Background <p>This study examines the associations among coping styles, resilience and mental health symptoms among Chinese first-year medical students. It highlights the significance of understanding coping mechanisms and resilience in relation to the unique academic stressors medical students face, particularly during their first year.</p> Methods <p>The study involved 2,000 first-year medical students aged 16 to 22 from medical universities and colleges in China. Participants completed validated questionnaires, including the Connor-Davidson Resilience Scale (for resilience), the Simple Coping Styles Questionnaire (for coping styles), and the Symptom Checklist-90 (for mental health symptoms). Regression analysis was conducted to identify associations with mental health symptoms, and structural equation modeling was used to explore the mediating effects of coping styles on the relationship between resilience and mental health symptoms.</p> Results <p>Both resilience and coping styles were significantly associated with mental health symptoms. Structural equation modeling indicated that positive and negative coping styles partially mediated the relationship between resilience and mental health symptoms.</p> Conclusions <p>This study suggests that resilience is related to mental health through its association with coping styles among first-year medical students. The findings may inform the design of tailored psychological interventions to support this population’s mental well-being.</p>