Perceived stress and severity of male etomidate use disorder in China: a moderated mediation model of anxiety symptoms severity and emotion regulation difficulties.

Background: Non-medical use of etomidate has emerged as a novel psychoactive substance (NPS) threat in China. Although stress-related mechanisms have been widely implicated in substance use disorders, evidence specific to etomidate use disorder (EUD) remains limited. This study examined whether anxiety symptoms (AS) severity mediates the association between perceived stress and EUD severity, and whether difficulties in emotion regulation strengthen the stress-AS severity link. Methods: A total of 556 male patients diagnosed with EUD were recruited from drug rehabilitation centers in Hunan Province, China (M Results: Perceived stress was positively associated with EUD severity. AS severity partially mediated the association between perceived stress and EUD severity. Moreover, DERS moderated the perceived stress-AS severity path, such that perceived stress was more strongly related to AS severity at higher levels of emotion regulation difficulties. Consistently, the indirect effect of perceived stress on EUD severity through AS severity was stronger among individuals reporting greater emotion regulation difficulties. Conclusion: These findings suggest that AS severity serves as a potential emotional correlate in the relationship between perceived stress and EUD severity, particularly among individuals with substantial emotion regulation difficulties. Individuals with greater deficits in emotion regulation exhibited a stronger indirect effect of stress on EUD severity via AS severity. This highlights the clinical importance of targeting emotion regulation in interventions for EUD, as improving emotional coping strategies may mitigate the impact of stress. Future longitudinal studies are needed to clarify the causal direction of these associations and investigate how changes in emotion regulation over time influence EUD progression.