The dynamic association between depression, psychological flexibility, and meaning in life among medical students: a cross-lagged analysis

Nov 18, 2025BMC psychology

How depression, mental adaptability, and sense of life meaning influence each other over time in medical students

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Abstract

A total of 1,837 medical students were tracked over a 12-week period.

Higher levels of are linked to lower levels of depression.
All three variables—psychological flexibility, , and depression—showed significant stability over time.
Increased psychological flexibility at the first measurement is associated with reduced depression at the second measurement.
Higher depression levels at the first measurement are connected to decreased psychological flexibility and meaning in life later.
Gender does not significantly influence the relationships among psychological flexibility, meaning in life, and depression.

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BACKGROUND: Medical students face significant challenges with depression, where and serve as protective factors that can mitigate the worsening of depressive symptoms. This study employs a two-wave panel design to explore the dynamic relationships among psychological flexibility, meaning in life, and depression in medical students.

METHODS: The study utilized panel data from two time points, tracking 1,837 medical students over a 12-week interval. Measurement tools included a demographic information form, the Acceptance and Commitment Therapy Comprehensive Assessment Questionnaire, the Meaning in Life Questionnaire, and the Center for Epidemiologic Studies Depression Scale. Descriptive analysis, correlation analysis, and cross-lagged analysis were conducted on the variables.

RESULTS: A relationship was found between higher levels of psychological flexibility and lower levels of depression. Autoregressive models indicated that all three variables showed significant stability over time. Cross-lagged analysis found that higher psychological flexibility at Time 1 was associated with lower depression at Time 2, but meaning in life was not associated with subsequent depression. In contrast, higher depression at Time 1 was associated with lower subsequent psychological flexibility and meaning in life. Additionally, gender did not have a significant association with these variables.

CONCLUSION: This study underscores the unique advantages of universities in the mental health education of medical students. It recommends enhancing psychological flexibility and meaning in life through mindfulness training, emotional regulation courses, and professional values education to effectively prevent the onset of depression.

CLINICAL TRIAL NUMBER: Not applicable.

Key numbers

1,837

Participants

Total number of medical students tracked over the study period.

−0.246

Negative prediction of depression

T1 depression negatively predicts T2 .

−0.139

Negative prediction of

T1 depression negatively predicts T2 .

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The dynamic association between depression, psychological flexibility, and meaning in life among medical students: a cross-lagged analysis

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