ArticleNursing open2026
The Mediating Role of Cognitive Flexibility in the Relationship Between Self-Transcendence and Depression Symptom Level: A Sample of Health Department Students.
Article in Nursing open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimTo examine the cross-sectional indirect association between self-transcendence and depressive symptoms through cognitive flexibility and to determine whether the Alternatives and Control dimensions show different indirect associations.
designThe study had a descriptive, correlational, cross-sectional design.
methodsThe study population consisted of students studying in the nursing and midwifery department of a state university's Faculty of Health Sciences, and the sample consisted of 451 students (245 nursing and 206 midwifery). The data were collected using a Students' Personal Information Form (SPIF), the Self-Transcendence Scale (STS), the Cognitive Flexibility Inventory (CFI) and the Beck Depression Inventory (BDI). The self-report questionnaires were administered in classroom settings. Item scoring was audited against the published Cognitive Flexibility Inventory scoring key. A one-factor model and a correlated two-factor model were compared using diagonally weighted least squares. Regression-based indirect associations were estimated with HC3 heteroskedasticity-consistent standard errors and 5000 bias-corrected and accelerated bootstrap samples. The parallel dimension model and covariate-adjusted models were treated as exploratory sensitivity analyses.
resultsThe mean Cognitive Flexibility Inventory total score was 59.44 ± 7.70, and 164 students (36.4%) scored at or above the Beck Depression Inventory screening cutoff of 17, indicating elevated depressive symptoms rather than a clinical diagnosis. The correlated two-factor model fit substantially better than the one-factor model (CFI = 0.939, TLI = 0.931, RMSEA = 0.069, SRMR = 0.094). In the prespecified total-score model, the indirect association between self-transcendence and depressive symptoms through cognitive flexibility was statistically significant (B = -0.174, BootSE = 0.051, BCa 95% CI [-0.278, -0.077]). In the exploratory parallel model, the indirect association through the Control dimension was statistically significant (B = -0.123, BootSE = 0.040, BCa 95% CI [-0.212, -0.057]), whereas the indirect association through the Alternatives dimension was not (B = 0.042, BootSE = 0.060, BCa 95% CI [-0.073, 0.160]).
conclusionThe findings support a cross-sectional indirect association between self-transcendence and depressive symptoms through cognitive flexibility. The dimension-specific findings suggest that the total cognitive flexibility score may conceal different patterns across the Alternatives and Control dimensions. Temporal or causal mediation cannot be inferred from this cross-sectional study. Longitudinal and experimental studies are needed to further clarify these relationships. PATIENT OR PUBLIC CONTRIBUTION: Health department students contributed by providing anonymous self-reports. IMPACT: The findings identify the Control dimension as a potentially important focus for future longitudinal and intervention research on student mental health.
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