Conserving biodiversity is crucial for maintaining essential ecosystem functions, as indicated by the positive relationships between biodiversity and ecosystem functioning. However, the impacts of declining biodiversity on ecosystem functions in response to mounting human pressures remain uncertain. This uncertainty arises from the complexity of trade-offs among human activities, climate change, river properties, and biodiversity, which have not been comprehensively addressed collectively. Here, we provide evidence that river biodiversity was significantly and positively associated with multifunctionality and contributed to key ecosystem functions such as microbially driven water purification, leaf litter decomposition and pathogen control. However, human pressure led to abrupt changes in microbial diversity and river multifunctionality relationships at a human pressure value of 0.5. In approximately 30 % (N = 58) of countries globally, the ratio of area above this threshold exceeded the global average (∼11 %), especially in Europe. Results show that human pressure affected ecosystem functions through direct effects and interactive effects. We provide more direct evidence that the nonadditive effects triggered by prevailing human pressure impact the multifunctionality of rivers globally. Under high levels of human stress, the beneficial effects of biodiversity on nutrient cycling, carbon storage, gross primary productivity, leaf litter decomposition, and pathogen control tend to diminish. Our findings highlight that considering interactions between human pressure and local abiotic and biotic factors is key for understanding the fate of river ecosystems under climate change and increasing human pressure.