Mediating Role of Mentalization in Depressive Symptoms Among College University Students
Main Article Content
Abstract
This study explores the mediating role of mentalization—the psychological capacity to understand the mental states of oneself and others—in the relationship between academic stress and depressive symptoms among university students during the COVID-19 pandemic. Conducted in Valparaíso, Chile, with a sample of 300 students, the study utilizes a cross-sectional design. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), stress levels were measured with the Depression Anxiety Stress Scales-21 (DASS-21), and mentalization was evaluated through the Reflective Functioning Questionnaire. Results reveal that disruptions in mentalization, specifically uncertainty about mental states, partially mediate the impact of stress on depressive symptoms, highlighting the crucial role of mentalization processes in the development and management of depressive symptoms under stressful conditions. The findings emphasize the importance of enhancing mentalization capabilities in university settings to improve students' resilience to stress, particularly in crisis situations like the pandemic. This research underscores the necessity of integrating mentalization-focused strategies in preventive and therapeutic interventions for university students to support their mental health and well-being.
Keywords:
COVID 19, college students, depression, stress, mentalization
Article Details
How to Cite
SOLERVICENS, Paula et al.
Mediating Role of Mentalization in Depressive Symptoms Among College University Students.
Medical Research Archives, [S.l.], v. 12, n. 6, june 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5479>. Date accessed: 02 july 2024.
doi: https://doi.org/10.18103/mra.v12i6.5479.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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28. Mechili EA, Saliaj A, Kamberi F, et al. Is the mental health of young students and their family members affected during the quarantine period? Evidence from the COVID‐19 pandemic in Albania. Journal of psychiatric and mental health nursing. 2021;28(3):317-325.
29. Kumaraswamy N. Academic stress, anxiety and depression among college students: A brief review. International review of social sciences and humanities. 2013;5(1):135-143.
30. Pozos-Radillo BE, de Lourdes Preciado-Serrano M, Acosta-Fernández M, de los Ángeles Aguilera-Velasco M, Delgado-García DD. Academic stress as a predictor of chronic stress in university students. Psicología educativa. 2014;20(1):47-52.
31. Akgun S, Ciarrochi J. Learned resourcefulness moderates the relationship between academic stress and academic performance. Educational Psychology. 2003; 23(3):287-294.
32. MacGeorge EL, Samter W, Gillihan SJ. Academic stress, supportive communication, and health. Communication Education. 2005; 54(4):365-372.
33. Kivimäki M, Kawachi I. Work stress as a risk factor for cardiovascular disease. Current cardiology reports. 2015;17:1-9.
34. van Dijke A. Dysfunctional Affect Regulation.
35. Bateman AW, Fonagy P. Handbook of mentalizing in mental health practice. American Psychiatric Pub; 2019.
36. Lassri D, Desatnik A. Losing and regaining reflective functioning in the times of COVID-19: Clinical risks and opportunities from a mentalizing approach. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(S1):S38.
37. Fonagy P, Luyten P. Attachment, mentalizing, and the self. Handbook of personality disorders: Theory, research, and treatment. 2018:123-140.
38. Luyten P, Lemma A, Target M. Depression. In: Bateman A, Fonagy P, eds. Handbook of Mentalizing in Mental health Practice. Second ed. American Psychiatric Association Publishing; 2019:446:chap 23.
39. Fonagy P, Gergely G, Jurist EL, Target M. Affect regulation, mentalization, and the development of the self. Affect regulation, mentalization, and the development of the self. Other Press; 2002:xiii, 577-xiii, 577.
40. Dean J, Keshavan M. The neurobiology of depression: An integrated view. Asian Journal of Psychiatry. 2017/06/01/ 2017;27:10 1-111.doi:https://doi.org/10.1016/j.ajp.2017.01.025
41. Østby Y, Tamnes CK, Fjell AM, Westlye LT, Due-Tønnessen P, Walhovd KB. Heterogeneity in subcortical brain development: a structural magnetic resonance imaging study of brain maturation from 8 to 30 years. Journal of neuroscience. 2009;29(38):11772-11782.
42. Wierenga L, Langen M, Ambrosino S, van Dijk S, Oranje B, Durston S. Typical development of basal ganglia, hippocampus, amygdala and cerebellum from age 7 to 24. Neuroimage. 2014;96:67-72.
43. Petito A, Pop TL, Namazova-Baranova L, et al. The burden of depression in adolescents and the importance of early recognition. The Journal of pediatrics. 2020;218:265-267. e1.
44. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. Sep 2001;16(9):6 06-13. doi:10.1046/j.1525-1497.2001.016009606.x
45. Baader M T, Molina F JL, Venezian B S, et al. Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria en Chile. Revista chilena de neuro-psiquiatría. 2012;50:10-22.
46. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995/03/01/ 1995;33( 3):335-343. doi: https://doi.org/10.1016/0005-7967(94)00075-U
47. Antúnez Z, Vinet EV. Escalas de Depresión, Ansiedad y Estrés (DASS - 21): Validación de la Versión abreviada en Estudiantes Universitarios Chilenos. Terapia psicológica. 2012;30:49-55.
48. Fonagy P, Luyten P, Moulton-Perkins A, et al. Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire. PLOS ONE. 2016;11(7):e0158678. doi:10.1371/journal.pone.0158678
49. Hayes AF. Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs. 2018/01/02 2018;85(1):4-40. doi:10.1080/03637751.2017.1352100
50. Domínguez JPS, Mendoza ED, Osorio MCP, Salinas EAB. Estrés académico y ansiedad en estudiantes de psicología. Dilemas contemporáneos: Educación, Política y Valores. 2022;
51. Chalan Huayanay ND, Galvez Infante I. Estrés académico y ansiedad en estudiantes universitarios de la ciudad de Cajamarca, 2023. 2023;
52. Vilca OML, Espinoza NB, Ugarte VEA, Ramos JRG. Estrés académico en estudiantes universitarios frente a la educación virtual asociada al covid-19. Puriq. 2022;4:e200-e200.
53. Rasmos MBOS, Huamaní AVC, Huamaní MMLC, Olano DJQ, Condori SZR. Estrés académico en estudiantes universitarios en contexto de la pandemia por covid-19: una revisión sistemática. Ciencia Latina Revista Científica Multidisciplinar. 2021;5(6):11279-11290.
54. Liu X-Q, Guo Y-X, Zhang W-J, Gao W-J. Influencing factors, prediction and prevention of depression in college students: a literature review. World journal of psychiatry. 2022;12(7):860.
55. De Coninck D, Matthijs K, Van Bavel J, Luyten P. To be a freshman during the COVID‐19 pandemic: A cross‐lagged model of depression, mentalizing, and epistemic trust. Personality and Mental Health. 2024;18(1):80-89.
56. Wang M-T, Scanlon CL, Del Toro J, Qin X. Adolescent psychological adjustment and social supports during pandemic-onset remote learning: A national multi-wave daily-diary study. Development and psychopathology. 2023:1-18.
57. Pouravari M, ZandiPour T, Hoseinian S, Bosmans G. Depressive symptoms and attachment with mother and father in Iranian young adults: The mediating role of reflective functioning and loneliness. Current Psychology. 2023;42(29):25614-25623.
58. Fonagy P, Allison E, Campbell C. Mentalizing, Resilience, and Epistemic Trust: Bateman A, Fonagy P, eds. Handbook of Mentalizing in Mental Health Practice. Second ed. American Psychiatric Association Publishing; 2019:64:chap 4.
59. Sharp C, Rossouw T. Borderline Personality Pathology in Adolescence. In: Bateman A, Fonagy P, eds. Handbook of Mentalizing in Mental Health Practice. Second ed. American Psychiatric Association Publishing; 2019:287:chap 17.
2. Lucchini L, Centellegher S, Pappalardo L, et al. Living in a pandemic: changes in mobility routines, social activity and adherence to COVID-19 protective measures. Scientific Reports. 2021/12/27 2021;11(1):244 52. doi:10.1038/s41598-021-04139-1
3. Czifra G, Molnár Z. Covid-19 and Industry 4.0. Research Papers Faculty of Materials Science and Technology Slovak University of Technology. 2020;28(46):36-45. doi:doi:10.24 78/rput-2020-0005
4. CEPAL N. The effects of the coronavirus disease (COVID-19) pandemic on international trade and logistics. 2020;
5. Pragholapati A. COVID-19 impact on students. 2020;
6. UNICEF. La respuesta a la COVID-19. Informe Anual de UNICEF 2020. Nova York: Fondo de las Naciones Unidas para la Infancia (UNICEF). 2020;
7. Caiceo Escudero J. Reflexiones acerca del retorno seguro a clases presenciales en pandemia en Chile. Papeles salmantinos de educación. 2021;
8. Pulido-Montes C, Ancheta-Arrabal A. La educación remota tras el cierre de escuelas como respuesta internacional a la Covid-19. Revista Prisma Social. 2021;(34):236-266.
9. Peña Estrada CC, Carranza Alcántar MdR, Ruiz Sánchez R, Islas Torres C. Enfoques innovadores en el proceso de enseñanza-aprendizaje en las universidades hispanohablantes. Dykinson; 2023.
10. Tadesse S, Muluye W. The impact of COVID-19 pandemic on education system in developing countries: a review. Open Journal of Social Sciences. 2020;8(10):159-170.
11. Korkmaz Ö, Erer E, Erer D. Internet access and its role on educational inequality during the COVID-19 pandemic. Telecommunications policy. 2022;46(5):102353.
12. Cepal N. La educación en tiempos de la pandemia de COVID-19. 2020;
13. Li M, Yu Z. Teachers’ satisfaction, role, and digital literacy during the COVID-19 pandemic. Sustainability. 2022;14(3):1121.
14. Kennedy AI, Mejía-Rodríguez AM, Strello A. Inequality in remote learning quality during COVID-19: student perspectives and mitigating factors. Large-scale Assessments in Education. 2022;10(1):29.
15. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The lancet. 2020;395(10227):912-920.
16. Wang C, Pan R, Wan X, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health. 2020;17(5):1729.
17. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. The Lancet Child & Adolescent Health. 2020;4(5):347-349.
18. González-Sanguino C, Ausín B, Castellanos MÁ, et al. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, behavior, and immunity. 2020;87 :172-176.
19. Organization WH. COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. 2022.
20. Mac-Ginty S, Jiménez-Molina Á, Martínez V. Impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios en Chile. Revista Chilena de Psiquiatría y Neurología de la Infancia y de la Adolescencia. 2021;32(1):23-37.
21. Martínez P, Jiménez-Molina Á, Mac-Ginty S, Martínez V, Rojas G. Salud mental en estudiantes de educación superior en Chile: una revisión de alcance con meta-análisis. Terapia psicológica. 2021;39:405-426.
22. Ramirez A, Rivera DB, Valadez AM, Mattis S, Cerezo A. Examining Mental Health, Academic, and Economic Stressors During the COVID-19 Pandemic Among Community College and 4-Year University Students. Community College Review. 2023;51(3):463-478.
23. Elharake JA, Akbar F, Malik AA, Gilliam W, Omer SB. Mental health impact of COVID-19 among children and college students: A systematic review. Child Psychiatry & Human Development. 2022:1-13.
24. Smith BJ, Lim MH. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res Pract. 2020;30(2):3022008.
25. Cao W, Fang Z, Hou G, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry research. 2020;287:112934.
26. Zimmermann M, Bledsoe C, Papa A. Initial impact of the COVID-19 pandemic on college student mental health: A longitudinal examination of risk and protective factors. Psychiatry Research. 2021/11/01/ 2021;305:1 14254.doi:https://doi.org/10.1016/j.psychres.2021.114254
27. Calandri E, Graziano F, Begotti T, et al. Adjustment to COVID-19 lockdown among Italian University students: the role of concerns, change in peer and family relationships and in learning skills, emotional, and academic self-efficacy on depressive symptoms. Frontiers in psychology. 2021;12:643088.
28. Mechili EA, Saliaj A, Kamberi F, et al. Is the mental health of young students and their family members affected during the quarantine period? Evidence from the COVID‐19 pandemic in Albania. Journal of psychiatric and mental health nursing. 2021;28(3):317-325.
29. Kumaraswamy N. Academic stress, anxiety and depression among college students: A brief review. International review of social sciences and humanities. 2013;5(1):135-143.
30. Pozos-Radillo BE, de Lourdes Preciado-Serrano M, Acosta-Fernández M, de los Ángeles Aguilera-Velasco M, Delgado-García DD. Academic stress as a predictor of chronic stress in university students. Psicología educativa. 2014;20(1):47-52.
31. Akgun S, Ciarrochi J. Learned resourcefulness moderates the relationship between academic stress and academic performance. Educational Psychology. 2003; 23(3):287-294.
32. MacGeorge EL, Samter W, Gillihan SJ. Academic stress, supportive communication, and health. Communication Education. 2005; 54(4):365-372.
33. Kivimäki M, Kawachi I. Work stress as a risk factor for cardiovascular disease. Current cardiology reports. 2015;17:1-9.
34. van Dijke A. Dysfunctional Affect Regulation.
35. Bateman AW, Fonagy P. Handbook of mentalizing in mental health practice. American Psychiatric Pub; 2019.
36. Lassri D, Desatnik A. Losing and regaining reflective functioning in the times of COVID-19: Clinical risks and opportunities from a mentalizing approach. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(S1):S38.
37. Fonagy P, Luyten P. Attachment, mentalizing, and the self. Handbook of personality disorders: Theory, research, and treatment. 2018:123-140.
38. Luyten P, Lemma A, Target M. Depression. In: Bateman A, Fonagy P, eds. Handbook of Mentalizing in Mental health Practice. Second ed. American Psychiatric Association Publishing; 2019:446:chap 23.
39. Fonagy P, Gergely G, Jurist EL, Target M. Affect regulation, mentalization, and the development of the self. Affect regulation, mentalization, and the development of the self. Other Press; 2002:xiii, 577-xiii, 577.
40. Dean J, Keshavan M. The neurobiology of depression: An integrated view. Asian Journal of Psychiatry. 2017/06/01/ 2017;27:10 1-111.doi:https://doi.org/10.1016/j.ajp.2017.01.025
41. Østby Y, Tamnes CK, Fjell AM, Westlye LT, Due-Tønnessen P, Walhovd KB. Heterogeneity in subcortical brain development: a structural magnetic resonance imaging study of brain maturation from 8 to 30 years. Journal of neuroscience. 2009;29(38):11772-11782.
42. Wierenga L, Langen M, Ambrosino S, van Dijk S, Oranje B, Durston S. Typical development of basal ganglia, hippocampus, amygdala and cerebellum from age 7 to 24. Neuroimage. 2014;96:67-72.
43. Petito A, Pop TL, Namazova-Baranova L, et al. The burden of depression in adolescents and the importance of early recognition. The Journal of pediatrics. 2020;218:265-267. e1.
44. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. Sep 2001;16(9):6 06-13. doi:10.1046/j.1525-1497.2001.016009606.x
45. Baader M T, Molina F JL, Venezian B S, et al. Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria en Chile. Revista chilena de neuro-psiquiatría. 2012;50:10-22.
46. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995/03/01/ 1995;33( 3):335-343. doi: https://doi.org/10.1016/0005-7967(94)00075-U
47. Antúnez Z, Vinet EV. Escalas de Depresión, Ansiedad y Estrés (DASS - 21): Validación de la Versión abreviada en Estudiantes Universitarios Chilenos. Terapia psicológica. 2012;30:49-55.
48. Fonagy P, Luyten P, Moulton-Perkins A, et al. Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire. PLOS ONE. 2016;11(7):e0158678. doi:10.1371/journal.pone.0158678
49. Hayes AF. Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs. 2018/01/02 2018;85(1):4-40. doi:10.1080/03637751.2017.1352100
50. Domínguez JPS, Mendoza ED, Osorio MCP, Salinas EAB. Estrés académico y ansiedad en estudiantes de psicología. Dilemas contemporáneos: Educación, Política y Valores. 2022;
51. Chalan Huayanay ND, Galvez Infante I. Estrés académico y ansiedad en estudiantes universitarios de la ciudad de Cajamarca, 2023. 2023;
52. Vilca OML, Espinoza NB, Ugarte VEA, Ramos JRG. Estrés académico en estudiantes universitarios frente a la educación virtual asociada al covid-19. Puriq. 2022;4:e200-e200.
53. Rasmos MBOS, Huamaní AVC, Huamaní MMLC, Olano DJQ, Condori SZR. Estrés académico en estudiantes universitarios en contexto de la pandemia por covid-19: una revisión sistemática. Ciencia Latina Revista Científica Multidisciplinar. 2021;5(6):11279-11290.
54. Liu X-Q, Guo Y-X, Zhang W-J, Gao W-J. Influencing factors, prediction and prevention of depression in college students: a literature review. World journal of psychiatry. 2022;12(7):860.
55. De Coninck D, Matthijs K, Van Bavel J, Luyten P. To be a freshman during the COVID‐19 pandemic: A cross‐lagged model of depression, mentalizing, and epistemic trust. Personality and Mental Health. 2024;18(1):80-89.
56. Wang M-T, Scanlon CL, Del Toro J, Qin X. Adolescent psychological adjustment and social supports during pandemic-onset remote learning: A national multi-wave daily-diary study. Development and psychopathology. 2023:1-18.
57. Pouravari M, ZandiPour T, Hoseinian S, Bosmans G. Depressive symptoms and attachment with mother and father in Iranian young adults: The mediating role of reflective functioning and loneliness. Current Psychology. 2023;42(29):25614-25623.
58. Fonagy P, Allison E, Campbell C. Mentalizing, Resilience, and Epistemic Trust: Bateman A, Fonagy P, eds. Handbook of Mentalizing in Mental Health Practice. Second ed. American Psychiatric Association Publishing; 2019:64:chap 4.
59. Sharp C, Rossouw T. Borderline Personality Pathology in Adolescence. In: Bateman A, Fonagy P, eds. Handbook of Mentalizing in Mental Health Practice. Second ed. American Psychiatric Association Publishing; 2019:287:chap 17.