Nurs Open. 2026 Aug;13(8):e70761. doi: 10.1002/nop2.70761.
ABSTRACT
AIM: To 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.
DESIGN: The study had a descriptive, correlational, cross-sectional design.
METHODS: The 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.
RESULTS: The 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]).
CONCLUSION: The 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.
PMID:42625518 | DOI:10.1002/nop2.70761
