Psychological Inflexibility and the Connection to Depression, Self-Harm, and Suicidality: Examining the Protective Role of Campus Belongingness for Black Undergraduate Students

Background and Purpose: Psychological inflexibility— the intended process of avoiding painful previous experiences or memories— has been linked to anxiety and depressive disorders. Few studies, however, have considered whether psychological inflexibility is associated with other outcomes like self-harm and suicide ideation; and even fewer studies have examined whether psychological inflexibility may explain some variability in increased rates of suicide in Black youth and young adults. Sense of belongingness is generally inked to improved mental health outcomes, though more work is needed to examine feelings of belongingness across various contexts and social domains. As such, the current study aims to redress this gap by (1) assessing whether psychological inflexibility is associated with past-year self-harm, depressive symptoms, and suicide ideation; and (2) testing whether sense of campus belongingness moderates the paths from inflexibility to self-harm, depression, and suicide ideation among Black undergraduate students in the U.S.

Methods: Cross-sectional survey responses were collected from 603 Black college students who participated in the Healthy Minds Survey. Psychological inflexibility was measured using the Acceptance and Action Questionnaire, while depressive symptoms were captured using the PHQ-9. Past year self-harm and suicide ideation were both measured using binary single items. Tests for measurement invariance and multiple-group structural equation modeling were conducted to determine whether the proposed model fit similarly for young adult Black men and women. Model fit indices (e.g., RMSEA, CFI, TLI, and SRMR) were assessed using cutoff criteria proposed by Hu and Bentler (1999). Missing data were handled using full information maximum likelihood in Mplus version 8.4.

Results: Measurement model results indicate that items in the PHQ-9 and AAQ were non-invariant across gender; scalar invariance was not achieved, and latent mean scores were not compared across gender groups. Instead, separate SEMs were conducted for Black women and men. Results from the structural models for both groups suggest good model fit. For women, psychological inflexibility was positively associated with depressive symptoms, self-harm, and suicide ideation. For men, psychological inflexibility was directly associated with depressive symptoms and self-harm, but not suicide ideation. The indirect effect from psychological inflexibility to suicide ideation via self-harm was statistically significant for women only. Further, sense of campus belongingness significantly weakened the strength of the association between inflexibility and depressive symptoms, while also moderating the relation between inflexibility and self-harm.

Conclusions and Implications: Facilitators and correlates of suicide ideation appear to differ for Black undergraduate women and men. Campuses and universities should prioritize policies that promote, foster, and facilitate a sense of campus belongingness in order to support Black college student’s wellbeing and mental health. Non-invariant items are indicative of larger psychometric issues, as the findings from this study suggest that young Black men and women are interpreting items on the PHQ-9 and AAQ differently. Study findings further highlight within-group differences when assessing mental health conditions among Black college students.