{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:14:04Z","timestamp":1790745244377,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acne impairs physical appearance and triggers significant psychological distress, particularly depression, in young adults, but the underlying psychological mechanisms remain underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to examine the potential mediating associations of psychological inflexibility and social avoidance in the relationship between body image disturbance and depressive tendencies among young adults with acne in East China, based on the Acceptance and Commitment Therapy (ACT) framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among 201 young adults (18\u201329\u202fyears, 72.1% female) with acne from two tertiary hospitals in East China between December 2024 and February 2025. Validated instruments were used to assess body image disturbance (BIDQ), psychological inflexibility (AAQ-II), social avoidance (SADS-SA), and depression (PHQ-9). A serial mediation model (PROCESS Model 6) was analyzed via SPSS 29 with 5,000 bootstrap samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Correlation analysis showed significant positive relationships between body image disturbance, psychological inflexibility, social avoidance, and depression (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Mediation analysis revealed that body image disturbance had a significant total effect on depression [Effect\u202f=\u202f0.147, 95% CI (0.088, 0.205)], while its direct effect was non-significant. Two indirect pathways accounted for 84.1% of the total effect: (1) a single mediation through psychological inflexibility (70.8% of the effect); and (2) a serial mediation through psychological inflexibility and social avoidance (7.4% of the effect). Additionally, acne severity significantly predicted psychological inflexibility (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.184,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Body image disturbance indirectly influences depression primarily through the pathways of psychological inflexibility and social avoidance. Integrating ACT into dermatological care to enhance psychological flexibility may effectively alleviate depressive symptoms in acne patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1771242","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T12:34:16Z","timestamp":1773146056000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The mediating role of psychological inflexibility and social avoidance in relationship between body image disturbance and depression among young adults with acne in China"],"prefix":"10.3389","volume":"14","author":[{"given":"Fen","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Nursing Science, Faculty of Medicine, University of Malaya","place":["Kuala Lumpur, Malaysia"]},{"name":"Department of Dermatology, Hangzhou Third Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei Chan","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Nursing Science, Faculty of Medicine, University of Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxian","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Nursing, Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nursing Science, Faculty of Medicine, University of Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayin","family":"Ruan","sequence":"additional","affiliation":[{"name":"Rory Meyers College of Nursing, New York University","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Nursing Science, Faculty of Medicine, University of Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juping","family":"Tang","sequence":"additional","affiliation":[{"name":"Nursing Department, Hangzhou Third Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nor Aziyan","family":"Yahaya","sequence":"additional","affiliation":[{"name":"Department of Nursing Science, Faculty of Medicine, University of Malaya","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1056\/NEJMcp1702493","article-title":"Acne 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