Psychological Inflexibility and Loneliness Mediate the Impact of Stress on Anxiety and Depression Symptoms in Healthcare Students and Early-Career Professionals During COVID-19
Open accessAbstract
Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge. Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms. Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects. Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19. Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.
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The findings support earlier research that lower psychological flexibility is linked with greater psychological distress among nursing students.
“Our findings support earlier research by indicating that lower levels of flexibility are linked with greater psychological distress among nursing students”
From Associations of psychological flexibility, mindfulness, and valued living with psychological distress among nursing students (2025) · cites this paper as [46]
The Results (Sample Description; page unavailable) report a significant positive correlation between psychological inflexibility and anxiety and depressive symptoms. The Methods (Participants; page unavailable) show that nursing students were included, but the study analyzed a mixed healthcare-student sample and did not establish the association specifically among nursing students. (LLM, conf=0.85)
Experimental — accuracy not yet measuredLimited psychological flexibility may heighten vulnerability to emotional challenges in high-pressure academic and clinical environments.
“This suggests that limited flexibility may heighten vulnerability to emotional challenges in high-pressure academic and clinical environments.”
From Associations of psychological flexibility, mindfulness, and valued living with psychological distress among nursing students (2025) · cites this paper as [46]
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- Authors
- Bonilla-Sierra, P., Manrique-G, A., Hidalgo-Andrade, P., & Ruisoto, P.
- Affiliations
- Universidad Técnica Particular de Loja (EC)
- Universidad de Las Américas (EC)
- Universidad Pública de Navarra (UPNA) (ES)
- Corresponding author
- Hidalgo-Andrade, Paula
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2021-09-20
- Volume
- 12
- Pages
- 729171-729171
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC8491304
- OpenAlex
- W3201507645
- Cited by
- 32
- References
- 56
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 11 · 2023: 3 · 2022: 3 · 2021: 1
- FWCI
- 3.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Academica-e (Universidad Pública de Navarra) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- Universidad Técnica Particular de Loja
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- psychological inflexibility, loneliness, psychological stress, anxiety symptoms, depressive symptoms, health professions students, COVID-19 pandemic, alcohol consumption, gender differences, mediation, Ecuador
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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