Background <p>Patients receiving maintenance hemodialysis (MHD) face significant physical and psychological challenges due to the chronic nature of their condition as well as the demands of treatment regimens. Mental health plays a crucial role in their overall well-being, yet the interplay between psychological factors such as social support, regulatory emotional self-efficacy, and flourishing remains underexplored.</p> Objective <p>This study aims to investigate the complex relationships between social support, regulatory emotional self-efficacy, and flourishing among patients receiving MHD using advanced network analysis to identify key factors that could inform targeted interventions to enhance their mental health and quality of life.</p> Methods <p>A cross-sectional study was conducted with 376 patients receiving MHD from tertiary and secondary hospitals in Shanghai. Data were collected through standardized questionnaires assessing flourishing, perceived social support, and regulatory emotional self-efficacy. Network analysis was used to explore the associations and centrality of these variables related to the psychological well-being of patients receiving MHD.</p> Results <p>The network analysis revealed that positive emotion is a central node, strongly connected to other dimensions of flourishing, social support, and emotional self-regulation. Accomplishment and meaning were also closely intertwined, indicating their pivotal roles in the well-being of patients receiving MHD. Notably, family support was negatively associated with engagement, highlighting potential areas of conflict within familial caregiving dynamics.</p> Conclusions <p>This study underscores the importance of positive emotion, accomplishment, and meaning in the psychological well-being of patients receiving MHD. The findings suggest that interventions aimed at enhancing emotional self-regulation and strengthening social support networks, could improve the mental health outcomes for this population.</p>