{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T02:28:49Z","timestamp":1786328929738,"version":"build-2736575974"},"reference-count":56,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nurs. Rep.","Nursing Reports"],"abstract":"<jats:p>Background: Early childhood caregivers are exposed to intensive caregiving demands and have a high risk of depression. Guided by the family stress process model and Acceptance and Commitment Therapy (ACT), this cross-sectional study examined whether psychological flexibility mediates the association between parenting stress and depression. Methods: A cross-sectional survey was conducted among 1140 Chinese primary caregivers of infants aged 0\u201336 months in Ya\u2019an, Sichuan, China, from 9 October 2022 to 8 October 2025 using convenience sampling. Validated scales included the Parenting Stress Index-Short Form (PSI-SF), Acceptance and Action Questionnaire-II (AAQ-II) (Higher AAQ-II scores reflected lower psychological flexibility), and Patient Health Questionnaire-8 (PHQ-8). Hayes\u2019 PROCESS Model 4, with 5000 bootstrap resamples, was adopted for the mediation analysis. Results: Parenting stress was positively associated with depressive symptoms (r = 0.335, p &lt; 0.01) (weak-to-moderate effect size). Psychological flexibility exerted a partial mediating effect between the two variables, and the indirect effect accounted for 45% of the total effect. Caregivers with lower household income, lower educational level, and those caring for children aged 0\u201312 months reported significantly higher depression (all p &lt; 0.05). Conclusions: Parenting stress is an important risk factor for depression, and psychological flexibility plays a significant partial mediating role in this relationship. ACT-based interventions targeting psychological flexibility may hold implications for depression among early childhood caregivers.<\/jats:p>","DOI":"10.3390\/nursrep16080278","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T01:20:03Z","timestamp":1786324803000},"page":"278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological Flexibility as a Mediator Between Parenting Stress and Depression Among Chinese Primary Caregivers of Infants: A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6234-1883","authenticated-orcid":false,"given":"Jie","family":"Zhou","sequence":"first","affiliation":[{"name":"School of Nursing, Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Nursing, Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Public Health, University of California, Berkeley, CA 94720, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwei","family":"Qian","sequence":"additional","affiliation":[{"name":"Research Institute of Economics and Management, Southwestern University of Finance and Economics, Chengdu 611130, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5094-6853","authenticated-orcid":false,"given":"Wei","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Nursing, Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxuan","family":"Ding","sequence":"additional","affiliation":[{"name":"School of Nursing, Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9677-1341","authenticated-orcid":false,"given":"Lei","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Nursing, Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1016\/S0140-6736(24)01389-8","article-title":"The next 1000 days: Building on early investments for the health and development of young children","volume":"404","author":"Draper","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Jiang, C., Li, X., Du, B.-C., Huang, J., Li, Y., Zhang, Y., Wei, M., Xu, X., Yang, Y., and Jiang, H. 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