Is psychological flexibility a mediator between perceived stress and general anxiety or depression among suspected patients of the 2019 coronavirus disease (COVID-19)?

Abstract

This study is aimed to investigate the status of general anxiety and depression among suspected patients of COVID-19 and explore whether psychological flexibility can serve as a mediator between perceived stress and general anxiety or depression. Total of 180 participants completed the online questionnaire which comprised demographic information, the Perceived Stress Scale (PSS), the 7-item Generalized Anxiety Disorder scale (GAD-7), the 9-item Patients Health Questionnaire (PHQ-9), the Acceptance and Action Questionnaire-II (AAQ-II) and the Cognitive Fusion Questionnaire (CFQ). Statistical methods including correlation analysis, multiple linear regression analysis and structural equation model were used in this study. The scores of 23.9% (43/180) and 34.4% (62/180) of participants were higher than the cut points of GAD-7 and PHQ-9 respectively. Psychological flexibility was significantly correlated with perceived stress, general anxiety and depression. Multiple regression analyses showed the possible mediation effect of psychological flexibility between perceived stress and general anxiety or depression. The structural equation model confirmed that psychological flexibility partially mediated between perceived stress and general anxiety or depression. Our findings suggested the potential benefit of Acceptance and Commitment Therapy (ACT) as a psychological support approach in suspected patients of COVID-19 because ACT targets psychological flexibility.

Behavioral Patterns of Depression Patients and Control Population

“…This is consistent with previous literature that showed that higher perceived stress was associated with lower psychological flexibility [ 44 ]. We also found that lower psychological flexibility was associated with higher levels of anxiety and depression, which is in line with previous studies that suggested that lower psychological flexibility was associated with more depressive symptoms, more anxiety-related symptoms, and poorer psychological health in general [ 45 ]. In this line, several studies found how depression, stress, anxiety, loneliness, and neuroticism are parameters related to mental illness [ 46 , 47 , 48 , 49 ].…”

Psychological Flexibility Mediates Wellbeing for People with Adverse Childhood Experiences during COVID-19

“…There is recent research on mitigating the effects of COVID-19 and improving mental health and wellbeing. Interventions that promote Psychological Flexibility, such as Acceptance and Commitment Therapy (ACT) and Mindfulness are shown to be effective [19,[46][47][48], and also mitigate the effects of ACEs [49,50]. Psychological Flexibility, the ability to adapt to situations by accepting and fully experiencing all thoughts and feelings and engaging in value-based behaviour, aims to promote positive mental health and wellbeing and reduces psychological distress [51].…”

“…Consequently, it was hypothesized that those with no ACEs will have significantly lower stress at Time 2 when compared to those with ACEs. Finally, this study aims to investigate whether self-reported Psychological Flexibility is a protective factor that can help mitigate the negative impacts of ACEs and psychological distress on wellbeing over time, due to the known positive relationship between psychological wellbeing and psychological flexibility [46][47][48][49][50].…”

The longitudinal association between Perceived Stress, PTSD Symptoms, and Post-Traumatic Growth during the COVID-19 Pandemic: the role of coping strategies and psychological inflexibility

“…For example, the presence of high psychological inflexibility determines the implementation of avoidance strategies (Dawson & Golijani-Moghaddam, 2020 ). In addition, psychological inflexibility has been successfully tested as a mediator in the relationship between different constructs such as COVID-19 stress and psychological distress (i.e., depression, anxiety, and somatization) (Arslan et al, 2021 ), perceived stress, anxiety, and depression (Huang et al, 2021 ), intolerance of uncertainty, and PTSD symptoms (Kennedy et al, 2021 ). One limitation is that the potential mediating role of psychological inflexibility in the relationship between perceived stress and PTSD symptoms in any stressful situation, as well as in the context of COVID-19 Pandemic, has not been examined.…”