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

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).