The Impact of Self - Esteem on Social Media Addiction in Medical Students: The Chain - Mediation Effects of Academic Over - competition (Involution) and Anxiety

The Impact of Self - Esteem on Social Media Addiction in Medical Students: The Chain - Mediation Effects of Academic Over - competition (Involution) and Anxiety | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Impact of Self - Esteem on Social Media Addiction in Medical Students: The Chain - Mediation Effects of Academic Over - competition (Involution) and Anxiety Wang Jinghuan, Lei Shuangyuan, Bing Li, Nie Hong, Zhao Mingjing, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6168986/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract This study aimed to explore the impact of self-esteem on social media addiction among medical students and examine the mediating roles of involution and anxiety. A cross-sectional survey was conducted among 1055 medical students using the Self-Esteem Scale, Social Media Addiction Scale, Involution Scale, and Anxiety Scale. Correlational analyses revealed that self-esteem was negatively correlated with social media addiction (r = − 0.233r = − 0.233), involution (r = − 0.257r = − 0.257), and anxiety (r = − 0.327r = − 0.327). Social media addiction was positively correlated with involution (r = 0.303r = 0.303) and anxiety (r = 0.332r = 0.332), while involution and anxiety were also positively correlated (r = 0.360r = 0.360).The structural equation modeling indicated that involution and anxiety partially mediated the relationship between self-esteem and social media addiction. The mediating effect of involution was − 0.2214 (effect size = -0.2214, 95% CI = [-0.3400, -0.1177]), and the mediating effect of anxiety was − 0.2579 (effect size = -0.2579, 95% CI = [-0.3657, -0.1608]). The total chain-mediating effect of involution and anxiety was − 0.0899 (effect size = -0.0899, 95% CI = [-0.1357, -0.0534]). Involution and anxiety served as sequential mediating pathways between self-esteem and social media addiction among medical students (path: self-esteem → involution → anxiety → social media addiction). Biological sciences/Psychology Health sciences/Health occupations Health sciences/Medical research Self - esteem Social media addiction Anxiety Academic over - competition (Involution) Medical students Figures Figure 1 Figure 2 1 Introduction Social media addiction has emerged as a common global issue. It refers to the situation where individuals overly focus on social media, invest a substantial amount of time and energy, and have difficulty self - regulating this usage behavior, which exerts negative impacts on other important aspects of an individual's life 1 . A meta - analysis revealed that the prevalence of social media addiction among college students worldwide was approximately 18.4%. Notably, the prevalence in the Asian region was significantly higher than that in other regions, amounting to 22.8% 2 . Medical students, constituting a distinct subset within the college - student population, are confronted with the compounded stressors stemming from both academic pursuits and clinical practice. This unique situation renders them more vulnerable to the risk of social media addiction compared to their non - medical counterparts 3 . Findings derived from epidemiological investigations and research indicate that the prevalence of social media addiction among medical students stands at 76.7%, a figure substantially higher than that observed in other groups 4 . Social media addiction among medical students exerts a multi - faceted negative impact. It has been demonstrated to significantly impinge upon their academic achievements. The excessive time and attention diverted to social media platforms often result in reduced study time, disrupted concentration during study sessions, and ultimately, suboptimal academic performance 5 . A profound exploration of the influencing factors and underlying mechanisms of social media addiction among medical students holds substantial significance. Self - esteem, which mirrors the extent to which an individual acknowledges themselves and perceives their self - worth, stands as a fundamental and core characteristic within the realm of mental health 6 . Self - esteem serves as a fundamental cornerstone in the construction of the relationship between an individual and the social environment. It plays a pivotal role in how an individual interacts with and perceives the surrounding social context 7 . In the context of Beck's cognitive - behavioral theory, the dysfunctional cognitive schema, through the induction of persistent negative affective states, impels individuals to adopt social media use as a strategy for regulating negative emotions. This self - perpetuating cycle of reinforcement, over time, gradually leads to the development of social media addiction 8 . A recent study has revealed that there exists a significant negative correlation between self - esteem levels and the incidence of social media addiction in the population of medical students 9 . A comprehensive large - scale meta - analysis, which integrated data from multiple relevant studies, has demonstrated that the percentage of individuals with low self - esteem who exhibit dependency on social media is significantly higher compared to that of those with high self - esteem 10 . Findings of the survey demonstrate that medical students are confronted with intense academic pressure. This pressure has the potential to exacerbate the fluctuations in self - esteem. Specifically, medical students with low self - esteem are more prone to utilize social media as a stress - alleviation tool within a high - pressure context 11 . In light of the above - mentioned background and considerations, this research puts forward Hypothesis 1: A significant negative correlation exists between self - esteem and social media addiction in the medical student population. According to the social comparison theory, individuals characterized by low self - esteem encounter challenges in objectively appraising their inherent capabilities and values. They exhibit a pronounced inclination towards engaging in upward social comparisons, wherein they consider external metrics like academic accomplishments as the pivotal benchmarks for determining their self - worth 12 . Such cognitive biases are likely to impel individuals to engage in irrational competition. In the educational domain, this form of irrational competition is referred to as academic involution. Specifically, it manifests as students' learning behaviors characterized by an over - investment of time, energy, and effort, while simultaneously experiencing a phenomenon of diminishing marginal returns 13 . Numerous empirical studies have demonstrated that students with low self - esteem, characterized by a diminished sense of self - efficacy, often attempt to offset their perceived incompetence by prolonging their study hours. This compensatory behavior, in turn, gives rise to a phenomenon known as passive involution. Such students, burdened with a negative psychological state and hampered by inefficiencies in their learning processes, are likely to experience a significant attenuation of their learning outcomes. As a consequence, they are trapped in a pernicious cycle where substantial investment in terms of time and effort yields meager academic returns, aptly described as the "high - input, low - output" conundrum 14 . Students with low self - esteem who are in an involuted environment for a long time are prone to induce negative emotions such as anxiety and depression. Through the stress - avoidance mechanism, individuals are prompted to use social media as an emotional regulation tool, ultimately leading to social media addiction 15 ; 16 . A recent study on involution and social media addiction found that there is a significant relationship between the two 17 . Therefore, research hypothesis 2 is proposed: Involution plays a mediating role between self - esteem and social media addiction. Anxiety represents a multifaceted and ubiquitously present emotional state. It is principally characterized by the manifestation of a constellation of negative emotions, including but not limited to restlessness, nervousness, apprehension, and fear 18 . Based on cognitive theory, individuals characterized by low self - esteem display pronounced cognitive dysregulation. This cognitive dysregulation leads to the emergence of cognitive biases. Cognitive biases, in turn, serve as a catalyst for the development of anxiety 8 . Neuroimaging studies have shown that in individuals with cognitive dysfunction, the activation intensity of the amygdala is 1.7 times higher than that of the healthy control group, and the cognitive function of the dorsolateral prefrontal cortex is impaired, resulting in a 38% increase in their anxiety 19 . Empirical evidence has shown that college students with low self-esteem have higher levels of stress hormones when dealing with difficult tasks and are more prone to anxiety 20 ; 21 .Anxiety is an important predictor of social media addiction among medical students, and there is a positive correlation between the two 22 . According to Gross's affect regulation theory, anxiety has a substantial negative impact on an individual's capacity to perceive positive emotions accurately. This impairment in emotional perception leads to a reduced ability to experience satisfaction and pleasure in daily life. As a compensatory mechanism, individuals turn to social media to seek positive affirmations. This behavior, in turn, elevates the likelihood of developing social media addiction 23 . Thus, research hypothesis 3 is proposed: Anxiety plays a mediating role between self - esteem and social media addiction. Involution and anxiety are likely to serve as mediating variables in the relationship between self - esteem and social media addiction among medical students, and a certain degree of correlation exists between them. Based on the transactional model of stress, the unrelenting competitive pressure induced by involution within the medical student group results in a deterioration of their emotional regulation capabilities. This, in turn, gives rise to negative emotions, prominently including anxiety 24 . Empirical investigations have revealed a significant correlation between involution and anxiety. In the context of involution, individuals are confronted with incessant and highly intensive learning processes. This unceasing academic or work - related pressure stemming from involution forces individuals to remain in a state of perpetual tension. As a result, their psychological stress accumulates, and the level of anxiety escalates 25 . On the contrary, a decrease in the intensity of involution can substantially mitigate the anxiety levels among medical students 26 . Consequently, the present research postulates Hypothesis 4: Involution and anxiety jointly exert a chain - mediating effect in the relationship between self - esteem and social media addiction. In conclusion, the present research is dedicated to examining the relationship between self - esteem and social media addiction among medical students. Therefore, this study constructs a hypothetical model diagram (Fig. 1 ) to further explore the potential mechanisms underlying the relationship between self-esteem and social media addiction among medical students. 2 Methods 2.1 Research Subjects This survey was carried out during the winter semester of 2024. The research subjects were medical students from two public universities in Heilongjiang Province, and a cross - sectional research method was adopted. Using a convenience sampling strategy, online electronic questionnaires were distributed to medical students by class. Before the distribution of the questionnaires, the researchers obtained the informed consent of the students and their counselors, and provided a detailed explanation to all the students, clearly informing the participants of the purpose of this survey, the anonymous processing method of the data, and the final use. The questionnaires were filled out anonymously, and an online informed consent form was attached to the front page of the electronic questionnaire. Only after the participants read and clicked to confirm was it considered that the informed consent for this survey had been obtained. Usually, the participants could complete all the electronic questionnaires within 10 minutes. This study has been approved by the Ethics Committee of Heilongjiang University of Chinese Medicine (Approval Number: HZYLLKT202319901). All research procedures followed the principles of the Declaration of Helsinki and ensured the privacy and rights of participants were fully protected. Finally, a total of 1,313 college students responded to this survey completely. After screening the data with too short answering times and regular answering patterns, 1,055 valid data were finally obtained (see Table 1 ). Table 1 Basic Information of the Participants Items N Percent Gender Male 240 22.7% Female 815 77.3% Father's degree Unascertained 72 6.8% Primary Education Level and Below 191 18.1% Secondary Education Level 684 64.8% Tertiary Education 102 9.7% Postgraduate Degree 6 0.6% Mother's degree Unspecified 68 6.4% Primary Education Level and Below 228 21.6% Secondary Education Level 650 61.6% Tertiary Education 104 9.9% Postgraduate Degree 5 0.5% Grade First-Year Undergraduate 482 45.7% Second-Year Undergraduate 485 46.0% Third-Year Undergraduate 81 7.7% Fourth-Year Undergraduate 2 0.2% Situation of Only Children Only-Child Status 414 39.2% Non-Only-Child Status 641 60.8% 2.2 Measurement Tools Due to the heavy academic tasks and tight course schedules of medical students, before the questionnaire filling, the investigators elaborated and defined the structural information covering the main variables in detail and clearly. In view of this, when selecting the research measurement tools, there was a strong preference for relatively concise tools. This could effectively reduce the cognitive load of medical students when participating in the survey, cut down their time investment, and at the same time, maximize the avoidance of misunderstandings or biases to ensure the accuracy and effectiveness of the survey results 27 ; 28 . 2.2.1 Self - esteem One question was used to assess the self - esteem level of the sample in this study. Question: Do you feel that your abilities are insufficient, that you are inferior to others in life and study, and that when you disagree with others, you subconsciously think that you are wrong? This question adopts a 5 - point scale, with scores ranging from 1 (completely inconsistent) to 5 (completely consistent). The higher the score, the lower the individual's self - esteem level. This has been found to have good robustness in previous studies. This has been widely used in previous studies 29 . 2.2.2 Involution The Involution Perception Measurement Questionnaire developed by Zhang Wen et al. was used for assessment 12 . This scale contains 18 items and adopts a 7 - point Likert scale. The scoring range of each question is from 1 (completely inconsistent) to 7 (completely consistent), and the total score range is 18–126. The higher the score, the higher the degree of involution perceived by the individual. In this study, the Cronbach's α of the sample was 0.799. 2.2.3 Anxiety The 2 - item Generalized Anxiety Disorder Scale (GAD − 2) was used to assess the anxiety levels of the sample in this study 30 ; 31 . The GAD − 2 consists of two items: (1) Feeling nervous, anxious, or on edge; (2) Not being able to stop or control worry. It adopts a 4 - point Likert scale, with scores ranging from 1 (never) to 4 (almost every day), and the total score range is 2–8. The higher the score, the higher the degree of anxiety perceived by the individual. In this study, the Cronbach's α of the sample was 0.879. 2.2.4 Social media addiction The Bergen Social Media Addiction Scale developed by Andreassen et al. was adopted 32 . This scale contains 6 items and adopts a 5 - point Likert scale. The scoring range of each question is from 1 (very rarely) to 5 (always). The total score ranges from 6 to 30. The higher the total score, the more severe the social media addiction. In this study, the Cronbach's α of the sample was 0.814. 2.3 Statistical analyses All statistical analyses were conducted using SPSS 26.0 software. Firstly, we checked for methodological biases to evaluate the potential bias resulting from self-report questionnaires Then, we standardized the data of the main variables before conducting the analyses. Finally, to test our hypotheses, we used the PROCESS macro (Model 6) in SPSS to analyze the relationships between variables. The PROCESS macro was based on a bootstrapping method with 5000 resamples to estimate the model testing and 95% confidence intervals (95% CI), and a relationship was considered significant when the 95% CI did not include 0. Gender and age were considered as covariates in the analyses, and the significance level was set at α = 0.05. 3 Results 3.1 Harman’s single factor test The results of the common method bias test in this study found that there were 6 factors with eigenvalues greater than 1. The first factor accounted for 22.71% of the total variance, which was less than the threshold of 40%, indicating that there was no obvious risk of common method bias in this study. 3.2 Correlation Analysis The results in Table 2 show that self - esteem has a significant negative correlation with social media addiction (r = − 0.233, p < 0.01), involution (r = − 0.257, p < 0.01), and anxiety (r = − 0.327, p < 0.01). Social media addiction has a significant positive correlation with involution (r = 0.303, p < 0.01) and anxiety (r = 0.332, p < 0.01). Involution has a significant positive correlation with anxiety (r = 0.360, p < 0.01) (see Table 2 ). Table 2 Correlational analyses Variables M SD 1 2 3 4 5 6 1age - - - 2Situation of Only Children - - −0.038 - 3Self-esteem 2.33 1.00 −0.003 −0.015 - 4Social media addiction 15.20 4.41 0.034 0.06 −.233** - 5 Involution 68.44 12.07 0.026 0.000 −.257** .303** - 6 Anxiety 3.17 1.33 −0.019 −0.034 −.327** .332** .360** - * p<0.05; ** p<0.01; ***p<0.001 3.3 Mediation Model Test After controlling for demographic variables (gender, age, grade, parents' education level, and only-child status), the results of Table 2 and Table 3 , as well as Fig. 2, indicate that: self - esteem had a significant negative direct predictive effect on medical students' social media addiction (total effect: β = -1.0085, p < 0.001). When mediating variables (involution, anxiety) were added, the direct effect of self - esteem on social media addiction was still significant (β = -0.4394, p < 0.01). Self - esteem significantly negatively predicted involution (β = -3.2156, p < 0.001), and involution significantly positively predicted social media addiction (β = 0.0689, p < 0.001). Self - esteem significantly negatively predicted anxiety (β = -0.3239, p < 0.001), and anxiety significantly positively predicted social media addiction (β = 0.7962, p < 0.001). Finally, there was a chain - mediating effect of involution and anxiety between self - esteem and social media addiction (β = -0.0899, p < 0.001), forming a chain - like path. Table 3 Mediation Model Testing Outcome variable Predictor variable β SE t R² F Involution Self-esteem −3.2156 0.3610 −8.91*** 0.0748 12.08*** Anxiety Self-esteem −0.3239 0.0384 −8.43*** 0.2043 33.58*** Involution 0.0351 0.0032 11.07*** Social media addiction Self-esteem −0.4394 0.1340 −3.28** 0.1718 24.08*** Involution 0.0689 0.0113 6.09*** Anxiety 0.7962 0.1043 7.63*** **: p<0.01; ***: p<0.001 3.4 The Chain Mediation Effect of Self-Respect and Social Media Addiction Between Involution and Anxiety Based on correlation analysis and mediation effect testing methods proposed by relevant literature, this study conducted path analysis with gender, age, grade, parents' education level, and only-child status as covariates, self-respect as the independent variable (X), social media addiction as the dependent variable (Y), and involution (M1) and anxiety (M2) as mediating variables. Please refer to Fig. 2. The research findings indicate:Total Effect of Self-Respect on Social Media Addiction: The total effect size of self-respect on social media addiction is -1.0085, with a direct effect of -0.4394 and an effect size of 43.6% (P < 0.05).Mediation Effect of Involution: Involution partially mediates the relationship between self-respect and social media addiction, with a mediation effect size of -0.2214 and an effect size of 22.0% (P < 0.05).Mediation Effect of Anxiety: Anxiety also partially mediates the relationship between self-respect and social media addiction, with a mediation effect size of -0.2579 and an effect size of 25.6% (P < 0.05).Chain Mediation Effect: Involution and anxiety together form a chain mediation path between self-respect and social media addiction, with a chain mediation effect size of -0.0899 and an effect size of 8.9% (P < 0.05).All paths' 95% confidence intervals do not include zero, indicating that all mediation effects are significant (P < 0.05). Please refer to Table 4 . Table 4 Path Analysis of the Mediation Model Paths 效应值 SE Bootstarp 95% CI 中介效应占比 Total Effect −1.0085 0.1330 [−1.2694,−0.7476] 100% Direct Effect −0.4394 0.1340 [−0.7022,−0.1765] 43.6% Total Indirect Effect −0.5691 0.0771 [−0.7308,−0.4277] 56.4% Ind 1 −0.2214 0.0571 [−0.3400,−0.1177] 22.0% Ind 2 −0.2579 0.0527 [−0.3657,−0.1608] 25.6% Ind 3 −0.0899 0.0209 [−0.1357,−0.0534] 8.9% Ind 1: Self-esteem → Involution → Social media addiction;Ind 2: Self-esteem → Anxiety → Social media addiction; Ind 3:Self-esteem → Involution → Anxiety → Social media addiction 4 Discussion This study explored the interrelationships among self - esteem, involution, anxiety, and medical students' social media addiction, and constructed the internal connections among them. This study found that there were significant correlations between each pair of self - esteem, involution, anxiety, and medical students' social media addiction. In addition, involution and anxiety served as mediating and chain - mediating roles between self - esteem and medical students' social media addiction. These findings enriched the influencing paths of medical students' social media addiction and provided new explanatory space for how self - esteem levels affect medical students' social media addiction. At the same time, it also provided empirical evidence for the impacts of self - esteem, involution, and anxiety on social media addiction. This study found that the relationship between self - esteem and medical students' social media addiction was significant, so H1 was established. This is consistent with previous research results 33 . Rooted in the self - cognition theory and the social comparison theory, individuals with low self - esteem typically exhibit low self - identity and a strong dependence on external validation. This psychological profile renders them high - risk candidates for social media addiction 34 . A comprehensive large - scale meta - analysis revealed that the proportion of individuals with low self - esteem who exhibit dependence on social media is approximately 1.85 - fold that of those with high self - esteem 10 . From a psychological perspective, the relationship between low self - esteem and social media addiction can be explained by the compensation hypothesis. When an individual's real - world needs are not met, they may compensate for this deficiency through online social interactions 35 . In addition, a meta - analysis found that internet addiction is related to cognitive control disorders associated with brain reward processing (ACC, insula, amygdala) and executive functions (DLPFC, frontal lobe, parietal lobe) 36 ，Moreover, due to the long - term lack of self - identity, individuals with low self - esteem disrupt the normal operation of the relevant brain systems. When facing online stimuli, they find it more difficult to exercise effective self - control, and thus are more prone to social media addiction 37 . From the perspective of modern medicine, low self - esteem is likely to generate negative emotions. These emotional states exacerbate the risk of internet addiction by affecting the brain's neurotransmitter systems (such as dopamine, serotonin, etc.) 38 . In addition, this study also found that involution plays a partial mediating role between self - esteem and social media addiction of medical students, so Hypothesis 2 (H2) is supported. The results of this study are consistent with the findings of relevant meta - analysis studies 17 . In a state of involution, individuals are overly engaged in competition, which restricts their interactions with others in reality. As a result, their social needs are difficult to meet, so they turn to social media to make up for the deficiencies in real - life social interactions 39 . At the neuro - mechanism level, due to the long - term involution pressure, the hypothalamic - pituitary - adrenal (HPA) axis function is disordered. The increase in cortisol levels not only directly exacerbates anxiety but may also further weaken an individual's control ability over social media use by reducing the inhibitory function of the prefrontal cortex on the amygdala 40 . A longitudinal study by Deng et al. found that there is a dose - response relationship between the salivary cortisol levels of medical students and the severity of social media addiction, suggesting that the dysregulation of the HPA axis may be a key biomarker for the transformation of involution pressure into addictive behaviors. At this time, the reward pathway is activated through the mesolimbic dopamine system, forming a stress - reward substitution mechanism, ultimately leading to the pathological development of social media addiction 41 . In addition, this study also found that anxiety mediates the relationship between self - esteem and social media addiction of medical students, so Hypothesis 3 (H3) is supported. The results of this study are consistent with the findings of relevant meta - analysis studies 42 . A meta-analysis indicates that there is a significant positive correlation between the frequency of social media use and the level of anxiety. At the same time, it will significantly reduce individuals' positive emotional experiences 43 . In addition, recent studies have found that when individuals with low self-esteem are exposed to content presenting an idealized self, it leads to self-evaluation bias, making them prone to falling into negative emotions such as anxiety. They often choose to escape from reality or relieve negative emotions, which in turn leads to social media addiction. Modern medicine has discovered that social media addiction is closely related to the excessive activation of the brain's reward system. Research shows that it causes the formation of addictive behaviors by stimulating the release of dopamine (which is associated with feelings of pleasure and the alleviation of negative emotions) 44 . Finally, this study also found that in the influence of self - esteem on social media addiction of medical students, involution and anxiety play a chain mediating role, verifying Hypothesis 4. Learning dominates the life of medical students in college. However, medical students with low self - esteem are more likely to compare themselves with others when facing high - intensity academic competition, thus deeply perceiving the pressure of involution. This pressure makes them have a strong sense of insecurity and self - doubt at the psychological level. According to the stress - coping theory, when they are in such a high - pressure situation for a long time, anxiety will emerge. The virtual environment created by social media provides them with a haven to temporarily escape from the real - world pressure and negative emotions, making them gradually indulge in it and eventually leading to addictive behaviors. This research delves deep into the intricate relationships among self - esteem, involution, anxiety, and social media addiction among medical students. For the first time, it endeavors to integrate these variables, thereby extending the existing research outcomes to a certain degree. By analyzing the chain - mediating model, the study further uncovers the underlying connections and interactions among them, which holds significant theoretical and practical implications.The findings indicate that there are substantial correlations among self - esteem, involution, anxiety, and social media addiction in medical students. Notably, involution functions as a single mediator, while anxiety serves as a chain - mediator. These discoveries not only enrich the theoretical framework regarding the psychological and behavioral mechanisms between self - esteem and social media addiction in medical students but also offer novel perspectives and strategies for clinical intervention.From a theoretical perspective, this study validates the close association between self - esteem and social media addiction among medical students through empirical research. It further corroborates the adverse effects of low self - esteem on an individual's physical and mental well - being, providing fresh evidence for understanding the pathological mechanisms of individuals with low self - esteem. Practically, the research results imply that for the medical student population, it is crucial to prioritize the assessment and intervention of involution and anxiety to mitigate the risk of social media addiction. Clinically, this study furnishes a scientific foundation for devising preventive and intervention measures targeting the low - self - esteem phenomenon among medical students. It underscores the significance and necessity of considering the self - esteem context when treating social media addiction in medical students.Furthermore, this study recommends that subsequent research should delve deeper into the causal relationships among self - esteem, involution, and anxiety. Simultaneously, future studies should also focus on other potential variables associated with social media addiction in medical students, such as the impact of physical exercise intervention on this addictive behavior 45 . Previous studies have found that there is a negative correlation between physical exercise and social media addiction among college students 46 . Moreover, physical exercise has the potential to mitigate negative emotions among medical students, alleviate the phenomenon of involution - related behaviors, and reduce the prevalence of social media addiction within this student group. By doing so, it offers novel and innovative intervention strategies in the realm of physical and mental well - being 47 . In conclusion, this study not only enhances the understanding of the relationship between self - esteem and social media addiction among medical students, but also provides valuable theoretical and practical guidance for the maintenance and promotion of physical and mental health. This study also has some deficiencies. First, the research data mainly come from subjective surveys and are easily interfered by personal subjective factors, so it is difficult to ensure the objectivity of the data. Because the respondents may have self - cognitive biases, social desirability effects, etc., the collected data have certain subjectivity. Second, the study adopts a cross - sectional design. Although this design can analyze the variable relationships at a specific time point, it is difficult to accurately infer the causal relationships between variables and cannot clearly present the influence mechanism of variables changing over time. Third, the study does not involve the cross - regional level. Under different cultural backgrounds, the relationships between variables may have significant differences, which limits the universality of the study. In view of the above deficiencies, subsequent research can consider using more objective data collection methods. For example, integrate physiological index data and third - party report data to improve the accuracy and reliability of the data. At the same time, in the research design, select the longitudinal research method, which can deeply analyze the causal logic between variables in the time dimension and make up for the deficiencies of the cross - sectional design. In addition, carry out cross - cultural research, compare the relationship characteristics between variables in different cultural contexts, which helps to expand the breadth and depth of the research and make the research results more universally applicable. 5 Conclusions This study reveals a significant correlation among self - esteem, involution, anxiety, and social media addiction of medical students. The research finds that self - esteem, involution, anxiety, and social media addiction of medical students are significantly correlated pairwise. In the influence of self - esteem on social media addiction of medical students, involution and anxiety play a separate mediating role and a chain mediating role respectively. This discovery not only provides a new theoretical basis for analyzing the formation mechanism of medical students' social media dependence, but also establishes a key practical entry point for the formulation of targeted intervention strategies. It is recommended that subsequent research further verify the stability and universality of the action paths between variables through longitudinal research design, interdisciplinary method integration, and comparative analysis of groups with different cultural backgrounds, so as to enhance the clinical application value of the research results. Declarations Funding: This research received no external funding. Ethical Approval: This study was conducted in accordance with the Declaration of Helsinki and approved by the Heilongjiang University of Chinese Medicine Research Ethics Committee (Approval Number: HZYLLKT202319901). Electronic informed consent was obtained from all individual participants included in the study. Data availability ： The datasets used during the current study are available from the corresponding author on reasonable request. 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Zeigler Hill V, Li H: Self-esteem instability and academic outcomes in American and Chinese college students. J Res Pers . 2013; 47 (5):455–463. Sherin Roshan RGVG: Association of Social Anxiety Disorder and Self-Esteem among Young Adults - A Single Centre Study . International Journal of Current Science Research and Review 2022. Liu, Xinqiao: Does Low Self-Esteem Predict Anxiety Among Chinese College Students? Psychology research and behavior management. 2022 Jun 11; 15 :1481-1487. Xie X, Cheng H, Chen Z: Anxiety predicts internet addiction, which predicts depression among male college students: A cross-lagged comparison by sex . FRONT PSYCHOL 2022, 13 :1102066. Leombruni P, Corradi A, Lo MG, Acampora A, Agodi A, Celotto D, Chironna M, Cocchio S, Cofini V, D'Errico MM et al : Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study . Int J Environ Res Public Health 2022, 19 (9). James BO, Thomas IF, Omoaregba JO, Okogbenin EO, Okonoda KM, Ibrahim AW, Salihu AS, Oshodi YO, Orovwigho A, Odinka PC et al : Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria . Int J Med Educ 2017, 8 :382-388. Ye W, Rietze BA, McQueen S, Zhang K, Quilty LC, Wickens CM: Barriers to Accessing Mental Health Support Services in Undergraduate Medical Training: A Multicenter, Qualitative Study . ACAD MED 2023, 98 (4):491-496. Davidshofer CO, Murphy KR: Psychological testing :principles and applications . Englewood Cliffs, N.J.: Prentice-Hall; 1988. M. S. Allen DIAS: Single Item Measures in Psychological Science . EUR J PSYCHOL ASSESS 2022. Rimes KA, Smith P, Bridge L: Low self-esteem: a refined cognitive behavioural model . Behav Cogn Psychother 2023, 51 (6):579-594. Byrd-Bredbenner C, Eck K, Quick V: GAD-7, GAD-2, and GAD-mini: Psychometric properties and norms of university students in the United States . Gen Hosp Psychiatry 2021, 69 :61-66. Skapinakis P: The 2-item Generalized Anxiety Disorder scale had high sensitivity and specificity for detecting GAD in primary care . Evid Based Med 2007, 12 (5):149. Schou AC, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, Pallesen S: The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study . PSYCHOL ADDICT BEHAV 2016, 30 (2):252-262. Guermazi F, Abid W, Baati I, Cherif F, Mziou E, Mnif D, Feki I, Masmoudi R, Masmoudi J: Social media addiction and personality dimensions among Tunisian medical students . FRONT PSYCHIATRY 2024, 15 :1471425. Ciacchini R, Orru G, Cucurnia E, Sabbatini S, Scafuto F, Lazzarelli A, Miccoli M, Gemignani A, Conversano C: Social Media in Adolescents: A Retrospective Correlational Study on Addiction . Children (Basel) 2023, 10 (2). Heni Purnama IDWM: Social Media Addiction and the Association with Self-Esteem among Adolescents in Rural Areas of Indonesia . KnE Life Sciences 2021. Leon MM, Padron I, Fumero A, Marrero RJ: Effects of internet and smartphone addiction on cognitive control in adolescents and young adults: A systematic review of fMRI studies . Neurosci Biobehav Rev 2024, 159 :105572. Jitoku D, Kobayashi N, Fujimoto Y, Qian C, Okuzumi S, Tei S, Matsuyoshi D, Tamura T, Takahashi H, Ueno T et al : Explicit and implicit effects of gaming content on social media on the behavior of young adults . FRONT PSYCHOL 2024, 15 :1332462. Park K, Yang TC. The Long-term Effects of Self-Esteem on Depression: The Roles of Alcohol and Substance Uses during Young Adulthood. Sociol Q. 2017; 58 (3):429-446. Arness DC, Ollis T: A mixed-methods study of problematic social media use, attention dysregulation, and social media use motives . CURR PSYCHOL 2022:1-20. McEwen BS, Akil H: Revisiting the Stress Concept: Implications for Affective Disorders . J NEUROSCI 2020, 40 (1):12-21. Papenberg G, Li SC, Nagel IE, Nietfeld W, Schjeide BM, Schroder J, Bertram L, Heekeren HR, Lindenberger U, Backman L: Dopamine and glutamate receptor genes interactively influence episodic memory in old age . NEUROBIOL AGING 2014, 35 (5):1213. Wu W, Huang L, Yang F: Social anxiety and problematic social media use: A systematic review and meta-analysis . ADDICT BEHAV 2024, 153 :107995. Ahmed O, Walsh EI, Dawel A, Alateeq K, Espinoza OD, Cherbuin N: Social media use, mental health and sleep: A systematic review with meta-analyses . J Affect Disord 2024, 367 :701-712. Walia B, Kim J, Ijere I, Sanders S: Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: Cross-sectional Questionnaire Study . JMIR SERIOUS GAMES 2022, 10 (2):e33661. Luo M, Duan Z, Chen X: The role of physical activity in mitigating stress-induced internet addiction among Chinese college students . J Affect Disord 2024, 366 :459-465. Zhang X, Yang H, Zhang K, Zhang J, Lu X, Guo H, Yuan G, Zhu Z, Du J, Shi H et al : Effects of exercise or tai chi on Internet addiction in college students and the potential role of gut microbiota: A randomized controlled trial . J Affect Disord 2023, 327 :404-415. de Vries JD, van Hooff ML, Geurts SA, Kompier MA: Exercise as an Intervention to Reduce Study-Related Fatigue among University Students: A Two-Arm Parallel Randomized Controlled Trial . PLOS ONE 2016, 11 (3):e152137. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 11 Jun, 2025 Reviews received at journal 10 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviewers invited by journal 23 Mar, 2025 Editor assigned by journal 23 Mar, 2025 Editor invited by journal 19 Mar, 2025 Submission checks completed at journal 18 Mar, 2025 First submitted to journal 06 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6168986","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":435284572,"identity":"2387b9d0-5207-4832-bb12-d3f90b6550b5","order_by":0,"name":"Wang Jinghuan","email":"","orcid":"","institution":"Heilongjiang University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Jinghuan","suffix":""},{"id":435284573,"identity":"f5a7ebf5-9249-4ffe-8f73-3e23ae16f06a","order_by":1,"name":"Lei Shuangyuan","email":"","orcid":"","institution":"Heilongjiang University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Shuangyuan","suffix":""},{"id":435284574,"identity":"59fa2bc7-9deb-4d8c-add5-d3e399e17ea6","order_by":2,"name":"Bing Li","email":"","orcid":"","institution":"Heilongjiang University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Li","suffix":""},{"id":435284575,"identity":"6a2ddb94-34b6-4a44-bdff-f55ccd9e8da3","order_by":3,"name":"Nie Hong","email":"","orcid":"","institution":"Heilongjiang University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Nie","middleName":"","lastName":"Hong","suffix":""},{"id":435284576,"identity":"0d0ec33c-74c4-4f84-91ed-39d9278544f6","order_by":4,"name":"Zhao Mingjing","email":"","orcid":"","institution":"Heilongjiang University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhao","middleName":"","lastName":"Mingjing","suffix":""},{"id":435284577,"identity":"f4f8cb67-5980-49c0-8795-cc9fa5564cd2","order_by":5,"name":"He Ruirui","email":"","orcid":"","institution":"Shaanxi Provincial Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"He","middleName":"","lastName":"Ruirui","suffix":""},{"id":435284578,"identity":"0a5feb8e-7a71-447e-a2e9-c28f56b7e355","order_by":6,"name":"Ma Xiaodi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYBACfmb+5x8SDGzkiNci2c7DxvCgIM2YeC0G53nYGB98OJzYQLwtzbzHHiQYMKf3HU9g/PAxhwgt/Mx86QYJBmy5M888YJacuY0oWxgMJBIMeHI33EhgY+YlRovBYbAWiXQDErTwmAG1AN1GtBbJZrZkoPoEw5lnHjYT5xd+/sMHH/7481+e73jywQ8fidGCAAdIiBqYlgRSdYyCUTAKRsFIAQBAuzfns4HxywAAAABJRU5ErkJggg==","orcid":"","institution":"Heilongjiang University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Ma","middleName":"","lastName":"Xiaodi","suffix":""}],"badges":[],"createdAt":"2025-03-06 09:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6168986/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6168986/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-24317-9","type":"published","date":"2025-11-18T15:59:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79648189,"identity":"9917f343-c162-4fb4-9744-510616bafde1","added_by":"auto","created_at":"2025-04-01 07:24:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32523,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThis study hypothesizes a chain mediation model where self-esteem and social media addiction mediate the relationship between involution and anxiety.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6168986/v1/b06e89a450cc5c14cb7f0aba.png"},{"id":79648188,"identity":"ae23b3ae-b586-459b-86ee-effc2779b3ea","added_by":"auto","created_at":"2025-04-01 07:24:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61510,"visible":true,"origin":"","legend":"\u003cp\u003eA Chain-Mediated Model of Self-Respect and Social Media Addiction between Involution and Anxiety\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6168986/v1/0e14bcd77305ee2cd74f16cc.png"},{"id":96650465,"identity":"35b1b4e9-6ed4-4220-88ba-d743f252f725","added_by":"auto","created_at":"2025-11-24 16:12:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2877083,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6168986/v1/1901788e-7f02-4420-bdd7-7a15a2e5912c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Self - Esteem on Social Media Addiction in Medical Students: The Chain - Mediation Effects of Academic Over - competition (Involution) and Anxiety","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eSocial media addiction has emerged as a common global issue. It refers to the situation where individuals overly focus on social media, invest a substantial amount of time and energy, and have difficulty self - regulating this usage behavior, which exerts negative impacts on other important aspects of an individual's life \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. A meta - analysis revealed that the prevalence of social media addiction among college students worldwide was approximately 18.4%. Notably, the prevalence in the Asian region was significantly higher than that in other regions, amounting to 22.8% \u003csup\u003e2\u003c/sup\u003e. Medical students, constituting a distinct subset within the college - student population, are confronted with the compounded stressors stemming from both academic pursuits and clinical practice. This unique situation renders them more vulnerable to the risk of social media addiction compared to their non - medical counterparts \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Findings derived from epidemiological investigations and research indicate that the prevalence of social media addiction among medical students stands at 76.7%, a figure substantially higher than that observed in other groups \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Social media addiction among medical students exerts a multi - faceted negative impact. It has been demonstrated to significantly impinge upon their academic achievements. The excessive time and attention diverted to social media platforms often result in reduced study time, disrupted concentration during study sessions, and ultimately, suboptimal academic performance \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. A profound exploration of the influencing factors and underlying mechanisms of social media addiction among medical students holds substantial significance.\u003c/p\u003e \u003cp\u003eSelf - esteem, which mirrors the extent to which an individual acknowledges themselves and perceives their self - worth, stands as a fundamental and core characteristic within the realm of mental health \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Self - esteem serves as a fundamental cornerstone in the construction of the relationship between an individual and the social environment. It plays a pivotal role in how an individual interacts with and perceives the surrounding social context \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In the context of Beck's cognitive - behavioral theory, the dysfunctional cognitive schema, through the induction of persistent negative affective states, impels individuals to adopt social media use as a strategy for regulating negative emotions. This self - perpetuating cycle of reinforcement, over time, gradually leads to the development of social media addiction \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. A recent study has revealed that there exists a significant negative correlation between self - esteem levels and the incidence of social media addiction in the population of medical students \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. A comprehensive large - scale meta - analysis, which integrated data from multiple relevant studies, has demonstrated that the percentage of individuals with low self - esteem who exhibit dependency on social media is significantly higher compared to that of those with high self - esteem \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Findings of the survey demonstrate that medical students are confronted with intense academic pressure. This pressure has the potential to exacerbate the fluctuations in self - esteem. Specifically, medical students with low self - esteem are more prone to utilize social media as a stress - alleviation tool within a high - pressure context \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. In light of the above - mentioned background and considerations, this research puts forward Hypothesis 1: A significant negative correlation exists between self - esteem and social media addiction in the medical student population.\u003c/p\u003e \u003cp\u003eAccording to the social comparison theory, individuals characterized by low self - esteem encounter challenges in objectively appraising their inherent capabilities and values. They exhibit a pronounced inclination towards engaging in upward social comparisons, wherein they consider external metrics like academic accomplishments as the pivotal benchmarks for determining their self - worth \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Such cognitive biases are likely to impel individuals to engage in irrational competition. In the educational domain, this form of irrational competition is referred to as academic involution. Specifically, it manifests as students' learning behaviors characterized by an over - investment of time, energy, and effort, while simultaneously experiencing a phenomenon of diminishing marginal returns \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Numerous empirical studies have demonstrated that students with low self - esteem, characterized by a diminished sense of self - efficacy, often attempt to offset their perceived incompetence by prolonging their study hours. This compensatory behavior, in turn, gives rise to a phenomenon known as passive involution. Such students, burdened with a negative psychological state and hampered by inefficiencies in their learning processes, are likely to experience a significant attenuation of their learning outcomes. As a consequence, they are trapped in a pernicious cycle where substantial investment in terms of time and effort yields meager academic returns, aptly described as the \"high - input, low - output\" conundrum \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Students with low self - esteem who are in an involuted environment for a long time are prone to induce negative emotions such as anxiety and depression. Through the stress - avoidance mechanism, individuals are prompted to use social media as an emotional regulation tool, ultimately leading to social media addiction \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e;\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. A recent study on involution and social media addiction found that there is a significant relationship between the two \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Therefore, research hypothesis 2 is proposed: Involution plays a mediating role between self - esteem and social media addiction.\u003c/p\u003e \u003cp\u003eAnxiety represents a multifaceted and ubiquitously present emotional state. It is principally characterized by the manifestation of a constellation of negative emotions, including but not limited to restlessness, nervousness, apprehension, and fear \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Based on cognitive theory, individuals characterized by low self - esteem display pronounced cognitive dysregulation. This cognitive dysregulation leads to the emergence of cognitive biases. Cognitive biases, in turn, serve as a catalyst for the development of anxiety \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Neuroimaging studies have shown that in individuals with cognitive dysfunction, the activation intensity of the amygdala is 1.7 times higher than that of the healthy control group, and the cognitive function of the dorsolateral prefrontal cortex is impaired, resulting in a 38% increase in their anxiety \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Empirical evidence has shown that college students with low self-esteem have higher levels of stress hormones when dealing with difficult tasks and are more prone to anxiety \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e;\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.Anxiety is an important predictor of social media addiction among medical students, and there is a positive correlation between the two \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. According to Gross's affect regulation theory, anxiety has a substantial negative impact on an individual's capacity to perceive positive emotions accurately. This impairment in emotional perception leads to a reduced ability to experience satisfaction and pleasure in daily life. As a compensatory mechanism, individuals turn to social media to seek positive affirmations. This behavior, in turn, elevates the likelihood of developing social media addiction \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Thus, research hypothesis 3 is proposed: Anxiety plays a mediating role between self - esteem and social media addiction.\u003c/p\u003e \u003cp\u003eInvolution and anxiety are likely to serve as mediating variables in the relationship between self - esteem and social media addiction among medical students, and a certain degree of correlation exists between them. Based on the transactional model of stress, the unrelenting competitive pressure induced by involution within the medical student group results in a deterioration of their emotional regulation capabilities. This, in turn, gives rise to negative emotions, prominently including anxiety \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Empirical investigations have revealed a significant correlation between involution and anxiety. In the context of involution, individuals are confronted with incessant and highly intensive learning processes. This unceasing academic or work - related pressure stemming from involution forces individuals to remain in a state of perpetual tension. As a result, their psychological stress accumulates, and the level of anxiety escalates \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. On the contrary, a decrease in the intensity of involution can substantially mitigate the anxiety levels among medical students \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Consequently, the present research postulates Hypothesis 4: Involution and anxiety jointly exert a chain - mediating effect in the relationship between self - esteem and social media addiction.\u003c/p\u003e \u003cp\u003eIn conclusion, the present research is dedicated to examining the relationship between self - esteem and social media addiction among medical students. Therefore, this study constructs a hypothetical model diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) to further explore the potential mechanisms underlying the relationship between self-esteem and social media addiction among medical students.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Research Subjects\u003c/h2\u003e\n \u003cp\u003eThis survey was carried out during the winter semester of 2024. The research subjects were medical students from two public universities in Heilongjiang Province, and a cross - sectional research method was adopted. Using a convenience sampling strategy, online electronic questionnaires were distributed to medical students by class. Before the distribution of the questionnaires, the researchers obtained the informed consent of the students and their counselors, and provided a detailed explanation to all the students, clearly informing the participants of the purpose of this survey, the anonymous processing method of the data, and the final use. The questionnaires were filled out anonymously, and an online informed consent form was attached to the front page of the electronic questionnaire. Only after the participants read and clicked to confirm was it considered that the informed consent for this survey had been obtained. Usually, the participants could complete all the electronic questionnaires within 10 minutes. This study has been approved by the Ethics Committee of Heilongjiang University of Chinese Medicine (Approval Number: HZYLLKT202319901). All research procedures followed the principles of the Declaration of Helsinki and ensured the privacy and rights of participants were fully protected. Finally, a total of 1,313 college students responded to this survey completely. After screening the data with too short answering times and regular answering patterns, 1,055 valid data were finally obtained (see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBasic Information of the Participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eFather\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnascertained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary Education Level and Below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary Education Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostgraduate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eMother\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary Education Level and Below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary Education Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostgraduate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst-Year Undergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond-Year Undergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird-Year Undergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFourth-Year Undergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSituation of Only Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnly-Child Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Only-Child Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Measurement Tools\u003c/h2\u003e\n \u003cp\u003eDue to the heavy academic tasks and tight course schedules of medical students, before the questionnaire filling, the investigators elaborated and defined the structural information covering the main variables in detail and clearly. In view of this, when selecting the research measurement tools, there was a strong preference for relatively concise tools. This could effectively reduce the cognitive load of medical students when participating in the survey, cut down their time investment, and at the same time, maximize the avoidance of misunderstandings or biases to ensure the accuracy and effectiveness of the survey results \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e;\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.1 Self - esteem\u003c/h2\u003e\n \u003cp\u003eOne question was used to assess the self - esteem level of the sample in this study. Question: Do you feel that your abilities are insufficient, that you are inferior to others in life and study, and that when you disagree with others, you subconsciously think that you are wrong? This question adopts a 5 - point scale, with scores ranging from 1 (completely inconsistent) to 5 (completely consistent). The higher the score, the lower the individual\u0026apos;s self - esteem level. This has been found to have good robustness in previous studies. This has been widely used in previous studies \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.2 Involution\u003c/h2\u003e\n \u003cp\u003eThe Involution Perception Measurement Questionnaire developed by Zhang Wen et al. was used for assessment \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This scale contains 18 items and adopts a 7 - point Likert scale. The scoring range of each question is from 1 (completely inconsistent) to 7 (completely consistent), and the total score range is 18\u0026ndash;126. The higher the score, the higher the degree of involution perceived by the individual. In this study, the Cronbach\u0026apos;s \u0026alpha; of the sample was 0.799.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.3 Anxiety\u003c/h2\u003e\n \u003cp\u003eThe 2 - item Generalized Anxiety Disorder Scale (GAD \u0026minus;\u0026thinsp;2) was used to assess the anxiety levels of the sample in this study \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e;\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The GAD \u0026minus;\u0026thinsp;2 consists of two items: (1) Feeling nervous, anxious, or on edge; (2) Not being able to stop or control worry. It adopts a 4 - point Likert scale, with scores ranging from 1 (never) to 4 (almost every day), and the total score range is 2\u0026ndash;8. The higher the score, the higher the degree of anxiety perceived by the individual. In this study, the Cronbach\u0026apos;s \u0026alpha; of the sample was 0.879.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.4 Social media addiction\u003c/h2\u003e\n \u003cp\u003eThe Bergen Social Media Addiction Scale developed by Andreassen et al. was adopted \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. This scale contains 6 items and adopts a 5 - point Likert scale. The scoring range of each question is from 1 (very rarely) to 5 (always). The total score ranges from 6 to 30. The higher the total score, the more severe the social media addiction. In this study, the Cronbach\u0026apos;s \u0026alpha; of the sample was 0.814.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Statistical analyses\u003c/h2\u003e\n \u003cp\u003eAll statistical analyses were conducted using SPSS 26.0 software. Firstly, we checked for methodological biases to evaluate the potential bias resulting from self-report questionnaires Then, we standardized the data of the main variables before conducting the analyses. Finally, to test our hypotheses, we used the PROCESS macro (Model 6) in SPSS to analyze the relationships between variables. The PROCESS macro was based on a bootstrapping method with 5000 resamples to estimate the model testing and 95% confidence intervals (95% CI), and a relationship was considered significant when the 95% CI did not include 0. Gender and age were considered as covariates in the analyses, and the significance level was set at \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Harman\u0026rsquo;s single factor test\u003c/h2\u003e\n \u003cp\u003eThe results of the common method bias test in this study found that there were 6 factors with eigenvalues greater than 1. The first factor accounted for 22.71% of the total variance, which was less than the threshold of 40%, indicating that there was no obvious risk of common method bias in this study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Correlation Analysis\u003c/h2\u003e\n \u003cp\u003eThe results in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e show that self - esteem has a significant negative correlation with social media addiction (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.233, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), involution (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.257, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and anxiety (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.327, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Social media addiction has a significant positive correlation with involution (r\u0026thinsp;=\u0026thinsp;0.303, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and anxiety (r\u0026thinsp;=\u0026thinsp;0.332, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Involution has a significant positive correlation with anxiety (r\u0026thinsp;=\u0026thinsp;0.360, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (see Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelational analyses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2Situation of Only Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3Self-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4Social media addiction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;.233**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026nbsp;Involution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;.257**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.303**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;.327**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.332**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.360**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e* p\u0026lt;0.05; ** p\u0026lt;0.01; ***p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Mediation Model Test\u003c/h2\u003e\n \u003cp\u003eAfter controlling for demographic variables (gender, age, grade, parents\u0026apos; education level, and only-child status), the results of Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, as well as Fig. 2, indicate that: self - esteem had a significant negative direct predictive effect on medical students\u0026apos; social media addiction (total effect: \u0026beta; = -1.0085, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When mediating variables (involution, anxiety) were added, the direct effect of self - esteem on social media addiction was still significant (\u0026beta; = -0.4394, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Self - esteem significantly negatively predicted involution (\u0026beta; = -3.2156, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and involution significantly positively predicted social media addiction (\u0026beta;\u0026thinsp;=\u0026thinsp;0.0689, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Self - esteem significantly negatively predicted anxiety (\u0026beta; = -0.3239, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and anxiety significantly positively predicted social media addiction (\u0026beta;\u0026thinsp;=\u0026thinsp;0.7962, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Finally, there was a chain - mediating effect of involution and anxiety between self - esteem and social media addiction (\u0026beta; = -0.0899, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), forming a chain - like path.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMediation Model Testing\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOutcome variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInvolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;3.2156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;8.91***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.08***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.3239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;8.43***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.58***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInvolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.07***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial media addiction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.4394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;3.28**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.08***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInvolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.09***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7962\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.63***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e**: p\u0026lt;0.01; ***: p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 The Chain Mediation Effect of Self-Respect and Social Media Addiction Between Involution and Anxiety\u003c/h2\u003e\n \u003cp\u003eBased on correlation analysis and mediation effect testing methods proposed by relevant literature, this study conducted path analysis with gender, age, grade, parents\u0026apos; education level, and only-child status as covariates, self-respect as the independent variable (X), social media addiction as the dependent variable (Y), and involution (M1) and anxiety (M2) as mediating variables. Please refer to Fig. 2.\u003c/p\u003e\n \u003cp\u003eThe research findings indicate:Total Effect of Self-Respect on Social Media Addiction: The total effect size of self-respect on social media addiction is -1.0085, with a direct effect of -0.4394 and an effect size of 43.6% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Mediation Effect of Involution: Involution partially mediates the relationship between self-respect and social media addiction, with a mediation effect size of -0.2214 and an effect size of 22.0% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Mediation Effect of Anxiety: Anxiety also partially mediates the relationship between self-respect and social media addiction, with a mediation effect size of -0.2579 and an effect size of 25.6% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Chain Mediation Effect: Involution and anxiety together form a chain mediation path between self-respect and social media addiction, with a chain mediation effect size of -0.0899 and an effect size of 8.9% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).All paths\u0026apos; 95% confidence intervals do not include zero, indicating that all mediation effects are significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Please refer to Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePath Analysis of the Mediation Model\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePaths\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e效应值\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootstarp 95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e中介效应占比\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;1.0085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e[\u0026minus;1.2694,\u0026minus;0.7476]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.4394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e[\u0026minus;0.7022,\u0026minus;0.1765]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal Indirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.5691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e[\u0026minus;0.7308,\u0026minus;0.4277]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInd 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.2214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e[\u0026minus;0.3400,\u0026minus;0.1177]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInd 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.2579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e[\u0026minus;0.3657,\u0026minus;0.1608]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInd 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.0899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e[\u0026minus;0.1357,\u0026minus;0.0534]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eInd 1: Self-esteem \u0026rarr; Involution \u0026rarr; Social media addiction;Ind 2: Self-esteem \u0026rarr; Anxiety \u0026rarr; Social media addiction; Ind 3:Self-esteem \u0026rarr; Involution \u0026rarr; Anxiety \u0026rarr; Social media addiction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study explored the interrelationships among self - esteem, involution, anxiety, and medical students' social media addiction, and constructed the internal connections among them. This study found that there were significant correlations between each pair of self - esteem, involution, anxiety, and medical students' social media addiction. In addition, involution and anxiety served as mediating and chain - mediating roles between self - esteem and medical students' social media addiction. These findings enriched the influencing paths of medical students' social media addiction and provided new explanatory space for how self - esteem levels affect medical students' social media addiction. At the same time, it also provided empirical evidence for the impacts of self - esteem, involution, and anxiety on social media addiction.\u003c/p\u003e\n\u003cp\u003eThis study found that the relationship between self - esteem and medical students' social media addiction was significant, so H1 was established. This is consistent with previous research results\u0026nbsp;\u003csup\u003e33\u003c/sup\u003e. Rooted in the self - cognition theory and the social comparison theory, individuals with low self - esteem typically exhibit low self - identity and a strong dependence on external validation. This psychological profile renders them high - risk candidates for social media addiction\u0026nbsp;\u003csup\u003e34\u003c/sup\u003e. A comprehensive large - scale meta - analysis revealed that the proportion of individuals with low self - esteem who exhibit dependence on social media is approximately 1.85 - fold that of those with high self - esteem\u0026nbsp;\u003csup\u003e10\u003c/sup\u003e. From a psychological perspective, the relationship between low self - esteem and social media addiction can be explained by the compensation hypothesis. When an individual's real - world needs are not met, they may compensate for this deficiency through online social interactions\u0026nbsp;\u003csup\u003e35\u003c/sup\u003e. In addition, a meta - analysis found that internet addiction is related to cognitive control disorders associated with brain reward processing (ACC, insula, amygdala) and executive functions (DLPFC, frontal lobe, parietal lobe)\u0026nbsp;\u003csup\u003e36\u003c/sup\u003e，Moreover, due to the long - term lack of self - identity, individuals with low self - esteem disrupt the normal operation of the relevant brain systems. When facing online stimuli, they find it more difficult to exercise effective self - control, and thus are more prone to social media addiction \u003csup\u003e37\u003c/sup\u003e. From the perspective of modern medicine, low self - esteem is likely to generate negative emotions. These emotional states exacerbate the risk of internet addiction by affecting the brain's neurotransmitter systems (such as dopamine, serotonin, etc.) \u003csup\u003e38\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, this study also found that involution plays a partial mediating role between self - esteem and social media addiction of medical students, so Hypothesis 2 (H2) is supported. The results of this study are consistent with the findings of relevant meta - analysis studies \u003csup\u003e17\u003c/sup\u003e. In a state of involution, individuals are overly engaged in competition, which restricts their interactions with others in reality. As a result, their social needs are difficult to meet, so they turn to social media to make up for the deficiencies in real - life social interactions \u003csup\u003e39\u003c/sup\u003e. At the neuro - mechanism level, due to the long - term involution pressure, the hypothalamic - pituitary - adrenal (HPA) axis function is disordered. The increase in cortisol levels not only directly exacerbates anxiety but may also further weaken an individual's control ability over social media use by reducing the inhibitory function of the prefrontal cortex on the amygdala \u003csup\u003e40\u003c/sup\u003e. A longitudinal study by Deng et al. found that there is a dose - response relationship between the salivary cortisol levels of medical students and the severity of social media addiction, suggesting that the dysregulation of the HPA axis may be a key biomarker for the transformation of involution pressure into addictive behaviors. At this time, the reward pathway is activated through the mesolimbic dopamine system, forming a stress - reward substitution mechanism, ultimately leading to the pathological development of social media addiction \u003csup\u003e41\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, this study also found that anxiety mediates the relationship between self - esteem and social media addiction of medical students, so Hypothesis 3 (H3) is supported. The results of this study are consistent with the findings of relevant meta - analysis studies \u003csup\u003e42\u003c/sup\u003e. A meta-analysis indicates that there is a significant positive correlation between the frequency of social media use and the level of anxiety. At the same time, it will significantly reduce individuals' positive emotional experiences \u003csup\u003e43\u003c/sup\u003e. In addition, recent studies have found that when individuals with low self-esteem are exposed to content presenting an idealized self, it leads to self-evaluation bias, making them prone to falling into negative emotions such as anxiety. They often choose to escape from reality or relieve negative emotions, which in turn leads to social media addiction. Modern medicine has discovered that social media addiction is closely related to the excessive activation of the brain's reward system. Research shows that it causes the formation of addictive behaviors by stimulating the release of dopamine (which is associated with feelings of pleasure and the alleviation of negative emotions) \u003csup\u003e44\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, this study also found that in the influence of self - esteem on social media addiction of medical students, involution and anxiety play a chain mediating role, verifying Hypothesis 4. Learning dominates the life of medical students in college. However, medical students with low self - esteem are more likely to compare themselves with others when facing high - intensity academic competition, thus deeply perceiving the pressure of involution. This pressure makes them have a strong sense of insecurity and self - doubt at the psychological level. According to the stress - coping theory, when they are in such a high - pressure situation for a long time, anxiety will emerge. The virtual environment created by social media provides them with a haven to temporarily escape from the real - world pressure and negative emotions, making them gradually indulge in it and eventually leading to addictive behaviors.\u003c/p\u003e\n\u003cp\u003eThis research delves deep into the intricate relationships among self - esteem, involution, anxiety, and social media addiction among medical students. For the first time, it endeavors to integrate these variables, thereby extending the existing research outcomes to a certain degree. By analyzing the chain - mediating model, the study further uncovers the underlying connections and interactions among them, which holds significant theoretical and practical implications.The findings indicate that there are substantial correlations among self - esteem, involution, anxiety, and social media addiction in medical students. Notably, involution functions as a single mediator, while anxiety serves as a chain - mediator. These discoveries not only enrich the theoretical framework regarding the psychological and behavioral mechanisms between self - esteem and social media addiction in medical students but also offer novel perspectives and strategies for clinical intervention.From a theoretical perspective, this study validates the close association between self - esteem and social media addiction among medical students through empirical research. It further corroborates the adverse effects of low self - esteem on an individual's physical and mental well - being, providing fresh evidence for understanding the pathological mechanisms of individuals with low self - esteem.\u003c/p\u003e\n\u003cp\u003ePractically, the research results imply that for the medical student population, it is crucial to prioritize the assessment and intervention of involution and anxiety to mitigate the risk of social media addiction. Clinically, this study furnishes a scientific foundation for devising preventive and intervention measures targeting the low - self - esteem phenomenon among medical students. It underscores the significance and necessity of considering the self - esteem context when treating social media addiction in medical students.Furthermore, this study recommends that subsequent research should delve deeper into the causal relationships among self - esteem, involution, and anxiety. Simultaneously, future studies should also focus on other potential variables associated with social media addiction in medical students, such as the impact of physical exercise intervention on this addictive behavior\u0026nbsp;\u003csup\u003e45\u003c/sup\u003e. Previous studies have found that there is a negative correlation between physical exercise and social media addiction among college students\u0026nbsp;\u003csup\u003e46\u003c/sup\u003e. Moreover, physical exercise has the potential to mitigate negative emotions among medical students, alleviate the phenomenon of involution - related behaviors, and reduce the prevalence of social media addiction within this student group. By doing so, it offers novel and innovative intervention strategies in the realm of physical and mental well - being \u003csup\u003e47\u003c/sup\u003e. In conclusion, this study not only enhances the understanding of the relationship between self - esteem and social media addiction among medical students, but also provides valuable theoretical and practical guidance for the maintenance and promotion of physical and mental health.\u003c/p\u003e\n\u003cp\u003eThis study also has some deficiencies. First, the research data mainly come from subjective surveys and are easily interfered by personal subjective factors, so it is difficult to ensure the objectivity of the data. Because the respondents may have self - cognitive biases, social desirability effects, etc., the collected data have certain subjectivity. Second, the study adopts a cross - sectional design. Although this design can analyze the variable relationships at a specific time point, it is difficult to accurately infer the causal relationships between variables and cannot clearly present the influence mechanism of variables changing over time. Third, the study does not involve the cross - regional level. Under different cultural backgrounds, the relationships between variables may have significant differences, which limits the universality of the study. In view of the above deficiencies, subsequent research can consider using more objective data collection methods. For example, integrate physiological index data and third - party report data to improve the accuracy and reliability of the data. At the same time, in the research design, select the longitudinal research method, which can deeply analyze the causal logic between variables in the time dimension and make up for the deficiencies of the cross - sectional design. In addition, carry out cross - cultural research, compare the relationship characteristics between variables in different cultural contexts, which helps to expand the breadth and depth of the research and make the research results more universally applicable.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eThis study reveals a significant correlation among self - esteem, involution, anxiety, and social media addiction of medical students. The research finds that self - esteem, involution, anxiety, and social media addiction of medical students are significantly correlated pairwise. In the influence of self - esteem on social media addiction of medical students, involution and anxiety play a separate mediating role and a chain mediating role respectively. This discovery not only provides a new theoretical basis for analyzing the formation mechanism of medical students' social media dependence, but also establishes a key practical entry point for the formulation of targeted intervention strategies. It is recommended that subsequent research further verify the stability and universality of the action paths between variables through longitudinal research design, interdisciplinary method integration, and comparative analysis of groups with different cultural backgrounds, so as to enhance the clinical application value of the research results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki and approved by the Heilongjiang University of Chinese Medicine Research Ethics Committee (Approval Number: HZYLLKT202319901). Electronic informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMa Xiaodi.Wang Jinghuan.Nie Hong.Zhao Mingjing wrote the main manuscript text and He Ruirui .Lei Shuangyuan .Bing Li prepared figures.All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSakamoto S, Miyawaki D, Goto A, Hirai K, Hama H, Kadono S, Nishiura S, Inoue K: \u003cstrong\u003eAssociations between Internet Addiction, Psychiatric Comorbidity, and Maternal Depression and Anxiety in Clinically Referred Children and Adolescents\u003c/strong\u003e. \u003cem\u003eNeuropsychiatr Dis Treat\u003c/em\u003e 2022, \u003cstrong\u003e18\u003c/strong\u003e:2421-2430.\u003c/li\u003e\n \u003cli\u003eBanna MHA, Brazendale K, Hamiduzzaman M, Ahinkorah BO, Abid MT, Rifat MA, Sultana MS, Tetteh JK, Kundu S, Shekhar MSR\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eExposure to secondhand smoke is associated with poor sleep quality among non-smoking university students in Bangladesh: a cross-sectional survey\u003c/strong\u003e. \u003cem\u003eSCI REP-UK\u003c/em\u003e 2023, \u003cstrong\u003e13\u003c/strong\u003e(1):16735.\u003c/li\u003e\n \u003cli\u003eAlshanqiti A, Alharbi OA, Ismaeel DM, Abuanq L: \u003cstrong\u003eSocial Media Usage and Academic Performance Among Medical Students in Medina, Saudi Arabia\u003c/strong\u003e. \u003cem\u003eAdv Med Educ Pract\u003c/em\u003e 2023, \u003cstrong\u003e14\u003c/strong\u003e:1401-1412.\u003c/li\u003e\n \u003cli\u003eSingh A, Chaudhury S, Chaudhari B: \u003cstrong\u003eImpact of Social Media Addiction Among Medical Students on Their Social Interaction, Well-Being, and Personality: A Comparative Study\u003c/strong\u003e. \u003cem\u003eCureus\u003c/em\u003e 2024, \u003cstrong\u003e16\u003c/strong\u003e(9):e70526.\u003c/li\u003e\n \u003cli\u003eMohammadbeigi A, Absari R, Valizadeh F, Saadati M, Sharifimoghadam S, Ahmadi A, Mokhtari M, Ansari H: \u003cstrong\u003eSleep Quality in Medical Students; 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\u003cstrong\u003e11\u003c/strong\u003e(3):e152137.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Self - esteem, Social media addiction, Anxiety, Academic over - competition (Involution), Medical students","lastPublishedDoi":"10.21203/rs.3.rs-6168986/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6168986/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to explore the impact of self-esteem on social media addiction among medical students and examine the mediating roles of involution and anxiety. A cross-sectional survey was conducted among 1055 medical students using the Self-Esteem Scale, Social Media Addiction Scale, Involution Scale, and Anxiety Scale. Correlational analyses revealed that self-esteem was negatively correlated with social media addiction (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.233r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.233), involution (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.257r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.257), and anxiety (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.327r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.327). Social media addiction was positively correlated with involution (r\u0026thinsp;=\u0026thinsp;0.303r\u0026thinsp;=\u0026thinsp;0.303) and anxiety (r\u0026thinsp;=\u0026thinsp;0.332r\u0026thinsp;=\u0026thinsp;0.332), while involution and anxiety were also positively correlated (r\u0026thinsp;=\u0026thinsp;0.360r\u0026thinsp;=\u0026thinsp;0.360).The structural equation modeling indicated that involution and anxiety partially mediated the relationship between self-esteem and social media addiction. The mediating effect of involution was \u0026minus;\u0026thinsp;0.2214 (effect size = -0.2214, 95% CI = [-0.3400, -0.1177]), and the mediating effect of anxiety was \u0026minus;\u0026thinsp;0.2579 (effect size = -0.2579, 95% CI = [-0.3657, -0.1608]). The total chain-mediating effect of involution and anxiety was \u0026minus;\u0026thinsp;0.0899 (effect size = -0.0899, 95% CI = [-0.1357, -0.0534]). Involution and anxiety served as sequential mediating pathways between self-esteem and social media addiction among medical students (path: self-esteem \u0026rarr; involution \u0026rarr; anxiety \u0026rarr; social media addiction).\u003c/p\u003e","manuscriptTitle":"The Impact of Self - Esteem on Social Media Addiction in Medical Students: The Chain - Mediation Effects of Academic Over - competition (Involution) and Anxiety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 07:23:52","doi":"10.21203/rs.3.rs-6168986/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-11T10:09:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-10T20:12:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154718701472482513565141924564582945183","date":"2025-06-02T08:23:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111364367151726120812806265981932704543","date":"2025-04-15T15:49:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T06:17:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282245480456592864757724835899167025955","date":"2025-03-28T10:14:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-24T03:50:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-24T03:09:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-19T13:35:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-18T13:54:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-06T09:07:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75eba3c0-2ecf-4de2-af9a-59f8612ccb7f","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":46350267,"name":"Biological sciences/Psychology"},{"id":46350268,"name":"Health sciences/Health occupations"},{"id":46350269,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-11-24T16:07:57+00:00","versionOfRecord":{"articleIdentity":"rs-6168986","link":"https://doi.org/10.1038/s41598-025-24317-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-11-18 15:59:02","publishedOnDateReadable":"November 18th, 2025"},"versionCreatedAt":"2025-04-01 07:23:52","video":"","vorDoi":"10.1038/s41598-025-24317-9","vorDoiUrl":"https://doi.org/10.1038/s41598-025-24317-9","workflowStages":[]},"version":"v1","identity":"rs-6168986","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6168986","identity":"rs-6168986","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}