American gymnast Simone Biles is grateful for the support of fans and family as she dealt with mental health issues that kept her away for two years before her triumphant return.

She pulled out of multiple events at the Tokyo Olympics in 2021 due to the "twisties", a temporary loss of spatial awareness in mid-air.

Her withdrawal to focus on her mental health was one of the biggest stories of those Games.

She returned in August to win a record eighth all-around title at the US Gymnastics Championships in San Jose.

At the Artistic Gymnastics World Championships that finished on Sunday in Antwerp, Belgium, she won five medals – four golds and a silver.

"I would like to extend my heartfelt gratitude to fans, friends, family & partnerships who have been unwavering pillars of support throughout my mental health journey," Biles wrote in a social media post on Wednesday.

"Your encouragement, love, and belief in me has been instrumental in my success and recovery. Knowing that you were there, cheering me on, gave me the strength to push through the toughest moments.

"World Championships was an absolute dream & I still can't believe it."

The 26-year-old is a four-time Olympic and 23-time world championship gold medallist who has looked as dominant as ever since returning to the sport.

Widely considered the greatest gymnast of all time, Biles has said she plans to compete at the Paris Olympics in 2024. REUTERS