Examining the role of social support in imposter phenomenon among medical students through mediation and moderation analysis of anxiety and stress

Imposter syndrome (IS) is characterized by individuals’ inability to internalize success and persistent feelings of being intellectual frauds despite evident achievements. Though not a clinically recognized disorder, IS significantly affects psychological well-being, particularly among medical professionals and students, leading to anxiety, stress, and burnout. In Pakistan, the relationship between IS, its psychological drivers, and protective factors remains underexplored. This study examines how perceived social support relates to IS, with a specific focus on the mediating and moderating roles of anxiety and stress. A multi-center cross-sectional study was conducted among 649 medical students from four medical institutions in Pakistan. Validated tools were used: the Clance IP Scale, Oslo Social Support Scale (OSSS-3), and the Anxiety and Stress Sub-Scale of DASS-21. Data were analyzed using hierarchical regression, correlation matrices, and mediation/moderation modeling via the PROCESS macro in SPSS v26. Mean IS scores (M = 61.23, SD = 16.46) indicated frequent impostor feelings. Social support negatively correlated with IS (r = − 0.141, p < 0.001), anxiety (r = − 0.130, p = 0.001), and stress (r = − 0.132, p = 0.001). In regression, social support initially predicted IS (β = − 0.141, p < 0.001), but became non-significant when anxiety and stress were included. Anxiety (β = 0.351, p < 0.001) and stress (β = 0.670, p < 0.001) were significant predictors. Mediation analysis confirmed that both anxiety and stress significantly mediated the social support–IS relationship. Moderation analyses showed no significant interaction effects (p > 0.05). Social support reduces IP primarily by alleviating anxiety and stress, rather than through direct buffering. Targeted interventions that address both emotional distress and enhance supportive environments are essential for fostering psychological resilience in medical education.