Psychological Inflexibility Mediates the Relationship between Mindfulness and Psychological Distress in Peruvian Parents with School Age Children

Psychological Inflexibility Mediates the Relationship between Mindfulness and Psychological Distress in Peruvian Parents with School Age Children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychological Inflexibility Mediates the Relationship between Mindfulness and Psychological Distress in Peruvian Parents with School Age Children Marisabel Lucia Seclén Uchuya, Roger Joaquin Angulo Salas, Antonio Serpa Barrientos, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7483309/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Feb, 2026 Read the published version in Discover Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Objective: The present research proposed a mediation model to examine the relationship between mindfulness and psychological distress, focusing on the mediating role of psychological inflexibility in parents of school-aged children. Methods: This cross-sectional explanatory study included 364 parents. The Mindful Attention Awareness Scale (MAAS-5), the Acceptance and Action Questionnaire II (AAQ-II), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were utilized. The data were analyzed using structural equation modeling (SEM) in R Studio 4.4.0, following a Confirmatory Factor Analysis (CFA) to assess the internal structure of the scales. Reliability was evaluated using alpha and omega coefficients. Results: The results demonstrated a partial mediation between mindfulness and psychological distress through psychological inflexibility (mediation effect a*b = -.27, p < .001). Furthermore, the model accounted for 58% of the variance in psychological distress (R² = .58). Conclusion: Reducing psychological distress in parents largely depends on decreasing psychological inflexibility and enhancing mindfulness techniques. This finding underscores the importance of interventions grounded in Acceptance and Commitment Therapy (ACT). The study contributes to a deeper understanding of the psychological processes underlying the relationship between mindfulness and psychological distress. Mindfulness Psychological Distress Psychological Inflexibility Mediation Figures Figure 1 Figure 2 Introduction Psychological distress is defined as an affective state characterized by depressive and anxious symptoms (Mirowsky & Ross, 2002 ), including overwhelming feelings, excessive worry, difficulty concentrating, changes in appetite, and sleep disturbances (American Psychiatric Association, 2023 ). These symptoms can significantly interfere with daily functioning, making it difficult to perform everyday tasks. Consequently, depression and anxiety rank among the leading causes of global disability (Alonso et al., 2018 ; Corea Del Cid, 2021). In the context of parenting, recent research highlights an association between psychological distress and various parenting challenges. Studies, primarily conducted on parents of children with special health conditions and behavioral problems (Zeng et al., 2023 ), indicate that elevated levels of psychological distress in parents are linked to lower parental self-efficacy (Aktu, 2024 ; Almendingen & Pilkington, 2024 ), an increased likelihood of aggressive behaviors toward children (Wang et al., 2024 ), and a higher prevalence of suicidal ideation, sleep disorders, and physical health issues (Nurhidayah et al., 2022 ). Additionally, mood changes characteristic of psychological distress, while significantly impacting mental health, are also associated with an increased risk of developing physical illnesses, such as cardiovascular and gastrointestinal diseases (Feng et al., 2024 ). The lack of timely treatment can worsen the situation, increasing the risk of substance abuse, suicidal ideation, and comorbidity with other disorders (World Health Organization [WHO], 2023). This problem is particularly concerning in low- and middle-income countries, where fewer than 25% of individuals with mental disorders receive the necessary treatment (Evans-Lacko et al., 2018 ). To understand the magnitude of psychological distress, it is essential to consider the increasing global prevalence of anxiety (9.8%) and depression (5%) in the adult population (Alonso et al., 2018 ; WHO, 2023). Furthermore, the findings of Prieto Molinari et al. ( 2020 ), which report even higher rates of depressive (39%) and anxious (10%) symptoms in the context of the studied population, highlight the urgency of investigating the underlying dynamics of this public health issue. Empirical evidence, as highlighted in a systematic review of several studies, indicates that scenarios involving a high capacity for full awareness of the present moment are associated with a lower incidence of psychological distress (Ho et al., 2022 ; Maddock & Blair, 2023 ). However, the task of uncovering the nature of this relationship—specifically, how mindfulness influences psychological distress—remains unresolved. It is important to note that previous research has indicated that using mindfulness as a means of escape or control in response to non-existent threats can paradoxically exacerbate distress and dysfunctionality (Dafter & Spearman, 2011; Hayes et al., 2014 ). The transdiagnostic concept of psychological flexibility (Hayes et al., 2014 ) comprises six processes that establish new ways of relating to life's inevitable discomfort: cognitive defusion, acceptance, values, committed action, self-as-context, and contact with the present moment. The latter process, often referred to as mindfulness, represents the attentional dimension of the model. Its counterpart, psychological inflexibility, has been shown to significantly predict psychological distress, as evidenced by recent empirical research (Makriyianis et al., 2019 ; McCracken et al., 2021 ). This relationship is explained by the authors through the adaptive limitations caused by cognitive fusion with rigid beliefs and thoughts, inflexible and avoidance-focused attention to negative emotions, and a behavioral repertoire that is unguided or misaligned with what truly matters to individuals (Hayes et al., 2014 ). Within this holistic model, low mindfulness capacity contributes to inflexible behavioral responses—characterized as rigid, reactionary, and maladaptive—thereby promoting anxious and depressive symptoms. Conversely, higher mindfulness capacity fosters flexibility, which in turn facilitates the remission of such symptoms (Alonso, 2012 ; Cebolla, 2012 ; Hayes et al., 2014 ). However, just as an improvement in mindfulness creates better conditions for the other flexibility processes, it is assumed that enhancing any of these processes will gradually contribute to overall psychological flexibility (Hayes et al., 2014 ). In contrast, the Unified Mindfulness and Flexibility Model (UFM) has recently emerged in the literature as a specific theoretical framework outlining how mindfulness and psychological flexibility processes operate (Rogge et al., 2021; Rogge et al., 2022). This model emphasizes that mindfulness levels serve as the core mechanism of psychological inflexibility. Specifically, it proposes a direct pathway where present-moment mindfulness capacity reduces inflexibility, thereby enabling individuals to engage in more ethical, informed, and value-consistent behaviors, ultimately promoting well-being (Rogge & Daks, 2021 ). Previous research evaluating both mindfulness and inflexibility within the same sample (Woodruff et al., 2014 ) has demonstrated that inflexibility more strongly predicts psychological well-being and negative mental health outcomes compared to mindfulness. This finding suggests a potential mediating role of inflexibility in the relationship between mindfulness practice and the reduction of anxiety and depressive symptoms. These findings, along with other studies (Dubey et al., 2020 ; Santosh & Suresh, 2022) that have identified significant associations between psychological flexibility, mindfulness, and well-being, support the hypothesis that psychological inflexibility may serve as a mechanism through which low mindfulness practice exerts its detrimental effects. In particular, there are precedents proposing mindfulness action pathways mediated by psychological flexibility/inflexibility in relation to pathological worry (Forrest et al., 2024), anxiety (Ruiz, 2014 ), and depression (Apolinário-Hagen et al., 2024 ) symptomatology. While these studies have illuminated these relationships in general populations, recent scientific literature has started to focus on adult parents in clinical contexts involving their children (Kulasinghe et al., 2021 ; O'Boyle-Finnegan et al., 2022). However, there is a gap in understanding the dynamics between mindfulness, inflexibility, and psychological distress (anxiety and depression) in parents of school-aged children—a population that faces unique demands and requires optimal mental health (Zhu et al., 2024 ). Analyzing the mediating role of psychological inflexibility in the relationship between mindfulness and psychological distress provides a deeper understanding of the mechanisms underlying the studied symptomatology. This analysis serves as a critical foundation for advancing to quasi-experimental studies on treatments that incorporate these variables in adult parents. Since the hypotheses are grounded in the psychological inflexibility model of Contextual Behavioral Science (CBS), the empirical findings contribute to validating its assumptions. Additionally, they enrich the field of clinical and health psychology with new evidence on significant factors influencing parental depressive and anxious symptomatology in non-hospital or non-clinical settings. This theoretical enrichment also addresses a key demand of Contextual Behavioral Science (CBS), which encourages the exploration of relationships between theoretically relevant processes and intervention methods through mediation and moderation studies (Hayes et al., 2014 ). These studies are conducted using structural equation modeling (SEM), a robust statistical technique that enables the analysis of complex relationships between multiple variables. SEM provides a rigorous approach to evaluating theoretical models by accounting for both direct and mediating effects among variables (Rahman et al., 2015 ). The present study explores the question, “Does psychological inflexibility mediate the relationship between mindfulness and psychological distress?” It aims to assess the mediating role of psychological inflexibility in this relationship. Four hypotheses were proposed (Fig. 1 ): H1: mindfulness is inversely related to psychological inflexibility; H2: psychological inflexibility is positively associated with psychological distress; H3: mindfulness capacity is inversely associated with psychological distress; and the overarching hypothesis (H4) posits that higher levels of mindfulness practice reduce psychological inflexibility, ultimately leading to lower levels of distress in the evaluated parents. Methods Design An explanatory cross-sectional design was employed to analyze a model examining the relationships between a set of variables, establishing causality based on underlying theoretical frameworks (Ato et al., 2013 ). Participants A total of 364 Peruvian adults participated in the study, including 67 males (18.4%) and 297 females (81.6%). Participants' ages ranged from 24 to 61 years (M = 41.54, SD = 7.18). Regarding educational level, 3.6% had primary education, 29.9% had secondary education, and 66.5% had technical or higher education. Regarding marital status, 16.5% of participants were single, 43.1% were married, 35.2% were cohabiting, 4.7% were divorced, and 0.5% were widowed. Finally, the parents had an average of two children (M = 2.04, SD = 0.87). The participants were parents of school-age children attending three private educational institutions offering kindergarten, elementary, and high school education. Selection was conducted using non-probabilistic convenience sampling. The inclusion criteria were being of adult age, holding Peruvian nationality, and providing informed consent. Conversely, the exclusion criteria included non-biological parents and responses submitted after the study period. The sample size estimation was conducted using the second version of the R package semPower , assuming an expected effect size of .05, a statistical power of 0.95, α = 0.05, and four observable variables. The analysis suggested a minimum required sample size of 342 participants (Moshagen & Bader, 2023 ). Instruments Mindfulness Attention and Awareness Scale (MAAS-5). The version validated in Peru by Caycho-Rodríguez et al. ( 2020 ) was used. This instrument provides a unidimensional measure that quantifies the degree of attention to present-moment events. The five items offer six response options (ranging from 1 = almost always to 6 = almost never), with higher scores indicating greater mindfulness. The study by Caycho-Rodríguez et al. ( 2020 ) provided evidence of validity based on internal structure using Confirmatory Factor Analysis (CFA) with appropriate fit indices (χ²/df = 2.25, CFI = .99, SRMR = .03, RMSEA = .06). Regarding internal consistency reliability, an adequate omega coefficient was reported (ω = .80). The data from the present study yielded appropriate fit indices (χ²/df = 3.70, CFI = .99, TLI = .98, SRMR = .02, RMSEA = .08). Regarding reliability, adequate alpha and omega coefficients were reported (α = .84, ω = .85). Acceptance and Action Questionnaire II (AAQ-II). The version validated in Peru by Valencia and Falcón ( 2022 ) was used. This questionnaire provides a unidimensional measure designed to assess experiential avoidance and psychological inflexibility within the framework of Acceptance and Commitment Therapy (ACT). The seven items offer seven response options (ranging from 1 = completely false to 7 = completely true), with higher scores indicating greater psychological inflexibility. In the study by Valencia and Falcón ( 2022 ), evidence of validity based on internal structure was demonstrated through Confirmatory Factor Analysis (CFA) with appropriate fit indices (MLRχ²(13) = 67.72, CFI = .98, TLI = .97, SRMR = .02, RMSEA = .07). Regarding reliability, an adequate omega coefficient was reported (ω = .84). Using the data from the present study, appropriate fit indices were obtained after removing item 7 ('My worries hinder my way to success') due to factor loadings below .30 (Kline, 1994 ) (χ²/df = 3.08, CFI = .99, TLI = .99, SRMR = .03, RMSEA = .07). Regarding reliability, adequate alpha and omega coefficients were reported (α = .87, ω = .88). Patient Health Questionnaire (PHQ-9). The version validated in Peru by Villarreal-Zegarra et al. ( 2019 ) was used. This scale provides a unidimensional measure that assesses depressive symptomatology over the past two weeks. It consists of nine items with four response options (0 = not at all, 1 = several days, 2 = more than half of the days, 3 = almost every day), where higher scores indicate greater depressive symptomatology. Validity based on internal structure was demonstrated through Confirmatory Factor Analysis (CFA) with appropriate fit indices (CFI = .94, TLI = .91, SRMR = .04, RMSEA = .08). Regarding reliability, adequate alpha and omega coefficients were reported (α = .87, ω = .87) (Villarreal-Zegarra et al., 2019 ). Using the data from the present study, appropriate fit indices were obtained (χ²/df = 2.72, CFI = .98, TLI = .97, SRMR = .07, RMSEA = .06). Regarding reliability, adequate alpha and omega coefficients were reported (α = .83, ω = .87). Generalized Anxiety Disorder Scale (GAD-7). This scale was validated in Peru by Villarreal-Zegarra et al. ( 2024 ) and provides a unidimensional measure to assess indicators of anxiety symptomatology over the past two weeks. It consists of seven items with four response options (0 = not at all, 1 = several days, 2 = more than half the days, 3 = almost every day), where higher scores indicate greater levels of anxiety symptomatology. Validity based on internal structure was demonstrated through Confirmatory Factor Analysis (CFA) with appropriate fit indices (CFI = .99, TLI = .99, WRMR = 1.56, RMSEA = .07). Regarding reliability, adequate alpha and omega coefficients were reported (α = .93, ω = .90) (Villarreal-Zegarra et al., 2024 ). Using the data from the present study, appropriate fit indices were obtained (χ²/df = 1.82, CFI = .99, TLI = .99, SRMR = .03, RMSEA = .05). Regarding reliability, adequate alpha and omega coefficients were reported (α = .86, ω = .88). Procedure The present study obtained written authorization from the directors of the three educational institutions for access to the sample, following the review and approval of the research protocol by the Institutional Ethics Committee of Universidad Católica Sedes Sapientiae (CE-1834). Permission was granted to the authors for the use of culturally and contextually validated instruments. Informed consent and assessments were conducted virtually and anonymously through a Google Forms questionnaire, which remained accessible for three weeks. Access to the data obtained was restricted exclusively to the study investigators and encrypted to ensure information security during analysis, thereby guaranteeing confidentiality. Data Analysis Data were downloaded into an Excel database for validation and subsequently exported to SPSS and R Studio for analysis. We began with a descriptive analysis of the data in SPSS, calculating extreme scores, means, standard deviations, skewness, and kurtosis, which fell within the acceptable range of [-1.5, 1.5] (Muthén & Kaplan, 1985 ). Polychoric matrices were used for both scales due to the ordinal nature of the items, allowing for a more accurate representation of the relationships between latent variables (Bandalos & Finney, 2010 ; Brown, 2006 ). The multivariate normality assumptions were tested using Mardia's coefficient (G2), with expected values < 70 (Rodriguez & Ruiz, 2008). Robust Mahalanobis distances were also calculated to identify potential outliers (Cabana et al., 2021 ). If the assumption of normality was not met, robust estimators appropriate for non-normal data were applied. Next, evidence of validity based on internal structure was evaluated through Confirmatory Factor Analysis (CFA) using R Studio 4.4.0, with the Lavaan (Rosseel, 2012 ) and Tidyverse (Wickham et al., 2019 ) packages. For the analysis, the Weighted Least Squares Means and Variance Adjusted (WLSMV) estimator was employed, as it is suitable for handling sample size restrictions, ordinal data, and non-normality characteristics (Li, 2016 ). In accordance with recommendations in the literature, acceptable goodness-of-fit indices were defined as values above .90 for the Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI), and error values below .08 for the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) (Medrano & Muñoz-Navarro, 2017 ; Ruiz et al., 2010). Additionally, a chi-square to degrees of freedom ratio (χ²/df) less than 3 was considered indicative of adequate model fit (Abad et al., 2011 ). Once the results confirmed evidence of validity based on the internal structure, mediation analysis was conducted using R Studio 4.4.0 with the 'Lavaan' package (Rosseel, 2012 ). After confirming the model, mediation was analyzed based on the criterion that the confidence interval did not include zero, which indicates the significance of the effect (Efron & Tibshirani, 1985). Finally, the results were diagrammed using AMOS software version 24. Results Preliminary analysis Table 1 presents the correlation matrix of the study variables, with values ranging from 0.36 to 0.76, alongside descriptive results such as skewness (A). These results suggest significant correlations among the study variables, as well as adequate indicators to test the hypotheses using structural equation modeling. Table 1 Descriptive statistics, internal consistencies, and correlations for the study variables Variables M SD A 1 2 3 4 1. Psychological inflexibility 10.65 5.54 -1.4 - 2. Mindfulness 25.12 3.36 1.8 -0.36 ** - 3. Anxiety 3.82 3.39 1.3 0.59 ** -0.39 ** - 4. Depression 10.65 5.88 1.8 0.64 ** -0.35 ** 0.76 ** - Note. M = Mean, SD = Standard Deviation, A = Skewness, ** p < 0.01. Structure of the model Model of the relationship between psychological inflexibility, mindfulness, and psychological distress (Fig. 1 ): The mediation model was evaluated, and the results indicated adequate fit indices (χ²/df = 1.85, SRMR = 0.04, RMSEA = 0.05, CFI = 0.98, and TLI = 0.98), supporting the validity of the proposed Structural Equation Model (SEM) based on the data (Table 2 ). Table 2 Structural equation model fit index (n = 364). CI 90% RMSEA Models χ² df χ²/df CFI TLI SRMR RMSEA Inf Sup Mediation model 94.51 51 1.85 0.98 0.98 0.04 0.05 0.03 0.06 Note. χ²: Chi-square, df: Degrees of freedom, χ²/df: Chi-square to degrees of freedom ratio, CFI: Comparative Fit Index, TLI: Tucker-Lewis Index, SRMR: Standardized Root Mean Square Residual, RMSEA: Root Mean Square Error of Approximation, CI: Confidence Intervals, n: Sample size. Table 3 Indirect and total effects. CI 95% Type Effect B LL UP β E.R (%) p Indirect MF ⇒ PI ⇒ PD (a*b) -0.77 -1.22 -0.45 -0.27 60.00 < .001 Direct MF ⇒ PD (c′) -0.52 -0.99 -0.10 -0.18 40.00 < .001 Total MF ⇒ PD (a*b) + (c′) -1.30 -1.82 -0.88 -0.45 100 < .000 Note. MF: Mindfulness, PI: Psychological Inflexibility, PD: Psychological Distress, B: Unstandardized Coefficient, CI: Confidence Interval, Inf: Lower Limit, Sup: Upper Limit, β: Standardized Coefficient, ER: Effect Percentage, p: Statistical Significance. A significant indirect effect was observed (MF ⇒ PI ⇒ PD: a*b = -0.27, p < .001), with approximately 60% of the effect of mindfulness on psychological distress being mediated by psychological inflexibility. This indicates that psychological inflexibility plays a partial mediating role in the relationship between mindfulness and psychological distress (Table 3 ). Estimation of direct effects. Table 4 Direct path analysis. IC 95% Paths B SE Inf. Sup. β p MF ⇒ MP -0.52 0.22 -0.99 -0.10 -0.18 < .001 MF ⇒ IP -0.33 0.06 -0.46 -0.22 -0.40 < .001 IP ⇒ MP 2.33 0.43 0.25 1.57 0.67 < .001 Note. B: Unstandardized Estimator, β: Standardized Estimator, CI: Confidence Interval, SE: Standard Error, p: Statistical Significance, MF: Mindfulness, PI: Psychological Inflexibility, PD: Psychological Distress. Table 4 shows that mindfulness, defined as attention to events occurring in the present moment, predicts the occurrence of psychological distress (i.e., symptoms of anxiety and depression). Specifically, as mindfulness increases, psychological distress decreases (β = -0.18, p < .001). Similarly, mindfulness predicts psychological inflexibility, characterized by experiential avoidance, with results indicating that as mindfulness increases, psychological inflexibility decreases (β = -0.40, p < .001). Furthermore, it was observed that as psychological distress increases, depressive symptomatology also increases (β = 0.89, p < .001), as does anxious symptomatology (β = 0.86, p < .001). Finally, psychological inflexibility was found to predict psychological distress, indicating that as psychological inflexibility increases, psychological distress also increases (β = 0.67, p < .001). The model accounts for 58% of the variance in psychological distress (R² = 0.58) and 16% of the variance in psychological inflexibility (R² = 0.16) (Fig. 2 ). Discussion Given the importance of understanding how mindfulness influences psychological distress in adults who are parents, the present study aimed to test whether psychological inflexibility mediates the relationship between mindfulness capacity and psychological distress, which includes symptoms of anxiety and depression. First, H1 was accepted, confirming an inverse association between mindfulness and psychological inflexibility. This finding aligns with previous studies suggesting that lower mindfulness capacity is associated with greater inflexible behavioral and cognitive patterns (Dubey et al., 2020 ; Santosh & Suresh, 2022). According to the holistic model proposed by Hayes et al. ( 2014 ), mindfulness, like other processes, reduces automatic reactivity by fostering greater awareness of the present moment and the values that guide behavior. This, in turn, creates favorable conditions for more flexible psychological processes. The Unified Model of Mindfulness and Flexibility (Rogge & Daks, 2021 ) aligns with this perspective but emphasizes that mindfulness serves as a precursor to psychological flexibility. Thus, while the Hexaflex model suggests that any process could promote more flexible behaviors (an aspect not addressed in this study), the Rogge & Daks ( 2021 ) model emphasizes mindfulness as a foundational element. It provides a solid basis for recognizing and accepting one's experiences, disengaging from rigid ideas, engaging in committed actions, using values as a guide, and perceiving oneself within a context capable of adapting behavior based on personal decisions. Second, a direct and significant relationship between psychological inflexibility and psychological distress was confirmed, supporting H2 of the study. These findings are consistent with previous research demonstrating that psychological inflexibility reliably predicts higher levels of distress (Forrest et al., 2024; Ruiz, 2014 ; Santosh & Suresh, 2022; Woodruff et al., 2013). This relationship is explained by the Hexaflex model, which posits that human suffering is not inherently pathological. Pathology arises from the persistent avoidance of discomfort. By clinging to rigid beliefs and avoiding unpleasant experiences, individuals restrict their range of responses, perpetuate counterproductive strategies, and hinder the development of new coping mechanisms. This rigidity is the underlying factor in various psychological problems (Hayes et al., 2014 ). Third, H3 was accepted, as an inverse relationship between mindfulness and psychological distress was identified. This finding aligns with previous studies that have recognized that a greater capacity for present-moment mindfulness contributes to a reduction in psychological distress and promotes greater well-being (Dubey et al., 2020 ; Ruiz, 2014 ; Woodruff et al., 2013). At a theoretical level, Contextual Behavioral Science (Hayes et al., 2014 ) explains this association through the avoidance paradox. Human beings have a natural tendency to avoid pain and seek pleasure. However, attempting to escape from unpleasant sensations, thoughts, and emotions in the present moment creates an internal struggle that consumes energy without altering the context or the problematic situation. Paradoxically, the discomfort one seeks to avoid intensifies upon realizing that, despite efforts to escape, one remains trapped (Alonso, 2012 ; Cebolla, 2012 ; Hayes et al., 2014 ). Allowing oneself to perceive and describe what is happening internally and externally, without judgment and without focusing on the future or the past, helps to disengage from ruminative behaviors. This practice enables a better understanding of the emergence of emotions and one's patterns of thought and behavior, thereby reducing the emotional intensity with which reality and internal experiences (sensations and thoughts) are interpreted. Finally, the study's mediating hypothesis (H4) was supported, as the indirect effect of mindfulness on psychological distress through psychological inflexibility was found to be significant in the Peruvian parents evaluated. This finding is consistent with the work of Forrest et al. (2024), which, using a network model, identified a mindfulness-inflexibility-psychological distress pathway. In this model, inflexibility processes demonstrated greater centrality, suggesting that improvements in these processes could lead to corresponding enhancements across much of the network, ultimately promoting well-being. Additionally, the studies by Ruiz ( 2014 ) and Li et al. (2024), although focusing on pathological worry and perceived stress as dependent variables respectively, similarly identified a mediation effect of psychological inflexibility on low levels of mindfulness. This further supports the accumulating evidence of inflexibility as a key mechanism underlying the effects of mindfulness. Thus, a reduced capacity to focus on the present moment is associated with a greater tendency to respond inflexibly to contextual demands, which, in turn, leads to an increase in anxious and depressive symptoms, culminating in psychological distress. Integrating the above, the validated mediation model suggests that practicing mindfulness enables individuals to develop greater psychological flexibility, allowing them to accept their internal experiences without judgment and make decisions that are more aligned with their values. This flexibility diminishes psychological rigidity and, consequently, alleviates suffering manifested as psychological distress of a pathological nature, including clinical symptoms of anxiety and depression. Overall, the findings demonstrate that mindfulness skills significantly reduce psychological distress in adult parents, both directly and indirectly through psychological inflexibility, effectively addressing the research objectives. The implications highlight the importance of understanding the mechanisms through which mindfulness exerts its beneficial effects. In this regard, the findings suggest the value of incorporating strategies to promote psychological flexibility into mindfulness training programs, aiming to enhance their therapeutic impact on psychological distress by ensuring the full mindfulness-flexibility-well-being pathway. Additionally, the findings provide empirical support for the relevance of psychological inflexibility processes in predicting psychological distress in a transdiagnostic manner (Hayes et al., 2014 ), while specifically verifying the sequence from mindfulness to distress through inflexibility (Rogge & Daks, 2021 ). In proposing recommendations for future research, the study's limitations are acknowledged, including its design, the self-reported nature of the variables, and the sample size of the study population. First, as this study employs a cross-sectional design, the data reflect a specific point in time, limiting the ability to infer causal relationships or assess the stability of the observed relationships over time. Future research is encouraged to validate the proposed explanatory model using longitudinal or quasi-experimental design studies. Secondly, the use of self-reported measures for the variables may introduce social desirability biases. This limitation could be addressed in future studies by incorporating methods such as direct clinical observation, progress reports, participant diaries, or other objective assessment techniques. Thirdly, it is important to note that the study population consisted of adult parents of school-age children, making the findings specific to this group. Additionally, as the suggested sample size was not fully achieved, the results may have lower statistical power to detect true effects. Future studies are recommended to replicate this research with larger samples to confirm the present findings. Conclusion The findings of this study provide evidence of the mediating role of psychological inflexibility in the relationship between mindfulness and psychological distress in parents of school-aged children. By demonstrating that mindfulness significantly reduces psychological distress, both directly and indirectly through its effect on psychological inflexibility, the study underscores the importance of addressing these processes in intervention strategies. Furthermore, by explaining 58% of the variance in psychological distress, the proposed model offers a foundation for future research and clinical applications. It contributes to a broader understanding of how mindfulness and psychological inflexibility interact to influence well-being, which is essential for designing interventions aimed at supporting parents in demanding caregiving roles. Declarations Ethics approval and consent to participate Ethical guidelines and standards of conduct in psychological research were respected, and the corresponding tools and procedures were properly followed. The research protocol was reviewed and approved by the Institutional Ethics Committee of Universidad Católica Sedes Sapientiae (Reference Number: CE-1834). Additionally, informed consent was obtained from all participants. The study was conducted in accordance with the ethical standards and amendments outlined in the Declaration of Helsinki. Consent for publication Not Applicable. Declaration of Interest The authors declare that they have no economic, institutional, labor, or personal conflict of interest in the preparation of this manuscript. Funding The authors declare that no financial support was received for the research, authorship, or publication of this manuscript. Author Contribution MLSU conducted statistical analysis, developed the methodology, and drafted the initial version of the manuscript. RJAS participated in the statistical analysis, interpreted the results, and revised the manuscript. AS-B contributed to the statistical analysis. JS contributed by drafting and reviewing multiple versions of the manuscript. All authors reviewed and approved the final version of the manuscript. Acknowledgement The authors would like to express their sincere gratitude to the participating parents for their time and willingness to contribute to this study. We also extend our appreciation to the schools that facilitated contact with the families, making this research possible. Finally, we thank the research assistants for their support in data collection and preliminary analysis, as well as the institutions that provided logistical support throughout the project. Data Availability The data sets generated to support the findings of this study are not publicly available, but can be requested from the corresponding author. References Abad FJ, Olea J, Ponsoda V, García C. (2011). Medición en ciencias sociales y de la salud . Síntesis. Aktu Y. The role of parenting stress on parenting self-efficacy and parental burnout among Turkish parents: a moderated mediation model. BMC Psychol. 2024;12(1). https://doi.org/10.1186/s40359-024-01980-7 . Almendingen A, Pilkington P. Parenting self-efficacy and psychological distress in parents of children with an autism spectrum disorder. J Autism Dev Disord. 2024;54(7):2604–14. https://doi.org/10.1007/s10803-023-05939-2 . Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, Abdulmalik J, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bruffaerts R, Cardoso G, Cia A, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, de Jonge P. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195–208. https://doi.org/10.1002/da.22711 . the WHO World Mental Health Survey Collaborators. Alonso M. (2012). Mindfulness en el tratamiento de los trastornos de ansiedad. En M. Miró & Simón, editors, Mindfulness en la práctica clínica (pp. 81–139). Desclée de Brouwer. American Psychiatric Association. Manual diagnóstico y estadístico de los trastornos mentales (DSM-5-TR). Panamericana Editorial Ltda; 2023. Apolinário-Hagen J, Drüge M, Guthardt L, Haller E. Acceptance and commitment therapy for major depressive disorder: Navigating depression treatment in traditional and digital settings with insights from current research. Adv Exp Med Biol. 2024;1456:227–56. https://doi.org/10.1007/978-981-97-4402-2_12 . Ato M, López J, Benavente A. Un sistema de clasificación de los diseños de investigación en psicología. Anales de Psicología. 2013;29(3):1038–59. https://doi.org/10.6018/analesps.29.3.178511 . Bandalos D, Finney S. (2010). Factor analysis: exploratory and confirmatory. En G. R. Hancock y R. O. Mueller, editor, Reviewer’s guide to quantitative methods (pp. 93–114). Routledge Member of the Taylor and Francis Group. Brown TA. Confirmatory factor analysis for applied research. Guilford Press; 2006. Cabana E, Lillo RE, Laniado H. Multivariate outlier detection based on a robust Mahalanobis distance with shrinkage estimators. Stat Papers (Berlin Germany). 2021;62(4):1583–609. https://doi.org/10.1007/s00362-019-01148-1 . Caycho-Rodríguez T, Tomás JM, Ventura- León J, Esteban C, Guadalupe RFO, Reyes-Bossio LA, García Cadena M, C. H., Cabrera-Orosco I. Factorial validity and invariance analysis of the five items version of Mindful Awareness Attention Scale in older adults. Aging Ment Health. 2020;25(4):756–65. https://doi.org/10.1080/13607863.2020.1716685 . Cebolla A. (2012). Mindfulness en terapia cognitiva para la depresión. En M. Miró & Simón, editors, Mindfulness en la práctica clínica (pp. 141–168). Desclée de Brouwer. Corea D, Cid MT. La depresión y su impacto en la salud pública. Revista Médica Hondureña. 2021;89(Supl1):46–52. https://doi.org/10.5377/rmh.v89isupl.1.12047 . Dubey N, Podder P, Pandey D. (2020). Knowledge of COVID-19 and its influence on mindfulness, cognitive emotion regulation and psychological flexibility in the Indian community. Frontiers in psychology , 11 . https://doi.org/10.3389/fpsyg.2020.589365 Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat science: Rev J Inst Math Stat. 1986;1(1):54–75. https://doi.org/10.1214/ss/1177013815 . Evans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Chiu WT, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hu C, Karam EG, Kawakami N, Lee S, Lund C, Kovess-Masfety V, Levinson D, Thornicroft G. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychol Med. 2018;48(9):1560–71. https://doi.org/10.1017/s0033291717003336 . Feng Y-T, Pei J-Y, Wang Y-P, Feng X-F. Association between depression and vascular aging: a comprehensive analysis of predictive value and mortality risks. J Affect Disord. 2024;367:632–9. https://doi.org/10.1016/j.jad.2024.08.100 . Hayes S, Strosahl K, Wilson K. Terapia de Aceptación y Compromiso. Proceso y práctica del cambio consciente (Mindfulness). Desclée de Brouwer; 2014. Ho CYY, Yu BCL, Mak WWS. Nonattachment mediates the associations between mindfulness, well-being, and psychological distress: A meta-analytic structural equation modeling approach. Clin Psychol Rev. 2022;95(102175):102175. https://doi.org/10.1016/j.cpr.2022.102175 . Kline P. An easy guide to factor analysis. Routledge; 1994. Kulasinghe K, Whittingham K, Mitchell AE. Mental health, broad autism phenotype and psychological inflexibility in mothers of young children with autism spectrum disorder in Australia: A cross-sectional survey. Autism: Int J Res Pract. 2021;136236132098462. https://doi.org/10.1177/1362361320984625 . Li C-H. Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behav Res Methods. 2016;48(3):936–49. https://doi.org/10.3758/s13428-015-0619-7 . Maddock A, Blair C. How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review. Curr Psychol (New Brunsw N J). 2023;42(12):10200–22. https://doi.org/10.1007/s12144-021-02082-y . Makriyianis HM, Adams EA, Lozano LL, Mooney TA, Morton C, Liss M. Psychological inflexibility mediates the relationship between adverse childhood experiences and mental health outcomes. J Context Behav Sci. 2019;14:82–9. https://doi.org/10.1016/j.jcbs.2019.09.007 . McCracken LM, Badinlou F, Buhrman M, Brocki KC. The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia. J Context Behav Sci. 2021;19:28–35. https://doi.org/10.1016/j.jcbs.2020.11.003 . Medrano LA, Muñoz-Navarro R. Aproximación conceptual y práctica a los modelos de ecuaciones estructurales. Revista Digit de Investigación en Docencia Universitaria. 2017;219–39. https://doi.org/10.19083/ridu.11.486 . Mirowsky J, Ross CE. Measurement for a Human Science. J Health Soc Behav. 2002;43(2):152. https://doi.org/10.2307/3090194 . Moshagen M, Bader M. semPower: General power analysis for structural equation models. Behav Res Methods. 2023;56(4):2901–22. https://doi.org/10.3758/s13428-023-02254-7 . Muthén B, Kaplan D. A comparison of some methodologies for the factor analysis of non-normal Likert variables. Br J Math Stat Psychol. 1985;38(2):171–89. https://doi.org/10.1111/j.2044-8317.1985.tb00832.x . Nurhidayah I, Kusuma Dewi R, Hidayati NO, Poddar S. Psychological Distress among Parents due to Their Children Having Cancer: A Systematic Review. Kesmas. 2022;17(1):54–62. https://scholarhub.ui.ac.id/kesmas/vol17/iss5/10 . O’Boyle-Finnegan Ú, Graham CD, Doherty N, Adair P. Exploring the contribution of psychological flexibility processes and self-compassion to depression, anxiety and adjustment in parents of preterm infants. J Context Behav Sci. 2022;24:149–59. https://doi.org/10.1016/j.jcbs.2022.05.002 . Organización Mundial de la Salud. (2023). Depresión . Organización Mundial de la Salud. https://www.who.int/es/news-room/fact-sheets/detail/depression?gad_source=1&gclid=CjwKCAjw6c63BhAiEiwAF0EH1AhbbdZmBvQmad69Xe4T2U2bnDoXk1ZL9BMLYi1qn_1GCoTIfPWF8RoCmTcQAvD_BwE Parker SF, Rogge RD, Drake CE, Fogle C. A fresh lens on psychological flexibility: Using network analysis and the Unified Flexibility and Mindfulness Model to uncover paths to wellbeing and distress. J Context Behav Sci. 2024;32(100753):100753. https://doi.org/10.1016/j.jcbs.2024.100753 . Prieto Molinari DE, Bravo A, De Pierola GL, Victoria-De Bona I, Silva GLM, Núñez LAL, Uribe-Bravo CS, K. A., Zegarra ÁC. Depresión y ansiedad durante el aislamiento obligatorio por el COVID-19 en Lima Metropolitana. Liberabit Revista Peruana de Psicología. 2020;26(2):e425. https://doi.org/10.24265/liberabit.2020.v26n2.09 . Rahman W, Shah A, F., Rasli A. Use of structural equation modeling in social science research. Asian social Sci. 2015;11(4). https://doi.org/10.5539/ass.v11n4p371 . Rodríguez M, Ruiz M. Atenuación de la asimetría y de la curtosis de las puntuaciones observadas mediante transformaciones de variables: Incidencia sobre la estructura factorial. Psicológica: Revista de Metodología y Psicología Experimental. 2008;29(2):205–27. https://dialnet.unirioja.es/servlet/articulo?codigo=2718372 . Rogge RD, Daks JS. Embracing the intricacies of the path toward mindfulness: Broadening our conceptualization of the process of cultivating mindfulness in day-to-day life by developing the unified flexibility and mindfulness model. Mindfulness. 2021;12(3):701–21. https://doi.org/10.1007/s12671-020-01537-w . Rogge RD, Lin Y-Y, Swanson DP, Amaro A. Tracing the path toward mindfulness back to its origins: Linking tenets of Buddhism to mindfulness within the Buddhism-informed unified flexibility and mindfulness (BI-UFM) model. Mindfulness. 2024;15(4):775–94. https://doi.org/10.1007/s12671-022-01886-8 . Rosseel Y. lavaan: An R Package for Structural Equation Modeling. J Stat Softw. 2012;48(2). https://doi.org/10.18637/jss.v048.i02 . Ruiz FJ. The relationship between low levels of mindfulness skills and pathological worry: The mediating role of psychological inflexibility. [La relación entre habilidades de mindfulness y preocupación patológica: El rol mediador de la inflexibilidad psicológica]. Anales de psicología. 2014;30(3). https://doi.org/10.6018/analesps.30.3.150651 . Ruíz M, Pardo A, San Martín R. Modelos de ecuaciones estructurales. Papeles del Psicólogo. 2010;31(1):34–45. http://www.papelesdelpsicologo.es/pdf/1794.pdf . Santosh, Darolia S. Trait Mindfulness and its Role with Psychological Inflexibility and Subjective Well-being among Adults: A Correlational Study. Indian J Health Wellbeing. 2022;13(2):143–8. Valencia P, Falcón C. Validez y confiabilidad del Cuestionario de Aceptación y Acción II (AAQ-II) en universitarios de lima. PSIENCIA. 2022;14(1):176–219. Villarreal-Zegarra D, Copez-Lonzoy A, Bernabé-Ortiz A, Melendez-Torres GJ, Bazo-Alvarez JC. Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics. PLoS ONE. 2019;14(9). https://doi.org/10.1371/journal.pone.0221717 . Villarreal-Zegarra D, Paredes-Angeles R, Mayo-Puchoc N, Arenas-Minaya E, Huarcaya-Victoria J, Copez-Lonzoy A. Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population. BMC Psychol. 2024;12(1). https://doi.org/10.1186/s40359-024-01688-8 . Wang Z, Zhang X, Ye Y. Does marital satisfaction predict children aggression? Insights from parents’ and children’s psychological distress. Child Family Social Work. 2024;29(3):615–24. https://doi.org/10.1111/cfs.13121 . Wickham H, Averick M, Bryan J, Chang W, McGowan L, François R, Grolemund G, Hayes A, Henry L, Hester J, Kuhn M, Pedersen T, Miller E, Bache S, Müller K, Ooms J, Robinson D, Seidel D, Spinu V, Yutani H. Welcome to the tidyverse. J open source Softw. 2019;4(43):1686. https://doi.org/10.21105/joss.01686 . Woodruff SC, Glass CR, Arnkoff DB, Crowley KJ, Hindman RK, Hirschhorn EW. Comparing self-compassion, mindfulness, and psychological inflexibility as predictors of psychological health. Mindfulness. 2014;5(4):410–21. https://doi.org/10.1007/s12671-013-0195-9 . Zeng S, Yuan L, Lee Y, Guan Y, Volk K, O’Riordan M, Stone-MacDonald AK. Parental stress in raising a child with mental health and behavior problems. En Autism and Child Psychopathology Series. Springer International Publishing; 2023. pp. 137–54. Zhu X, Dou D, Karatzias T. Editorial: Parental influence on child social and emotional functioning. Front Psychol. 2024;15:1–4. https://doi.org/10.3389/fpsyg.2024.1392772 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Feb, 2026 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 26 Nov, 2025 Reviews received at journal 17 Nov, 2025 Reviewers agreed at journal 25 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviews received at journal 23 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers invited by journal 13 Sep, 2025 Editor assigned by journal 13 Sep, 2025 Editor invited by journal 05 Sep, 2025 Submission checks completed at journal 04 Sep, 2025 First submitted to journal 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7483309","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518356626,"identity":"409af153-4343-4749-b6a6-dffdea3005fe","order_by":0,"name":"Marisabel Lucia Seclén Uchuya","email":"","orcid":"","institution":"National University of San Marcos","correspondingAuthor":false,"prefix":"","firstName":"Marisabel","middleName":"Lucia Seclén","lastName":"Uchuya","suffix":""},{"id":518356627,"identity":"cf4ce9d0-88a6-44a5-89c0-d331cf544859","order_by":1,"name":"Roger Joaquin Angulo Salas","email":"","orcid":"","institution":"Universidad Católica Sedes Sapientiae","correspondingAuthor":false,"prefix":"","firstName":"Roger","middleName":"Joaquin Angulo","lastName":"Salas","suffix":""},{"id":518356628,"identity":"ccdd1a31-32b9-481f-9f7e-7825eee322f7","order_by":2,"name":"Antonio Serpa Barrientos","email":"","orcid":"","institution":"National University of San Marcos","correspondingAuthor":false,"prefix":"","firstName":"Antonio","middleName":"Serpa","lastName":"Barrientos","suffix":""},{"id":518356629,"identity":"38d6ee0e-3ed9-4f9f-90ca-c086ea8de04c","order_by":3,"name":"Jacksaint Saintila","email":"data:image/png;base64,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","orcid":"","institution":"Universidad Señor de Sipán","correspondingAuthor":true,"prefix":"","firstName":"Jacksaint","middleName":"","lastName":"Saintila","suffix":""}],"badges":[],"createdAt":"2025-08-28 21:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7483309/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7483309/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-026-01595-w","type":"published","date":"2026-02-26T15:58:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91951603,"identity":"6748d059-79d7-414f-aa3a-63cd896e264b","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85027,"visible":true,"origin":"","legend":"","description":"","filename":"Maindocument02.docx","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/d451e880aa7f91692329f1d2.docx"},{"id":91953380,"identity":"2d12eb45-53a1-460f-a11b-d1004b67b176","added_by":"auto","created_at":"2025-09-23 06:55:31","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6467,"visible":true,"origin":"","legend":"","description":"","filename":"a342b043df444b3584961335f0c205b2.json","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/e942d853237160b2c543fc23.json"},{"id":91951612,"identity":"5af92b00-56d9-488c-ad92-855ee42df6e8","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":143041,"visible":true,"origin":"","legend":"","description":"","filename":"a342b043df444b3584961335f0c205b21enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/475af188807db6a60ae18f2b.xml"},{"id":91951604,"identity":"666c9231-e08b-458c-b301-d22aa725a28e","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15087,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/f4ddf02cd241d9a370abdff2.png"},{"id":91951608,"identity":"25569022-328f-4b9a-a385-6977041677d1","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12585,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/a6276770600897c79a8c46e6.png"},{"id":91953381,"identity":"c264bee6-e351-4367-86a1-7f0dc25d6470","added_by":"auto","created_at":"2025-09-23 06:55:31","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15230,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/027c98c94d30c85388aedca7.png"},{"id":91951607,"identity":"933736b2-be34-4346-9952-7d8badac3300","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12910,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/c91a8a5afc8b607eb3f1c7e8.png"},{"id":91951610,"identity":"6d8bc039-39c2-4c56-95ba-67a324a3eeac","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":139978,"visible":true,"origin":"","legend":"","description":"","filename":"a342b043df444b3584961335f0c205b21structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/f3c98a977e660b58ed3ddc4b.xml"},{"id":91951611,"identity":"f83ba463-80b2-4496-aab0-81dc11107384","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":150392,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/19700756577e8b15d1d0ca79.html"},{"id":91951601,"identity":"8dd52e0e-a2fd-439b-b3a2-e23cf904875c","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13103,"visible":true,"origin":"","legend":"\u003cp\u003eSpecific hypotheses of the study within the proposed mediation model.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/669bda605c649589ed5c3285.png"},{"id":91951602,"identity":"8d05b50f-45ff-4610-a6d0-9080528b09cd","added_by":"auto","created_at":"2025-09-23 06:47:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20250,"visible":true,"origin":"","legend":"\u003cp\u003eResults of the structural equation model.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e MF: Mindfulness, IP: Psychological inflexibility, PD: Psychological distress, DE: Depression, AN: Anxiety.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/a8a63015bcc496cfb71facb1.png"},{"id":103765694,"identity":"2b74c2ae-31b6-40d6-806c-4bd626873745","added_by":"auto","created_at":"2026-03-02 16:07:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":797097,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7483309/v1/c7362280-d590-45f5-a226-a4adcd894e49.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychological Inflexibility Mediates the Relationship between Mindfulness and Psychological Distress in Peruvian Parents with School Age Children","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePsychological distress is defined as an affective state characterized by depressive and anxious symptoms (Mirowsky \u0026amp; Ross, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), including overwhelming feelings, excessive worry, difficulty concentrating, changes in appetite, and sleep disturbances (American Psychiatric Association, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These symptoms can significantly interfere with daily functioning, making it difficult to perform everyday tasks. Consequently, depression and anxiety rank among the leading causes of global disability (Alonso et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Corea Del Cid, 2021).\u003c/p\u003e\u003cp\u003eIn the context of parenting, recent research highlights an association between psychological distress and various parenting challenges. Studies, primarily conducted on parents of children with special health conditions and behavioral problems (Zeng et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), indicate that elevated levels of psychological distress in parents are linked to lower parental self-efficacy (Aktu, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Almendingen \u0026amp; Pilkington, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), an increased likelihood of aggressive behaviors toward children (Wang et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and a higher prevalence of suicidal ideation, sleep disorders, and physical health issues (Nurhidayah et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAdditionally, mood changes characteristic of psychological distress, while significantly impacting mental health, are also associated with an increased risk of developing physical illnesses, such as cardiovascular and gastrointestinal diseases (Feng et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The lack of timely treatment can worsen the situation, increasing the risk of substance abuse, suicidal ideation, and comorbidity with other disorders (World Health Organization [WHO], 2023). This problem is particularly concerning in low- and middle-income countries, where fewer than 25% of individuals with mental disorders receive the necessary treatment (Evans-Lacko et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). To understand the magnitude of psychological distress, it is essential to consider the increasing global prevalence of anxiety (9.8%) and depression (5%) in the adult population (Alonso et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; WHO, 2023). Furthermore, the findings of Prieto Molinari et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), which report even higher rates of depressive (39%) and anxious (10%) symptoms in the context of the studied population, highlight the urgency of investigating the underlying dynamics of this public health issue.\u003c/p\u003e\u003cp\u003eEmpirical evidence, as highlighted in a systematic review of several studies, indicates that scenarios involving a high capacity for full awareness of the present moment are associated with a lower incidence of psychological distress (Ho et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Maddock \u0026amp; Blair, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, the task of uncovering the nature of this relationship\u0026mdash;specifically, how mindfulness influences psychological distress\u0026mdash;remains unresolved. It is important to note that previous research has indicated that using mindfulness as a means of escape or control in response to non-existent threats can paradoxically exacerbate distress and dysfunctionality (Dafter \u0026amp; Spearman, 2011; Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe transdiagnostic concept of psychological flexibility (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) comprises six processes that establish new ways of relating to life's inevitable discomfort: cognitive defusion, acceptance, values, committed action, self-as-context, and contact with the present moment. The latter process, often referred to as mindfulness, represents the attentional dimension of the model. Its counterpart, psychological inflexibility, has been shown to significantly predict psychological distress, as evidenced by recent empirical research (Makriyianis et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; McCracken et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This relationship is explained by the authors through the adaptive limitations caused by cognitive fusion with rigid beliefs and thoughts, inflexible and avoidance-focused attention to negative emotions, and a behavioral repertoire that is unguided or misaligned with what truly matters to individuals (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWithin this holistic model, low mindfulness capacity contributes to inflexible behavioral responses\u0026mdash;characterized as rigid, reactionary, and maladaptive\u0026mdash;thereby promoting anxious and depressive symptoms. Conversely, higher mindfulness capacity fosters flexibility, which in turn facilitates the remission of such symptoms (Alonso, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Cebolla, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). However, just as an improvement in mindfulness creates better conditions for the other flexibility processes, it is assumed that enhancing any of these processes will gradually contribute to overall psychological flexibility (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn contrast, the Unified Mindfulness and Flexibility Model (UFM) has recently emerged in the literature as a specific theoretical framework outlining how mindfulness and psychological flexibility processes operate (Rogge et al., 2021; Rogge et al., 2022). This model emphasizes that mindfulness levels serve as the core mechanism of psychological inflexibility. Specifically, it proposes a direct pathway where present-moment mindfulness capacity reduces inflexibility, thereby enabling individuals to engage in more ethical, informed, and value-consistent behaviors, ultimately promoting well-being (Rogge \u0026amp; Daks, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrevious research evaluating both mindfulness and inflexibility within the same sample (Woodruff et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) has demonstrated that inflexibility more strongly predicts psychological well-being and negative mental health outcomes compared to mindfulness. This finding suggests a potential mediating role of inflexibility in the relationship between mindfulness practice and the reduction of anxiety and depressive symptoms. These findings, along with other studies (Dubey et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Santosh \u0026amp; Suresh, 2022) that have identified significant associations between psychological flexibility, mindfulness, and well-being, support the hypothesis that psychological inflexibility may serve as a mechanism through which low mindfulness practice exerts its detrimental effects.\u003c/p\u003e\u003cp\u003eIn particular, there are precedents proposing mindfulness action pathways mediated by psychological flexibility/inflexibility in relation to pathological worry (Forrest et al., 2024), anxiety (Ruiz, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), and depression (Apolin\u0026aacute;rio-Hagen et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) symptomatology. While these studies have illuminated these relationships in general populations, recent scientific literature has started to focus on adult parents in clinical contexts involving their children (Kulasinghe et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; O'Boyle-Finnegan et al., 2022). However, there is a gap in understanding the dynamics between mindfulness, inflexibility, and psychological distress (anxiety and depression) in parents of school-aged children\u0026mdash;a population that faces unique demands and requires optimal mental health (Zhu et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnalyzing the mediating role of psychological inflexibility in the relationship between mindfulness and psychological distress provides a deeper understanding of the mechanisms underlying the studied symptomatology. This analysis serves as a critical foundation for advancing to quasi-experimental studies on treatments that incorporate these variables in adult parents. Since the hypotheses are grounded in the psychological inflexibility model of Contextual Behavioral Science (CBS), the empirical findings contribute to validating its assumptions. Additionally, they enrich the field of clinical and health psychology with new evidence on significant factors influencing parental depressive and anxious symptomatology in non-hospital or non-clinical settings.\u003c/p\u003e\u003cp\u003eThis theoretical enrichment also addresses a key demand of Contextual Behavioral Science (CBS), which encourages the exploration of relationships between theoretically relevant processes and intervention methods through mediation and moderation studies (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). These studies are conducted using structural equation modeling (SEM), a robust statistical technique that enables the analysis of complex relationships between multiple variables. SEM provides a rigorous approach to evaluating theoretical models by accounting for both direct and mediating effects among variables (Rahman et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe present study explores the question, \u0026ldquo;Does psychological inflexibility mediate the relationship between mindfulness and psychological distress?\u0026rdquo; It aims to assess the mediating role of psychological inflexibility in this relationship. Four hypotheses were proposed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): H1: mindfulness is inversely related to psychological inflexibility; H2: psychological inflexibility is positively associated with psychological distress; H3: mindfulness capacity is inversely associated with psychological distress; and the overarching hypothesis (H4) posits that higher levels of mindfulness practice reduce psychological inflexibility, ultimately leading to lower levels of distress in the evaluated parents.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eAn explanatory cross-sectional design was employed to analyze a model examining the relationships between a set of variables, establishing causality based on underlying theoretical frameworks (Ato et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eA total of 364 Peruvian adults participated in the study, including 67 males (18.4%) and 297 females (81.6%). Participants' ages ranged from 24 to 61 years (M\u0026thinsp;=\u0026thinsp;41.54, SD\u0026thinsp;=\u0026thinsp;7.18). Regarding educational level, 3.6% had primary education, 29.9% had secondary education, and 66.5% had technical or higher education. Regarding marital status, 16.5% of participants were single, 43.1% were married, 35.2% were cohabiting, 4.7% were divorced, and 0.5% were widowed. Finally, the parents had an average of two children (M\u0026thinsp;=\u0026thinsp;2.04, SD\u0026thinsp;=\u0026thinsp;0.87).\u003c/p\u003e\u003cp\u003eThe participants were parents of school-age children attending three private educational institutions offering kindergarten, elementary, and high school education. Selection was conducted using non-probabilistic convenience sampling. The inclusion criteria were being of adult age, holding Peruvian nationality, and providing informed consent. Conversely, the exclusion criteria included non-biological parents and responses submitted after the study period. The sample size estimation was conducted using the second version of the R package \u003cem\u003esemPower\u003c/em\u003e, assuming an expected effect size of .05, a statistical power of 0.95, α\u0026thinsp;=\u0026thinsp;0.05, and four observable variables. The analysis suggested a minimum required sample size of 342 participants (Moshagen \u0026amp; Bader, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eMindfulness Attention and Awareness Scale (MAAS-5).\u003c/b\u003e The version validated in Peru by Caycho-Rodr\u0026iacute;guez et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) was used. This instrument provides a unidimensional measure that quantifies the degree of attention to present-moment events. The five items offer six response options (ranging from 1\u0026thinsp;=\u0026thinsp;almost always to 6\u0026thinsp;=\u0026thinsp;almost never), with higher scores indicating greater mindfulness. The study by Caycho-Rodr\u0026iacute;guez et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) provided evidence of validity based on internal structure using Confirmatory Factor Analysis (CFA) with appropriate fit indices (χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;2.25, CFI\u0026thinsp;=\u0026thinsp;.99, SRMR\u0026thinsp;=\u0026thinsp;.03, RMSEA\u0026thinsp;=\u0026thinsp;.06). Regarding internal consistency reliability, an adequate omega coefficient was reported (ω\u0026thinsp;=\u0026thinsp;.80). The data from the present study yielded appropriate fit indices (χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.70, CFI\u0026thinsp;=\u0026thinsp;.99, TLI\u0026thinsp;=\u0026thinsp;.98, SRMR\u0026thinsp;=\u0026thinsp;.02, RMSEA\u0026thinsp;=\u0026thinsp;.08). Regarding reliability, adequate alpha and omega coefficients were reported (α\u0026thinsp;=\u0026thinsp;.84, ω\u0026thinsp;=\u0026thinsp;.85).\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcceptance and Action Questionnaire II (AAQ-II).\u003c/b\u003e The version validated in Peru by Valencia and Falc\u0026oacute;n (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) was used. This questionnaire provides a unidimensional measure designed to assess experiential avoidance and psychological inflexibility within the framework of Acceptance and Commitment Therapy (ACT). The seven items offer seven response options (ranging from 1\u0026thinsp;=\u0026thinsp;completely false to 7\u0026thinsp;=\u0026thinsp;completely true), with higher scores indicating greater psychological inflexibility. In the study by Valencia and Falc\u0026oacute;n (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), evidence of validity based on internal structure was demonstrated through Confirmatory Factor Analysis (CFA) with appropriate fit indices (MLRχ\u0026sup2;(13)\u0026thinsp;=\u0026thinsp;67.72, CFI\u0026thinsp;=\u0026thinsp;.98, TLI\u0026thinsp;=\u0026thinsp;.97, SRMR\u0026thinsp;=\u0026thinsp;.02, RMSEA\u0026thinsp;=\u0026thinsp;.07). Regarding reliability, an adequate omega coefficient was reported (ω\u0026thinsp;=\u0026thinsp;.84). Using the data from the present study, appropriate fit indices were obtained after removing item 7 ('My worries hinder my way to success') due to factor loadings below .30 (Kline, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1994\u003c/span\u003e) (χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.08, CFI\u0026thinsp;=\u0026thinsp;.99, TLI\u0026thinsp;=\u0026thinsp;.99, SRMR\u0026thinsp;=\u0026thinsp;.03, RMSEA\u0026thinsp;=\u0026thinsp;.07). Regarding reliability, adequate alpha and omega coefficients were reported (α\u0026thinsp;=\u0026thinsp;.87, ω\u0026thinsp;=\u0026thinsp;.88).\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatient Health Questionnaire (PHQ-9).\u003c/b\u003e The version validated in Peru by Villarreal-Zegarra et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) was used. This scale provides a unidimensional measure that assesses depressive symptomatology over the past two weeks. It consists of nine items with four response options (0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half of the days, 3\u0026thinsp;=\u0026thinsp;almost every day), where higher scores indicate greater depressive symptomatology. Validity based on internal structure was demonstrated through Confirmatory Factor Analysis (CFA) with appropriate fit indices (CFI\u0026thinsp;=\u0026thinsp;.94, TLI\u0026thinsp;=\u0026thinsp;.91, SRMR\u0026thinsp;=\u0026thinsp;.04, RMSEA\u0026thinsp;=\u0026thinsp;.08). Regarding reliability, adequate alpha and omega coefficients were reported (α\u0026thinsp;=\u0026thinsp;.87, ω\u0026thinsp;=\u0026thinsp;.87) (Villarreal-Zegarra et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Using the data from the present study, appropriate fit indices were obtained (χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;2.72, CFI\u0026thinsp;=\u0026thinsp;.98, TLI\u0026thinsp;=\u0026thinsp;.97, SRMR\u0026thinsp;=\u0026thinsp;.07, RMSEA\u0026thinsp;=\u0026thinsp;.06). Regarding reliability, adequate alpha and omega coefficients were reported (α\u0026thinsp;=\u0026thinsp;.83, ω\u0026thinsp;=\u0026thinsp;.87).\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeneralized Anxiety Disorder Scale (GAD-7).\u003c/b\u003e This scale was validated in Peru by Villarreal-Zegarra et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and provides a unidimensional measure to assess indicators of anxiety symptomatology over the past two weeks. It consists of seven items with four response options (0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the days, 3\u0026thinsp;=\u0026thinsp;almost every day), where higher scores indicate greater levels of anxiety symptomatology. Validity based on internal structure was demonstrated through Confirmatory Factor Analysis (CFA) with appropriate fit indices (CFI\u0026thinsp;=\u0026thinsp;.99, TLI\u0026thinsp;=\u0026thinsp;.99, WRMR\u0026thinsp;=\u0026thinsp;1.56, RMSEA\u0026thinsp;=\u0026thinsp;.07). Regarding reliability, adequate alpha and omega coefficients were reported (α\u0026thinsp;=\u0026thinsp;.93, ω\u0026thinsp;=\u0026thinsp;.90) (Villarreal-Zegarra et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Using the data from the present study, appropriate fit indices were obtained (χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;1.82, CFI\u0026thinsp;=\u0026thinsp;.99, TLI\u0026thinsp;=\u0026thinsp;.99, SRMR\u0026thinsp;=\u0026thinsp;.03, RMSEA\u0026thinsp;=\u0026thinsp;.05). Regarding reliability, adequate alpha and omega coefficients were reported (α\u0026thinsp;=\u0026thinsp;.86, ω\u0026thinsp;=\u0026thinsp;.88).\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003e The present study obtained written authorization from the directors of the three educational institutions for access to the sample, following the review and approval of the research protocol by the Institutional Ethics Committee of Universidad Cat\u0026oacute;lica Sedes Sapientiae (CE-1834). Permission was granted to the authors for the use of culturally and contextually validated instruments. Informed consent and assessments were conducted virtually and anonymously through a Google Forms questionnaire, which remained accessible for three weeks. Access to the data obtained was restricted exclusively to the study investigators and encrypted to ensure information security during analysis, thereby guaranteeing confidentiality.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were downloaded into an Excel database for validation and subsequently exported to SPSS and R Studio for analysis.\u003c/p\u003e\u003cp\u003eWe began with a descriptive analysis of the data in SPSS, calculating extreme scores, means, standard deviations, skewness, and kurtosis, which fell within the acceptable range of [-1.5, 1.5] (Muth\u0026eacute;n \u0026amp; Kaplan, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). Polychoric matrices were used for both scales due to the ordinal nature of the items, allowing for a more accurate representation of the relationships between latent variables (Bandalos \u0026amp; Finney, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Brown, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The multivariate normality assumptions were tested using Mardia's coefficient (G2), with expected values\u0026thinsp;\u0026lt;\u0026thinsp;70 (Rodriguez \u0026amp; Ruiz, 2008). Robust Mahalanobis distances were also calculated to identify potential outliers (Cabana et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). If the assumption of normality was not met, robust estimators appropriate for non-normal data were applied.\u003c/p\u003e\u003cp\u003eNext, evidence of validity based on internal structure was evaluated through Confirmatory Factor Analysis (CFA) using R Studio 4.4.0, with the Lavaan (Rosseel, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) and Tidyverse (Wickham et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) packages. For the analysis, the Weighted Least Squares Means and Variance Adjusted (WLSMV) estimator was employed, as it is suitable for handling sample size restrictions, ordinal data, and non-normality characteristics (Li, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In accordance with recommendations in the literature, acceptable goodness-of-fit indices were defined as values above .90 for the Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI), and error values below .08 for the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) (Medrano \u0026amp; Mu\u0026ntilde;oz-Navarro, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ruiz et al., 2010). Additionally, a chi-square to degrees of freedom ratio (χ\u0026sup2;/df) less than 3 was considered indicative of adequate model fit (Abad et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOnce the results confirmed evidence of validity based on the internal structure, mediation analysis was conducted using R Studio 4.4.0 with the 'Lavaan' package (Rosseel, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). After confirming the model, mediation was analyzed based on the criterion that the confidence interval did not include zero, which indicates the significance of the effect (Efron \u0026amp; Tibshirani, 1985). Finally, the results were diagrammed using AMOS software version 24.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003ePreliminary analysis\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the correlation matrix of the study variables, with values ranging from 0.36 to 0.76, alongside descriptive results such as skewness (A). These results suggest significant correlations among the study variables, as well as adequate indicators to test the hypotheses using structural equation modeling.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive statistics, internal consistencies, and correlations for the study variables\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1. Psychological inflexibility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2. Mindfulness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.36\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3. Anxiety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.59\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4. Depression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.64\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.35\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.76\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"8\"\u003eNote. M\u0026thinsp;=\u0026thinsp;Mean, SD\u0026thinsp;=\u0026thinsp;Standard Deviation, A\u0026thinsp;=\u0026thinsp;Skewness, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eStructure of the model\u003c/h3\u003e\n\u003cp\u003eModel of the relationship between psychological inflexibility, mindfulness, and psychological distress (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e): The mediation model was evaluated, and the results indicated adequate fit indices (\u0026chi;\u0026sup2;/df\u0026thinsp;=\u0026thinsp;1.85, SRMR\u0026thinsp;=\u0026thinsp;0.04, RMSEA\u0026thinsp;=\u0026thinsp;0.05, CFI\u0026thinsp;=\u0026thinsp;0.98, and TLI\u0026thinsp;=\u0026thinsp;0.98), supporting the validity of the proposed Structural Equation Model (SEM) based on the data (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eStructural equation model fit index (n\u0026thinsp;=\u0026thinsp;364).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCI 90% RMSEA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModels\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edf\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u0026sup2;/df\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCFI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTLI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSRMR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRMSEA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInf\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSup\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMediation model\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e94.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\"\u003e\u003cem\u003eNote.\u003c/em\u003e \u0026chi;\u0026sup2;: Chi-square, df: Degrees of freedom, \u0026chi;\u0026sup2;/df: Chi-square to degrees of freedom ratio, CFI: Comparative Fit Index, TLI: Tucker-Lewis Index, SRMR: Standardized Root Mean Square Residual, RMSEA: Root Mean Square Error of Approximation, CI: Confidence Intervals, n: Sample size.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIndirect and total effects.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCI 95%\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEffect\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLL\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eUP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eE.R (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndirect\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMF \u0026rArr; PI \u0026rArr; PD (a*b)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDirect\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMF \u0026rArr; PD\u003c/p\u003e\n\u003cp\u003e(c\u0026prime;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMF \u0026rArr; PD\u003c/p\u003e\n\u003cp\u003e(a*b) + (c\u0026prime;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"8\"\u003e\u003cem\u003eNote.\u003c/em\u003e MF: Mindfulness, PI: Psychological Inflexibility, PD: Psychological Distress, B: Unstandardized Coefficient, CI: Confidence Interval, Inf: Lower Limit, Sup: Upper Limit, \u0026beta;: Standardized Coefficient, ER: Effect Percentage, p: Statistical Significance.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA significant indirect effect was observed (MF \u0026rArr; PI \u0026rArr; PD: a*b = -0.27, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with approximately 60% of the effect of mindfulness on psychological distress being mediated by psychological inflexibility. This indicates that psychological inflexibility plays a partial mediating role in the relationship between mindfulness and psychological distress (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEstimation of direct effects.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDirect path analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eIC 95%\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePaths\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInf.\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSup.\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMF \u0026rArr; MP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMF \u0026rArr; IP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIP \u0026rArr; MP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e B: Unstandardized Estimator, \u0026beta;: Standardized Estimator, CI: Confidence Interval, SE: Standard Error, p: Statistical Significance, MF: Mindfulness, PI: Psychological Inflexibility, PD: Psychological Distress.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows that mindfulness, defined as attention to events occurring in the present moment, predicts the occurrence of psychological distress (i.e., symptoms of anxiety and depression). Specifically, as mindfulness increases, psychological distress decreases (\u0026beta; = -0.18, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Similarly, mindfulness predicts psychological inflexibility, characterized by experiential avoidance, with results indicating that as mindfulness increases, psychological inflexibility decreases (\u0026beta; = -0.40, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Furthermore, it was observed that as psychological distress increases, depressive symptomatology also increases (\u0026beta;\u0026thinsp;=\u0026thinsp;0.89, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), as does anxious symptomatology (\u0026beta;\u0026thinsp;=\u0026thinsp;0.86, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Finally, psychological inflexibility was found to predict psychological distress, indicating that as psychological inflexibility increases, psychological distress also increases (\u0026beta;\u0026thinsp;=\u0026thinsp;0.67, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The model accounts for 58% of the variance in psychological distress (R\u0026sup2; = 0.58) and 16% of the variance in psychological inflexibility (R\u0026sup2; = 0.16) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGiven the importance of understanding how mindfulness influences psychological distress in adults who are parents, the present study aimed to test whether psychological inflexibility mediates the relationship between mindfulness capacity and psychological distress, which includes symptoms of anxiety and depression.\u003c/p\u003e\u003cp\u003eFirst, H1 was accepted, confirming an inverse association between mindfulness and psychological inflexibility. This finding aligns with previous studies suggesting that lower mindfulness capacity is associated with greater inflexible behavioral and cognitive patterns (Dubey et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Santosh \u0026amp; Suresh, 2022). According to the holistic model proposed by Hayes et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), mindfulness, like other processes, reduces automatic reactivity by fostering greater awareness of the present moment and the values that guide behavior. This, in turn, creates favorable conditions for more flexible psychological processes. The Unified Model of Mindfulness and Flexibility (Rogge \u0026amp; Daks, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) aligns with this perspective but emphasizes that mindfulness serves as a precursor to psychological flexibility. Thus, while the Hexaflex model suggests that any process could promote more flexible behaviors (an aspect not addressed in this study), the Rogge \u0026amp; Daks (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) model emphasizes mindfulness as a foundational element. It provides a solid basis for recognizing and accepting one's experiences, disengaging from rigid ideas, engaging in committed actions, using values as a guide, and perceiving oneself within a context capable of adapting behavior based on personal decisions.\u003c/p\u003e\u003cp\u003eSecond, a direct and significant relationship between psychological inflexibility and psychological distress was confirmed, supporting H2 of the study. These findings are consistent with previous research demonstrating that psychological inflexibility reliably predicts higher levels of distress (Forrest et al., 2024; Ruiz, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Santosh \u0026amp; Suresh, 2022; Woodruff et al., 2013). This relationship is explained by the Hexaflex model, which posits that human suffering is not inherently pathological. Pathology arises from the persistent avoidance of discomfort. By clinging to rigid beliefs and avoiding unpleasant experiences, individuals restrict their range of responses, perpetuate counterproductive strategies, and hinder the development of new coping mechanisms. This rigidity is the underlying factor in various psychological problems (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThird, H3 was accepted, as an inverse relationship between mindfulness and psychological distress was identified. This finding aligns with previous studies that have recognized that a greater capacity for present-moment mindfulness contributes to a reduction in psychological distress and promotes greater well-being (Dubey et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ruiz, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Woodruff et al., 2013). At a theoretical level, Contextual Behavioral Science (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) explains this association through the avoidance paradox. Human beings have a natural tendency to avoid pain and seek pleasure. However, attempting to escape from unpleasant sensations, thoughts, and emotions in the present moment creates an internal struggle that consumes energy without altering the context or the problematic situation. Paradoxically, the discomfort one seeks to avoid intensifies upon realizing that, despite efforts to escape, one remains trapped (Alonso, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Cebolla, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Allowing oneself to perceive and describe what is happening internally and externally, without judgment and without focusing on the future or the past, helps to disengage from ruminative behaviors. This practice enables a better understanding of the emergence of emotions and one's patterns of thought and behavior, thereby reducing the emotional intensity with which reality and internal experiences (sensations and thoughts) are interpreted.\u003c/p\u003e\u003cp\u003eFinally, the study's mediating hypothesis (H4) was supported, as the indirect effect of mindfulness on psychological distress through psychological inflexibility was found to be significant in the Peruvian parents evaluated. This finding is consistent with the work of Forrest et al. (2024), which, using a network model, identified a mindfulness-inflexibility-psychological distress pathway. In this model, inflexibility processes demonstrated greater centrality, suggesting that improvements in these processes could lead to corresponding enhancements across much of the network, ultimately promoting well-being. Additionally, the studies by Ruiz (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and Li et al. (2024), although focusing on pathological worry and perceived stress as dependent variables respectively, similarly identified a mediation effect of psychological inflexibility on low levels of mindfulness. This further supports the accumulating evidence of inflexibility as a key mechanism underlying the effects of mindfulness.\u003c/p\u003e\u003cp\u003eThus, a reduced capacity to focus on the present moment is associated with a greater tendency to respond inflexibly to contextual demands, which, in turn, leads to an increase in anxious and depressive symptoms, culminating in psychological distress. Integrating the above, the validated mediation model suggests that practicing mindfulness enables individuals to develop greater psychological flexibility, allowing them to accept their internal experiences without judgment and make decisions that are more aligned with their values. This flexibility diminishes psychological rigidity and, consequently, alleviates suffering manifested as psychological distress of a pathological nature, including clinical symptoms of anxiety and depression.\u003c/p\u003e\u003cp\u003eOverall, the findings demonstrate that mindfulness skills significantly reduce psychological distress in adult parents, both directly and indirectly through psychological inflexibility, effectively addressing the research objectives. The implications highlight the importance of understanding the mechanisms through which mindfulness exerts its beneficial effects. In this regard, the findings suggest the value of incorporating strategies to promote psychological flexibility into mindfulness training programs, aiming to enhance their therapeutic impact on psychological distress by ensuring the full mindfulness-flexibility-well-being pathway. Additionally, the findings provide empirical support for the relevance of psychological inflexibility processes in predicting psychological distress in a transdiagnostic manner (Hayes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), while specifically verifying the sequence from mindfulness to distress through inflexibility (Rogge \u0026amp; Daks, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn proposing recommendations for future research, the study's limitations are acknowledged, including its design, the self-reported nature of the variables, and the sample size of the study population. First, as this study employs a cross-sectional design, the data reflect a specific point in time, limiting the ability to infer causal relationships or assess the stability of the observed relationships over time. Future research is encouraged to validate the proposed explanatory model using longitudinal or quasi-experimental design studies. Secondly, the use of self-reported measures for the variables may introduce social desirability biases. This limitation could be addressed in future studies by incorporating methods such as direct clinical observation, progress reports, participant diaries, or other objective assessment techniques. Thirdly, it is important to note that the study population consisted of adult parents of school-age children, making the findings specific to this group. Additionally, as the suggested sample size was not fully achieved, the results may have lower statistical power to detect true effects. Future studies are recommended to replicate this research with larger samples to confirm the present findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study provide evidence of the mediating role of psychological inflexibility in the relationship between mindfulness and psychological distress in parents of school-aged children. By demonstrating that mindfulness significantly reduces psychological distress, both directly and indirectly through its effect on psychological inflexibility, the study underscores the importance of addressing these processes in intervention strategies. Furthermore, by explaining 58% of the variance in psychological distress, the proposed model offers a foundation for future research and clinical applications. It contributes to a broader understanding of how mindfulness and psychological inflexibility interact to influence well-being, which is essential for designing interventions aimed at supporting parents in demanding caregiving roles.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e Ethical guidelines and standards of conduct in psychological research were respected, and the corresponding tools and procedures were properly followed. The research protocol was reviewed and approved by the Institutional Ethics Committee of Universidad Cat\u0026oacute;lica Sedes Sapientiae (Reference Number: CE-1834). Additionally, informed consent was obtained from all participants. The study was conducted in accordance with the ethical standards and amendments outlined in the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot Applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no economic, institutional, labor, or personal conflict of interest in the preparation of this manuscript.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors declare that no financial support was received for the research, authorship, or publication of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMLSU conducted statistical analysis, developed the methodology, and drafted the initial version of the manuscript. RJAS participated in the statistical analysis, interpreted the results, and revised the manuscript. AS-B contributed to the statistical analysis. JS contributed by drafting and reviewing multiple versions of the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors would like to express their sincere gratitude to the participating parents for their time and willingness to contribute to this study. We also extend our appreciation to the schools that facilitated contact with the families, making this research possible. Finally, we thank the research assistants for their support in data collection and preliminary analysis, as well as the institutions that provided logistical support throughout the project.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data sets generated to support the findings of this study are not publicly available, but can be requested from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbad FJ, Olea J, Ponsoda V, Garc\u0026iacute;a C. (2011). \u003cem\u003eMedici\u0026oacute;n en ciencias sociales y de la salud\u003c/em\u003e. S\u0026iacute;ntesis.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAktu Y. The role of parenting stress on parenting self-efficacy and parental burnout among Turkish parents: a moderated mediation model. BMC Psychol. 2024;12(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40359-024-01980-7\u003c/span\u003e\u003cspan address=\"10.1186/s40359-024-01980-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlmendingen A, Pilkington P. Parenting self-efficacy and psychological distress in parents of children with an autism spectrum disorder. J Autism Dev Disord. 2024;54(7):2604\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10803-023-05939-2\u003c/span\u003e\u003cspan address=\"10.1007/s10803-023-05939-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, Abdulmalik J, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bruffaerts R, Cardoso G, Cia A, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, de Jonge P. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195\u0026ndash;208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/da.22711\u003c/span\u003e\u003cspan address=\"10.1002/da.22711\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. the WHO World Mental Health Survey Collaborators.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlonso M. (2012). Mindfulness en el tratamiento de los trastornos de ansiedad. En M. Mir\u0026oacute; \u0026amp; Sim\u0026oacute;n, editors, \u003cem\u003eMindfulness en la pr\u0026aacute;ctica cl\u0026iacute;nica\u003c/em\u003e (pp. 81\u0026ndash;139). Descl\u0026eacute;e de Brouwer.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. Manual diagn\u0026oacute;stico y estad\u0026iacute;stico de los trastornos mentales (DSM-5-TR). Panamericana Editorial Ltda; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eApolin\u0026aacute;rio-Hagen J, Dr\u0026uuml;ge M, Guthardt L, Haller E. Acceptance and commitment therapy for major depressive disorder: Navigating depression treatment in traditional and digital settings with insights from current research. Adv Exp Med Biol. 2024;1456:227\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-981-97-4402-2_12\u003c/span\u003e\u003cspan address=\"10.1007/978-981-97-4402-2_12\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAto M, L\u0026oacute;pez J, Benavente A. Un sistema de clasificaci\u0026oacute;n de los dise\u0026ntilde;os de investigaci\u0026oacute;n en psicolog\u0026iacute;a. Anales de Psicolog\u0026iacute;a. 2013;29(3):1038\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.6018/analesps.29.3.178511\u003c/span\u003e\u003cspan address=\"10.6018/analesps.29.3.178511\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBandalos D, Finney S. (2010). Factor analysis: exploratory and confirmatory. En G. R. Hancock y R. O. Mueller, editor, \u003cem\u003eReviewer\u0026rsquo;s guide to quantitative methods\u003c/em\u003e (pp. 93\u0026ndash;114). Routledge Member of the Taylor and Francis Group.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown TA. Confirmatory factor analysis for applied research. Guilford Press; 2006.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCabana E, Lillo RE, Laniado H. Multivariate outlier detection based on a robust Mahalanobis distance with shrinkage estimators. Stat Papers (Berlin Germany). 2021;62(4):1583\u0026ndash;609. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00362-019-01148-1\u003c/span\u003e\u003cspan address=\"10.1007/s00362-019-01148-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCaycho-Rodr\u0026iacute;guez T, Tom\u0026aacute;s JM, Ventura- Le\u0026oacute;n J, Esteban C, Guadalupe RFO, Reyes-Bossio LA, Garc\u0026iacute;a Cadena M, C. H., Cabrera-Orosco I. Factorial validity and invariance analysis of the five items version of \u003cem\u003eMindful Awareness Attention Scale\u003c/em\u003e in older adults. Aging Ment Health. 2020;25(4):756\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13607863.2020.1716685\u003c/span\u003e\u003cspan address=\"10.1080/13607863.2020.1716685\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCebolla A. (2012). Mindfulness en terapia cognitiva para la depresi\u0026oacute;n. En M. Mir\u0026oacute; \u0026amp; Sim\u0026oacute;n, editors, \u003cem\u003eMindfulness en la pr\u0026aacute;ctica cl\u0026iacute;nica\u003c/em\u003e (pp. 141\u0026ndash;168). Descl\u0026eacute;e de Brouwer.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCorea D, Cid MT. La depresi\u0026oacute;n y su impacto en la salud p\u0026uacute;blica. Revista M\u0026eacute;dica Hondure\u0026ntilde;a. 2021;89(Supl1):46\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5377/rmh.v89isupl.1.12047\u003c/span\u003e\u003cspan address=\"10.5377/rmh.v89isupl.1.12047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDubey N, Podder P, Pandey D. (2020). Knowledge of COVID-19 and its influence on mindfulness, cognitive emotion regulation and psychological flexibility in the Indian community. \u003cem\u003eFrontiers in psychology\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2020.589365\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2020.589365\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEfron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat science: Rev J Inst Math Stat. 1986;1(1):54\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1214/ss/1177013815\u003c/span\u003e\u003cspan address=\"10.1214/ss/1177013815\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEvans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Chiu WT, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hu C, Karam EG, Kawakami N, Lee S, Lund C, Kovess-Masfety V, Levinson D, Thornicroft G. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychol Med. 2018;48(9):1560\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/s0033291717003336\u003c/span\u003e\u003cspan address=\"10.1017/s0033291717003336\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeng Y-T, Pei J-Y, Wang Y-P, Feng X-F. Association between depression and vascular aging: a comprehensive analysis of predictive value and mortality risks. J Affect Disord. 2024;367:632\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jad.2024.08.100\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2024.08.100\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHayes S, Strosahl K, Wilson K. Terapia de Aceptaci\u0026oacute;n y Compromiso. Proceso y pr\u0026aacute;ctica del cambio consciente (Mindfulness). Descl\u0026eacute;e de Brouwer; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHo CYY, Yu BCL, Mak WWS. Nonattachment mediates the associations between mindfulness, well-being, and psychological distress: A meta-analytic structural equation modeling approach. Clin Psychol Rev. 2022;95(102175):102175. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cpr.2022.102175\u003c/span\u003e\u003cspan address=\"10.1016/j.cpr.2022.102175\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKline P. An easy guide to factor analysis. Routledge; 1994.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKulasinghe K, Whittingham K, Mitchell AE. Mental health, broad autism phenotype and psychological inflexibility in mothers of young children with autism spectrum disorder in Australia: A cross-sectional survey. Autism: Int J Res Pract. 2021;136236132098462. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1362361320984625\u003c/span\u003e\u003cspan address=\"10.1177/1362361320984625\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi C-H. Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behav Res Methods. 2016;48(3):936\u0026ndash;49. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3758/s13428-015-0619-7\u003c/span\u003e\u003cspan address=\"10.3758/s13428-015-0619-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaddock A, Blair C. How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review. Curr Psychol (New Brunsw N J). 2023;42(12):10200\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12144-021-02082-y\u003c/span\u003e\u003cspan address=\"10.1007/s12144-021-02082-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMakriyianis HM, Adams EA, Lozano LL, Mooney TA, Morton C, Liss M. Psychological inflexibility mediates the relationship between adverse childhood experiences and mental health outcomes. J Context Behav Sci. 2019;14:82\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcbs.2019.09.007\u003c/span\u003e\u003cspan address=\"10.1016/j.jcbs.2019.09.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCracken LM, Badinlou F, Buhrman M, Brocki KC. The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia. J Context Behav Sci. 2021;19:28\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcbs.2020.11.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jcbs.2020.11.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMedrano LA, Mu\u0026ntilde;oz-Navarro R. Aproximaci\u0026oacute;n conceptual y pr\u0026aacute;ctica a los modelos de ecuaciones estructurales. Revista Digit de Investigaci\u0026oacute;n en Docencia Universitaria. 2017;219\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.19083/ridu.11.486\u003c/span\u003e\u003cspan address=\"10.19083/ridu.11.486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMirowsky J, Ross CE. Measurement for a Human Science. J Health Soc Behav. 2002;43(2):152. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2307/3090194\u003c/span\u003e\u003cspan address=\"10.2307/3090194\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoshagen M, Bader M. semPower: General power analysis for structural equation models. Behav Res Methods. 2023;56(4):2901\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3758/s13428-023-02254-7\u003c/span\u003e\u003cspan address=\"10.3758/s13428-023-02254-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuth\u0026eacute;n B, Kaplan D. A comparison of some methodologies for the factor analysis of non-normal Likert variables. Br J Math Stat Psychol. 1985;38(2):171\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.2044-8317.1985.tb00832.x\u003c/span\u003e\u003cspan address=\"10.1111/j.2044-8317.1985.tb00832.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNurhidayah I, Kusuma Dewi R, Hidayati NO, Poddar S. Psychological Distress among Parents due to Their Children Having Cancer: A Systematic Review. Kesmas. 2022;17(1):54\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scholarhub.ui.ac.id/kesmas/vol17/iss5/10\u003c/span\u003e\u003cspan address=\"https://scholarhub.ui.ac.id/kesmas/vol17/iss5/10\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Boyle-Finnegan \u0026Uacute;, Graham CD, Doherty N, Adair P. Exploring the contribution of psychological flexibility processes and self-compassion to depression, anxiety and adjustment in parents of preterm infants. J Context Behav Sci. 2022;24:149\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcbs.2022.05.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jcbs.2022.05.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganizaci\u0026oacute;n Mundial de la Salud. (2023). \u003cem\u003eDepresi\u0026oacute;n\u003c/em\u003e. Organizaci\u0026oacute;n Mundial de la Salud. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/es/news-room/fact-sheets/detail/depression?gad_source=1\u0026amp;gclid=CjwKCAjw6c63BhAiEiwAF0EH1AhbbdZmBvQmad69Xe4T2U2bnDoXk1ZL9BMLYi1qn_1GCoTIfPWF8RoCmTcQAvD_BwE\u003c/span\u003e\u003cspan address=\"https://www.who.int/es/news-room/fact-sheets/detail/depression?gad_source=1\u0026amp;gclid=CjwKCAjw6c63BhAiEiwAF0EH1AhbbdZmBvQmad69Xe4T2U2bnDoXk1ZL9BMLYi1qn_1GCoTIfPWF8RoCmTcQAvD_BwE\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParker SF, Rogge RD, Drake CE, Fogle C. A fresh lens on psychological flexibility: Using network analysis and the Unified Flexibility and Mindfulness Model to uncover paths to wellbeing and distress. J Context Behav Sci. 2024;32(100753):100753. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcbs.2024.100753\u003c/span\u003e\u003cspan address=\"10.1016/j.jcbs.2024.100753\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrieto Molinari DE, Bravo A, De Pierola GL, Victoria-De Bona I, Silva GLM, N\u0026uacute;\u0026ntilde;ez LAL, Uribe-Bravo CS, K. A., Zegarra \u0026Aacute;C. Depresi\u0026oacute;n y ansiedad durante el aislamiento obligatorio por el COVID-19 en Lima Metropolitana. Liberabit Revista Peruana de Psicolog\u0026iacute;a. 2020;26(2):e425. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.24265/liberabit.2020.v26n2.09\u003c/span\u003e\u003cspan address=\"10.24265/liberabit.2020.v26n2.09\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahman W, Shah A, F., Rasli A. Use of structural equation modeling in social science research. Asian social Sci. 2015;11(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5539/ass.v11n4p371\u003c/span\u003e\u003cspan address=\"10.5539/ass.v11n4p371\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodr\u0026iacute;guez M, Ruiz M. Atenuaci\u0026oacute;n de la asimetr\u0026iacute;a y de la curtosis de las puntuaciones observadas mediante transformaciones de variables: Incidencia sobre la estructura factorial. Psicol\u0026oacute;gica: Revista de Metodolog\u0026iacute;a y Psicolog\u0026iacute;a Experimental. 2008;29(2):205\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dialnet.unirioja.es/servlet/articulo?codigo=2718372\u003c/span\u003e\u003cspan address=\"https://dialnet.unirioja.es/servlet/articulo?codigo=2718372\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogge RD, Daks JS. Embracing the intricacies of the path toward mindfulness: Broadening our conceptualization of the process of cultivating mindfulness in day-to-day life by developing the unified flexibility and mindfulness model. Mindfulness. 2021;12(3):701\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12671-020-01537-w\u003c/span\u003e\u003cspan address=\"10.1007/s12671-020-01537-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogge RD, Lin Y-Y, Swanson DP, Amaro A. Tracing the path toward mindfulness back to its origins: Linking tenets of Buddhism to mindfulness within the Buddhism-informed unified flexibility and mindfulness (BI-UFM) model. Mindfulness. 2024;15(4):775\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12671-022-01886-8\u003c/span\u003e\u003cspan address=\"10.1007/s12671-022-01886-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosseel Y. lavaan: An R Package for Structural Equation Modeling. J Stat Softw. 2012;48(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18637/jss.v048.i02\u003c/span\u003e\u003cspan address=\"10.18637/jss.v048.i02\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuiz FJ. The relationship between low levels of mindfulness skills and pathological worry: The mediating role of psychological inflexibility. [La relaci\u0026oacute;n entre habilidades de mindfulness y preocupaci\u0026oacute;n patol\u0026oacute;gica: El rol mediador de la inflexibilidad psicol\u0026oacute;gica]. Anales de psicolog\u0026iacute;a. 2014;30(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.6018/analesps.30.3.150651\u003c/span\u003e\u003cspan address=\"10.6018/analesps.30.3.150651\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRu\u0026iacute;z M, Pardo A, San Mart\u0026iacute;n R. Modelos de ecuaciones estructurales. Papeles del Psic\u0026oacute;logo. 2010;31(1):34\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.papelesdelpsicologo.es/pdf/1794.pdf\u003c/span\u003e\u003cspan address=\"http://www.papelesdelpsicologo.es/pdf/1794.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSantosh, Darolia S. Trait Mindfulness and its Role with Psychological Inflexibility and Subjective Well-being among Adults: A Correlational Study. Indian J Health Wellbeing. 2022;13(2):143\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eValencia P, Falc\u0026oacute;n C. Validez y confiabilidad del Cuestionario de Aceptaci\u0026oacute;n y Acci\u0026oacute;n II (AAQ-II) en universitarios de lima. PSIENCIA. 2022;14(1):176\u0026ndash;219.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVillarreal-Zegarra D, Copez-Lonzoy A, Bernab\u0026eacute;-Ortiz A, Melendez-Torres GJ, Bazo-Alvarez JC. Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics. PLoS ONE. 2019;14(9). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0221717\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0221717\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVillarreal-Zegarra D, Paredes-Angeles R, Mayo-Puchoc N, Arenas-Minaya E, Huarcaya-Victoria J, Copez-Lonzoy A. Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population. BMC Psychol. 2024;12(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40359-024-01688-8\u003c/span\u003e\u003cspan address=\"10.1186/s40359-024-01688-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Z, Zhang X, Ye Y. Does marital satisfaction predict children aggression? Insights from parents\u0026rsquo; and children\u0026rsquo;s psychological distress. Child Family Social Work. 2024;29(3):615\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/cfs.13121\u003c/span\u003e\u003cspan address=\"10.1111/cfs.13121\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWickham H, Averick M, Bryan J, Chang W, McGowan L, Fran\u0026ccedil;ois R, Grolemund G, Hayes A, Henry L, Hester J, Kuhn M, Pedersen T, Miller E, Bache S, M\u0026uuml;ller K, Ooms J, Robinson D, Seidel D, Spinu V, Yutani H. Welcome to the tidyverse. J open source Softw. 2019;4(43):1686. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.21105/joss.01686\u003c/span\u003e\u003cspan address=\"10.21105/joss.01686\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWoodruff SC, Glass CR, Arnkoff DB, Crowley KJ, Hindman RK, Hirschhorn EW. Comparing self-compassion, mindfulness, and psychological inflexibility as predictors of psychological health. Mindfulness. 2014;5(4):410\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12671-013-0195-9\u003c/span\u003e\u003cspan address=\"10.1007/s12671-013-0195-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeng S, Yuan L, Lee Y, Guan Y, Volk K, O\u0026rsquo;Riordan M, Stone-MacDonald AK. Parental stress in raising a child with mental health and behavior problems. En Autism and Child Psychopathology Series. Springer International Publishing; 2023. pp. 137\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu X, Dou D, Karatzias T. Editorial: Parental influence on child social and emotional functioning. Front Psychol. 2024;15:1\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2024.1392772\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2024.1392772\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mindfulness, Psychological Distress, Psychological Inflexibility, Mediation","lastPublishedDoi":"10.21203/rs.3.rs-7483309/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7483309/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The present research proposed a mediation model to examine the relationship between mindfulness and psychological distress, focusing on the mediating role of psychological inflexibility in parents of school-aged children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional explanatory study included 364 parents. The Mindful Attention Awareness Scale (MAAS-5), the Acceptance and Action Questionnaire II (AAQ-II), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were utilized. The data were analyzed using structural equation modeling (SEM) in R Studio 4.4.0, following a Confirmatory Factor Analysis (CFA) to assess the internal structure of the scales. Reliability was evaluated using alpha and omega coefficients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The results demonstrated a partial mediation between mindfulness and psychological distress through psychological inflexibility (mediation effect a*b = -.27, p \u0026lt; .001). Furthermore, the model accounted for 58% of the variance in psychological distress (R² = .58).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Reducing psychological distress in parents largely depends on decreasing psychological inflexibility and enhancing mindfulness techniques. This finding underscores the importance of interventions grounded in Acceptance and Commitment Therapy (ACT). The study contributes to a deeper understanding of the psychological processes underlying the relationship between mindfulness and psychological distress.\u003c/p\u003e","manuscriptTitle":"Psychological Inflexibility Mediates the Relationship between Mindfulness and Psychological Distress in Peruvian Parents with School Age Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 06:47:26","doi":"10.21203/rs.3.rs-7483309/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-26T14:51:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-18T01:11:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272452778283304752885779832591078132356","date":"2025-10-26T01:18:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140408693343640737638361132959934596785","date":"2025-09-30T16:26:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T22:11:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23028683392469863310405954588691234019","date":"2025-09-15T14:45:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-13T09:17:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-13T09:12:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-05T06:52:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T01:09:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-09-05T01:06:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"65e30acc-f287-4dbf-89cf-ed481c2ae0f0","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:04:13+00:00","versionOfRecord":{"articleIdentity":"rs-7483309","link":"https://doi.org/10.1186/s12982-026-01595-w","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-02-26 15:58:15","publishedOnDateReadable":"February 26th, 2026"},"versionCreatedAt":"2025-09-23 06:47:26","video":"","vorDoi":"10.1186/s12982-026-01595-w","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01595-w","workflowStages":[]},"version":"v1","identity":"rs-7483309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7483309","identity":"rs-7483309","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}