The multifactor chain mediation model of anxiety in the MSM population: the pathways of perceived social support, self-esteem, and psychological resilience

This study investigates how perceived social support is associated with anxiety among men who have sex with men (MSM). A cross-sectional online survey was conducted from March to June, 2024, recruiting 1,070 MSM participants via internet platforms. Measures included the Perceived Social Support Scale-12 (PSSS-12), Self-Esteem Scale-10 (SES), Connor-Davidson Resilience Scale-25 (CD-RISC-25), and Generalized Anxiety Disorder Scale (GAD-7). Using PROCESS Model 6 and the Bootstrap method, a significant negative correlation was found between perceived social support and anxiety (r = − 0.187, P < 0.01). The total effect of perceived social support on anxiety was − 0.0970 (95% CI: − 0.1181 to − 0.0759), with mediation accounting for 53.92% of the total effect. Specifically, self-esteem (effect value = − 0.0444) and psychological resilience (effect value = − 0.0054) significantly mediated the relationship, accounting for 45.77% and 5.57% of the total mediation effect, respectively. The joint indirect effect through self-esteem and psychological resilience accounted for an additional 2.58% of the total effect. The study highlights that social support is linked to lower anxiety in MSM by enhancing self-esteem and resilience, emphasizing their importance for MSM mental health.