The mental health of healthcare professionals is critical to the resilience of the public health system (1). As a core component of the healthcare workforce, nurses experiencing high anxiety levels not only jeopardize their own well-being but also pose a significant threat to patient safety and care quality, making this a pressing public health issue (2). Globally, stress related to clinical practice affects approximately one-third of nurses (3). Tasked with providing high-quality care, nurses face considerable psychological stressors, including long working hours, shift rotations, exposure to patient suffering, and workplace violence (4, 5). These demands render nurses more susceptible to depression, anxiety, and burnout compared to other professional groups (6), ultimately impairing work efficiency, clinical performance, and the stability of the healthcare system (7).

Anxiety is among the most prevalent psychological issues reported by clinical nurses (8). Recent studies highlight the global scale of this challenge: in the United States, approximately 30% of nurses experience moderate to severe anxiety (9), with burnout studies indicating anxiety as a major component affecting up to 41.5% of hospital nurses (10). Survey from Japan reveals anxiety symptoms in about 24.2% of nurses (11). In China, a recent study of 7,114 nurses found an anxiety prevalence of 29.03% (12), which escalated to 46% among 4,188 nurses surveyed amid the COVID-19 pandemic (13). This persistent anxiety crisis not only threatens nursing workforce stability but also challenges the sustainable development of healthcare systems worldwide, underscoring the urgent need to identify protective factors and intervention pathways.

Drawing on the stress-buffering model (14), we hypothesize that the effect of social support on anxiety is mediated by psychological resilience. The underlying rationale is that social support does not neutralize anxiety directly (15). Rather, we propose that it first fosters the development of psychological resilience. This internalized resource then empowers nurses to better manage stressors, thereby reducing anxiety. Social support refers to the psychological, informational, and material resources that individuals obtain through social connections, which may help them cope with stress (16). Evidence suggests that enhancing social support is an effective strategy for mitigating psychological symptoms, buffering occupational stress, and reducing emotional distress among healthcare workers (17, 18). For instance, one study indicated that nurses with lower levels of social support were nearly twice as likely to experience anxiety symptoms compared to those with adequate support (19). However, the specific mechanisms underlying this protective effect require further elucidation. Psychological resilience—defined as the capacity to adapt and recover from adversity (20)—is a well-established protective factor against anxiety and depression (21). Empirical studies confirm that resilience-focused interventions can significantly reduce anxiety and stress among nurses (22). Critically, social support and psychological resilience are closely associated. Beyond directly alleviating distress, social support may also enhance an individual’s ability to cope with stress by fostering psychological resilience (23). Research suggests a positive correlation between the two, with potential synergistic effects strengthening emotional protection (24). This suggests that psychological resilience may act as a potential mediator, indicating that the protective effect of social support against anxiety is partly achieved by enhancing psychological resilience.

Nevertheless, the interrelationships between these constructs merit deeper investigation. Social support is best understood as an external resource, in contrast to psychological resilience, which is an intrinsic characteristic (25). The theoretical pathway explored in this study therefore investigates how external social resources (i.e., social support) contribute to the accumulation of internal psychological resources (i.e., psychological resilience), thereby helping to preserve core mental health resources and reduce manifestations of anxiety.

This study proposes that psychological resilience mediates the relationship between social support and anxiety among nurses. We aim to verify this mediating effect, determine its type and magnitude, and provide evidence for targeted mental health interventions. The findings are expected to help nurses better manage workplace stress, enhance their psychological well-being, and improve their overall quality of life.

Grounded in a public health perspective, this study examines the interaction between social-environmental factors and individual characteristics in relation to nurses’ occupational mental health. Based on a cross-sectional survey in Chengdu, China, the findings support the hypothesized mediation model, wherein psychological resilience mediates the effect of social support on anxiety. This reveals a salient psychological mechanism among nursing staff: the pathway from the acquisition of external resources to the building of internal capacity, ultimately shaping emotional outcomes.

The primary finding confirms that psychological resilience mediates the effect of social support on anxiety. Conceptually, social support—an external resource encompassing connections with leaders, colleagues, family, and friends (35)—serves a dual function: it directly reduces anxiety, and it is also converted into psychological resilience. This internal resource, characterized by self-efficacy, hope, resiliency, and optimism (36), enhances nurses’ ability to deploy cognitive and emotional strategies under stress, thereby buffering against anxiety. This mechanism is not unique to our sample; it has been replicated in diverse populations. For example, Eliza et al. reported a significant mediation effect of psychological resilience (explaining up to 30.9% of the total effect) between social support and anxiety among nurses, foreign domestic helpers, and residents in Hong Kong (37). Consistent evidence from varied contexts supports this mechanism from nurses. First, in a study of people living with HIV/AIDS, psychological resilience fully mediated the social support-anxiety link, accounting for 68.42% of the effect (38). Second, research among postpartum women found that resilience partially mediated the relationship between increased support and reduced anxiety (39). Third, the COVID-19 pandemic underscored this pathway under crisis conditions; multiple studies confirmed that resilience mediated the effects of specific stressors—such as perceived pandemic stress, job stress, occupational exposure, and fear of infection—on the anxiety, depression, and distress of healthcare workers (40–43). Thus, psychological resilience emerges as a key mediator, defining a resource-transformation pathway: external support builds internal resilience, which ultimately safeguards emotional well-being. This pathway aligns with and elaborates upon two key theories. It concretely illustrates the COR Theory’s principle of resource investment and gain (44), showing how social support, as an external resource, translates into psychological resilience to prevent mental health depletion. It also provides a specific cognitive-personal mechanism for the Stress-Buffering Model (14), demonstrating that support alleviates anxiety by building resilience, thereby enacting the stress-buffering process.

Building on the confirmed partial mediation model, this study provides a nuanced understanding of how different dimensions of social support relate to anxiety. The pathways diverged markedly: while “support utilization” and “objective support” had stronger direct links to anxiety, “subjective support” exerted its influence predominantly indirectly through psychological resilience, with its mediated effect being nearly double. This underscores that the protective mechanism is not uniform; the subjective perception of available support is uniquely channeled through the development of internal resilience. This pattern diverges from findings in other contexts, such as among lung cancer patients, where resilience mediated the link for subjective support and support utilization but not for objective support (45), suggesting important population or context-specific moderators. Furthermore, a study of older adults in China demonstrated a gender difference: the association between subjective support and cognitive function was fully mediated by psychological resilience in men, whereas it was only partially mediated in women (46). Therefore, interventions should be population-specific. For the nursing population, our study yields two practical recommendations. First, reinforce the provision and accessible use of objective, material support. This involves securing necessary resources and training to utilize them effectively. Simultaneously, fostering a supportive climate that enhances nurses’ subjective perception and experience of support is critical, as this directly cultivates psychological resilience. Building this internal resource is key to safeguarding mental health and alleviating anxiety.

Our analysis revealed differential correlations between the constituent dimensions of psychological resilience—self-efficacy, hope, resiliency, and optimism (36)—and anxiety. Notably, resiliency (defined as focused persistence in adversity) (47) showed the strongest inverse association, highlighting the paramount importance of stable adaptability under stress for anxiety reduction. Similarly, optimism (48) and hope (49) were significantly negatively correlated with anxiety. Optimism fosters adaptive stress appraisal (50), whereas hope underpins the pursuit of viable pathways despite obstacles (49, 51), both mitigating anxiety. Of the four dimensions, self-efficacy exhibited the weakest, albeit significant, negative correlation. This likely reflects that while professional confidence facilitates proactive stress coping, its direct protective effect against anxiety may be less pronounced than that of other resilience facets.

It is also noteworthy that the anxiety levels observed among nurses in Chengdu, China, were relatively high, nearing the upper bound of prevalence estimates for Chinese nurses in a global synthesis (52). This elevated prevalence points to acute mental health strains within the current healthcare environment. The immediate context includes the legacy of the pandemic, specifically 3 years of lockdown measures in China. These pressures are compounded by longer-term structural factors, such as the ongoing economic slowdown and stricter healthcare payment reforms, which may adversely affect nurses’ socioeconomic stability and mental health (53). The high anxiety levels likely result from a confluence of acute, sub-acute, and chronic stressors. First, anxiety may be a lingering psychological sequel of the extreme stress nurses faced during the pandemic. Second, this is compounded by sustained post-pandemic pressures, as healthcare systems address care backlogs, potentially maintaining high workloads (54). Finally, these are exacerbated by the profession’s inherent, chronic stressors—including extended hours, high-intensity tasks, and shift-work disruption—which continuously elevate burnout risk and undermine mental health (55).

Policy and practice should focus on evidence-based interventions targeting psychological resilience—the critical mediator identified. For instance, individual-focused approaches like resilience training, mindfulness, and cognitive-behavioral therapy have proven effective (56). Simultaneously, healthcare institutions must implement system-level strategies, including mental health education, competency training, and confidential counseling. Implementing structured peer-support networks within clinical teams is also essential, as they facilitate mutual assistance and open communication, fostering team cohesion and sustained well-being (57, 58). This multi-pronged approach builds the core facets of resilience (self-efficacy, hope, resiliency, optimism), leading to significant anxiety reduction.

This study has several limitations. First, the cross-sectional design precludes causal inference regarding the relationships among social support, psychological resilience, and anxiety, so there may be confounding bias related to time. Second, as the sample was drawn exclusively from Sichuan Province, China, the generalizability of the findings to other regions or cultural contexts may be limited, there may be selection bias. Future research should adopt longitudinal or experimental designs to examine the long-term and causal effects of social support and resilience on anxiety. It would also be valuable to validate the current model in diverse healthcare systems and cultural settings. Furthermore, future studies should design, implement, and evaluate multi-level interventions based on the present findings, and conduct cost-effectiveness evaluations to inform public health resource allocation. Nurse characteristics were accounted for as confounders in this study and thus were not analyzed in detail. A fruitful direction for future research would be to conduct stratified analyses based on these or other clinically meaningful variables to uncover potential subgroup differences and elucidate nuanced intervention targets.

This empirical survey study, conducted among nurses in Chengdu, Sichuan Province, China, in the post-pandemic era, reveals two key findings. First, anxiety levels within the nursing cohort remain notably elevated. Second, psychological resilience plays a partial mediating role in the relationship between social support and anxiety. Notably, the strongest mediating effect of psychological resilience is observed on the pathway linking subjective support to anxiety. This suggests that the anxiety-alleviating function of social support may operate through the internalization of psychological resilience. Moreover, the interaction between perceived support from the social environment and individual nurse characteristics—such as psychological resilience—appears to be a critical factor in emotional regulation. The findings further indicate that, to advance public-health policy implementation through nurses’ occupational well-being, it is essential not only to foster a supportive environment but also to adopt systematic strategies that enhance nurses’ subjective perception of support, thereby cultivating their psychological resilience to mitigate anxiety.