Social support and anxiety, a moderated mediating model

Abstract

This study aims to explore the relationship between social support and anxiety among college students, as well as the mediating role of resilience and the moderating effect of physical exercise. A questionnaire survey was conducted to measure levels of social support, resilience, physical exercise, and anxiety among 1097 college students from two universities in Hunan Province. A total of 997 valid questionnaires were collected, with 562 from male students and 435 from female students. Statistical analysis revealed that social support significantly negatively predicts anxiety, with family support being the most prominent. Additionally, the impact of social support on anxiety is moderated by physical exercise. Resilience plays a significant mediating role between social support and anxiety. Enhancing resilience through physical exercise can help prevent anxiety-related behaviors among college students and improve their overall mental health.

Introduction

Anxiety is an unpleasant feeling characterized by unease, tension, worry, fear, or apprehension, and it is one of the most commonly experienced emotions by humans¹. It is a normal response to stressors and typically persists for an extended period. While moderate anxiety can enhance an individuals ability to respond to urgent situations, excessive anxiety can significantly disrupt normal daily life². Research indicates that over the past 30 years, the prevalence of anxiety disorders among university students in Asia has surpassed 30%, and the global prevalence has exceeded 32%, with this trend continuing to intensify^3,4. This phenomenon underscores the widespread and urgent nature of contemporary students’ mental health issues. Anxiety often triggers a cascade of physical and psychological reactions, such as irritability⁵, feelings of suffocation⁶, and sleep disturbances⁷. Prolonged anxiety can lead to poor academic performance, increased dropout rates, and heightened risk of suicide^8–10. Therefore, timely attention to and effective management of anxiety among university students has become an essential responsibility and mission for society.

Existing research suggests that there are various methods to alleviate anxiety, with social support being a prominent focus of current studies^{11–16,100–102}. Social support refers to the functions performed by significant others (such as family members, friends, and broader social networks), including the provision of emotional, informational, and instrumental assistance¹⁷. It comprises three dimensions: family support, peer support, and other types of support¹⁸. The main effect hypothesis of social support posits that social support positively impacts individuals regardless of their stress levels¹⁹. Numerous studies have found that different dimensions of social support have varying effects and strategies for alleviating anxiety. Family support is considered a crucial resource in combating anxiety; the sense of safety and stability in the family environment, along with the emotional and practical assistance provided by the family, contributes to enhancing individual resilience²⁰ and effectively reducing anxiety levels^21,22. Peer support can lower anxiety levels by providing emotional support (reducing feelings of loneliness and distress) and sharing experiences²³, although this support varies by gender²⁴ and is reversible, meaning a decrease in peer support can potentially increase anxiety risk²⁵. Additionally, support from schools and communities can also mitigate anxiety to some extent^26–28. Based on these observations, this study hypothesizes that social support significantly predicts anxiety and that different dimensions of social support vary in their predictive power regarding anxiety.

Social support directly predicts anxiety by alleviating stress and enhancing coping abilities, with physical exercise moderating this effect and further enhancing the impact of social support on anxiety relief. The biopsychosocial model suggests that physical exercise reduces anxiety through physiological mechanisms (such as increasing endorphin levels), psychological mechanisms (such as improving self-efficacy and emotional regulation), and social mechanisms (such as providing social interaction opportunities)^29,103–106. Self-determination theory emphasizes that physical exercise can meet individuals’ basic psychological needs, such as autonomy, competence, and relatedness, thereby enhancing their ability to effectively utilize social support and reduce anxiety levels³⁰. Research has shown that physical exercise, as an easily accessible and effective non-pharmacological tool, regulates social support levels and thus more effectively alleviates anxiety and depressive symptoms through various means, including chronic disease prevention, cognitive and mental health enhancement, aging process delay, improved social belonging, and reduced social sensitivity^31–36. When individuals engage in physical exercise, positive psychological feedback leads to healthier psychological outcomes³⁷, and this positive lifestyle can further alleviate individual anxiety³⁸. Based on this evidence, this study hypothesizes that physical exercise strengthens the predictive power of social support on anxiety.

The prediction of anxiety by social support can be mediated by several variables, particularly resilience^39–42. Resilience is the capacity of individuals to self-adjust and adapt when facing adversity (such as stress or trauma)⁴³. The dynamic model of resilience posits that external resources used to meet psychological needs create internal resources that protect individuals from risk and promote healthy development⁴⁴. As a dynamic personal characteristic that can be developed, resilience plays a critical role in helping individuals overcome adversity, maintain and improve mental and physical health, and buffer negative emotions^45–47,107. Existing research has also revealed a positive facilitative relationship between social support and resilience^48–51. Family support is a key factor in the development of resilience, as its provision of a stable and supportive family environment can enhance individual resilience by reducing stress and boosting self-efficacy^52–54. Similarly, peer support is an important source of resilience. Good peer support provides emotional comfort, practical help, and social recognition, which all contribute to increasing individual resilience^55,56. Especially during adolescence, peer support is considered a significant factor in enhancing individuals’ ability to cope with challenges⁵⁷. Additionally, other forms of support also play a crucial role in enhancing resilience and promoting mental health^58–60. Therefore, multidimensional social support collectively enhances resilience, reduces psychological vulnerability in the face of adversity, and consequently reduces the occurrence of anxiety and other psychological issues^61–65. Another study has demonstrated that resilience, as a measure of stress coping ability, has been confirmed as an important therapeutic target for alleviating anxiety, depression, and stress responses⁴³. Similarly, multiple studies have shown a negative correlation between resilience and anxiety, indicating that individuals with higher resilience tend to have lower levels of anxiety^66–70. Based on this, the present study hypothesizes that resilience has a significant mediating effect on the relationship between social support and anxiety.

In summary, given the increasing prominence of mental health issues, finding effective methods for preventing and alleviating anxiety is crucial. While substantial research has investigated the interactions between social support, resilience, physical exercise, and anxiety, studies exploring the relationships among all four variables are relatively sparse and require further empirical investigation to reveal the underlying mechanisms and practical applications. Therefore, this study will use resilience as a mediating variable and physical exercise as a moderating variable to explore the predictive role of social support and its different dimensions on anxiety, aiming to provide additional empirical evidence for this field. The proposed hypothetical path model is illustrated in Fig. 1.

Fig. 1.

Proposes a moderation and mediation model.

Methods

Participants

This study was conducted in June 2024 using convenience sampling. Questionnaires were distributed via online electronic surveys in class group chats to 1097 college students at two universities in Hunan Province. The study adhered to the regulations of the Declaration of Helsinki. All participants voluntarily and freely participated. Prior to distributing the questionnaires, participants were informed about the survey content, data anonymity, confidentiality, usage, and their right to withdraw at any time. Informed consent was obtained online from all participants. Participants completed the electronic questionnaire in approximately 15 min. Data were screened to exclude responses with completion times shorter than 10 min and those with obvious patterned responses (i.e., all the items of the questionnaires select the same option.). The final analytic sample included 997 participants (562 males, 435 females; 360 freshmen, 257 sophomores, 192 juniors, 188 seniors; 262 in humanities, 611 in sciences, 124 in other fields; 274 only children, 723 not only children).

Measurement tools

Social support

To assess participants’ perceived social support, the study used the Chinese version of the Perceived Social Support Scale (PSSS) developed by Zimet et al. ¹¹⁶ and revised by Huang Li et al. ¹⁸. This scale includes three dimensions: family support, peer support, and other support¹⁸. The scale consists of 12 items with a 7-point rating system, wherescores range from 0 to 100, with 1 indicating “strongly disagree” and 7 indicating “strongly agree.” The total score for social support is the sum of the 12 items, with higher scores reflecting higher perceived social support levels⁷¹. In this study, the internal consistency of the three dimensions ranged from α = 0.840 to 0.923.

Resilience

To measure resilience, the study employed the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC), developed by Connor et al. (2003) and later revised by Yu et al. ¹¹⁷. This scale includes three dimensions: tenacity, strength, and optimism^43,72. The scale contains 25 items with a 5-point rating system, where scores range from 0 to 100, with 0 indicating “not at all true” and 4 indicating “very true.” The total score for resilience is the sum of the 25 items, with higher scores indicating greater resilience. In this study, the internal consistency of the scale was α = 0.970.

Physical exercise

To evaluate participants’ physical exercise levels, the study used the Chinese version of the International Physical Activity Questionnaire (IPAQ), developed by the International Consensus Group on Physical Activity Measurement (1997) and translated by Qu Ningning et al. (2004). The IPAQ includes five sections: work, household, transportation, leisure, and sedentary activities⁷². The scale consists of 27 items. Based on the IPAQ physical activity evaluation standards⁷³, participants’ exercise levels were categorized into low, moderate, and high.

Anxiety

To assess anxiety levels, the study employed the Generalized Anxiety Disorder Scale (GAD-7) developed by Spitzer et al.⁷⁴. The GAD-7 consists of 7 items, with scores ranging from 0 to 21, and a 0–3 point rating system, where 0 indicates “not at all” and 3 indicates “nearly every day.” The total score for anxiety is the sum of the 7 items, with higher scores reflecting more severe anxiety symptoms. Scores were categorized as follows: 0–4 indicates no anxiety symptoms, 5–9 indicates mild anxiety, 10–14 indicates moderate anxiety, and 15–21 indicates severe anxiety⁷⁵. In this study, the internal consistency of the scale was α = 0.945.

Statistical analysis

Statistical analyses were performed using SPSS 26.0 software. First, Harman’s single-factor test was used to assess common method bias in this study, with a threshold of less than 40% indicating no significant common method bias⁷⁶. Subsequent analyses included descriptive statistics, comparative analyses (t-tests), and Pearson correlation analyses (r) for demographic variables and key study variables. To test our hypotheses, the PROCESS macro plug-in (Models 4 and 5) in SPSS was utilized to analyze the relationships between social support and anxiety, and to examine the moderating effects of resilience and the mediating effects of physical exercise on this relationship⁷⁷. The PROCESS macro utilized 5000 bootstrap resamples to evaluate model tests and 95% confidence intervals (CI) estimation. A significant relationship was determined if the 95% CI excluded zero. Gender and Grade were controlled as covariates.

Results

Common method bias test

The common method bias test for this study revealed two factors with eigenvalues greater than 1. The first factor accounted for 34.52% of the total variance, which is below the 40% threshold. This indicates that the risk of common method bias is not significant in this study.

Correlation analysis

The results in Table 1 indicate that social support is significantly negatively correlated with college students’ anxiety (r = −0.398, p < 0.001), and significantly positively correlated with resilience (r = 0.506, p < 0.001). Resilience, in turn, is significantly negatively correlated with college students’ anxiety (r = −0.396, p < 0.001) and significantly positively correlate.

Table 1.

Correlation analysis.

Variables	1	2	3	4	5	6	7	8	9
1 Gender	-					-
2 Grade	−0.084**	-
3 Family support	0.024	0.022	-
4 Peer support	0.003	0.020	0.818***	-
5 Others support	0.026	0.014	0.831***	0.870***	-
6 Social support	0.018	0.020	0.937***	0.947***	0.951***	-
7 Anxiety	−0.016	−0.014	−0.378***	−0.371***	−0.379***	−0.398***	-
8 Resilience	0.024	0.009	0.475***	0.477***	0.483***	0.506***	−0.396***	-
9 Physical exercise	0.029	−0.028	0.304***	0.335***	0.304***	0.332***	−0.297***	0.171***	-
M	-	-	19.37	18.84	19.56	57.77	7.34	57.11	3159.26
Sd	-	-	6.09	5.76	5.66	16.55	5.82	21.10	2944.34

**: p<0.01; ***: p<0.001

Mediation model testing

After controlling for covariates, the results presented in Table 2 demonstrate that social support significantly negatively predict college students’ anxiety (β = −0.398, p < 0.001). Even with the inclusion of the mediator variable, resilience, social support to significantly negatively predict college students’ anxiety (β = −0.266, p < 0.001). Furthermore, the mediation model analysis reveals that social support significantly positively predict college students’ resilience (β =  0.506, p < 0.001), while resilience significantly negatively predicts college students’ anxiety (β = −0.261, p < 0.001).

Table 2.

Mediation model Testing.

	Anxiety		Resilience		Anxiety
	β	SE	β	SE	β	SE
Gender	−0.019	0.059	0.030	0.055	−0.011	0.057
Grade	−0.006	0.026	0.001	0.024	−0.006	0.025
Social Support	−0.398***	0.029	0.506***	0.027	−0.266***	0.033
Resilience					−0.261	0.033
R²	0.159		0.257		0.209
F	62.374***		114.323***		65.651***

***: p<0.001

Moderated mediation analysis

The results presented in Table 3; Fig. 2, and Fig. 3 indicate that after incorporating the moderator variable, the predictive effect of social support on college students’ anxiety remains significant (β = −0.165, p < 0.001). Additionally, physical exercise significantly predicts college students’ anxiety (β = −0.239, p < 0.001), and the interaction term between physical exercise and social support also significantly predicts college students’ anxiety (β = 0.123, p < 0.001). Further analysis reveals that at different levels of physical exercise (low, medium, high), only low and medium levels of physical exercise positively moderate the effect of social support on college students’ anxiety (see Table 4).

Table 3.

Moderated mediation model testing.

Variables	Resilience			Anxiety
	β	SE	t	β	SE	t
Gender	0.030	0.055	0.536	0.005	0.056	0.092
Grade	0.001	0.024	0.016	−0.009	0.025	−0.363
Social support(A)	0.506	0.027	18.494***	−0.165	0.035	−4.698***
Resilience				−0.228	0.033	−6.838***
physical exercise(B)				−0.239	0.033	−7.248***
A × B				0.123	0.035	3.553***
R²	0.257			0.249
F	114.323***			54.760***

***: p<0.001

Fig. 2.

Moderated mediation model (***: p < 0.001).

Fig. 3.

A simple slope plot of the moderating effect of different levels of physical activity on the relationship between social support and anxiety.

Table 4.

The moderating effect of different levels of physical activity between social support and anxiety in college students.

physical exercise levels	Effect size	SE	t	95% CI
Low	−0.288	0.041	−7.053***	−0.368, −0.208
Medium	−0.165	0.035	−4.698***	−0.234, −0.096
High	−0.043	0.056	−0.753	−0.153, 0.068

***: p<0.001.

Discussion

This study further explores the relationships between social support, resilience, physical exercise, and anxiety, and reveals the psychological mechanisms through which social support alleviates anxiety. The findings indicate that strengthening social support, enhancing resilience, and engaging in regular physical exercise can each significantly alleviate anxiety to varying degrees. This has profound implications and practical significance, as it not only provides diverse options for individuals coping with anxiety but also underscores the critical role of integrated intervention methods in promoting mental health, thereby helping individuals establish healthier and more positive lifestyles. Consequently, the study concludes that different dimensions of social support have a significant predictive effect on anxiety, with family support being the strongest predictor. Additionally, physical exercise enhances the predictive power of social support on anxiety, and resilience mediates the relationship between social support and anxiety, confirming the initial hypotheses of this study.

The results demonstrate a significant negative predictive effect of social support on anxiety, meaning that higher levels of social support are associated with lower levels of anxiety. This finding confirms the initial hypothesis of the study and aligns with previous research^78–80. Furthermore, family support emerges as the most significant predictor of anxiety, enriching the theoretical foundation of this field. Family serves as a crucial support system for individual mental health, playing an essential role in regulating emotions and managing stress⁸¹. In the face of emergencies, family support provides not only emotional comfort but also helps individuals develop effective coping strategies, thereby reducing anxiety⁸². Social support, in all its dimensions, can modulate negative emotions⁸³, enhance the ability to resist psychological stress, and maintain mental health⁸⁴. This study highlights the importance of social support as an effective buffering mechanism against anxiety, substantiating its role in preventing and alleviating anxiety and promoting mental health. This adds theoretical support for developing more proactive psychological intervention strategies.

The study reveals physical exercise significantly moderates anxiety, enhancing social support⁸⁵and suppressing anxiety⁸⁶. While individuals with high exerciselevels gain more social support than low-exercise peers, our analysis indicates a ceiling effect: social support improvements plateau at high exercise intensities due to resource saturation. Physical exercise improves psychological health behaviorally and neurologically^87,108–115, builds social networks, and mitigates bullying-related distress⁸⁸. Aerobic exercise (e.g., running) disrupts anxiety responses^89–91.For high-anxiety individuals, exercise directly reduces anxiety states. This alleviation corrects cognitive biases that cause underestimation of social support, weakening the inverse anxiety-support relationship. Critically, the non-significant moderation at high exercise levels (Table 4) dilutes the overall interaction strength (β = 0.123), explaining its small magnitude—a hallmark of nonlinear moderation.The anxiety-support moderation mechanism remains complex⁹², particularly regarding high-exercise thresholds. Promoting incremental exercise in low-activity groups maximizes benefits. Scientific regular exercise is essential for anxiety alleviation.

The study also finds that resilience mediates the relationship between social support and anxiety. Social support reduces anxiety levels by enhancing individual resilience, aligning with the initial hypothesis and consistent with previous research^39–42. Individuals with high levels of social support often have richer psychological and material resources, which enhances their resilience^93–95 and subsequently lowers their anxiety levels⁹⁶. Additionally, such individuals are more likely to approach challenges from a positive perspective and adopt adaptive behaviors to resolve difficulties, thereby reducing internal anxiety⁹⁷. Thus, emphasizing the importance of social support and encouraging individuals to actively utilize their resilience resources to overcome obstacles and reduce anxiety is crucial.

This study explores the multifaceted factors influencing anxiety, particularly emphasizing the interactive mechanisms between social support, resilience, and physical exercise, thereby enriching the theoretical foundation for anxiety prevention and alleviation. The results suggest that increasing social support levels, especially family support, can effectively enhance resilience and reduce anxiety. Furthermore, the study highlights the positive role of physical exercise in alleviating anxiety and its unique role as a moderator, encouraging people to incorporate physical exercise into their daily lives. In school education, considering the role of Acceptance and Commitment Therapy (ACT)⁹⁸ and weekly recall and elaboration of past events⁹⁹ in improving overall well - being among college students, interventions and counseling could be provided for students with high - stress levels identified through psychological testing. These findings are significant for developing more comprehensive and personalized anxiety intervention strategies and advancing societal attention and investment in mental health, ultimately promoting overall mental health improvement.

Limitations & recommendations

In conclusion, this study innovatively constructs a mediating model where social support influences anxiety through resilience and reveals the moderating role of physical exercise in this predictive process. It provides a new theoretical perspective and empirical evidence for anxiety research, enriching the theoretical framework of the field. The conclusions also have strong practical application value, providing scientific evidence for developing effective anxiety intervention measures and contributing to the precision and efficiency of mental health services. However, the study relies primarily on questionnaire-based surveys, lacks in-depth qualitative research. Additionally, based on cross-sectional data analysis with a limited sample size, demographic factors such as gender were not subjected to additional stratified or moderation analyses in methodological considerations. Consequently, the generalizability and representativeness of the findings may be constrained, limiting broad extrapolation of conclusions. Future research should expand sample sizes, conduct multi-center cross-regional investigations, thoroughly explore demographic differences (e.g., gender), further enhance the robustness and reliability of conclusions, and provide more precise guidance for anxiety prevention and intervention.

Conclusion

This study investigates the relationships among various dimensions of social support, resilience, physical exercise, and anxiety. It provides both theoretical and empirical evidence on how social support mitigates anxiety through resilience, and reveals the moderating role of physical exercise in this process. The findings suggest that engaging in physical exercise can significantly reduce anxiety and improve overall psychological well-being. The results indicate that social support, particularly family support, plays a crucial role in alleviating anxiety. Additionally, resilience acts as a mediator between social support and anxiety. Physical exercise further enhances the effectiveness of social support in reducing anxiety. Therefore, it is recommended that college students incorporate regular physical exercise into their daily routines to promote their physical and mental health. By increasing social support, enhancing resilience, and engaging in physical exercise, individuals can effectively manage and reduce anxiety. These findings have important implications for the development and implementation of mental health interventions, particularly in improving the psychological well-being of university students.

Author contributions

Liyuan Yang123456, Ning Wang123456, Dan Li1235, Xuesen Zhao125, Mofei Wen125, Yichi Zhang125, Yang Liu123456.1 Conceptualization; 2 Methodology; 3 Data curation; 4 Writing - Original Draft; 5 Writing - Review & Editing; 6 Funding acquisition.

Funding

This project was funded by the Graduate Education Innovation Program gxmzu-chxb2024199 of Guangxi Minzu University.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due [our experimental team’s policy] but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study was approved by the Biomedicine Ethics Committee of Jishou University before the initiation of the project (Grant number: JSDX-2024-0086). And informed consent was obtained from the participants before starting the program. We confirm that all the experiment is in accordance with the relevant guidelines and regulations such as the declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.