Psychological Inflexibility Moderates Stress and Loneliness in Depression Among Indonesian College Students During the COVID-19 Pandemic


The COVID-19 pandemic has had a tremendous impact on college students’ mental health. Recent studies have found increased perceived stress and loneliness during the pandemic, which are significant risk factors for depression. However, few researchers have specifically discussed the particular factors that can exacerbate the impact of these risk factors on depression. Psychological inflexibility is said to have an important role in facilitating the development of mental health problems. The current study explored the role of psychological inflexibility in moderating perceived stress and loneliness in depression during the COVID-19 pandemic. A cross-sectional study using an online survey was conducted to assess college students’ sociodemographic information, perceived stress, loneliness, and depression during the COVID-19 pandemic. A total of 941 Indonesian college students (age range = 18-39 years old, 74% female) were analyzed using correlation analysis and SPSS macro PROCESS moderation analysis. Several sociodemographic factors such as age, marital status, previous mental health record, education level, perceived impact of COVID-19, income, and financial status were significantly associated with depression and psychological inflexibility, and were thus controlled as covariates. As predicted, higher psychological inflexibility was associated with higher perceived stress, loneliness, and depression. Results showed psychological inflexibility elevated the effect of both perceived stress and loneliness on the depression level. These findings support previous literature regarding the significant role of psychological inflexibility in moderating the development of depression, especially during the COVID-19 pandemic. Based on the findings, it is recommended that alternative interventions are implemented to inhibit the development of depression by decreasing psychological inflexibility, while considering sociodemographic factors.

Keywords: OVID-19 pandemic, college student, depression, psychological Inflexibility, perceived stress, loneliness

[1] World Health Organization. WHO coronavirus disease (COVID-19) dashboard. 2020. Cite at 21 Dec 2021. Available from:

[2] Chakraborty I, Maity, P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Science of the Total Environment. 2020;728:138882.

[3] Cao W, Fang Z, Hou G, Han M, Xu X, Dong J. The psychological impact of the COVID- 19 epidemic on college students in China. Psychiatry Research. 2020;287(May 2020)112934.

[4] Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)- related psychological and mental problems: Structured letter therapy. Psychiatry Investigation. 2020;17(2):175–176.

[5] Pierce M, Hope H, Ford T, et al. Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry. 2020;7(10):883–892.

[6] Liu CH, Zhang E, Wong GTF, Hyun S, Hahm HC. Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health. Psychiatry Research. 2020;290:113172.

[7] Bruffaerts R, Mortier P, Kiekens G, et al. Mental health problems in college freshmen: Prevalence and academic functioning. Journal of Affective Disorders. 2018;225(December 2016):97–103.

[8] Arnett JJ. Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist. 2000;55(5):469–480.

[9] Pedrelli P, Nyer M, Yeung A, Zulauf C, Wilens T. College students: Mental health problems and treatment considerations. Academic Psychiatry. 2015;39(5):503–511.

[10] Tavakoli N, Broyles A, Reid EK, Sandoval JR, Correa-Fernández V. Psychological inflexibility as it relates to stress, worry, generalized anxiety, and somatization in an ethnically diverse sample of college students. Journal of Contextual Behavioral Science. 2019;11(May):1–5.

[11] Zhang M, Zhang J, Zhang F, Zhang L, Feng D. Prevalence of psychological distress and the effects of resilience and perceived social support among Chinese college students: Does gender make a difference? Psychiatry Research. 2018;267( June):409–413.

[12] Conrad R, Rayala H, Menon M, Vora K. Universities’ response to supporting mental health of college students during the COVID-19 pandemic. Psychiatric Times. 23 March 2020. Cite 21 Dec 2021 Available from: college-students-during-covid-19-pandemic

[13] Huckins JF, daSilva AW, Wang W, et al. Mental health and behavior of college students during the early phases of the COVID-19 pandemic: Longitudinal smartphone and ecological momentary assessment study. Journal of Medical Internet Research. 2020;22(6):e20185.

[14] Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. 2020;186.

[15] Wang ZH, Yang HL, Yang YQ, et al. Prevalence of anxiety and depression symptom, and the demands for psychological knowledge and interventions in college students during COVID-19 epidemic: A large cross-sectional study. Journal of Affective Disorders. 2020;275(1023):188–193.

[16] Pakenham KI, Landi G, Boccolini G, Furlani A, Grandi S, Tossani E. The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy. Journal of Contextual Behavioral Science. 2020;17( July):109–118.

[17] Chirikov I, Soria KM, Horgos B, Jones-White, D. Undergraduate and graduate students’ mental health during the COVID-19 pandemic. 2020. 2020- 08-17. UC Berkeley: Center for Studies in Higher Education. Retrieved from

[18] Evans TM, Bira L, Gastelum, JB, Weiss LT, Vanderford NL. Evidence for a mental health crisis in graduate education. Nature Biotechnology. 2018;36(3):282–284.

[19] Levecque K, Anseel F, De Beuckelaer A, Van der Heyden J, Gisle L. Work organization and mental health problems in PhD students. Research Policy. 2017;46(4):868–879.

[20] Stay home, President says. The Jakarta Post. 2020 March 16. Available from:

[21] Indonesian Psychiatric Association. 5 bulan pandemi COVID-19 di Indonesia. 2020 August 4. Available from:

[22] UNICEF. Young people take the lead on mental health. 2020 August 28. Available from: health

[23] Tull MT, Edmonds KA, Scamaldo KM, Richmond JR, Rose JP, Gratz KL. Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Research. 2020;289(April):113098.

[24] World Health Organization. Depression. [Date Unknown]. Available from:

[25] Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging. 2006;21(1):140–151.

[26] Richardson T, Elliott P, Roberts R. Relationship between loneliness and mental health in students. Journal of Public Mental Health. 2017;16(2):48–54.

[27] Alaviani M, Parvan R, Karimi F, Safiri S, Mahdavi N. Prevalence of loneliness and associated factors among Iranian college students during 2015. Journal of Archives in Military Medicine. 2017;5(1).

[28] Moeller RW, Seehuus M. Loneliness as a mediator for college students’ social skills and experiences of depression and anxiety. Journal of Adolescence. 2019;73(March):1–13.

[29] Thomas L, Orme E, Kerrigan F. Student loneliness: The role of social media through life transitions. Computers and Education. 2020;146(September):103754.

[30] Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. 2nd ed. 2012. New York: The Guilford Press

[31] Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior. 1983;24(4):385–396.

[32] Cristóbal-Narváez P, Haro JM, Koyanagi A. Perceived stress and depression in 45 low- and middle-income countries. Journal of Affective Disorders. 2020;274(April):799–805.

[33] Kuiper NA, Olinger LJ, Lyons LM. Global perceived stress level as a moderator of the relationship between negative life events and depression. Journal of Human Stress. 1986;12(4):149–153.

[34] Pedrelli P, Feldman GC, Vorono S, Fava M, Petersen T. Dysfunctional attitudes and perceived stress predict depressive symptoms severity following antidepressant treatment in patients with chronic depression. Psychiatry Research. 2008;161(3):302– 308.

[35] Lazarus RS. Psychological stress and the coping process. The American Journal of Psychology. 1966;83(4):634–637.

[36] Peplau LA, Perlman D. Loneliness: A sourcebook of current theory, research, and therapy. New Jersey: Wiley; 1982.

[37] Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet. 2020;395(10227):912–920.

[38] Davis AK, Barrett FS, Griffiths RR. Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science. 2020;15(April 2019):39–45.

[39] Dawson DL, Golijani-Moghaddam N. COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic. Journal of Contextual Behavioral Science. 2020.

[40] Kroska EB, Roche AI, Adamowicz JL, Stegall MS. Psychological flexbility in the context of COVID-19 adversity: Associations with distress. Journal of Contextual Behavioral Science. 2020.

[41] Kashdan TB, Rottenberg J. Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review. 2010;30(4):865–878.

[42] Tyndall I, Waldeck D, Pancani L, Whelan R, Roche B, Pereira A. Profiles of psychological flexibility. Behavior Modification. 2020;44(3):365–393.

[43] Bond FW, Hayes SC, Baer RA, et al. Preliminary psychometric properties of the acceptance and action questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy. 2011;42(4):676–688.

[44] Eisenbeck N, Carreno DF, Uclés-Juárez R. From psychological distress to academic procrastination: Exploring the role of psychological inflexibility. Journal of Contextual Behavioral Science. 2019;13(February):103–108.

[45] kashdan ME, MacLane C, Daflos S, et al. Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science. 2014;3(3):155–163.

[46] Schramm AT, Pandya K, Fairchild AJ, Venta AC, de Roon-Cassini TA, Sharp C. Decreases in psychological inflexibility predict PTSD symptom improvement in inpatient adolescents. Journal of Contextual Behavioral Science. 2020;17( June):102–108.

[47] Crasta D, Daks JS, Rogge RD. Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide. Journal of Contextual Behavioral Science. 2020;18(August):117–127.

[48] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy. 2006;44(1):1–25.

[49] Peltz JS, Rogge RD, Bodenlos JS, Kingery JN, Pigeon WR. Changes in psychological inflexibility as a potential mediator of longitudinal links between college students’ sleep problems and depressive symptoms. Journal of Contextual Behavioral Science. 2020;15( July):110–122.

[50] Jeffords JR, Bayly BL, Bumpus MF, Hill LG. Investigating the relationship between university students’ psychological flexibility and college self-efficacy. Journal of College Student Retention: Research, Theory & Practice. 2020;22(2):351–372.

[51] Hary ZAP. Hubungan antara kelekatan terhadap ibu dengan tingkat stres pada mahasiswa perantau [Undergraduate thesis].Jakarta: Sanata Dharma University; 2017.

[52] Russell D. UCLA Loneliness Scale Version 3 (Instructions). Journal of Personality Assessment. 1996;66(42):3–4.

[53] Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology. 1980;39(3):472–480.

[54] Jaya ES, Arjadi R, Ayuningtyas AUH, Utoyo DB. Investigation in the validity and reliability of the Indonesian UCLA loneliness scale. 22nd International Congress IACCP. 2014.

[55] Permadi D, Nurwianti F. Mindfulness and coping skills as predictors of competitive anxiety amongst athletes in Indonesia. ANIMA Indonesian Psychological Journal. 2019;33(4):231–240.

[56] Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606–613.

[57] Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Kenny DA, Little TD, editors. New York: The Guilford Press; 2018.

[58] Kelley K, Preacher KJ. On effect size. Psychological Methods. 2012;17(2):137–152.

[59] Kashdan TB, Kane JQ. Post-traumatic distress and the presence of post-traumatic growth and meaning in life: Experiential avoidance as a moderator. Personality and Individual Differences. 2011;50(1):84–89.

[60] Inchausti F, MacBeth A, Hasson-Ohayon I, Dimaggio G. Psychological intervention and COVID-19: What we know so far and what we can do. Journal of Contemporary Psychotherapy. 2020;50(4):243–250.

[61] Levin ME, Krafft J, Twohig MP. Examining processes of change in an online acceptance and commitment therapy dismantling trial with distressed college students. Journal of Contextual Behavioral Science. 2020;17(April):10–16.

[62] Xiao H, Carney DM, Youn SJ, et al. Are we in crisis? National mental health and treatment trends in college counseling centers. Psychological Services. 2017;14(4):407–415.