Perceived social support and general psychological distress in the post-pandemic era: mediation of perceived stress and moderation of psychological resilience

As societies continue to navigate the intricate landscape of the post-pandemic era, public health research is increasingly turning its focus toward the lagging psychological recovery of populations worldwide. Following the National Health Commission of the People’s Republic of China’s transition to Category B, Level B management policies for COVID-19 at the close of 2022, daily life and economic frameworks gradually resumed normal pacing by January 2023. However, the psychological aftermath has proven remarkably persistent. A comprehensive nationwide study conducted across mainland China between February and March 2025 has shed new light on this phenomenon, revealing complex interactions between perceived social support, perceived stress, psychological resilience, and general psychological distress.

Methodology and Nationwide Demographic Scope

To evaluate the psychological state of the population during this transitional phase, researchers deployed a cross-sectional survey design utilizing convenience sampling via the Questionnaire Star digital platform. Disseminated widely through WeChat networks, the survey captured responses from a massive demographic cross-section across mainland China.

Out of 12,241 total submissions collected between February and March 2025, rigorous data cleaning—specifically checking for logical consistency and removing mismatched duplicate item answers—yielded a robust final sample of 8,131 valid questionnaires. The study cohort presented distinct demographic characteristics: the sample was predominantly male, accounting for 74% of participants, while female respondents comprised 26%. The age bracket of 18 to 20 years represented the largest segment at 53.1%, with students (28.4%) and public institution employees (26.3%) forming the primary occupational groupings. Furthermore, 77.1% of the participants reported being single, and low-income households constituted the largest financial tier at 54.5%.

To measure the core psychological variables, the researchers utilized established, culturally validated psychometric instruments. Perceived social support was evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS), yielding a high internal consistency with a Cronbach’s alpha of 0.98. Perceived stress was gauged through the Chinese Perceived Stress Scale (CPSS, alpha = 0.933), while psychological resilience was assessed via the 10-item Connor–Davidson Resilience Scale (CD-RISC-10, alpha = 0.987). Finally, general psychological distress was screened using the 28-item General Health Questionnaire (GHQ-28, alpha = 0.932). Confirmatory factor analysis and variance inflation factor checks verified both construct validity and the absence of problematic multicollinearity.

Core Findings: The Moderated Mediation Model

The empirical findings offer a nuanced perspective on how external support mechanisms translate into internal psychological well-being. Bivariate correlation analyses initially established strong baseline relationships: general psychological distress was positively correlated with perceived stress ($r = 0.59, p < 0.01$) and negatively correlated with both psychological resilience ($r = -0.59, p < 0.01$) and perceived social support ($r = -0.60, p < 0.01$).

Using Hayes’ PROCESS macro (Version 4.3, Model 8) with 5,000 bootstrap resamples, the researchers tested a sophisticated moderated mediation model. The analysis confirmed that perceived stress positively predicted general psychological distress ($beta = 0.3628, p < 0.001$). More importantly, psychological resilience was found to significantly moderate both the direct path from perceived social support to general psychological distress and the predictive path from perceived social support to perceived stress.

A striking discovery emerged from the simple slope decomposition regarding the first-stage moderation. While perceived social support typically acts as a buffer against stress, the direction of this effect reversed depending on an individual’s baseline psychological resilience. At high levels of psychological resilience ($M + 1SD$), greater perceived social support was associated with lower perceived stress ($beta = -0.4703, p < 0.001$), aligning with traditional stress-buffering hypotheses. However, at low levels of psychological resilience ($M – 1SD$), the relationship inverted: perceived social support positively predicted perceived stress ($beta = 0.2488, p < 0.001$).

Consequently, the conditional indirect effect of perceived social support on psychological distress via perceived stress shifted from negative under high resilience to positive under low resilience [index of moderated mediation = $-0.1304$, 95% CI ($-0.1449$, $-0.1165$)]. This crossover interaction suggests that for individuals lacking sufficient internal coping resources, receiving social support may not uniformly alleviate stress and could potentially translate into an added psychological burden or demand.

Exploratory Demographic Insights

To further dissect the data, exploratory simple moderation analyses examined whether gender, income, marital status, or occupation influenced the association between perceived stress and general psychological distress. Statistically significant interactions were identified for income ($beta = 0.055, p < 0.001$), marital status ($beta = 0.168, p < 0.001$), and gender ($beta = 0.085, p < 0.001$), whereas occupation showed no significant moderating effect ($beta = 0.017, p = 0.303$).

Women, lower-income individuals, and married participants exhibited heightened vulnerability to distress when confronting high perceived stress. Nevertheless, because the incremental variance explained by these demographic interactions was extremely small ($Delta R^2 le 0.0024$), researchers cautioned against overinterpreting these as sweeping subgroup rules, framing them instead as hypothesis-generating indicators for future investigations.

Implications for Post-Pandemic Mental Health Interventions

The insights derived from this nationwide survey carry profound implications for clinical practice, public health policy, and community-level psychological support systems in the post-pandemic era. Traditional mental health campaigns frequently rely on generalized assumptions that increasing social support will universally reduce stress and psychological distress. However, the identification of a crossover interaction at low levels of psychological resilience challenges this one-size-fits-all approach.

Mental health professionals and institutional policymakers must design stratified, targeted interventions. For individuals possessing robust psychological resilience, bolstering community and social support networks remains an effective strategy for mitigating stress. Conversely, for vulnerable populations presenting with low psychological resilience—such as certain low-income demographics or individuals exhibiting signs of chronic fatigue and neurocognitive distress leftover from long COVID—simply increasing social support may prove insufficient or counterproductive.

Instead, these cohorts require specialized cognitive-behavioral interventions focused on cognitive reappraisal and the active building of internal coping resources before external social support can be effectively metabolized into stress relief. As health systems worldwide continue to grapple with the delayed psychological tolls of the pandemic, this study underscores the necessity of continuous, multidisciplinary rehabilitation frameworks that balance external social networks with the cultivation of internal psychological resilience.