Automatic Thoughts as Mediators Between Eco-Anxiety, Depression, and Anxiety

Background: This study investigated the associations between eco-anxiety, anxiety, depression, and automatic thoughts, and tested whether automatic thoughts mediate the relationship of eco-anxiety with anxiety and depression. Methods: A cross-sectional survey was conducted with 319 medical students. Participants completed the Eco-Anxiety Scale, Hospital Anxiety and Depression Scale (HAD), and Automatic Thoughts Scale (ATS). Results: Eco-anxiety scores were significantly correlated with HAD-anxiety (r = 0.523, P < .001), HAD-depression (r = 0.296, P < .001), and ATS (r = 0.704, P < .001). In mediation analyses, ATS fully mediated the relationship between eco-anxiety and depression (indirect effect a×b = 0.180, standard error (SE) = 0.027), accounting for 83% of the total effect, while the direct effect was nonsignificant (c′ = −0.037, P = .258). For anxiety, ATS partially mediated the association (indirect effect a×b = 0.161, SE = 0.026), explaining 64.8% of the total effect, with the direct effect remaining significant (c′ = 0.088, P = .005). In multiple-mediator models, only the Giving Up/Helplessness subscale showed significant indirect effects for both depression and anxiety. Conclusion: This study suggests that eco-anxiety is present and clinically relevant in this young medical student sample and its association with anxiety and depression. Furthermore, a strong correlation between eco-anxiety and automatic thoughts was found, and the Giving Up/Helplessness subscale emerged as a specific cognitive phenotype. Interventions targeting automatic thoughts may be promising, although longitudinal studies are needed.