The Influence of Self-Esteem and Psychological Flexibility on Medical College Students' Mental Health: A Cross-Sectional Study
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Background: Mental health problems has become a major public health issue among medical students. Self-esteem and psychological flexibility were important associated factors for mental health, but their relations have not been discussed in medical students. The present study aimed to assess the status of mental health problems among medical students and identified whether psychological flexibility had a mediating role in the effects of self-esteem on the top three most common psychological symptoms. Methods: A total of 810 undergraduate students from 18 classes comprised in the sample. Nine dimensions of psychological symptoms was assessed by the Symptom Checklist-90-revised (SCL-90-R). Self-esteem was measured by the Self-esteem Scale (SES) and psychological flexibility was evaluated by the Acceptance and Action Questionnaire 2nd Edition (AAQ-II) and Cognitive Fusion Questionnaire (CFQ-F). Univariate analysis and logistic regression analysis were used to determine the relationship among the top three common psychological symptoms, self-esteem, psychological flexibility, and participants' characteristics. The mediating effect of psychological flexibility between self-esteem and psychological symptoms was detected by bootstrap method. Results: 57.8% of the medical undergraduate students reported positive at least one of the nine psychological symptom dimensions assessed by the SCL-90-R and 13.8% of students had moderate or more severe symptoms. The symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression were the three most common psychological symptoms among the medical students. Meanwhile, self-esteem and psychological flexibility were negatively associated to the symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression. And, almost 50% effects of self-esteem on these three symptoms in medical students exert indirect effects through psychological flexibility. Conclusions: Psychological distress was quite common in the Chinese medical students. The three most common psychological symptoms were successively obsessive-compulsiveness, interpersonal sensitivity, and depression. Low self-esteem and psychological inflexibility might be the risk factors for these top three symptoms, and psychological flexibility might play a mediating role in the effects of self-esteem on these psychological symptoms.
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AAQ2, CD-RISC 10, and PSRS have good validity and reliability for measuring psychological flexibility, resilience, and stress reactivity.
“which exhibits strong convergent and discriminant validity, while also being robust to social desirability bias.”
From Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation (2025) · cites this paper as [38]
The Methods > Measures passage reports that AAQ-II assessed experiential avoidance and had a Cronbach coefficient of 0.883 in this study, supporting the reliability portion for that instrument. It does not establish validity for AAQ-II or address CD-RISC 10 or PSRS; a search also found no support for the verbatim sentence’s claims about convergent and discriminant validity or social desirability bias. The indexed passages provide no page numbers. (LLM, conf=0.85)
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Self-citationFang, Y., Li, J., Yang, M., Zhang, Y., Huang, W., Meng, S., Xiang, X., Miao, G., & Zeng, S. (2026) · BMC Medical Education · doi:10.1186/s12909-026-09371-9
Perfectionism and Obsessive-Compulsive Symptom Dimensions in University Students
Quarantini-Alvim, Y., Lima, M. O., Alves-Pereira, R., Christo, R. B., Alves, G. S., Dib, L., Roiter, D. G., Cupertino, F., Quarantini, L. C., & Sampaio, A. (2026) · Cureus · doi:10.7759/cureus.109940
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Shiota, S., Ohitokata, T., & Harada, H. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1884043
Self‐Esteem Is Associated With Attentional Selection Efficiency: An ERP Study
Lan, Y., Liu, X., Wang, G., Jing, J., & 崔轶 (2026) · Scandinavian Journal of Psychology · doi:10.1111/sjop.70145
西憲, 敬. (2026) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-026-01183-6
Söymen, E., & Aktaş, A. (2026) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.2006213
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- Authors
- Guo, J., Huang, X., Zheng, A., Chen, W., Lei, Z., Tang, C., Chen, H., Ma, H., & Li, X.
- Affiliations
- The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
- Hunan University of Medicine (CN)
- Corresponding author
- Li, Xuemei
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2022-05-16
- Volume
- 13
- Pages
- 836956-836956
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC9148951
- OpenAlex
- W4280620065
- Cited by
- 38
- References
- 64
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 6 · 2023: 4 · 2022: 1
- FWCI
- 8.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Science-Health Joint Medical Scientific Research Project of Chongqing (2020MSXM079)
- Chongqing Municipal Education Commission
- Hunan University of Chinese Medicine
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- self-esteem, psychological flexibility, medical students, mental health, psychological symptoms, obsessive-compulsiveness, interpersonal sensitivity, depression, mediating effect, psychological distress, cognitive fusion
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