Relationship Between Psychological Flexibility and Psychological Distress Among Medical Students at a Malaysian Public University: A Cross-sectional Study

Introduction: In the demanding environment of medical education, medical students are increasingly vulnerable to psychological distress, including stress, anxiety, and depression. Despite its significant impact on students’ well-being and academic performance, and evidence suggesting that psychological flexibility may protect against mental health disorders, the relationship between psychological flexibility and psychological distress remains relatively underexplored among medical students. Exploring this association is crucial for developing interventions to support medical students' mental health and academic success. Materials and Methods: This cross-sectional study involved 266 medical students enrolled in a public university in Selangor, Malaysia. Participants were selected through stratified random sampling. Personalized Psychological Flexibility Index (PPFI) was used to assess psychological flexibility and the Depression Anxiety Stress Scales-21 (DASS-21) was used to measure psychological distress. Results: The students exhibit moderate psychological flexibility. Anxiety is the most prevalent psychological distress, followed by depression and stress. Higher avoidance is associated with reduced depression and stress. Later academic years, greater satisfaction with academic performance and social life consistently correlate with reduced psychological distress.  Conclusion: This study found no association between overall psychological flexibility score and psychological distress among medical students, however subgroup analysis indicated that higher avoidance was linked to reduced depression and stress. Future research should investigate the mechanisms by which avoidance may contribute to lower psychological distress, as well as to explore mechanisms to promote healthier coping strategies to improve psychological flexibility.