Relationship between cirrhosis patients' social support and post-traumatic stress symptoms: Chained multiple mediating effects of sense of control and avoidance coping strategies.

Patients with cirrhosis frequently exhibit post-traumatic stress symptoms (PTSS), which may further aggravate serious psychological and psychiatric conditions. However, the underlying mediating mechanisms by which social support affects PTSS remain insufficiently elucidated. From November 2024 to July 2025, patients with cirrhosis were recruited via cluster sampling from a tertiary hospital in Shenzhen, Guangdong Province, China. A total of 380 participants completed the Perceived Social Support Scale, the civilian version of the Post-Traumatic Stress Checklist, the Sense of Control Scale, and the Self-Report Coping Scale. Data were analyzed using chi-square tests, Pearson's correlation analyses, and structural equation modeling to examine the relationships among variables. The mean PTSS score was 29.09 ± 10.61, indicating a moderate level of symptom severity. Perceived social support (61.23 ± 15.53) and sense of control (49.22 ± 11.76) were relatively low, whereas avoidant coping subtypes - withdrawal (9.11 ± 4.64), internalization (8.95 ± 4.08), and externalization (10.86 ± 4.90) - were moderately prevalent. Structural equation modeling results indicated that perceived social support not only directly and negatively predicted PTSS, but also exerted significant indirect effects through sense of control, internalization, and externalization, collectively accounting for 25.21% of the total effect. Moreover, sense of control and internalization sequentially mediated the association between social support and PTSS, forming a significant chain mediation pathway. Social support mitigates PTSS both directly and indirectly via enhanced control and reduced avoidant coping (internalization/externalization). The identified chain mediation pathway underscores the importance of developing interventions that enhance sense of control and reduce maladaptive coping strategies in patients with cirrhosis.