AccScience Publishing / JCBP / Online First / DOI: 10.36922/JCBP025150028
ORIGINAL RESEARCH ARTICLE

Moderated mediation associations between interpersonal sensitivity, depression, somatization, and emotional stability in adolescents

Rapson Gomez1,2* Vasileios Stavropoulos1 Taylor Brown1 Stelios Papapetrou3
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1 Department of Applied Health, School of Health and Biomedical Science, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
2 Department of Psychology, Institute of Health and Well Being, Federation University, Ballarat, Victoria, Australia
3 Cyprus Youth Organization, Nicosia, Cyprus
Received: 7 April 2025 | Revised: 16 January 2026 | Accepted: 16 January 2026 | Published online: 20 February 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Somatization in adolescence is a growing concern, often linked to underlying psychological factors, such as interpersonal sensitivity and depression. This study recruited 997 adolescents aged 14–18 years from Cyprus (436 males and 561 females) to investigate the moderated mediation model in which depression mediated the relationship between interpersonal sensitivity and somatization, and emotional stability was tested as a moderator of key pathways. All participants completed standardized self-report measures assessing interpersonal sensitivity, depression, somatization, and emotional stability. The moderated mediation model was analyzed using Hayes’ PROCESS macro for SPSS (Model 59). The findings indicated that emotional stability did not moderate the association between interpersonal sensitivity and depression, nor between depression and somatization. However, emotional stability moderated the association between interpersonal sensitivity and somatization, such that the association was stronger at higher levels of emotional stability. With respect to moderated mediation, comparable support was observed for the indirect effect across low, mean, and high levels of emotional stability, providing no evidence of moderated mediation. The theoretical and applied implications of these findings are discussed.

Keywords
Adolescence
Cyprus
Depression
Interpersonal sensitivity
Somatization
Emotional stability
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Anderson G, Berk M, Maes M. Biological phenotypes underpin the physio-somatic symptoms of somatization, depression, and chronic fatigue syndrome. Acta Psychiatr Scand. 2014;129(2):83-97. doi: 10.1111/acps.12182

 

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. doi: 10.1176/appi.books.9780890425596

 

  1. Becker JP, Paixão R, Quartilho MJ. Psychopathology and somatic complaints: A cross-sectional study with Portuguese adults. Healthcare (Basel). 2021;9(4):478. doi: 10.3390/healthcare9040478

 

  1. Gierk B, Kohlmann S, Hagemann-Goebel M, Löwe B, Nestoriuc Y. Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the somatic symptom scale–8 (SSS-8). Gen Hosp Psychiatry. 2017;48:51-55. doi: 10.1016/j.genhosppsych.2017.07.002

 

  1. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258-266. doi: 10.1097/00006842-200203000-00008

 

  1. Lignier B, Petot JM, Canada B, Nicolas M, Courtois R, De Oliveira P. The structure of the Symptom Checklist-90- Revised: Global distress, somatization, hostility, and phobic anxiety scales are reliable and robust across community and clinical samples from four European countries. Psychiatry Res. 2024;331:115635. doi: 10.1016/j.psychres.2023.115635

 

  1. Löwe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment. Gen Hosp Psychiatr. 2008;30(3):191-199. doi: 10.1016/j.genhosppsych.2008.01.001

 

  1. Toussaint A, Murray AM, Voigt K, et al. Development and validation of the somatic symptom disorder-B criteria scale (SSD-12). Psychosom Med. 2016;78(1):5-12. doi: 10.1097/PSY.0000000000000240

 

  1. Dhossche D, van der Steen F, Ferdinand R. Somatoform disorders in children and adolescents: A comparison with other internalizing disorders. Ann Clin Psychiatry. 2002;14:23-31. doi: 10.3109/10401230209147395

 

  1. Geremek A, Lindner C, Jung M, Calvano C, Munz M. Prevalence of somatic symptoms and somatoform disorders among a German adolescent psychiatric inpatient sample. Children (Basel). 2024;11(3):280. doi: 10.3390/children11030280

 

  1. Gomez R, Stavropoulos V, Zarate D, Palikara O. Symptom Checklist-90-Revised: A structural examination in relation to family functioning. PLoS One. 2021;16(3):e0247902. doi: 10.1371/journal.pone.0247902

 

  1. Schmidt U, Laessle R. Physical complaints in girls with major depression--a controlled study. Psychiatry Res. 2014;218(1-2):98-100. doi: 10.1016/j.psychres.2014.04.010

 

  1. Tylee A, Gandhi P. The importance of somatic symptoms in depression in primary care. Prim Care Companion J Clin Psychiatr. 2005;7:167-176. doi: 10.4088/pcc.v07n0405

 

  1. Anda R, Tietjen G, Schulman E, Felitti V, Croft J. Adverse childhood experiences and frequent headaches in adults. Headache. 2010;50(9):1473-1481. doi: 10.1111/j.1526-4610.2010.01756.x

 

  1. Otani K, Suzuki A, Kamata M, Matsumoto Y, Shibuya N, Sadahiro R. Interpersonal sensitivity is correlated with sociotropy but not with autonomy in healthy subjects. J Nerv Ment Dis. 2012;200(2):153-155. doi: 10.1097/NMD.0b013e3182438cba

 

  1. Çolak TS. Somatic expression of psychological problems somatization: Examination with structural equation model. Int J Psychol Educ Stud. 2014;1(1):8-14. doi: 10.17220/ijpes.2014.01.003

 

  1. Davidson J, Zisook S, Giller E, Helms M. Symptoms of interpersonal sensitivity in depression. Compr Psychiatry. 1989;30(5):357-368. doi: 10.1016/0010-440X(89)90001-1

 

  1. Jiang Y, Ren Y, Liu T, You, J. Rejection sensitivity and adolescent non-suicidal self-injury: Mediation through depressive symptoms and moderation by fear of self-compassion. Psychol Psychother. 2021;94 Suppl 2:481-496. doi: 10.1111/papt.12293

 

  1. Jin J, Tang YY, Ma Y, Lv S, Bai Y, Zhang H. A structural equation model of depression and the defense system factors: A survey among Chinese college students. Psychiatry Res. 2009;165(3):288-296. doi: 10.1016/j.psychres.2008.03.012

 

  1. Lei X, Liu C, Jiang H. Mental health of college students and associated factors in Hubei of China. PLoS One. 2021;16(7):e0254183. doi: 10.1371/journal.pone.0254183

 

  1. Xu H, Peng L, Wang Z, Zeng P, Liu X. Interpersonal sensitivity on college freshmen’s depression: A moderated moderation model of psychological capital and family support. Front Psychiatry. 2022;13:921045. doi: 10.3389/fpsyt.2022.921045

 

  1. Zhao X, Wu M, Zhang D, et al. The relationship of interpersonal sensitivity and depression among patients with chronic atrophic gastritis: The mediating role of coping styles. J Clin Nurs. 2017;27(5-6):e984-e991. doi: 10.1111/jocn.14114

 

  1. Wilhelm K, Boyce P, Brownhill S. The relationship between interpersonal sensitivity, anxiety disorders and major depression. J Affect Disord. 2004;79(1-3):33-41. doi: 10.1016/S0165-0327(02)00069-1

 

  1. McCrae RR, Costa PT. The five-factor theory of personality. In: John, OP, Robins RW, Pervin LA, editors. Handbook of Personality: Theory and Research. 3rd ed. New York: Guilford Press; 2008. p. 159-181.

 

  1. McCrae RR, Costa PT, de Lima MP, et al. Age differences in personality across the adult life span: Parallels in five cultures. Dev Psychol. 1999;35(2):466-477. doi: 10.1037/0012-1649.35.2.466

 

  1. McCrae RR, Terracciano A. Universal features of personality traits from the observer’s perspective: Data from 50 cultures. J Pers Soc Psychcol. 2005;88(3):547-561. doi: 10.1037/0022-3514.88.3.547

 

  1. Gomez R, Corr PJ. ADHD and personality: A meta-analytic review. Clin Psychol Rev. 2014;34(5):376-388. doi: 10.1016/j.cpr.2014.05.002

 

  1. Jeronimus BF, Kotov R, Riese H, Ormel J. Neuroticism’s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time. Psychol Med. 2016;46(14):2883-2906. doi: 10.1017/S0033291716001653

 

  1. Klein DN, Kotov R, Bufferd SJ. Personality and depression: Explanatory models and review of the evidence. Ann Rev Clin Psychol. 2011;7:269-295. doi: 10.1146/annurev-clinpsy-032210-104540

 

  1. Kotov R, Gamez W, Schmidt F, Watson D. Linking big personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychol Bull. 2010;136(5):768-821. doi: 10.1037/a0020327

 

  1. Malouff JM, Thorsteinsson EB, Schutte NS. The relationship between the five-factor model of personality and symptoms of clinical disorders: A meta-analysis. J Psychopathol Behav Assess. 2005;27:101-114. doi: 10.1007/s10862-005-5384-y

 

  1. Ohi K, Shimada T, Nitta Y, et al. The five-factor model personality traits in schizophrenia: A meta-analysis. Psychiatry Res. 2016;240:34-41. doi: 10.1016/j.psychres.2016.04.004

 

  1. Ormel J, Jeronimus BF, Kotov R, et al. Neuroticism and common mental disorders: Meaning and utility of a complex relationship. Clin Psych Rev. 2013;33(5):686-697. doi: 10.1016/j.cpr.2013.04.003

 

  1. Widiger TA. Personality and psychopathology. World Psychiatry. 2011;10(2):103-106. doi: 10.1002/j.2051-5545.2011.tb00024.x

 

  1. Hakulinen C, Jokela M, Kivimäki M, Elovainio M. Personality traits and mental disorders. In: The Cambridge Handbook of Personality Psychology. Cambridge: Cambridge University Press; 2020. p. 183-192.

 

  1. Rosmalen JG, Neeleman J, Gans RO, de Jonge P. The association between neuroticism and self-reported common somatic symptoms in a population cohort. J Psychosom Res. 2007;62(3):305-311. doi: 10.1016/j.jpsychores.2006.10.014

 

  1. Williams PG, O’Brien CD, Colder CR. The effects of neuroticism and extraversion on self-assessed health and health-relevant cognition. Pers Individ Differ. 2004; 37(1):83-94. doi: 10.1016/j.paid.2003.08.001

 

  1. Lamm TT, Von Schrottenberg V, Rauch A, et al. Five-factor personality traits and functional somatic disorder: A systematic review and meta-analysis. Clin Psych Rev. 2024;11:102529. doi: 10.1016/j.cpr.2024.102529

 

  1. Gomez R, Karimi L, Hein K, Papapetrou S, Stavropoulos V. Symptom Checklist-90-Revised: Factor structure and relevance as a measure for the Hierarchical Taxonomy of Psychopathology model. Int J Ment Health. 2024:1-24. doi: 10.1080/00207411.2024.2347188

 

  1. Watson D, Kendall PC. Understanding anxiety and depression. In: Kendall PC, Watson D, editors. Anxiety and Depression: Distinctive and Overlapping Features. Cambridge: Academic Press; 1989. p. 3-26.

 

  1. Xia J, He Q, Li Y, et al. The relationship between neuroticism, major depressive disorder and comorbid disorders in Chinese women. J Affect Disord. 2011;135(1-3):100-105. doi: 10.1016/j.jad.2011.06.053

 

  1. Liu C, Chen L, Chen S. Influence of neuroticism on depressive symptoms among Chinese adolescents: Mediation effects of cognitive emotion regulation strategies. Front Psychiatry. 2020;11:420. doi: 10.3389/fpsyt.2020.00420

 

  1. Costa PT, McCrae RR. Major contributions to the psychology of personality. In: Hans Eysenck: Consensus and Controversy. London: Routledge; 2012. p. 65-74.

 

  1. Dong Y, Liu F, Jiang Y, Wei S. Neuroticism and aggressive behavior among left behind children: Mediating roles of interpersonal sensitivity and bullying victimization. Int J Environl Res Public Health. 2022;19(17):11072. doi: 10.3390/ijerph191711072

 

  1. Tackett JL. Evaluating models of the personality-psychopathology relationship in children and adolescents. Clin Psychol Rev. 2006;26(5):584-599. doi: 10.1016/j.cpr.2006.04.003

 

  1. Kredentser MS, Mackenzie CS, McClement SE, et al. Neuroticism as a moderator of symptom-related distress and depression in noncancer end-of-life populations. Palliat Support Care. 2024;22(6):1750-1758. doi: 10.1017/S147895152300127X

 

  1. Smith KA, Barstead MG, Rubin KH. Neuroticism and conscientiousness as moderators of the relation between social withdrawal and internalizing problems in adolescence. J Youth Adolesc. 2017;46:772-786. doi: 10.1007/s10964-016-0594-z

 

  1. Vesterling C, Schütz-Wilke J, Bäker N, et al. Epidemiology of somatoform symptoms and disorders in childhood and adolescence: A systematic review and meta-analysis. Health Soc Care Community. 2023;2023:6242678. doi: 10.1155/2023/6242678

 

  1. Silber TJ. Somatization disorders: Diagnosis, treatment, and prognosis. Pediatr Rev. 2011;32(2):56-64. doi: 10.1542/pir.32-2-56

 

  1. Derogatis LR. SCL-90-R: Administration, Scoring, and Procedures Manual. Minneapolis: National Computer Systems; 1983.

 

  1. Derogatis LR, Cleary PA. Factorial invariance across gender for the primary symptom dimensions of the SCL-90. Br J Soc Clin Psychcol. 1977;16(4):347-356. doi: 10.1111/j.2044-8260.1977.tb00241.x

 

  1. Derogatis LR, Savitz KL. The SCL–90–R and Brief Symptom Inventory (BSI) in primary care. In: Maruish ME, editor. Handbook of Psychological Assessment in Primary Care Settings. New Jersey: Lawrence Erlbaum Associates; 2000. p. 297-334.

 

  1. Asendorpf JB, Van Aken MAG. Personality-relationship transaction in adolescence: Core versus surface personality characteristics. J Pers. 2003;71(4):629-666. doi: 10.1111/1467-6494.7104005

 

  1. Asendorpf JB, Van Aken MAG. Validity of the big five personality judgments in childhood: A 9-year longitudinal study. Eur J Pers. 2003;17(1):629-66. doi: 10.1002/per.460

 

  1. Donias S, Karastergiou A, Manos N. Standardization of the Symptom Checklist-90-R rating scale in a Greek population. Psychiatriki. 1991;2(1):42-48.

 

  1. Franke GH. Symptom-Checklist-90®-Standard. Göttingen: Hogrefe; 2016.

 

  1. Vaurio R. Symptom checklist-90-revised. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. Berlin: Springer New York; 2011. p. 2447-2450. doi: 10.1007/978-0-387-79948-3_2012

 

  1. Morera OF, Stokes SM. Coefficient α as a measure of test score reliability: Review of 3 popular misconceptions. Am J Public Health. 2016;106:458-461. doi: 10.2105/AJPH.2015.302993

 

  1. McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers. 1992;60(2):175-215. doi: 10.1111/j.1467-6494.1992.tb00970.x

 

  1. Widiger TA, Trull TJ. Plate tectonics in the classification of personality disorder: Shifting to a dimensional model. Am Psychol. 2007;62(2):71-83. doi: 10.1037/0003-066X.62.2.71

 

  1. Raharjanti NW, Wiguna T, Purwadianto A, et al. Translation, validity and reliability of decision style scale in forensic psychiatric setting in Indonesia. Heliyon. 2022;8(7):e09810. doi: 10.1016/j.heliyon.2022.e09810

 

  1. Hair JF, Babin B, Money AH, Samuel P. Essentials of Business Research Methods. United States: John Wiley & Sons; 2003.

 

  1. Shi J, Mo X, Sun Z. Content validity index in scale development. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012;37:152-155. doi: 10.3969/j.issn.1672-7347.2012.02.007

 

  1. Fuller CM, Simmering MJ, Atinc G, Atinc Y, Babin BJ. Common methods variance detection in business research. J Bus Res. 2016;60:3195-3198. doi: 10.1016/j.jbusres.2015.12.008

 

  1. Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate Data Analysis with Readings. 4th ed. United States: Prentice Hall; 1995.

 

  1. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. 3rd ed. New York: Guilford Press; 2022.

 

  1. Harman HH. Modern Factor Analysis. Chicago: University of Chicago Press; 1960.

 

  1. Cohen J. Statistical power analysis. Curr Dir Psychol Sci. 1992;1(3):98-101. doi: 10.1111/1467-8721.ep10768783

 

  1. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clin Psychol Sci Pract. 2003;10(2):144-156. doi: 10.1093/clipsy.bpg016

 

  1. Billones R, Nada L, Saligan L. What works in mindfulness interventions for medically unexplained symptoms? A systematic review. Asian Pac Isl Nurs J. 2020;5(1):1-11. doi: 10.31372//20200501.1082

 

  1. Hoge EA, Bui E, Marques L, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder. J Clin Psychiatry. 2013;74(8):786-792. doi: 10.4088/JCP.12m08083

 

  1. Hilton L, Hempel S, Ewing BA, et al. Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Ann Behav Med. 2017;51(2):199-213. doi: 10.1007/s12160-016-9844-2

 

  1. Lakhan, SE, Schofield, KL. Mindfulness-based therapies in the treatment of somatization disorders: A systematic review and meta-analysis. PLoS One. 2013;8(8):e71834. doi: 10.1371/journal.pone.0071834

 

  1. Micheli, N, Porcelli, P, Barrault-Couchouron, M, Dantzer, C. Does the practice of mindfulness reduce somatic symptoms and COVID-19-related anxiety? Front Psychol. 2022;13:996559. doi: 10.3389/fpsyg.2022.996559

 

  1. Zargar F, Rahafrouz L, Tarrahi MJ. Effect of mindfulness-based stress reduction on psychological symptoms and symptom severity in patients with somatic symptom disorder. Adv Biomed Res. 2021;10(1):9. doi: 10.4103/abr.abr_111_19

 

  1. Dekeyser M, Raes F, Leijssen M, Leysen S, Dewulf D. Mindfulness skills and interpersonal behaviour. Pers Individ Differ. 2008;44(5):1235-1245. doi: 10.1016/j.paid.2007.11.018

 

  1. Franco C, Mañas I, Cangas AJ, Moreno E, Gallego J. Reducing teachers’ psychological distress through a mindfulness training program. Span J Psychol. 2010;13(2):655-666. doi: 10.1017/S1138741600002328

 

  1. Hofmann SG, Gómez AF. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am. 2017;40(4):739-749. doi: 10.1016/j.psc.2017.08.008

 

  1. Strauss C, Cavanagh K, Oliver A, Pettman D. Mindfulness-based interventions for anxiety or depressive disorders: A meta-analysis. PLoS One. 2014;9(4):e96110. doi: 10.1371/journal.pone.0096110

 

  1. Teasdale JD, Segal ZV, Williams JMG, et al. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68(4):615-623. doi: 10.1037/0022-006X.68.4.615

 

  1. Angarita-Osorio N, Escorihuela RM, Cañete T. The relationship between neuroticism as a personality trait and mindfulness skills: A scoping review. Front Psychol. 2024;15:1401969. doi: 10.3389/fpsyg.2024.1401969

 

  1. Drake MM, Morris M, Davis TJ. Neuroticism’s susceptibility to distress moderated by mindfulness. Pers Individ Dif. 2017;106:248-252. doi: 10.1016/j.paid.2016.10.060

 

  1. Segal Z, Williams M, Teasdale J. Mindfulness-Based Cognitive Therapy for Depression. New York: Guilford Press; 2012.

 

  1. Perry-Parrish C, Copeland-Linder N, Webb L, Sibinga EM. Mindfulness-based approaches for children and youth. Curr Probl Pediatr Adolesc Health Care. 2016;46(6):172-178. doi: 10.1016/j.cppeds.2015.12.006

 

  1. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis. New York: Guilford Press; 2013.

 

  1. Winer ES, Cervone D, Bryant J, McKinney C, Liu RT, Nadorff MR. Distinguishing mediational models and analyses in clinical psychology. J Clin Psychol. 2016;72(9):947-955. doi: 10.1002/jclp.22298
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