Parallel Mediation of Psychological Flexibility and Vulnerability Between Multiple-Screen Addiction and Mental Health Outcomes in Adolescents

Parallel Mediation of Psychological Flexibility and Vulnerability Between Multiple-Screen Addiction and Mental Health Outcomes in Adolescents | 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 Parallel Mediation of Psychological Flexibility and Vulnerability Between Multiple-Screen Addiction and Mental Health Outcomes in Adolescents Oğuzhan YILDIRIM, Hasan BATMAZ, Nuri TÜRK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6996902/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jan, 2026 Read the published version in BMC Psychology → Version 1 posted 15 You are reading this latest preprint version Abstract This study examines the mediating role of psychological flexibility and vulnerability variables in the relationships between multiple-screen addiction and depression, anxiety, and stress. Data were collected from 309 high school students (M age = 16.13, SD = 1.40; 57% girls, 43% boys). Analyses were conducted using SPSS 25 and Hayes Model 6. Findings show that students with multiple screen addiction and high levels of depression, anxiety, and stress have low levels of psychological flexibility and high levels of psychological vulnerability. More importantly, psychological flexibility and vulnerability were found to play a fully mediating role in this relationship. As a result, it seems that strengthening psychological flexibility and reducing vulnerability have a significant effect in reducing the adverse effects of depression, anxiety, and stress caused by multiple screen addiction on students. These findings can provide necessary guidance in developing intervention programs and school policies. Multiple-screen addiction depression anxiety stress psychological flexibility vulnerability Figures Figure 1 Impact Statement This study reveals that psychological flexibility and vulnerability are crucial mediators in the relationship between multiple-screen addiction and mental health issues in adolescents. By enhancing psychological flexibility and reducing vulnerability, it is possible to significantly mitigate the adverse effects of screen addiction on depression, anxiety, and stress. These findings can inform the development of targeted intervention programs and school policies to improve adolescent mental health. Introduction As the role and function of technology in our lives have increased, internet use has become more challenging to manage. This process has caused severe concern by causing excessive internet use by young people and adults (Nie et al., 2016 ). The internet is used through digital devices. This usage leads to the concepts of multi-screen and screen addiction. Screen addiction can be classified as digital game addiction (offline, online, single-player, multiplayer), internet addiction (sex, gambling, shopping), technological device addiction (smartphone, VR, tablet, and computer, etc.), and media addiction (traditional and social media) (Macit & Kavafoglu, 2019). Indeed, Gupta et al. ( 2018 ) stated that internet addiction is a serious problem. They found that the most frequently used smart devices are phones, laptops, desktops, and tablets. These findings prove that the screen is the "window" of our lives that opens to the virtual world. Life in the Digital Age and Multiple Screen Addiction Digital games have become widespread in the lives of children and adolescents especially (Paulus et al., 2018 ). Children and adolescents are vulnerable to digital devices due to their incomplete development of impulse control and cognitive flexibility (Kim et al., 2019 ). Additionally, multiple screens increase depressive symptoms and harm sleep quality (Li et al., 2019 ). Adolescents who are addicted to the Internet are at risk of unhealthy diets, smoking and alcohol use, violence, cyberbullying, and exposure to pornography (Chang et al., 2015 ). Most people have constant access to technological devices. They engage in continuous activities such as sending e-mails, watching and sharing videos, listening to music, playing games, making voice calls, sending messages, sending e-mails, and using social media via smartphones (Samaha & Hawi, 2016 ; Soni et al., 2017 ). This access process can turn into excessive, obsessive, and repetitive behaviors over time and may reveal disorders such as MSA (Saritepeci et al., 2023 ). However, it becomes inevitable for individuals, especially those who strive to have free time, to be exposed to MSA (Multi-screen addiction) (Lin et al., 2019 ). MSA, which is a severe risk factor for mental health, can be considered a behavioral addiction, such as internet addiction and smartphone addiction (Saritepeci, 2021). "Human," the actor of the digital world, has started to change his life habits based on the screen. Of individuals between the ages of 16 and 64 who use digital devices, 96.2% use a mobile phone, 95.6% use a smartphone, 58% use a laptop or desktop computer, 33.7% use a tablet, 20.3% use a game console, and 29.9% use smartwatches and wristbands. The number of internet users in the world has reached 5.16 billion. These people spend an average of 6H 37M daily online (Meltwater, 2023 ; We Are Social, 2023 ). In Turkey, the usage rate of portable computers such as laptops and tablets has increased to 46.6%, and the usage rate of smartphones/mobile phones has increased to 99.2% (Turkish Statistical Institute [TSI], 2022). In addition, the rate of internet access for households has exceeded 95%. The internet usage rate among individuals between the ages of 19–74 has reached 87% (TSI, 2023). The widespread use of digital devices and increased internet access reveal the indispensable place of technology in our daily lives. On the other hand, adolescents can be accurately informed about substance use, sexual health, bullying, and body image through the media (Bailin et al., 2014 ). This reveals that the effect of digital devices may be related to the purpose of use. Multiple Screen Addiction and Depression Anxiety Stress (DAS) Technological innovations in the digital age have brought new problems, such as MSA. Multi-screen refers to digital devices such as smartphones, computers, tablets, and TVs. These devices' most common activities include the internet, communication, games, and movies (Li et al., 2019 ). MSA causes symptoms such as tolerance, withdrawal, and apathy. This type of addiction is associated with depression, anxiety, stress, and suicidality (Wan Ismail et al., 2020). Additionally, individuals who are frequently exposed to screens and engage in online experiences are at risk of self-harm (Liu et al., 2017 ). Internet use is one of the most critical factors in the emergence of MSA. Internet addiction has a triggering role in psychopathological features and dysfunctional attitudes (Taymur et al., 2016 ). Problematic internet use and internet addiction can cause depression (Lau et al., 2018 ; Priego et al., 2020), anxiety (Kim et al., 2018 ), stress (Gupta et al., 2018 ), suicide (Sami et al., 2018 ), low self-esteem, semantic verbal fluency (Nie et al., 2016 ), social anxiety (Lee & Stapinski, 2012 ), family conflicts, low academic achievement (Boonvisudhi & Kuladee, 2017 ), low psychosocial well-being (Lai et al., 2015 ), social phobia (Yücens & Üzer, 2018 ), ADHD, lack of excitement seeking and assertiveness (Dalbudak et al., 2015 ), and pornography and harassment (Yang & Tung, 2007 ) are situations that trigger various psychological and social problems. Mental disorders and internet addiction interact with each other. Adverse life events and depressive experiences may be effective in the emergence, severity, and recurrence of addiction (Taymur et al., 2016 ). Individuals experiencing psychological distress have a higher level of internet addiction. Internet addiction also increases psychological distress (Anand et al., 2018 ). Individuals with depressive symptoms also have a high tendency to become internet addicted, and the prevalence of internet addiction in depressed individuals is 36%. In addition, depressed individuals have significantly higher levels of television, computer games, and internet addiction than other individuals (Dieris-Hirche et al., 2017 ). Individuals with personalities characterized by shyness, dependence, and low self-esteem have a higher risk of internet addiction (Yang & Tung, 2007 ). Individuals may increase their Internet use time because they believe online communication is low-level harmful (Chi et al., 2016 ). This explains the complex relationship between online communication and screen addiction. Easier access to the internet via mobile phones has increased mobile phone usage (Toda et al., 2006 ). Smartphone addiction can be considered a more serious risk factor than internet addiction (Kim et al., 2018 ). This can be explained by smartphones being functional devices with computer and phone features (Mohamed & Mostafa, 2020 ). Mobile phone use also causes technology addiction over time. Mobile phone addiction and problematic use are associated with depression, anxiety (Li et al., 2020 ; Rozgonjuk et al., 2018 ), low self-esteem (Mohamed & Mostafa, 2020 ), chronic and excessive stress (Gligor & Mozoş, 2019), anger and impulsivity (Kim et al., 2015 ), low academic achievement and low life satisfaction (Samaha & Hawi, 2016 ), physical fatigue, insomnia (Boumosleh & Jaalouk, 2017), behavioral problems (Soni et al., 2017 ), ADHD, smoking and alcohol use (Kim et al., 2019 ). On the other hand, depression and anxiety are also predictors of smartphone addiction (Boumosleh & Jaalouk, 2017). Users sometimes turn to their mobile phones to eliminate their negative emotions. Thus, they can feel that they are free from stress and anxiety. This cycle can become more complex over time. In the digital world, social media usage is increasing daily for most individuals. Addiction caused by excessive social media use can lead to individuals experiencing mental health problems. However, these individuals have a higher risk of experiencing somatic symptoms, social dysfunction, depression, and anxiety (Hanprathet et al., 2015 ). It can be said that one of the components of multi-screen addiction is game addiction. Gaming applications, which are a severe and growing social problem for young generations (Rajab et al., 2020), cause depression, anxiety, and poor sleep quality (Alshammari et al., 2022 ). Additionally, the majority of individuals with digital gaming disorder have high levels of daily and chronic stress (Kaess et al., 2017 ). While game addiction increases stress, stress can also trigger game addiction (Rajab et al., 2020). In conclusion, the interrelationship of MSA with mental health problems suggests that the variables underlying these complex relationships need to be understood in depth. The Mediating Role of Psychological Flexibility and Vulnerability Psychological flexibility is maintaining and changing conscious behavior for selected values (Hayes et al., 2012 ). Individuals who do not have this flexibility can integrate their sense of self with their thoughts, actions, and feelings. Thus, the individual cannot distinguish between the self and private feelings, thoughts, and memories. As a result, the individual may evaluate themself as worthless and useless (Kashdan et al., 2006 ). Psychological flexibility is an important skill not only for individuals but also for social events. Cognitive and behavioral flexibility is necessary in dealing with problems such as economic crises, epidemics, and health problems that concern society as a whole (Uddin, 2021 ). Therefore, psychological flexibility is vital at the individual and social levels. The ACT approach uses six essential components to increase psychological flexibility: acceptance, present moment awareness, self as context, defusion, values, and committed action. Each of these components is associated with distress, anxiety, and depression (Landi et al., 2020 ). Bramwell and Richardson ( 2018 ) found that ACT was an important mechanism of reduced dissociation and increased values-based action in people with depression and mental health problems. ACT practices are effective in increasing psychological flexibility (Azadeh et al., 2016 ) to cope with depression (Bai et al., 2020 ), stress (Cekic et al., 2016), and anxiety (Sharp, 2012 ). Theoretically, these approaches play an important role in increasing psychological flexibility. Additionally, ACT has been determined to be effective in reducing technological addiction (Mohammadi & Mohammadi, 2025 ). Psychological flexibility, which is multidimensional, is associated with both psychopathology (Cherry et al., 2021 ). Flexibility and decisive action, two key components of psychological flexibility, effectively reduce sleep problems, depression, and anxiety (Finnegan et al., 2022; McCracken et al., 2021 ). Vulnerability is another variable associated with internet and screen addiction (Siwiak et al., 2023 ). Vulnerability, which is more common and hidden than diagnosable diseases, is based on psychological, social, and biological factors. Six factors are indicative of psychological vulnerability: delinquency, early socialization, mental illness, perceived discrimination, social capital, and traumatic experiences (Harpviken, 2020 ). Psychological vulnerability, which has a critical role in mental health (Teixeira et al., 2022), is effective inindividuals' well-being, hope, and psychological resilience (Satici, 2016 ). It is observed that vulnerable individuals experience higher levels of self-alienation and have lower authentic living skills (Satici et al., 2013 ). In human life, parents, peers, difficult family conditions, poverty, and low socioeconomic level can contribute to pathology, causing individuals to be more vulnerable to stress (Hanson et al., 2019 ). The triple vulnerability model argues that psychological vulnerability contributes to the etiology of emotional disorders such as anxiety and stress (Barlow, 2002 ). In addition, the cognitive dimension of vulnerability can be evaluated according to the hopelessness theory. According to this theory, vulnerability is the tendency to infer the causes and consequences of adverse events. Individuals with high levels of vulnerability associate negative experiences with a fixed cause, feel worthless, and believe that there will be other negative experiences (Haeffel, 2010 ). In the current study, which aims to examine the effect of MSA on individuals' DAS levels, it is thought that psychological flexibility will have a positive effect. However, psychological vulnerability will harm mental health. Therefore, it is aimed to examine the mediating effect of psychological flexibility and vulnerability in the relationship between MSA and DAS. Present Study Nowadays, individuals are at risk of screen addiction because they are constantly accessed by digital devices (Manimekalai & Poulpunitha, 2022 ). This type of addiction is associated with depression, anxiety, and stress (Wan Ismail et al., 2020). Therefore, it is essential to investigate factors that may affect the relationship between screen addiction and psychopathology. Individuals with high psychological vulnerability (Satici et al., 2014 ) and low flexibility (Güldal et al., 2022 ) have a high risk of becoming addicted to social media, which causes multi-screen addiction. In this context, multi-screen addiction can be expected to increase addiction and decrease flexibility. In addition, relationships have been found between psychological flexibility and depression (Bryan et al., 2015 ; Masuda & Tully, 2012 ), anxiety (Arslan et al., 2021 ; Fledderus et al., 2013 ), distress (Dawson & Golijani-Moghaddam, 2020 ). Additionally, psychological vulnerability is associated with depression (Lohman et al., 2016 ; Lv et al., 2023 ) and state anxiety (Mallett et al., 2021 ). When the literature is examined, it is seen that there are studies examining the relationships between technology addiction and mental health, psychological flexibility, and vulnerability. However, it is striking that these studies do not specifically address "multi-screen addiction." MSA is a comprehensive and current study topic regarding technology addiction concepts. It covers many factors, including phone, computer, social media, and internet addiction. In addition, the level of depression, anxiety, and stress (DAS) is fundamental in determining mental health. These three psychopathologies were examined in this study. It is thought that the concepts of psychological flexibility and vulnerability may have a critical role in the relationship between multi-screen and DAS. Because flexibility and vulnerability are predicted to affect mental health and psychopathology. In addition, no study has been found where these four concepts are studied together. In this context, the current study is thought to be original and has a potential explanatory role in MSA and mental health. This study examined the mediating role of psychological flexibility and vulnerability in the relationship between MSA and DAS. Considering the research in the literature, the following hypotheses were tested. H1: Multiple Screen Addiction has a significant direct effect on DAS. H2: Multiple Screen Addiction has a significant direct effect on psychological vulnerability. H3: Psychological vulnerability has a significant direct effect on DAS. H4: Multiple Screen Addiction has a significant direct effect on psychological flexibility. H5: Psychological flexibility has a significant direct effect on DAS. H6: Psychological vulnerability and psychological flexibility have mediated effects between Multiple Screen Addiction and DAS. H7: Multiple Screen Addiction has an insignificant indirect effect on DAS. Method This study examines the mediating roles of cognitive psychological vulnerability and flexibility in the relationship between MSA and DAS. The study was conducted using a correlational design, and quantitative methods were applied. In the data collection process, due to time, budget, and labor limitations, the convenience sampling method was preferred, in which the easiest-to-reach participants were selected. Procedure An online questionnaire was prepared for data collection. On the first page of the online survey, participants were informed about the duration and purpose of the study. Google Forms sent the research link to the participants through social media platforms and messaging programs such as WhatsApp, Twitter, and Instagram. The inclusion criteria were being a university student aged 14 years and above. Consent was obtained from the parents of the students based on ethics committee approval. Students with no high school students were not included in the study. Individuals who met these criteria and volunteered to participate were included in the study. Since the study's data was collected after the earthquake disaster and this is a sensitive traumatic experience, the participants were informed that they could stop answering the questionnaire if they felt uncomfortable. In addition, participants were advised not to provide information about their personal information to protect confidentiality and anonymity. The response time was 10 minutes at the beginning of the questionnaire. The study data were collected while the education process was in progress. The data collection process continued for about two months to avoid coinciding with the exam periods of the students. The data were analyzed using SPSS 28 and AMOS 24 package programs. Participants This study was conducted with 309 participants. The mean age of the participants was 16.13 years (SD = 1.40), and their ages ranged from 14 to 19 years. There were 57% (n: 176) girls and 43% (n:133) boys. In terms of grades, 96 (31.1%) of the participants were high school 3rd-grade students, followed by high school 2nd-grade (29.8%), high school 1st-grade (20.4%) and high school 4th grade (18.8%). In addition, 24 of the participants indicated a low level, 249 showed a medium level, and 36 indicated a high level according to the country's economic status. In addition, the average daily TV watching was 2.34 hours (SD: 1.13), daily tablet-computer use was 2.24 hours (SD: 1.38), and daily phone use was 4.29 hours (SD: 1.32). Measures The Multi-Screen Addiction Scale (MSAS) The scale developed by Sarıtepeci ( 2021 ) is a 5 Likert-type and has 15 items consisting of 3 sub-dimensions. There are four items in “Excessive Screen Time (EST),” 8 items in “Compulsive Behavior (CB),” and three items in “Loss of Control (LoC).” The Cronbach Alpha, internal consistency coefficient, was reported for the MSAS scale, and its sub-dimensions range between .71–92. Accordingly, it was found that there was an acceptable fit between the factor structure of the MSAS scale and the data (CMIN / DF = 4.232, GFI = .946, CFI = .947, RMSEA = .091). The internal reliability coefficient value of MSAS and its subscales was between .70-.93. The internal reliability estimate of the MSA in the present sample is shown in Table 1 . Table 1 Descriptive Statistic. Linearity. Normality. and Multicollinearity Variables N Min. Max. Means SD Skew. Kurt. VIF Tolerance DAS 309 21.00 78.00 41.65 11.45 .704 .099 MSA 309 15.00 73.00 40.92 13.27 .278 − .562 1.236 .809 Psychological vulnerability 309 6.00 28.00 17.72 4.87 .038 − .774 1.887 .533 Psychological flexibility 309 7.00 49.00 30.24 10.19 − .186 .226 1.828 .547 Depression Anxiety Stress (DAS-21) DASS-21 was developed by Lovinond and Lovibond ( 1995 ) by selecting the items of DASS-42 to shorten the duration. DASS-21 contains seven items for each scale, multiplying the evaluation result by two. Henry and Crawford ( 2005 ) showed that the Cronbach alpha internal consistency reliability coefficient value was 0.88 for the depression subscale, 0.90 for the stress subscale, and 0.93 for the entire scale. According to the same study, the fit index values ​​of the DASS-21 model are S-Bχ2 = 628.0, χ2 = 1092.1, df = 180, CFI = 0.93, SRMR = 0.03, and RMSEA = 0.05. DAS-21 was adapted to Turkish culture by Sarıçam ( 2018 ). In the clinical sample, Cronbach's alpha internal consistency reliability coefficient was found to be α = 0.87 for the depression subscale, α = 0.85 for the anxiety subscale, and α = 0.81 for the stress subscale. Within the validity scope, the scale's factor loadings range from 42 to 72. Three factors explain 49.72% of the total variance. Confirmatory factor analysis (CFA) scale results were calculated as GFI = 0.90, CFI = 0.90, TLI = 0.89, RMSEA = 0.065, and SRMR = 0.067. According to the psychometric properties obtained, it was concluded that DAS-21 is a valid and reliable measurement tool for Turkish culture. The internal reliability estimate of the DAS-21 in the present sample is shown in Table 1 . Psychological Vulnerability Scale The scale was developed by Sinclair and Wallston ( 1999 ) and adapted into Turkish by Akın and Eker ( 2011 ). This scale is intended to determine the psychological vulnerability levels of adults. The scale includes six questions on a 5-point Likert type (1 - Not suitable for me, 2-3-4- 5- Completely suitable for me). The internal consistency coefficient calculated while adopting the psychological vulnerability scale to Turkish was 0.75. The highest score that can be obtained from the scale is 30, and the lowest score is 5. It is stated that as the score increases, adult individuals' psychological vulnerability increases and psychological vulnerability decreases. The internal reliability estimate of the psychological vulnerability scale in the present sample is shown in Table 1 . Acceptance and Action Questionnaire-II (AAQ-II) AAQ-II was used to measure psychological flexibility. The scale was developed by Bond et al. ( 2011 ). The scale consists of 7 items. It is on a 7-point Likert scale (1: never true, 7: always true). High scores on the scale indicate that psychological flexibility is high and experiential avoidance increases. The internal consistency coefficient of the original scale is 0.84. CFA values ​​(N = 290), CFI = 0.99, SRMR = O.03, RMSEA = 0.04, CMIN/df = 1.49. Yavuz et al. ( 2016 ) adapted the scale to Turkish culture. Cronbach's α coefficient of the scale is 0.84. As for construct validity, the Kaiser-Meyer-Olkin index (r = 0.83) was compatible with factor analysis (Bartlett chi-square = 1151.20; p < 0.0001). The single-factor solution (Eigenvalue 3.62) explains 51.76% of the total variance. CFA shows that the revised scale model fits the 7-item and single-factor structure well (RMSEA = 0.079, SRMR = 0.021, CFI = 0.97, GFI = 0.97, NFI = 0.96). The internal reliability estimate of the AAQ-II scale in the present sample is shown in Table 1 . Data Analysis In this study, a mediation model was used to examine the mediating roles of psychological vulnerability and psychological flexibility. The data were analyzed with SPSS PROCESS 25 (Model 4). Prior to the analysis, linear relationship, normality, and multicollinearity were examined. Five outliers that violated the normality distribution were removed from the initially collected 309 data, and the analysis was carried out with 309 data. Data were collected through Google Forms and delivered to the target audience through various channels [such as e-mail, social media, or academic forums]. Multicollinearity was assessed by Variance Inflation Factor (VIF) values, and all values were below 10. For the normality test, Shapiro-Wilk (p > .05), skewness (-1 to + 1), and kurtosis (-2 to + 2) values were examined, Q-Q graphs were analyzed, and it was determined that the data were approximately normally distributed. The significance level was taken as p < 0.05 in the analyses performed with Pearson correlation. F statistic was calculated in regression analysis, and R and R² values were reported. In addition, the model's validity was evaluated by checking the normality of the residuals. No multicollinearity was found in the analysis results, and it was confirmed that the data were normally distributed. Detailed results are presented in Table 1 . Table 1 is here. Table 1 Descriptive Statistic. Linearity. Normality. and Multicollinearity Variables N Min. Max. Means SD Skew. Kurt. VIF Tolerance DAS 309 21.00 78.00 41.65 11.45 .704 .099 MSA 309 15.00 73.00 40.92 13.27 .278 -.562 1.236 .809 Psychological vulnerability 309 6.00 28.00 17.72 4.87 .038 -.774 1.887 .533 Psychological flexibility 309 7.00 49.00 30.24 10.19 -.186 .226 1.828 .547 Results The relationships between variables were examined with the Pearson correlation coefficient, and the results are presented in Table 2 . Additionally, the reliability of the scales was assessed using Cronbach's alpha, and the values are reported in Table 2 . Table 2 The Relationships between Variables α 1 2 3 4 1 = DAS .90 1 2 = MSA .91 .38 * 1 3 = Psychological vulnerability .65 .60 * .41 * 1 4 = Psychological flexibility .85 − .72 * − .38 * − .66 * 1 * p < 0.01 Table 2 is here. As shown in Table 2 , DAS is positively correlated to MSA ( r = .38) and psychological vulnerability ( r = .60) but negatively correlated to psychological flexibility ( r = − .72). Mediation Analysis As demonstrated in Table 3 , before mediation analysis, the result of the simple linear regression showed that an MSA significantly predicted DAS ( β = .09, 95% CI: 0.05–0.15; p < .05). Table 3 The Result of the Regression Analysis Predictor β SE p F R R 2 Constant 48.858 3.79 < .001 124.266 .74 .55 MSA .08 .04 < .05 Psychological vulnerability .47 .12 < .001 Psychological flexibility − .62 .06 < .001 Table 3 is here. The mediation role of psychological vulnerability and psychological flexibility was tested with the mediation model, and the results are presented in Table 4 . Table 4 Mediational Model Coefficients Psychological vulnerability Psychological flexibility DAS Predictors β p β p β p MSA .15 .001 − .29 .001 .08 > .05 Ind1 .07 .001 Ind2 .18 .001 Psychological vulnerability ------ ------ ------ ------ .47 .001 Psychological flexibility ------ ------ ------ ------ − .62 .001 Constant i1 11.54 .001 i2 42.29 .001 i3 48.85 .001 R = .41, R 2 = .17 R = .38, R 2 = .15 R = .74; R 2 = .55 F (1,307) = 62.54, p < .001 F (1,307) = 52.83, p < .001 F (3, 305) = 124.26 p .05), psychological vulnerability ( β = .47, 95% LLCI = 0.22 ULCI = 0.71; p < .01) and psychological flexibility ( β = − .61, 95% LLCI=-.73 ULCI = − .50). Finally, mediation analysis revealed that psychological vulnerability and psychological flexibility played a parallel mediating role in the relationship between a MSA and DAS. Figure 1 is here. Table 5 is here. Table 5 Effects of the psychological vulnerability and psychological flexibility on the DAS Effects Estimates of Point β %95 Confidence Interval The lowest The highest Total effect .33 .24 42 Direct effect .08 .005 .15 Total Indirect Effect .25 .18 .32 Ind1 .07 .03 .12 Ind2 .18 .12 .25 Ind1 = MSA → Psychological Vulnerability → DAS Ind2 = MSA → Psychological Flexibility → DAS The mediation analysis examined and presented the indirect, total, and direct effects of psychological vulnerability and psychological flexibility on DAS in Table 5 . As seen in Table 5 , the indirect effect of the Ind1 ( β = .07, 95%, p < .001) and Ind2 ( β = .18, 95%, p < .001) on the DAS is significant. These results confirm that the parallel mediating role of psychological vulnerability and psychological flexibility is significant in the relationship between an MSA and DAS (Full mediation). In addition, the findings obtained from the bootstrap analysis with 5000 resamplings are presented in Table 6 . Table 6 Results of Bootstrapping Analyses for the Parallel Mediation Model Model pathways Coefficient Confidence Interval (%95) Lower Upper a → b 0.08 -0.018** 0.16** a → c 0.15 0.12* 0.19* a → d -0.29 -0.37* -0.21* c → b 0.47 0.20* 0.73* d → b -0.62 -0.73* -0.49* a: MSA, b: DAS, c: psychological vulnerability, d: psychological flexibility, *p 0.05 Table 6 is here. Discussion The fact that digital tools and screens surround the individual from all sides has made behavioral addictions inevitable. MSA, consisting of loss of control, compulsive behavior, and excessive screen time, has become one of the most critical behavioral addiction phenomena of recent years (Sarıtepeci, 2021 ). There seems to be insufficient scientific research to understand the effects of this phenomenon on individuals and to carry out preventive studies. There is a need to examine this more, especially during a period such as adolescence, when identity construction and self-presentation are done through digital screens. In this context, the mediating role of psychological flexibility and psychological vulnerability in the relationship between MSA and DAS in adolescents was examined in the study. The study's first finding showed that MSA in adolescents has a significant positive effect on DAS (confirmed H1). This finding indicates that adolescents addicted to multiple screens are likely to experience depression, anxiety, and stress. In other words, excessive use of any digital screen causes adolescents to lose control and exhibit compulsive behavior, leading to increased depression, anxiety, and stress levels. It is known that behavioral addictions such as internet addiction, smartphone addiction, and social media addiction have significant positive relationships with DAS (Jahagirdar et al., 2024 ; Nikolic et al., 2023 ; Stanković et al., 2021 ; Taş, 2019 ; Younes et al., 2016 ). These studies support previous findings and reveal that MSA creates similar effects. This finding is consistent with behavioral theories of addiction. In particular, compulsive digital media use can negatively affect an individual's daily functionality, leading to increased levels of stress, anxiety, and depression. This theoretical framework can help us understand the mechanisms underlying the finding. Adolescents' subjective experiences and perceptions of digital screens may also determine the effects of DAS. For example, adolescents who believe that screen use increases social connections may experience different psychological consequences. According to another study, MSA predicts psychological vulnerability (confirmed H2). This finding shows that as the individual's screen addiction increases, his psychological vulnerability also increases. It is known that adolescents who use multiple screens are exposed to cyber victimization (Çimke & Cerit, 2021 ; Peláez-Fernández et al., 2021 ) and experience traumatic experiences (Park et al., 2017 ; Schimmenti et al., 2017). Previous studies have proved that the psychological vulnerability of adolescents who experience these negative experiences also decreases (Ardakan et al., 2021 ; McCormick et al., 2012 ; Satici, 2022 ). Considering that individuals with high levels of vulnerability attribute negative experiences to a fixed cause, feel worthless, and believe that there will be other negative experiences (Haeffel, 2010 ), previous studies have revealed that this is similar to the pathologies that occur in adolescents exposed to multiple screens. A study found that adolescents who used smartphones for more than four hours a day worsened indicators related to stress perception, sleep satisfaction, depressive symptoms, and suicide (Woo et al., 2021 ). A different study concluded that more smartphone screen time may be associated with common underlying symptoms of multiple mental illnesses (Noel et al., 2022 ). Considering that high psychological vulnerability predicts DAS (confirmed H3), the expected result was that MSA predicts DAS through psychological vulnerability. It has been proven that psychologically vulnerable adolescents, that is, weak resilience, are more likely to show mental health problems such as depression, anxiety, and stress (Nogueira et al., 2022 ; Teixeira et al., 2022). The findings of this study show that MSA increases psychological vulnerability and increases DAS levels in adolescents. In particular, screen addiction has been found to predict DAS by increasing psychological vulnerability. Adolescents' exposure to cyber victimization and traumatic experiences further increases their psychological vulnerability, which leads to mental health problems. These findings highlight the need to carefully manage digital media use and develop strategies to protect young people's digital health. According to another study, MSA predicts psychological vulnerability (confirmed H2). This finding shows that as the individual's screen addiction increases, his psychological vulnerability also increases. It is known that adolescents who use multiple screens are exposed to cyber victimization (Çimke & Cerit, 2021 ; Peláez-Fernández et al., 2021 ) and experience traumatic experiences (Park et al., 2017 ; Schimmenti et al., 2017). Previous studies have proved that the psychological vulnerability of adolescents who experience these negative experiences also decreases (Ardakan et al., 2021 ; McCormick et al., 2012 ; Satici, 2022 ). Considering that individuals with high levels of vulnerability attribute negative experiences to a fixed cause, feel worthless, and believe that there will be other negative experiences (Haeffel, 2010 ), previous studies have revealed that this is similar to the pathologies that occur in adolescents exposed to multiple screens. A study found that adolescents who used smartphones for more than four hours a day worsened indicators related to stress perception, sleep satisfaction, depressive symptoms, and suicide (Woo et al., 2021 ). A different study concluded that more smartphone screen time may be associated with common underlying symptoms of multiple mental illnesses (Noel et al., 2022 ). Considering that high psychological vulnerability predicts DAS (confirmed H3), the expected result was that MSA predicts DAS through psychological vulnerability. It has been proven that psychologically vulnerable adolescents, that is, weak resilience, are more likely to show mental health problems such as depression, anxiety, and stress (Nogueira et al., 2022 ; Teixeira et al., 2022). The findings of this study show that MSA increases psychological vulnerability and increases DAS levels in adolescents. In particular, screen addiction has been found to predict DAS by increasing psychological vulnerability. Adolescents' exposure to cyber victimization and traumatic experiences further increases their psychological vulnerability, which leads to mental health problems. These findings highlight the need to carefully manage digital media use and develop strategies to protect young people's digital health. This result confirms that high psychological flexibility reduces adolescents' DAS levels. Psychological flexibility, coping with difficulties, and maintaining psychological resilience may improve mental health. A study on this subject concluded that psychological flexibility predicts DAS (Wang et al., 2023 ). Additionally, low psychological flexibility is a significant risk factor for depression, anxiety, and stress symptoms (Yao et al., 2023 ). The study's findings reveal that psychological flexibility is vital in reducing adolescent DAS levels. It has been found that high psychological flexibility reduces DAS symptoms by increasing adolescents' ability to cope with difficulties and maintain their psychological resilience. These findings confirm the mental health-improving effect of psychological flexibility and highlight that low psychological flexibility is a significant risk factor for DAS. Therefore, interventions to improve psychological flexibility in adolescents are of critical importance in the prevention and management of mental health problems. Based on the research results, it can be said that there are different ways to reduce adolescents' depression, anxiety, and stress levels, including lowering their screen addiction and psychological vulnerability and increasing psychological flexibility. The study's main finding was that psychological vulnerability and flexibility fully mediated the relationship between MSA and DAS (confirmed H6, H7). According to these results, it appears that adolescents' addiction to the screen triggers mental health problems. The negative impact of psychological vulnerability can be mentioned in increasing these problems. However, it has been revealed that psychological flexibility positively affects reducing these problems. It follows that psychological flexibility, which positively affects the mental health of adolescents, should be increased, and psychological vulnerability should be reduced. MSA may affect DAS by increasing psychological vulnerability and reducing psychological flexibility. MSA may increase adolescents' psychological vulnerability. Increased psychological vulnerability may weaken adolescents' ability to cope with stress, which may increase DAS levels. Thus, psychological vulnerability is part of the relationship between MSA and DAS. Likewise, MSA may reduce adolescents' psychological flexibility. Decreased psychological flexibility may weaken adolescents' ability to cope and recover from difficulties, which may increase DAS levels. In this case, psychological flexibility also influences the relationship between MSA and DAS. When considering the full mediation effect, it indicates that the entire impact of MSA on DAS is not explained through psychological vulnerability and flexibility. Still, these two variables play an essential role. In conclusion, part of the impact of MSA on DAS occurs through psychological vulnerability and resilience. Limitations and Strengths As in every research, this scientific study also has some limitations. First, being a cross-sectional study can be considered the main limitation. In addition, the data of this study were collected after the earthquake disaster in the country (Turkey), which affected 11 provinces and killed more than 55,000 people. The students who responded to the questionnaires may have been affected by the trauma caused by the earthquake. Despite these limitations, the results of the study should be addressed. Therefore, when the valuable results of this study are considered to contribute to the literature, the negative effect of the existing limitations can be reduced. The study sample was based on a specific demographic group or geographical region, so the results may need to be more generalizable to the general population. Different age groups, cultural backgrounds, or socioeconomic situations may influence the study's findings. In addition, abstract concepts such as psychological vulnerability, resilience, and DAS may be challenging to measure, and the way these concepts are operationalized may affect the study's results. Since screen addiction and technological devices are constantly changing, the study's findings may need to be updated quickly. New technologies and social media platforms may affect the behaviors of the participants. The study may ignore other variables other than screen addiction that may have an impact on DAS. For example, factors such as family dynamics, school or work stress, and physical health may also affect DAS. Despite these limitations, the originality of the study should be addressed. It brings a new perspective to the literature by examining the relationship between screen addiction and DAS. In particular, evaluating the effects of mediating variables such as psychological vulnerability and resilience deepens the knowledge in this field. Testing a large number of hypotheses in the study provides a comprehensive picture of the effects of screen addiction on DAS and how psychological variables mediate these effects. The findings provide important insights for practical applications. For example, for educators, parents, and mental health professionals, understanding the relationships between screen addiction and DAS can help them develop intervention strategies. The study offers a multidisciplinary perspective at the intersection of various disciplines, such as psychology, communication, education, and health. This increases the applicability of the findings across a broader spectrum. Conclusion This study confirmed that MSA and DAS have a negative relationship with psychological resilience and a positive relationship with psychological vulnerability. As the participants' MSA increased, their DAS levels also increased. However, as psychological resilience levels increased, multiscreen addiction and DAS levels decreased. It also revealed significant findings by examining the direct and indirect effects of MSA on depression, anxiety, and stress (DAS). Our research shows that MSA has a direct effect on DAS and that this effect is also mediated indirectly through psychological vulnerability and resilience. MSA was found to have a significant and direct effect on DAS. This suggests that intensive screen use may have direct adverse effects on mental health. MSA was also found to have essential effects on psychological vulnerability and resilience. In particular, psychological vulnerability had a direct effect on DAS, while psychological flexibility was found to reduce the adverse effects of DAS. Psychological vulnerability and resilience mediate the relationship between MSA and WFC, revealing the complexity of this relationship. These psychological factors shape the indirect effects of MSA on DAS. In terms of theoretical and practical contribution, it helps us better understand the relationships between screen addiction and mental health. The study makes significant contributions to the literature in this field by expanding the theoretical frameworks regarding screen addiction. It can also offer practical guidance for educators, parents, and mental health professionals, helping them develop strategies to reduce the adverse effects of screen addiction among youth. The findings of this study open several avenues for future research. First, it is essential to test the generalizability of the findings by conducting similar studies on different demographic groups. Additionally, examining changes over time and long-term effects by conducting longitudinal studies will help us understand the lasting effects of screen addiction on mental health. Finally, experimental studies are needed to evaluate the effectiveness of intervention and prevention programs. Declarations Ethics approval and consent to participate This study used the ethical principles stated in the Declaration of Helsinki. Ethical approval for this research was obtained from the Siirt University Ethics Committee. (Approval Number: 599, Date: 03.05.2023). Informed consent was obtained from all individual participants included in the study. Consent for publication Applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions NT contributed to the conception and design of the study. HB performed data collection and analysis. OY wrote the first draft of the manuscript, and all authors commented on previous versions. 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The development and validation of the Psychological Vulnerability Scale. Cognitive Therapy and Research , 23 (2), 119-129. https://doi.org/10.1023/A:1018770926615 Soni, R., Upadhyay, R., & Jain, M. (2017). Prevalence of smart phone addiction, sleep quality and associated behaviour problems in adolescents. International Journal of Research in Medical Sciences , 5 (2), 515-519.http://dx.doi.org/10.18203/2320-6012.ijrms20170142 Stanković, M., Nešić, M., Čičević, S., & Shi, Z. (2021). Association of smartphone use with depression, anxiety, stress, sleep quality, and internet addiction. Empirical evidence from a smartphone application. Personality and Individual Differences , 168 , 110342. https://doi.org/10.1016/j.paid.2020.110342 Siwiak, A., Suris, J. C., Chok, L., Stadelmann, S., Corre, T., & Barrense-Dias, Y. (2023). Are vulnerable adolescents more prone to smartphone and Internet addiction? A cross-sectional study among adolescents in Switzerland. Vulnerable Children and Youth Studies, 18 (4), 570-580. https://doi.org/10.1080/17450128.2023.2253511 Taş, İ. (2019). Association between depression, anxiety, stress, social support, resilience and internet addiction: A structural equation modelling. Malaysian Online Journal of Educational Technology , 7 (3), 1-10. http://dx.doi.org/10.17220/mojet.2019.03.001 Taymur, I., Budak, E., Demirci, H., Akdağ, H. A., Güngör, B. B., & Özdel, K. (2016). A study of the relationship between internet addiction, psychopathology and dysfunctional beliefs. Computers in Human Behavior , 61 , 532-536.https://doi.org/10.1016/j.chb.2016.03.043 Teixeira, S., Ferré-Grau, C., Canut, T. L., Pires, R., Carvalho, J. C., Ribeiro, I., ... & Sequeira, C. A. (2022). Positive mental health in university students and its relations with psychological vulnerability, mental health literacy, and sociodemographic characteristics: a descriptive correlational study. International Journal of Environmental Research And Public Health , 19 (6), 3185.https://doi.org/10.3390/ijerph19063185 Toda, M., Monden, K., Kubo, K., & Morimoto, K. (2006). Mobile phone dependence and health-related lifestyle of university students. Social Behavior and Personality: An International Journal , 34 (10), 1277-1284.https://doi.org/10.2224/sbp.2006.34.10.1277 Turkish Statistical Institute (TSI). (2022). Statistics on family, 2022. https://data.tuik.gov.tr/Bulten/Index?p=Statistics-on-Family-2022-49683&dil=2 Turkish Statistical Institute (TSI). (2023). Survey on Information and Communication Technology (ICT) usage in households and by individuals, 2023. https://data.tuik.gov.tr/Bulten/Index?p=Hanehalki-Bilisim-Teknolojileri-(BT)-Kullanim-Arastirmasi-2023-49407 Uddin, L. Q. (2021). Cognitive and behavioural flexibility: neural mechanisms and clinical considerations. Nature Reviews Neuroscience , 22 (3), 167-179.https://doi.org/10.1038/%20s41583-021-00428-%20w Wan Ismail, W. S., Sim, S. T., Tan, K. A., Bahar, N., Ibrahim, N., Mahadevan, R., ... & Abdul Aziz, M. (2020). The relations of internet and smartphone addictions to depression, anxiety, stress, and suicidality among public university students in Klang Valley, Malaysia. Perspectives in Psychiatric Care , 56 (4), 949-955.https://doi.org/10.1111/ppc.12517 Wang, J., Fang, S., Yang, C., Tang, X., Zhu, L., & Nie, Y. (2023). The relationship between psychological flexibility and depression, anxiety, and stress: a latent profile analysis. Psychology Research and Behavior Management , 997-1007.https://doi.org/10.2147/PRBM.S400757 We Are Social (2023). Digital 2023 global overview report. https://wearesocial.com/uk/blog/2023/01/digital-2023/ Woo, K. S., Bong, S. H., Choi, T. Y., & Kim, J. W. (2021). Mental health, smartphone use type, and screen time among adolescents in South Korea. Psychology research and behavior management , 1419-1428. https://doi.org/10.2147/PRBM.S324235 Yang, S. C., & Tung, C. J. (2007). Comparison of Internet addicts and non-addicts in Taiwanese high school. Computers in Human Behavior , 23 (1), 79-96.https://doi.org/10.1016/j.chb.2004.03.037 Yao, X., Xu, X., Chan, K. L., Chen, S., Assink, M., & Gao, S. (2023). Associations between psychological inflexibility and mental health problems during the COVID-19 pandemic: A three-level meta-analytic review. Journal of Affective Disorders , pp. 320 , 148–160. https://doi.org/10.1016/j.jad.2022.09.116 Yavuz, F., Ulusoy, S., Iskin, M., Esen, F. B., Burhan, H. S., Karadere, M. E., & Yavuz, N. (2016). The Turkish version of Acceptance and Action Questionnaire-II (AAQ-II) is a reliability and validity analysis in clinical and non-clinical samples. Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology , 26 (4), 397-408. https://doi.org/10.5455/bcp.20160223124107 Younes, F., Halawi, G., Jabbour, H., El Osta, N., Karam, L., Hajj, A., & Rabbaa Khabbaz, L. (2016). Internet addiction and relationships with insomnia, anxiety, depression, stress and self-esteem in university students: a cross-sectional designed study. PloS one , 11 (9), e0161126. https://doi.org/10.1371/journal.pone.0161126 Yücens, B., & Üzer, A. (2018). The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students. Psychiatry Research , 267 , 313-318.https://doi.org/10.1016/j.psychres.2018.06.033 Additional Declarations No competing interests reported. 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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-6996902","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501840122,"identity":"22a8d859-94d3-45ba-b31f-e4f713b61ebd","order_by":0,"name":"Oğuzhan YILDIRIM","email":"","orcid":"","institution":"Kahramanmaraş Sütçü İmam University","correspondingAuthor":false,"prefix":"","firstName":"Oğuzhan","middleName":"","lastName":"YILDIRIM","suffix":""},{"id":501840123,"identity":"09ef8a92-8b25-4467-b92d-0043457609e0","order_by":1,"name":"Hasan BATMAZ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYBACAxDB2ABmMz5sAIuwAUk2wlokgBSzIYoWHiK0sEkSpcWc/fjDz4U77Op0248/q5xRc0/eXCItgeFD2WEGe+kDWLVY9uQYS888kyxhdiYh7eaGY8WGO2ekHWCcce4wAw9fAnaHHchhkOZtY5YwO5Bw7OYDtgTGDTfSG5h524BacLjM4Pzzx7952+olzM4/bCt88C/BHqzlLz4tNxLMgLYcljC7kczGuLEtIXHDjbQDzIx4tbwxs+Y9c1xy241nzJIz+xKSd/Y8SzjYcy6dh+cMLoelP77Nu6Oa3+x8+sOPPd8SbLezpxk++FFmLcfeg10LdnCAAXe0jIJRMApGwSggAgAAIWxismesUgIAAAAASUVORK5CYII=","orcid":"","institution":"Karabuk University","correspondingAuthor":true,"prefix":"","firstName":"Hasan","middleName":"","lastName":"BATMAZ","suffix":""},{"id":501840124,"identity":"c67f400e-cb25-4d49-93e7-d72d9b4c21bc","order_by":2,"name":"Nuri TÜRK","email":"","orcid":"","institution":"Siirt University","correspondingAuthor":false,"prefix":"","firstName":"Nuri","middleName":"","lastName":"TÜRK","suffix":""}],"badges":[],"createdAt":"2025-06-28 09:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6996902/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6996902/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-025-03856-w","type":"published","date":"2026-01-10T15:59:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89370098,"identity":"66585f1e-b485-4b85-a2ea-27cf951bec8e","added_by":"auto","created_at":"2025-08-19 09:55:51","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":134498,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSerial Mediation Role of psychological vulnerability and psychological flexibility\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6996902/v1/4d95e4ed2ef0a873b2012971.jpeg"},{"id":100070046,"identity":"b211ff19-efec-4a82-8769-9a1abc4366ff","added_by":"auto","created_at":"2026-01-12 16:16:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1245525,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6996902/v1/b30df8c1-3199-4958-ad6f-e613c2c0a94f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Parallel Mediation of Psychological Flexibility and Vulnerability Between Multiple-Screen Addiction and Mental Health Outcomes in Adolescents","fulltext":[{"header":"Impact Statement","content":"\u003cp\u003eThis study reveals that psychological flexibility and vulnerability are crucial mediators in the relationship between multiple-screen addiction and mental health issues in adolescents. By enhancing psychological flexibility and reducing vulnerability, it is possible to significantly mitigate the adverse effects of screen addiction on depression, anxiety, and stress. These findings can inform the development of targeted intervention programs and school policies to improve adolescent mental health.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eAs the role and function of technology in our lives have increased, internet use has become more challenging to manage. This process has caused severe concern by causing excessive internet use by young people and adults (Nie et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The internet is used through digital devices. This usage leads to the concepts of multi-screen and screen addiction. Screen addiction can be classified as digital game addiction (offline, online, single-player, multiplayer), internet addiction (sex, gambling, shopping), technological device addiction (smartphone, VR, tablet, and computer, etc.), and media addiction (traditional and social media) (Macit \u0026amp; Kavafoglu, 2019). Indeed, Gupta et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) stated that internet addiction is a serious problem. They found that the most frequently used smart devices are phones, laptops, desktops, and tablets. These findings prove that the screen is the \u003cem\u003e\"window\"\u003c/em\u003e of our lives that opens to the virtual world.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLife in the Digital Age and Multiple Screen Addiction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDigital games have become widespread in the lives of children and adolescents especially (Paulus et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Children and adolescents are vulnerable to digital devices due to their incomplete development of impulse control and cognitive flexibility (Kim et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, multiple screens increase depressive symptoms and harm sleep quality (Li et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Adolescents who are addicted to the Internet are at risk of unhealthy diets, smoking and alcohol use, violence, cyberbullying, and exposure to pornography (Chang et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost people have constant access to technological devices. They engage in continuous activities such as sending e-mails, watching and sharing videos, listening to music, playing games, making voice calls, sending messages, sending e-mails, and using social media via smartphones (Samaha \u0026amp; Hawi, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Soni et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This access process can turn into excessive, obsessive, and repetitive behaviors over time and may reveal disorders such as MSA (Saritepeci et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, it becomes inevitable for individuals, especially those who strive to have free time, to be exposed to MSA (Multi-screen addiction) (Lin et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). MSA, which is a severe risk factor for mental health, can be considered a behavioral addiction, such as internet addiction and smartphone addiction (Saritepeci, 2021).\u003c/p\u003e\u003cp\u003e\"Human,\" the actor of the digital world, has started to change his life habits based on the screen. Of individuals between the ages of 16 and 64 who use digital devices, 96.2% use a mobile phone, 95.6% use a smartphone, 58% use a laptop or desktop computer, 33.7% use a tablet, 20.3% use a game console, and 29.9% use smartwatches and wristbands. The number of internet users in the world has reached 5.16\u0026nbsp;billion. These people spend an average of 6H 37M daily online (Meltwater, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; We Are Social, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In Turkey, the usage rate of portable computers such as laptops and tablets has increased to 46.6%, and the usage rate of smartphones/mobile phones has increased to 99.2% (Turkish Statistical Institute [TSI], 2022). In addition, the rate of internet access for households has exceeded 95%. The internet usage rate among individuals between the ages of 19–74 has reached 87% (TSI, 2023). The widespread use of digital devices and increased internet access reveal the indispensable place of technology in our daily lives. On the other hand, adolescents can be accurately informed about substance use, sexual health, bullying, and body image through the media (Bailin et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This reveals that the effect of digital devices may be related to the purpose of use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultiple Screen Addiction and Depression Anxiety Stress (DAS)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTechnological innovations in the digital age have brought new problems, such as MSA. Multi-screen refers to digital devices such as smartphones, computers, tablets, and TVs. These devices' most common activities include the internet, communication, games, and movies (Li et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). MSA causes symptoms such as tolerance, withdrawal, and apathy. This type of addiction is associated with depression, anxiety, stress, and suicidality (Wan Ismail et al., 2020). Additionally, individuals who are frequently exposed to screens and engage in online experiences are at risk of self-harm (Liu et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Internet use is one of the most critical factors in the emergence of MSA. Internet addiction has a triggering role in psychopathological features and dysfunctional attitudes (Taymur et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Problematic internet use and internet addiction can cause depression (Lau et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Priego et al., 2020), anxiety (Kim et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), stress (Gupta et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), suicide (Sami et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), low self-esteem, semantic verbal fluency (Nie et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), social anxiety (Lee \u0026amp; Stapinski, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), family conflicts, low academic achievement (Boonvisudhi \u0026amp; Kuladee, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), low psychosocial well-being (Lai et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), social phobia (Yücens \u0026amp; Üzer, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), ADHD, lack of excitement seeking and assertiveness (Dalbudak et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), and pornography and harassment (Yang \u0026amp; Tung, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) are situations that trigger various psychological and social problems.\u003c/p\u003e\u003cp\u003eMental disorders and internet addiction interact with each other. Adverse life events and depressive experiences may be effective in the emergence, severity, and recurrence of addiction (Taymur et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Individuals experiencing psychological distress have a higher level of internet addiction. Internet addiction also increases psychological distress (Anand et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Individuals with depressive symptoms also have a high tendency to become internet addicted, and the prevalence of internet addiction in depressed individuals is 36%. In addition, depressed individuals have significantly higher levels of television, computer games, and internet addiction than other individuals (Dieris-Hirche et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Individuals with personalities characterized by shyness, dependence, and low self-esteem have a higher risk of internet addiction (Yang \u0026amp; Tung, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Individuals may increase their Internet use time because they believe online communication is low-level harmful (Chi et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This explains the complex relationship between online communication and screen addiction.\u003c/p\u003e\u003cp\u003eEasier access to the internet via mobile phones has increased mobile phone usage (Toda et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Smartphone addiction can be considered a more serious risk factor than internet addiction (Kim et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This can be explained by smartphones being functional devices with computer and phone features (Mohamed \u0026amp; Mostafa, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Mobile phone use also causes technology addiction over time. Mobile phone addiction and problematic use are associated with depression, anxiety (Li et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Rozgonjuk et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), low self-esteem (Mohamed \u0026amp; Mostafa, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), chronic and excessive stress (Gligor \u0026amp; Mozoş, 2019), anger and impulsivity (Kim et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), low academic achievement and low life satisfaction (Samaha \u0026amp; Hawi, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), physical fatigue, insomnia (Boumosleh \u0026amp; Jaalouk, 2017), behavioral problems (Soni et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), ADHD, smoking and alcohol use (Kim et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). On the other hand, depression and anxiety are also predictors of smartphone addiction (Boumosleh \u0026amp; Jaalouk, 2017). Users sometimes turn to their mobile phones to eliminate their negative emotions. Thus, they can feel that they are free from stress and anxiety. This cycle can become more complex over time.\u003c/p\u003e\u003cp\u003eIn the digital world, social media usage is increasing daily for most individuals. Addiction caused by excessive social media use can lead to individuals experiencing mental health problems. However, these individuals have a higher risk of experiencing somatic symptoms, social dysfunction, depression, and anxiety (Hanprathet et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). It can be said that one of the components of multi-screen addiction is game addiction. Gaming applications, which are a severe and growing social problem for young generations (Rajab et al., 2020), cause depression, anxiety, and poor sleep quality (Alshammari et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAdditionally, the majority of individuals with digital gaming disorder have high levels of daily and chronic stress (Kaess et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). While game addiction increases stress, stress can also trigger game addiction (Rajab et al., 2020). In conclusion, the interrelationship of MSA with mental health problems suggests that the variables underlying these complex relationships need to be understood in depth.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Mediating Role of Psychological Flexibility and Vulnerability\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePsychological flexibility is maintaining and changing conscious behavior for selected values (Hayes et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Individuals who do not have this flexibility can integrate their sense of self with their thoughts, actions, and feelings. Thus, the individual cannot distinguish between the self and private feelings, thoughts, and memories. As a result, the individual may evaluate themself as worthless and useless (Kashdan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Psychological flexibility is an important skill not only for individuals but also for social events. Cognitive and behavioral flexibility is necessary in dealing with problems such as economic crises, epidemics, and health problems that concern society as a whole (Uddin, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Therefore, psychological flexibility is vital at the individual and social levels.\u003c/p\u003e\u003cp\u003eThe ACT approach uses six essential components to increase psychological flexibility: acceptance, present moment awareness, self as context, defusion, values, and committed action. Each of these components is associated with distress, anxiety, and depression (Landi et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Bramwell and Richardson (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that ACT was an important mechanism of reduced dissociation and increased values-based action in people with depression and mental health problems.\u003c/p\u003e\u003cp\u003eACT practices are effective in increasing psychological flexibility (Azadeh et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) to cope with depression (Bai et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), stress (Cekic et al., 2016), and anxiety (Sharp, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Theoretically, these approaches play an important role in increasing psychological flexibility. Additionally, ACT has been determined to be effective in reducing technological addiction (Mohammadi \u0026amp; Mohammadi, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Psychological flexibility, which is multidimensional, is associated with both psychopathology (Cherry et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Flexibility and decisive action, two key components of psychological flexibility, effectively reduce sleep problems, depression, and anxiety (Finnegan et al., 2022; McCracken et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVulnerability is another variable associated with internet and screen addiction (Siwiak et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Vulnerability, which is more common and hidden than diagnosable diseases, is based on psychological, social, and biological factors. Six factors are indicative of psychological vulnerability: delinquency, early socialization, mental illness, perceived discrimination, social capital, and traumatic experiences (Harpviken, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Psychological vulnerability, which has a critical role in mental health (Teixeira et al., 2022), is effective inindividuals' well-being, hope, and psychological resilience (Satici, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). It is observed that vulnerable individuals experience higher levels of self-alienation and have lower authentic living skills (Satici et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In human life, parents, peers, difficult family conditions, poverty, and low socioeconomic level can contribute to pathology, causing individuals to be more vulnerable to stress (Hanson et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The triple vulnerability model argues that psychological vulnerability contributes to the etiology of emotional disorders such as anxiety and stress (Barlow, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). In addition, the cognitive dimension of vulnerability can be evaluated according to the hopelessness theory. According to this theory, vulnerability is the tendency to infer the causes and consequences of adverse events. Individuals with high levels of vulnerability associate negative experiences with a fixed cause, feel worthless, and believe that there will be other negative experiences (Haeffel, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the current study, which aims to examine the effect of MSA on individuals' DAS levels, it is thought that psychological flexibility will have a positive effect. However, psychological vulnerability will harm mental health. Therefore, it is aimed to examine the mediating effect of psychological flexibility and vulnerability in the relationship between MSA and DAS.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePresent Study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNowadays, individuals are at risk of screen addiction because they are constantly accessed by digital devices (Manimekalai \u0026amp; Poulpunitha, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This type of addiction is associated with depression, anxiety, and stress (Wan Ismail et al., 2020). Therefore, it is essential to investigate factors that may affect the relationship between screen addiction and psychopathology. Individuals with high psychological vulnerability (Satici et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and low flexibility (Güldal et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) have a high risk of becoming addicted to social media, which causes multi-screen addiction. In this context, multi-screen addiction can be expected to increase addiction and decrease flexibility. In addition, relationships have been found between psychological flexibility and depression (Bryan et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Masuda \u0026amp; Tully, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), anxiety (Arslan et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Fledderus et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), distress (Dawson \u0026amp; Golijani-Moghaddam, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Additionally, psychological vulnerability is associated with depression (Lohman et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lv et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and state anxiety (Mallett et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhen the literature is examined, it is seen that there are studies examining the relationships between technology addiction and mental health, psychological flexibility, and vulnerability. However, it is striking that these studies do not specifically address \"multi-screen addiction.\" MSA is a comprehensive and current study topic regarding technology addiction concepts. It covers many factors, including phone, computer, social media, and internet addiction. In addition, the level of depression, anxiety, and stress (DAS) is fundamental in determining mental health. These three psychopathologies were examined in this study. It is thought that the concepts of psychological flexibility and vulnerability may have a critical role in the relationship between multi-screen and DAS. Because flexibility and vulnerability are predicted to affect mental health and psychopathology. In addition, no study has been found where these four concepts are studied together. In this context, the current study is thought to be original and has a potential explanatory role in MSA and mental health.\u003c/p\u003e\u003cp\u003eThis study examined the mediating role of psychological flexibility and vulnerability in the relationship between MSA and DAS. Considering the research in the literature, the following hypotheses were tested.\u003c/p\u003e\u003cp\u003eH1: Multiple Screen Addiction has a significant direct effect on DAS.\u003c/p\u003e\u003cp\u003eH2: Multiple Screen Addiction has a significant direct effect on psychological vulnerability.\u003c/p\u003e\u003cp\u003eH3: Psychological vulnerability has a significant direct effect on DAS.\u003c/p\u003e\u003cp\u003eH4: Multiple Screen Addiction has a significant direct effect on psychological flexibility.\u003c/p\u003e\u003cp\u003eH5: Psychological flexibility has a significant direct effect on DAS.\u003c/p\u003e\u003cp\u003eH6: Psychological vulnerability and psychological flexibility have mediated effects between Multiple Screen Addiction and DAS.\u003c/p\u003e\u003cp\u003eH7: Multiple Screen Addiction has an insignificant indirect effect on DAS.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis study examines the mediating roles of cognitive psychological vulnerability and flexibility in the relationship between MSA and DAS. The study was conducted using a correlational design, and quantitative methods were applied. In the data collection process, due to time, budget, and labor limitations, the convenience sampling method was preferred, in which the easiest-to-reach participants were selected.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAn online questionnaire was prepared for data collection. On the first page of the online survey, participants were informed about the duration and purpose of the study. Google Forms sent the research link to the participants through social media platforms and messaging programs such as WhatsApp, Twitter, and Instagram. The inclusion criteria were being a university student aged 14 years and above. Consent was obtained from the parents of the students based on ethics committee approval. Students with no high school students were not included in the study. Individuals who met these criteria and volunteered to participate were included in the study. Since the study's data was collected after the earthquake disaster and this is a sensitive traumatic experience, the participants were informed that they could stop answering the questionnaire if they felt uncomfortable. In addition, participants were advised not to provide information about their personal information to protect confidentiality and anonymity. The response time was 10 minutes at the beginning of the questionnaire. The study data were collected while the education process was in progress. The data collection process continued for about two months to avoid coinciding with the exam periods of the students. The data were analyzed using SPSS 28 and AMOS 24 package programs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted with 309 participants. The mean age of the participants was 16.13 years (SD = 1.40), and their ages ranged from 14 to 19 years. There were 57% (n: 176) girls and 43% (n:133) boys. In terms of grades, 96 (31.1%) of the participants were high school 3rd-grade students, followed by high school 2nd-grade (29.8%), high school 1st-grade (20.4%) and high school 4th grade (18.8%). In addition, 24 of the participants indicated a low level, 249 showed a medium level, and 36 indicated a high level according to the country's economic status. In addition, the average daily TV watching was 2.34 hours (SD: 1.13), daily tablet-computer use was 2.24 hours (SD: 1.38), and daily phone use was 4.29 hours (SD: 1.32).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Multi-Screen Addiction Scale (MSAS)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe scale developed by Sarıtepeci (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) is a 5 Likert-type and has 15 items consisting of 3 sub-dimensions. There are four items in “Excessive Screen Time (EST),” 8 items in “Compulsive Behavior (CB),” and three items in “Loss of Control (LoC).” The Cronbach Alpha, internal consistency coefficient, was reported for the MSAS scale, and its sub-dimensions range between .71–92. Accordingly, it was found that there was an acceptable fit between the factor structure of the MSAS scale and the data (CMIN / DF = 4.232, GFI = .946, CFI = .947, RMSEA = .091). The internal reliability coefficient value of MSAS and its subscales was between .70-.93. The internal reliability estimate of the MSA in the present sample is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistic. Linearity. Normality. and Multicollinearity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMin.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMax.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMeans\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSkew.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eKurt.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTolerance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e78.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e41.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.704\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e40.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e− .562\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.809\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological vulnerability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e17.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e− .774\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.887\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.533\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological flexibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e30.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e− .186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.547\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eDepression Anxiety Stress (DAS-21)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDASS-21 was developed by Lovinond and Lovibond (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) by selecting the items of DASS-42 to shorten the duration. DASS-21 contains seven items for each scale, multiplying the evaluation result by two. Henry and Crawford (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) showed that the Cronbach alpha internal consistency reliability coefficient value was 0.88 for the depression subscale, 0.90 for the stress subscale, and 0.93 for the entire scale. According to the same study, the fit index values ​​of the DASS-21 model are S-Bχ2 = 628.0, χ2 = 1092.1, df = 180, CFI = 0.93, SRMR = 0.03, and RMSEA = 0.05. DAS-21 was adapted to Turkish culture by Sarıçam (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In the clinical sample, Cronbach's alpha internal consistency reliability coefficient was found to be α = 0.87 for the depression subscale, α = 0.85 for the anxiety subscale, and α = 0.81 for the stress subscale. Within the validity scope, the scale's factor loadings range from 42 to 72. Three factors explain 49.72% of the total variance. Confirmatory factor analysis (CFA) scale results were calculated as GFI = 0.90, CFI = 0.90, TLI = 0.89, RMSEA = 0.065, and SRMR = 0.067. According to the psychometric properties obtained, it was concluded that DAS-21 is a valid and reliable measurement tool for Turkish culture. The internal reliability estimate of the DAS-21 in the present sample is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychological Vulnerability Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe scale was developed by Sinclair and Wallston (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e1999\u003c/span\u003e) and adapted into Turkish by Akın and Eker (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). This scale is intended to determine the psychological vulnerability levels of adults. The scale includes six questions on a 5-point Likert type (1 - Not suitable for me, 2-3-4- 5- Completely suitable for me). The internal consistency coefficient calculated while adopting the psychological vulnerability scale to Turkish was 0.75. The highest score that can be obtained from the scale is 30, and the lowest score is 5. It is stated that as the score increases, adult individuals' psychological vulnerability increases and psychological vulnerability decreases. The internal reliability estimate of the psychological vulnerability scale in the present sample is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcceptance and Action Questionnaire-II (AAQ-II)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAAQ-II was used to measure psychological flexibility. The scale was developed by Bond et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The scale consists of 7 items. It is on a 7-point Likert scale (1: never true, 7: always true). High scores on the scale indicate that psychological flexibility is high and experiential avoidance increases. The internal consistency coefficient of the original scale is 0.84. CFA values ​​(N = 290), CFI = 0.99, SRMR = O.03, RMSEA = 0.04, CMIN/df = 1.49. Yavuz et al. (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) adapted the scale to Turkish culture. Cronbach's α coefficient of the scale is 0.84. As for construct validity, the Kaiser-Meyer-Olkin index (r = 0.83) was compatible with factor analysis (Bartlett chi-square = 1151.20; p \u0026lt; 0.0001). The single-factor solution (Eigenvalue 3.62) explains 51.76% of the total variance. CFA shows that the revised scale model fits the 7-item and single-factor structure well (RMSEA = 0.079, SRMR = 0.021, CFI = 0.97, GFI = 0.97, NFI = 0.96). The internal reliability estimate of the AAQ-II scale in the present sample is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eIn this study, a mediation model was used to examine the mediating roles of psychological vulnerability and psychological flexibility. The data were analyzed with SPSS PROCESS 25 (Model 4). Prior to the analysis, linear relationship, normality, and multicollinearity were examined. Five outliers that violated the normality distribution were removed from the initially collected 309 data, and the analysis was carried out with 309 data. Data were collected through Google Forms and delivered to the target audience through various channels [such as e-mail, social media, or academic forums].\u003c/p\u003e\u003cp\u003eMulticollinearity was assessed by Variance Inflation Factor (VIF) values, and all values were below 10. For the normality test, Shapiro-Wilk (p \u0026gt; .05), skewness (-1 to + 1), and kurtosis (-2 to + 2) values were examined, Q-Q graphs were analyzed, and it was determined that the data were approximately normally distributed. The significance level was taken as p \u0026lt; 0.05 in the analyses performed with Pearson correlation. F statistic was calculated in regression analysis, and R and R² values were reported. In addition, the model's validity was evaluated by checking the normality of the residuals. No multicollinearity was found in the analysis results, and it was confirmed that the data were normally distributed. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDescriptive Statistic. Linearity. Normality. and Multicollinearity\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eMin.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eMax.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eMeans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eSkew.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp; Kurt.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eTolerance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eDAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e21.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e78.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e41.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e11.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eMSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e15.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e73.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e40.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e13.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003ePsychological vulnerability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e17.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e4.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003ePsychological flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e49.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e30.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e10.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.547\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe relationships between variables were examined with the Pearson correlation coefficient, and the results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Additionally, the reliability of the scales was assessed using Cronbach's alpha, and the values are reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eThe Relationships between Variables\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eα\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026thinsp;=\u0026thinsp;DAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026thinsp;=\u0026thinsp;MSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.38\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026thinsp;=\u0026thinsp;Psychological vulnerability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.60\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.41\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026thinsp;=\u0026thinsp;Psychological flexibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.72\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.38\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.66\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, DAS is positively correlated to MSA (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.38) and psychological vulnerability (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.60) but negatively correlated to psychological flexibility (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.72).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMediation Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, before mediation analysis, the result of the simple linear regression showed that an MSA significantly predicted DAS (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.09, 95% CI: 0.05\u0026ndash;0.15; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Result of the Regression Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48.858\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e124.266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological vulnerability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological flexibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe mediation role of psychological vulnerability and psychological flexibility was tested with the mediation model, and the results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eMediational Model Coefficients\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePsychological\u003c/p\u003e\u003cp\u003evulnerability\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ePsychological flexibility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eDAS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eInd1\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eInd2\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological vulnerability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological flexibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e------\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003ei1\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ei2\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003ei3\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e48.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eR\u0026thinsp;=\u0026thinsp;.41, R\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cem\u003eR\u0026thinsp;=\u0026thinsp;.38, R\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e\u003cem\u003eR\u0026thinsp;=\u0026thinsp;.74; R\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e(1,307)\u0026thinsp;=\u0026thinsp;62.54, p\u0026thinsp;\u003cem\u003e\u0026lt;\u003c/em\u003e\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e(1,307)\u0026thinsp;=\u0026thinsp;52.83, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e(3, 305)\u0026thinsp;=\u0026thinsp;124.26\u003c/p\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAs seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the result of mediation analysis was found that DAS was significantly predicted by MSA (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.08, 95%, LLCI\u0026thinsp;=\u0026thinsp;0.05 ULCI\u0026thinsp;=\u0026thinsp;0.15; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05), psychological vulnerability (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.47, 95% LLCI\u0026thinsp;=\u0026thinsp;0.22 ULCI\u0026thinsp;=\u0026thinsp;0.71; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01) and psychological flexibility (\u003cem\u003eβ\u003c/em\u003e = \u0026minus;\u0026thinsp;.61, 95% LLCI=-.73 ULCI\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.50). Finally, mediation analysis revealed that psychological vulnerability and psychological flexibility played a parallel mediating role in the relationship between a MSA and DAS.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEffects of the psychological vulnerability and psychological flexibility on the DAS\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEstimates of Point \u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e%95 Confidence Interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe lowest\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe highest\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Indirect Effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInd1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInd2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eInd1\u0026thinsp;=\u0026thinsp;MSA \u0026rarr; Psychological Vulnerability \u0026rarr; DAS\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eInd2\u0026thinsp;=\u0026thinsp;MSA \u0026rarr; Psychological Flexibility \u0026rarr; DAS\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mediation analysis examined and presented the indirect, total, and direct effects of psychological vulnerability and psychological flexibility on DAS in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. As seen in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the indirect effect of the Ind1 (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.07, 95%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and Ind2 (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.18, 95%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) on the DAS is significant. These results confirm that the parallel mediating role of psychological vulnerability and psychological flexibility is significant in the relationship between an MSA and DAS (Full mediation). In addition, the findings obtained from the bootstrap analysis with 5000 resamplings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eResults of Bootstrapping Analyses for the Parallel Mediation Model\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eModel pathways\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eConfidence Interval (%95)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ea \u0026rarr; b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.018**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.16**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ea \u0026rarr; c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.12*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.19*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ea \u0026rarr; d\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.37*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.21*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ec \u0026rarr; b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.20*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.73*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ed \u0026rarr; b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.73*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.49*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea: MSA, b: DAS, c: psychological vulnerability, d: psychological flexibility, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, **p\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cem\u003eis here.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe fact that digital tools and screens surround the individual from all sides has made behavioral addictions inevitable. MSA, consisting of loss of control, compulsive behavior, and excessive screen time, has become one of the most critical behavioral addiction phenomena of recent years (Sarıtepeci, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). There seems to be insufficient scientific research to understand the effects of this phenomenon on individuals and to carry out preventive studies. There is a need to examine this more, especially during a period such as adolescence, when identity construction and self-presentation are done through digital screens. In this context, the mediating role of psychological flexibility and psychological vulnerability in the relationship between MSA and DAS in adolescents was examined in the study. The study's first finding showed that MSA in adolescents has a significant positive effect on DAS (confirmed H1). This finding indicates that adolescents addicted to multiple screens are likely to experience depression, anxiety, and stress. In other words, excessive use of any digital screen causes adolescents to lose control and exhibit compulsive behavior, leading to increased depression, anxiety, and stress levels. It is known that behavioral addictions such as internet addiction, smartphone addiction, and social media addiction have significant positive relationships with DAS (Jahagirdar et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Nikolic et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Stanković et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Taş, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Younes et al., \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These studies support previous findings and reveal that MSA creates similar effects. This finding is consistent with behavioral theories of addiction. In particular, compulsive digital media use can negatively affect an individual's daily functionality, leading to increased levels of stress, anxiety, and depression. This theoretical framework can help us understand the mechanisms underlying the finding. Adolescents' subjective experiences and perceptions of digital screens may also determine the effects of DAS. For example, adolescents who believe that screen use increases social connections may experience different psychological consequences.\u003c/p\u003e\u003cp\u003eAccording to another study, MSA predicts psychological vulnerability (confirmed H2). This finding shows that as the individual's screen addiction increases, his psychological vulnerability also increases. It is known that adolescents who use multiple screens are exposed to cyber victimization (\u0026Ccedil;imke \u0026amp; Cerit, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Pel\u0026aacute;ez-Fern\u0026aacute;ndez et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and experience traumatic experiences (Park et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Schimmenti et al., 2017). Previous studies have proved that the psychological vulnerability of adolescents who experience these negative experiences also decreases (Ardakan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McCormick et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Satici, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Considering that individuals with high levels of vulnerability attribute negative experiences to a fixed cause, feel worthless, and believe that there will be other negative experiences (Haeffel, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), previous studies have revealed that this is similar to the pathologies that occur in adolescents exposed to multiple screens. A study found that adolescents who used smartphones for more than four hours a day worsened indicators related to stress perception, sleep satisfaction, depressive symptoms, and suicide (Woo et al., \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A different study concluded that more smartphone screen time may be associated with common underlying symptoms of multiple mental illnesses (Noel et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Considering that high psychological vulnerability predicts DAS (confirmed H3), the expected result was that MSA predicts DAS through psychological vulnerability. It has been proven that psychologically vulnerable adolescents, that is, weak resilience, are more likely to show mental health problems such as depression, anxiety, and stress (Nogueira et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Teixeira et al., 2022). The findings of this study show that MSA increases psychological vulnerability and increases DAS levels in adolescents. In particular, screen addiction has been found to predict DAS by increasing psychological vulnerability. Adolescents' exposure to cyber victimization and traumatic experiences further increases their psychological vulnerability, which leads to mental health problems. These findings highlight the need to carefully manage digital media use and develop strategies to protect young people's digital health.\u003c/p\u003e\u003cp\u003eAccording to another study, MSA predicts psychological vulnerability (confirmed H2). This finding shows that as the individual's screen addiction increases, his psychological vulnerability also increases. It is known that adolescents who use multiple screens are exposed to cyber victimization (\u0026Ccedil;imke \u0026amp; Cerit, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Pel\u0026aacute;ez-Fern\u0026aacute;ndez et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and experience traumatic experiences (Park et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Schimmenti et al., 2017). Previous studies have proved that the psychological vulnerability of adolescents who experience these negative experiences also decreases (Ardakan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McCormick et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Satici, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Considering that individuals with high levels of vulnerability attribute negative experiences to a fixed cause, feel worthless, and believe that there will be other negative experiences (Haeffel, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), previous studies have revealed that this is similar to the pathologies that occur in adolescents exposed to multiple screens. A study found that adolescents who used smartphones for more than four hours a day worsened indicators related to stress perception, sleep satisfaction, depressive symptoms, and suicide (Woo et al., \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A different study concluded that more smartphone screen time may be associated with common underlying symptoms of multiple mental illnesses (Noel et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Considering that high psychological vulnerability predicts DAS (confirmed H3), the expected result was that MSA predicts DAS through psychological vulnerability. It has been proven that psychologically vulnerable adolescents, that is, weak resilience, are more likely to show mental health problems such as depression, anxiety, and stress (Nogueira et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Teixeira et al., 2022). The findings of this study show that MSA increases psychological vulnerability and increases DAS levels in adolescents. In particular, screen addiction has been found to predict DAS by increasing psychological vulnerability. Adolescents' exposure to cyber victimization and traumatic experiences further increases their psychological vulnerability, which leads to mental health problems. These findings highlight the need to carefully manage digital media use and develop strategies to protect young people's digital health.\u003c/p\u003e\u003cp\u003eThis result confirms that high psychological flexibility reduces adolescents' DAS levels. Psychological flexibility, coping with difficulties, and maintaining psychological resilience may improve mental health. A study on this subject concluded that psychological flexibility predicts DAS (Wang et al., \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Additionally, low psychological flexibility is a significant risk factor for depression, anxiety, and stress symptoms (Yao et al., \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The study's findings reveal that psychological flexibility is vital in reducing adolescent DAS levels. It has been found that high psychological flexibility reduces DAS symptoms by increasing adolescents' ability to cope with difficulties and maintain their psychological resilience. These findings confirm the mental health-improving effect of psychological flexibility and highlight that low psychological flexibility is a significant risk factor for DAS. Therefore, interventions to improve psychological flexibility in adolescents are of critical importance in the prevention and management of mental health problems. Based on the research results, it can be said that there are different ways to reduce adolescents' depression, anxiety, and stress levels, including lowering their screen addiction and psychological vulnerability and increasing psychological flexibility.\u003c/p\u003e\u003cp\u003eThe study's main finding was that psychological vulnerability and flexibility fully mediated the relationship between MSA and DAS (confirmed H6, H7). According to these results, it appears that adolescents' addiction to the screen triggers mental health problems. The negative impact of psychological vulnerability can be mentioned in increasing these problems. However, it has been revealed that psychological flexibility positively affects reducing these problems. It follows that psychological flexibility, which positively affects the mental health of adolescents, should be increased, and psychological vulnerability should be reduced. MSA may affect DAS by increasing psychological vulnerability and reducing psychological flexibility. MSA may increase adolescents' psychological vulnerability. Increased psychological vulnerability may weaken adolescents' ability to cope with stress, which may increase DAS levels. Thus, psychological vulnerability is part of the relationship between MSA and DAS. Likewise, MSA may reduce adolescents' psychological flexibility. Decreased psychological flexibility may weaken adolescents' ability to cope and recover from difficulties, which may increase DAS levels. In this case, psychological flexibility also influences the relationship between MSA and DAS. When considering the full mediation effect, it indicates that the entire impact of MSA on DAS is not explained through psychological vulnerability and flexibility. Still, these two variables play an essential role. In conclusion, part of the impact of MSA on DAS occurs through psychological vulnerability and resilience.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations and Strengths\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs in every research, this scientific study also has some limitations. First, being a cross-sectional study can be considered the main limitation. In addition, the data of this study were collected after the earthquake disaster in the country (Turkey), which affected 11 provinces and killed more than 55,000 people. The students who responded to the questionnaires may have been affected by the trauma caused by the earthquake. Despite these limitations, the results of the study should be addressed. Therefore, when the valuable results of this study are considered to contribute to the literature, the negative effect of the existing limitations can be reduced. The study sample was based on a specific demographic group or geographical region, so the results may need to be more generalizable to the general population. Different age groups, cultural backgrounds, or socioeconomic situations may influence the study's findings. In addition, abstract concepts such as psychological vulnerability, resilience, and DAS may be challenging to measure, and the way these concepts are operationalized may affect the study's results. Since screen addiction and technological devices are constantly changing, the study's findings may need to be updated quickly. New technologies and social media platforms may affect the behaviors of the participants. The study may ignore other variables other than screen addiction that may have an impact on DAS. For example, factors such as family dynamics, school or work stress, and physical health may also affect DAS.\u003c/p\u003e\u003cp\u003eDespite these limitations, the originality of the study should be addressed. It brings a new perspective to the literature by examining the relationship between screen addiction and DAS. In particular, evaluating the effects of mediating variables such as psychological vulnerability and resilience deepens the knowledge in this field. Testing a large number of hypotheses in the study provides a comprehensive picture of the effects of screen addiction on DAS and how psychological variables mediate these effects. The findings provide important insights for practical applications. For example, for educators, parents, and mental health professionals, understanding the relationships between screen addiction and DAS can help them develop intervention strategies. The study offers a multidisciplinary perspective at the intersection of various disciplines, such as psychology, communication, education, and health. This increases the applicability of the findings across a broader spectrum.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirmed that MSA and DAS have a negative relationship with psychological resilience and a positive relationship with psychological vulnerability. As the participants' MSA increased, their DAS levels also increased. However, as psychological resilience levels increased, multiscreen addiction and DAS levels decreased. It also revealed significant findings by examining the direct and indirect effects of MSA on depression, anxiety, and stress (DAS). Our research shows that MSA has a direct effect on DAS and that this effect is also mediated indirectly through psychological vulnerability and resilience. MSA was found to have a significant and direct effect on DAS. This suggests that intensive screen use may have direct adverse effects on mental health. MSA was also found to have essential effects on psychological vulnerability and resilience. In particular, psychological vulnerability had a direct effect on DAS, while psychological flexibility was found to reduce the adverse effects of DAS. Psychological vulnerability and resilience mediate the relationship between MSA and WFC, revealing the complexity of this relationship. These psychological factors shape the indirect effects of MSA on DAS.\u003c/p\u003e\u003cp\u003eIn terms of theoretical and practical contribution, it helps us better understand the relationships between screen addiction and mental health. The study makes significant contributions to the literature in this field by expanding the theoretical frameworks regarding screen addiction. It can also offer practical guidance for educators, parents, and mental health professionals, helping them develop strategies to reduce the adverse effects of screen addiction among youth. The findings of this study open several avenues for future research. First, it is essential to test the generalizability of the findings by conducting similar studies on different demographic groups. Additionally, examining changes over time and long-term effects by conducting longitudinal studies will help us understand the lasting effects of screen addiction on mental health. Finally, experimental studies are needed to evaluate the effectiveness of intervention and prevention programs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used the ethical principles stated in the Declaration of Helsinki. Ethical approval for this research was obtained from the Siirt University Ethics Committee. (Approval Number: 599, Date: 03.05.2023). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApplicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNT contributed to the conception and design of the study. HB performed data collection and analysis. OY wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants who participated in this study voluntarily.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAkın, A., \u0026amp; Eker, H. (2011). Turkish version of the Psychological Vulnerability Scale: A validity and reliability study. \u003cem\u003e32nd International Conference of the Stress and Anxiety Research Society\u003c/em\u003e. M\u0026uuml;nster, Germany.\u003c/li\u003e\n\u003cli\u003eAlshammari, T., Alseraye, S., Rogowska, A., Alrasheed, N., \u0026amp; Alshammari, M. (2022). 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The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students. \u003cem\u003ePsychiatry Research\u003c/em\u003e, \u003cem\u003e267\u003c/em\u003e, 313-318.https://doi.org/10.1016/j.psychres.2018.06.033\u003c/li\u003e\n\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":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Multiple-screen addiction, depression, anxiety, stress, psychological flexibility, vulnerability","lastPublishedDoi":"10.21203/rs.3.rs-6996902/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6996902/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study examines the mediating role of psychological flexibility and vulnerability variables in the relationships between multiple-screen addiction and depression, anxiety, and stress. Data were collected from 309 high school students (M\u003csub\u003eage\u003c/sub\u003e = 16.13, SD\u0026thinsp;=\u0026thinsp;1.40; 57% girls, 43% boys). Analyses were conducted using SPSS 25 and Hayes Model 6. Findings show that students with multiple screen addiction and high levels of depression, anxiety, and stress have low levels of psychological flexibility and high levels of psychological vulnerability. More importantly, psychological flexibility and vulnerability were found to play a fully mediating role in this relationship. As a result, it seems that strengthening psychological flexibility and reducing vulnerability have a significant effect in reducing the adverse effects of depression, anxiety, and stress caused by multiple screen addiction on students. These findings can provide necessary guidance in developing intervention programs and school policies.\u003c/p\u003e","manuscriptTitle":"Parallel Mediation of Psychological Flexibility and Vulnerability Between Multiple-Screen Addiction and Mental Health Outcomes in Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 09:55:46","doi":"10.21203/rs.3.rs-6996902/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-16T13:32:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-16T11:32:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52399089712949596239421938824142897939","date":"2025-11-12T08:44:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-09T02:29:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47950404790995391088209463769940850006","date":"2025-10-14T22:19:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261951906554013170149226348883490308337","date":"2025-10-14T19:41:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44252309296401654778997701334577395370","date":"2025-09-10T14:46:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T00:44:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318773340334328817338984462037329238375","date":"2025-08-20T08:53:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269682286562705239031875540321090057237","date":"2025-08-14T09:25:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T17:44:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-15T12:52:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-08T02:21:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-08T02:20:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-06-28T09:32:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6da5f70-ee0a-4638-be67-d894ceb8b10f","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:09:50+00:00","versionOfRecord":{"articleIdentity":"rs-6996902","link":"https://doi.org/10.1186/s40359-025-03856-w","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-01-10 15:59:12","publishedOnDateReadable":"January 10th, 2026"},"versionCreatedAt":"2025-08-19 09:55:46","video":"","vorDoi":"10.1186/s40359-025-03856-w","vorDoiUrl":"https://doi.org/10.1186/s40359-025-03856-w","workflowStages":[]},"version":"v1","identity":"rs-6996902","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6996902","identity":"rs-6996902","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}