Perceived stress and depression among Chinese nurses: a cross-sectional mediation analysis of psychological flexibility and its components

BackgroundPerceived stress is a significant risk factor for depression among healthcare professionals. While this fundamental relationship is well-documented, the potential mediating mechanisms—specifically the role of psychological flexibility and its distinct components—in buffering the impact of perceived stress on depression within the nursing community remain poorly understood.MethodsThis cross-sectional study recruited 3,920 nurses from three tertiary Grade A public hospitals in Xi’an, China, using convenience sampling, of whom 3,611 were included in the final analysis. Data were collected online using the Chinese versions of Cohen’s Perceived Stress Scale and the Comprehensive Assessment of Acceptance and Commitment Therapy Processes, as well as the Patient Health Questionnaire-9. Pearson correlation analyzes and mediation analysis were conducted to examine the associations among perceived stress, psychological flexibility, and depression.ResultsDepression was positively correlated with perceived stress (r = 0.63, p < 0.01). Mediation analysis indicated that perceived stress was significantly associated with depression both directly (b = 0.47, 95% CI: 0.45 to 0.49) and indirectly via psychological flexibility (b = 0.12, 95% CI: 0.11 to 0.13) and its components, including acceptance and cognitive defusion (b = 0.14, 95% CI: 0.13 to 0.15), and values and committed action (b = 0.06, 95% CI: 0.04 to 0.08). The indirect association through mindfulness and self-as-context was not significant (b = 0.01, 95% CI: 0.00 to 0.02).ConclusionsPsychological flexibility and some of its components were involved in partial indirect associations between perceived stress and depression among Chinese nurses. These findings suggest that psychological flexibility may help understand how perceived stress is statistically associated with depression in this population. Given the cross-sectional design, however, the results should be interpreted as statistical associations rather than evidence of causal relationships.