burnout (β = 0.106, P < 0.01). This indicates that social support can play a regulatory role in the prediction of self-efficacy by depression, and also in the prediction of academic burnout by depression. Through simple slope analysis, the regulatory effect of social support between depression and self-efficacy is shown in Figure 4. At high levels of social support, as the depression level increases, the self-efficacy level shows a downward trend (B_simple = −0.491, P < 0.01). The regulatory effect of social support between depression and academic burnout is shown in Figure 5. At both high and low levels of social support, as the depression level increases, the academic burnout level shows an upward trend (B_simple = 0.670, P < 0.01; B_simple = 0.440, P < 0.001). Compared to the low group, the positive effect of the high group is stronger. With the increase in the level of social support, the effect of depression on self-efficacy shows a gradually increasing trend, and the mediating effect of self-efficacy between depression and academic burnout also shows an upward trend, as shown in Table 7.

Currently, the elderly care industry is predominantly staffed by female workers, which aligns with the observation that the proportion of female participants in this study was significantly higher than that of male participants. The findings of this study are therefore representative and applicable to the broader elderly care industry. The study revealed that the detection rate of academic burnout among undergraduate students majoring in elderly services was 26.92%, which is lower than the 49% reported by Thun-Hohenstein et al. (2021) and the 44% academic burnout rate observed among medical students globally (Frajerman et al., 2019). This may be related to differences in survey schools and survey scales. Compared with Vasconcelos’s 20.0% detection rate of academic burnout among Brazilian nursing students and Kong’s 23.0% research results, this difference can be attributed to the larger sample size used in this study, which reduced sampling errors, improved the representativeness and accuracy of the research results, and thus more comprehensively revealed the detection rate of academic burnout among undergraduate students majoring in eldercare services (Kong et al., 2023; Vasconcelos et al., 2020).

Among the undergraduate students majoring in eldercare services in this study, depression, self-efficacy, academic burnout, and social support were significantly correlated pairwise. Depression was significantly negatively correlated with self-efficacy and social support, meaning that as depression levels increased, students’ self-efficacy significantly decreased. Depression was significantly positively correlated with academic burnout, meaning that as depression levels increased, academic burnout also increased, which is consistent with the results of related studies, and the hypothesis one was established (Liu et al., 2024; Meier and Kim, 2022). Academic burnout is a long-term, accumulated psychological state, manifested as emotional exhaustion, decreased academic efficacy, and negative attitudes toward learning. These characteristics are very similar to the core symptoms of depression. Students majoring in eldercare services frequently encounter aging, diseases, and end-of-life care scenarios regularly, which leads to the loss of interest in studies and life, and subsequently, the emergence of depression. In this situation, students’ learning efficiency may decrease, their learning state may become negative, and they may develop academic burnout. Therefore, it is crucial for students majoring in eldercare services to maintain a positive mindset while enhancing self-efficacy and increasing social support, which can effectively reduce academic burnout.

The mediation effect test shows that self-efficacy plays a partial mediating role between depression and academic burnout, indicating that depression not only directly predicts learning burnout but also can influence academic burnout through self-efficacy. This is consistent with the previous research results, and research hypothesis two is confirmed (Zhu et al., 2023). The theory of self-efficacy holds that self-efficacy is a protective factor against stress, which will affect an individual’s attitude and behavior in specific situations, thereby influencing their effort and perseverance. Depressive emotions may lead students to have a negative evaluation of academic goals; this cognitive bias further reduces their effort level, forming a vicious cycle of “low efficacy-high burnout.” Undergraduate students with depressive emotions have lower learning adaptability and are more likely to experience setbacks, despair, and hopelessness (Zhang et al., 2022), which may cause a decrease in self-efficacy, leading students to believe that they cannot complete learning tasks. When students believe that they cannot effectively utilize their energy, they will have negative expectations for good academic performance. Therefore, students should actively adopt effective strategies to enhance self-efficacy, thereby maintaining a good mindset, having high-level learning motivation, seeking social support, participating in sports activities, learning relaxation techniques, etc., to overcome negative emotions, and thereby reducing the negative impact of depressive emotions on academic burnout.

The adjusted mediating effect test shows that the product term of depression and social support can significantly predict self-efficacy. This indicates that social support can effectively regulate the impact of depression on self-efficacy, thus confirming hypothesis three. Specifically, when students receive a high level of social support, the negative impact of depression on self-efficacy will be reduced; the product term of depression and social support can also significantly predict academic burnout, indicating that social support can also effectively regulate the impact of depression on academic burnout, thus confirming hypothesis four. When students have a lower level of social support, the impact of depression on academic burnout will increase. That is to say, when undergraduate students majoring in eldercare services are in a state of depression, it is appropriate to increase the intensity of social support to reduce the adverse effects of depression on academic burnout, which is consistent with the existing research results (Cheng et al., 2020; Meier and Kim, 2022). This is also consistent with the buffering hypothesis, which holds that social support provides an increase in coping ability to alleviate the negative effects of stress (Yuan et al., 2025). Social support, as an important psychological resource, reduces the negative impact of academic burnout on depression through providing emotional comfort, information support, and practical assistance. Due to the long-term impact of depression, students with a high degree of academic burnout may exhibit avoidance behavior in learning, show a cold attitude toward things, reduce social interaction, and thus have limited access to actual support (Kim et al., 2018). With the decrease in social support and the increase in isolation, students’ participation in academic and daily activities may decline, thereby forming a cycle of negative cognition and behavior reinforcement. Therefore, to alleviate the impact of depression on the academic burnout of undergraduate students majoring in eldercare services, in the process of mental health intervention, attention should be paid to improving their social support level, especially from family, friends, and school.