Psychological inflexibility, depression and anxiety: A contextual approach to suicidal ideation in university students in Huancayo-Peru
DOI:
https://doi.org/10.18050/psiquemag.v15i1.3501Keywords:
Psychological inflexibility, anxiety, Suicidal ideationAbstract
The objective was to determine the influence of psychological inflexibility, anxiety, and depression on suicidal ideation among university students in the Faculty of Health Sciences at a university in Huancayo, thereby validating the contextual model of human suffering. The study employed a non-experimental, explanatory, and cross-sectional methodology with latent variables, using the covariance-based SEM technique for data processing. The non-probabilistic criterion sample consisted of 1,030 students. The instruments applied included the Acceptance and Action Questionnaire (AAQ-II), the Lima Anxiety Scale (EAL-20), the Depressive Psychopathology Scale (EPD-6), and the Suicidal Ideation Frequency Inventory (IFIS). The findings showed that Model 1, in which no questionnaire items were removed, exhibited an adequate fit; however, Model 2, which conceptualized psychological inflexibility as a unidimensional structure with seven items and correlated measurement errors (items 2 and 5), demonstrated a better and more parsimonious fit (CFI = .939, TLI = .934, RMSEA [90% CI] = .037 [.034-.039], SRMR = .041). The results indicate that psychological inflexibility has a direct influence on anxiety (β = .647) and depression (β = .646), while these correlated variables (r = .473) influence suicidal ideation (βA = .190, βD = .509, r² = .429, r² = .751). These findings suggest that psychological inflexibility acts as a factor that increases human suffering (anxiety and depression), which in turn heightens suicidal ideation, highlighting the need for interventions targeting these variables to mitigate suicide risk
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References
Abad, F., Olea, J., V, P., & García, C. (2011). Medición en ciencias sociales y de la salud. Síntesis.
Al-Halabí, S., & Fonseca-Pedrero, E. (2023). Manual de psicología de la conducta suicida. Editorial Pirámide.
Allan, N., Gorka, S., Saulnier, K., & Bryan, C. (2023). Anxiety Sensitivity and Intolerance of Uncertainty: Transdiagnostic Risk Factors for Anxiety as Targets to Reduce Risk of Suicide. Current Psychiatry Reports, 25, 139-147. https://doi.org/10.1007/s11920-023-01413-z
Ato, M., & Vallejo, G. (2015). Diseño de investigación en psicología. Ediciones Piramide.
Aykut, K., & Fulya, T. (2024). Is Psychological Inflexibility a Predictor of Depression and Anxiety of Pre-Adolescents? International Journal of Psychology and Educational Studies, 11(3), 272-285. https://doi.org/10.52380/ijpes.2024.11.3.1373
Baños-Chaparro, J., Ynquillay-Lima, P., Lamas-Delgado, F., & Fuster-Guillen, F. (2021). Inventario de Frecuencia de Ideación Suicida: evidencias psicométricas en adultos peruanos. Revista información científica, 100(4) Article e3507. https://revinfcientifica.sld.cu/index.php/ric/article/view/3507
Bond, F., Hayes, S., Baer, R., Carpenter, K., Guenole, N., Orcutt, H., . . . Zettle, R. (2011). Preliminary psychometric properties of the Acceptance and Action Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behavior therapy, 42(4), 676-688. https://doi.org/10.1016/j.beth.2011.03.007
Busby, J., Batterham, P., McCallum, S., Werner-Seidler, A., & Calear, A. (2023). Specific anxiety and depression symptoms are risk factors for the onset of suicidal ideation and suicide attempts in youth. Journal of Affective Disorders, 327, 299-305. https://doi.org/10.1016/j.jad.2023.02.024
Chang, E., & Chang, O. (2016). Development of the Frequency of Suicidal Ideation Inventory: Evidence for the validity and reliability of a brief measure of suicidal ideation frequency in a college student population. Cognitive Therapy and Research, 40(4), 549–556. https://doi.org/10.1007/s10608-016-9758-0
Chen, C., Chen, F., Liu, X., Tao, J., & Wu, M. (2023). Relationship between parental negative family expressiveness and internalizing problems among adolescents: mediating roles of emotional clarity and emotion dysregulation. Current Psychology, 42(30), 26429-26439. https://doi.org/10.1007/s12144-022-03789-2
Emmelkamp, P., & Spada, M. (2022). Depression and suicide: What an evidence-based clinician should know. Clinical Psychology & Psychotherapy, 29(5), 1491-1493. https://doi.org/10.1002/cpp.2787
Eysenck, M., & Fajkowska, M. (2017). Anxiety and depression: toward overlapping and distinctive features. Cognition and Emotion, 32(7), 1391-1400. https://doi.org/10.1080/02699931.2017.1330255
Fava, M., Rankin, M., Wright, E., Alpert, J., Nierenberg, A., Pava, J., & Rosenbaum, J. (2000). Anxiety disorders in major depression. Comprehensive Psychiatry, 41(2), 97-102. https://doi.org/10.1016/S0010-440X(00)90140-8
Ferster, C. (1973). A functional analysis of depression. American Psychologist, 28(10), 857-870. https://doi.org/10.1037/h0035605
González, M. G., García-Haro, J. M., García-Pascual, H., Pérez, M. T. S., Barrio-Martínez, S., & Oviedo, J. V. (2021). Hacia un enfoque contextual-existencial del suicidio: recomendaciones para la prevención. Clínica Contemporánea, 12(1), e1. https://doi.org/10.5093/cc2021a3
Gorbunova, V., Klymchuk, V., Savychenko, O., Palii, V., Kondur, Z. P., & Oates, J. (2024). Depression, anxiety, suicidal ideation and social determinants of mental health of Romani in Ukraine. Mental Health and Social Inclusion, 28(5), 678-698. https://doi.org/10.1108/MHSI-06-2023-0070
Haro, J. G., Pascual, H. G., Rico, P. A., Sallent, M. M., de Tena Dávila, E. B., Martínez, S. B., & Pérez, M. T. S. (2023). Una meditación existencial-contextual sobre el suicidio. Revista de Psicoterapia, 34(124), 117-135. https://doi.org/10.5944/rdp.v34i124.37052
Hayes, S., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, S., Strosahl, K., & Wilson, K. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. Guilford Press.
Hayes, S., Strosahl, K., & Wilson, K. (2014). Terapia de aceptación y compromiso: Proceso y práctica del cambio consciente (Mindfulness). Desclee de Brouwer.
Hernández-Bello, L., Hueso-Montoro, C., Gómez-Urquiza, J., & Cogollo-Milanés, Z. (2020). Prevalencia y factores asociados a la ideación e intentos de suicidio en adolescentes: Revisión sistemática. Revista Española de Salud Pública, 94, 1-15. https://ojs.sanidad.gob.es/index.php/resp/article/view/887
Hopwood, M. (2023). Anxiety Symptoms in Patients with Major Depressive Disorder: Commentary on Prevalence and Clinical Implications. Neurology and Therapy , 12(1), 5-12. https://doi.org/10.1007/s40120-023-00469-6
Hyland, M. E. (2020). A reformulated contextual model of psychotherapy for treating anxiety and depression. Clinical Psychology Review, 80, 101890. https://doi.org/10.1016/j.cpr.2020.101890
Ishizu, K., Ohtsuki, T., & Shimoda, Y. (2022). Contingent self-worth and depression in early adolescents: The role of psychological inflexibility as a mediator. Acta Psychologica, 230, 1-7. https://doi.org/10.1016/j.actpsy.2022.103744
Jöreskog, K., & Sörbom, D. (1981). LISREL VI: Analysis of Linear Structural Relationships by Maximum Likelihood, Instrumental Variables, and Least Squares Methods. Scientific Software.
Kalin, N. (2020). The Critical Relationship Between Anxiety and Depression. The American journal of psychiatry, 177(5), 365-367. https://doi.org/10.1176/appi.ajp.2020.20030305
Keith, T. (2015). Multiple Regression and Beyond: An Introduction to Multiple Regression and Structural Equation Modeling (2 nd ed.). Taylor & Francis.
Klein, R., Collares, A., Boff, N., & Da Silva, M. (2021). Estresse, Ansiedade, Depressão e Inflexibilidade Psicológica em Estudantes Universitários de Graduação e Pós-Graduação. Estudos e Pesquisas em Psicologia, 21(1), 749-767. https://doi.org/10.12957/epp.2021.61067
Kline, R. (2016). Principles and Practice of Structural Equation Modeling (4ta ed.). The Guilford Press.
Li, C. H. (2016). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods, 48(3), 936-949. https://doi.org/10.3758/s13428-015-0619-7
Lozano-Vargas, A., & Vega-Dienstmaier, J. (2013). Evaluación psicométrica y desarrollo de una versión reducida de una nueva escala de ansiedad en una muestra hospitalaria de Lima, Perú. Revista Peruana de Medicina Experimental y Salud Pública, 30(2), 212–219. https://www.scielo.org.pe/scielo.php?pid=S1726-46342013000200008&script=sci_arttext
Lozano-Vargas, A., & Vega-Dienstmaier, J. (2018). Construcción y propiedades psicométricas de la Escala de Ansiedad de Lima de 20 ítems (EAL-20). Revista de Neuro-Psiquiatría, 81(4), 226-234. https://doi.org/10.20453/rnp.v81i4.3437
MacCallum, R. C., Roznowski, M., & Necowitz, L. B. (1992). Model modifications in covariance structure analysis: the problem of capitalization on chance. Psychological Bulletin, 111(3), 490–504. https://doi.org/10.1037/0033-2909.111.3.490
O´Connor, R., & Nock, M. (2014). The psychology of suicidal behaviour. The Lancet Psychiatry, 1(1), 73-85. https://doi.org/10.1016/S2215-0366(14)70222-6
Organización de las Naciones Unidas. (6 de octubre de 2022). Prevenir el suicidio en África debe ser una prioridad. https://news.un.org/es/story/2022/10/1515967
Organización Mundial de la Salud. (29 de agosto de 2024). Suicidio. https://www.who.int/es/news-room/fact-sheets/detail/suicide
Organización Panamericana de la Salud. (2023). Una nueva agenda para la salud mental en las Américas: Informe de la Comisión de Alto Nivel sobre Salud Mental y COVID-19 de la Organización Panamericana de la Salud. OPS. https://iris.paho.org/items/98547aae-a616-4921-a289-77bd87bd34b2
Rudd, M. (2000). The Suicidal Mode: A Cognitive-Behavioral Model of Suicidality. Suicide and Life-Threatening Behavior, 30(1), 18-33. https://doi.org/10.1111/j.1943-278X.2000.tb01062.x
Ruiz, F., & Odriozola-González, P. (2016). The role of psychological inflexibility in Beck’s cognitive model of depression in a sample of undergraduates. Anales de Psicologia , 32(2), 441-447. https://doi.org/10.6018/analesps.32.2.214551
Ruiz, F., Suárez-Falcón, J., Cárdenas-Sierra, S., Durán, Y., Guerrero, K., & Riaño-Hernández, D. (2016). Psychometric Properties of the Acceptance and Action Questionnaire–II in Colombia. The Psychological Record, 66(3), 429-437. https://doi.org/10.1007/s40732-016-0183-2
Rusch, L. C., Kanter, J. W., & Brondino, M. J. (2009). A comparison of contextual and biomedical models of stigma reduction for depression with a nonclinical undergraduate sample. The Journal of Nervous and Mental Disease, 197(2), 104-110. https://doi.org/10.1097/NMD.0b013e318192416f
Salcedo-Ramón, H., & Quijada, D. (2024). Inflexibilidad psicológica y riesgo suicida en adolescentes de Cerro de Pasco, Perú. Revista Peruana de Ciencias de la Salud, 6(4). https://doi.org/10.37711/rpcs.2024.6.3.547
SINADEF. (04 de octubre de 2024). Tablero de control. https://www.minsa.gob.pe/reunis/data/defunciones_registradas.asp
Tavakoli, N., Broyles, A., Reid, E., Sandoval, R., & Correa-Fernández, V. (2019). Psychological inflexibility as it relates to stress, worry, generalized anxiety, and somatization in an ethnically diverse sample of college students. Journal of Contextual Behavioral Science, 11, 1-5. https://doi.org/10.1016/j.jcbs.2018.11.001
Tenreiro, C. (2015). A New Test for Multivariate Normality by Combining Extreme and Non-extreme BHEP Tests. Communications in Statistics - Simulation and Computation, 46(3), 1746-1759. https://doi.org/10.1080/03610918.2015.1011334
Valencia, P., & Falcón, C. (2022). Validez y confiabilidad del Cuestionario de Aceptación y acción II (AAQ-II) en universitarios de Lima. Psiencia, 14(1), 176-219. https://www.researchgate.net/publication/330025662_Validez_y_confiabilidad_del_Cuestionario_de_Aceptacion_y_Accion_II_AAQ-II_en_universitarios_de_Lima_Validity_and_reliability_of_the_Acceptance_and_Action_Questionnaire_II_AAQ-II_in_university_students
Vega-Dienstmaier, J. (2018). Construcción de versiones cortas de la Escala de Psicopatología Depresiva para tamizaje de depresión mayor y sus características psicométricas. Revista de neuro-psiquiatría, 81(3), 154-164. https://doi.org/10.20453/rnp.v81i3.3383
Vega-Dienstmaier, J., Stucchi-Portocarrero, S., Valdez-Huarcaya, N., Cabra-Bravo, M., & Zapata-Vega, M. (2011). The Depressive Psychopathology Scale: presentation and initial validation in a sample of Peruvian psychiatric patients. Revista Panamericana de Salud Pública, 30(4), 317–326. https://pubmed.ncbi.nlm.nih.gov/22124690/
Wolpe, J. (1993). Práctica de la terapia de la conducta (3ra ed.). Editorial Trillas.
Yang, T., He, Y., Wu, L., Ren, L., Lin, J., Wang, C., . . . Liu, X. (2023). The relationships between anxiety and suicidal ideation and between depression and suicidal ideation among Chinese college students: A network analysis. Heliyon, 10(1-9), 9. https://doi.org/10.1016/j.heliyon.2023.e20938
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Copyright (c) 2026 Henry Angel Salcedo Ramon, Dina Yupanqui Porras, Carlos Carbajal-León, Tomás Caycho-Rodríguez

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