Relationship between socio-linguistic factors and symptoms of depression, anxiety and psychosis in the general population

F on ie s in Psychology 01 on ie sin.o g
TYPE O iginal Resea ch
PUBLISHED 20 Feb ua y 2026
DOI 10.3389/ psyg.2026.1690424
OPEN ACCESS
EDITED BY
Daniel H. Robinson,
The Uni e si y o Texas a A ling on
College o Educa ion, Uni ed S a es
REVIEWED BY
Inmaculada Méndez,
Uni e si y o Mu cia, Spain
Ca los Fe ás Sex o,
Uni e si y o San iago de Compos ela,
Spain
*CORRESPONDENCE
Lei e E ko eka
lei e.e ko ekagonzalez@
osakide za.eus
RECEIVED 21 Augus 2025
REVISED 26 Janua y 2026
ACCEPTED 26 Janua y 2026
PUBLISHED 20 Feb ua y 2026
CITATION
Ozamiz-E xeba ia N, E ko eka L and
Mancini S (2026) Rela ionship be ween
socio-linguis ic ac o s and symp oms
o dep ession, anxie y and psychosis in
he gene al popula ion.
F on . Psychol. 17:1690424.
doi: 10.3389/ psyg.2026.1690424
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© 2026 Ozamiz-E xeba ia, E ko eka
and Mancini. This is an open-access
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C ea i e Commons A ibu ion License
(CC BY). The use, dis ibu ion o
ep oduc ion in o he o ums is
pe mi ed, p o ided he o iginal
au ho (s) and he copy igh owne (s) a e
c edi ed and ha he o iginal publica ion
in his jou nal is ci ed, in acco dance
wi h accep ed academic p ac ice. No
use, dis ibu ion o ep oduc ion is
pe mi ed which does no comply wi h
hese e ms.
Rela ionship be ween
socio-linguis ic ac o s and
symp oms o dep ession, anxie y
and psychosis in he gene al
popula ion
Naia aOzamiz-E xeba ia
1, Lei eE ko eka
1,2,3,4* and
SimonaMancini
5,6
1Uni e si y o he Basque Coun y UPV-EHU, Leioa, Spain, 2Galdakao-Usansolo Uni e si y Hospi al,
Osakide za Basque Heal h Se ice, Galdakao, Spain, 3BioBizkaia Heal h Resea ch Ins i u e, Ba akaldo,
Spain, 4CIBERSAM ISCII, Mad id, Spain, 5Basque Cen e on Cogni ion, B ain and Language,
Donos ia-San Sebas ian, Spain, 6Ike basque, Basque Founda ion o Science, Bilbao, Spain
In oduc ion: O e he las decade, and especially since he COVID-19 pandemic,
psychological dis ess has inc eased signi ican ly in he gene al popula ion, wi h a
pa icula ly s ong impac on young people. This si ua ion has in ensi ied in e es
in iden i ying isk and p o ec i e ac o s associa ed wi h men al heal h. Wi hin his
amewo k, he p esen s udy aimed o analyze he ela ionship be ween sociode-
mog aphic and linguis ic a iables and di e en indica o s o men al heal h in a
bilingual popula ion om he Basque Coun y.
Me hods: A o al o 521 bilingual indi iduals (Basque/Spanish) om he gene al
popula ion pa icipa ed in he s udy. Pa icipan s comple ed alida ed ques ion-
nai es assessing anxie y (GAD-7), dep ession (PHQ-9), and p od omal psycho ic
symp oms (PQ-B), along wi h a sociodemog aphic ques ionnai e and a mea-
su e o linguis ic compe ence. Uni a ia e analyses and linea eg ession models
we e conduc ed o examine associa ions be ween men al heal h indica o s and
sociodemog aphic a iables (age, gende , educa ional le el, employmen s a us,
ma i al s a us, and o sp ing), as well as linguis ic a iables (sel -pe cei ed p o i-
ciency in local languages and o eign language ce i ica ion).
Resul s: The esul s indica e ha highe educa ional a ainmen is consis en ly
associa ed wi h lowe le els o dep essi e symp oms and p od omal psycho ic
symp oms. Addi ionally, be e sel -pe cei ed compe ence in he usual languages
o communica ion (Basque and Spanish) is ela ed o lowe sco es on p od omal
psycho ic symp oms. Ha ing child en is associa ed wi h lowe le els o dep es-
si e symp oms. In con as , a iables such as gende , ma i al s a us, and employ-
men s a us did no show signi ican associa ions wi h men al heal h indica o s
in his p edominan ly young sample.
Discussion: O e all, hese indings highligh he ele ance o educa ional le el
and sociolinguis ic con ex as impo an ac o s in men al heal h. They unde -
sco e he need o inco po a e educa ional and linguis ic dimensions in o he
design o p e en ion and in e en ion s a egies, pa icula ly hose a ge ing
young popula ions in bilingual and mul ilingual con ex s.
KEYWORDS
bilingual, educa ion, language p o iciency, men al heal h, sociocul u al con ex
Ozamiz-E xeba ia e al. 10.3389/ psyg.2026.1690424
F on ie s in Psychology 02 on ie sin.o g
In oduc ion
Wo ldwide, he e has been a ma ked inc ease in psychological
dis ess in ecen yea s (Keyes and Pla , 2024). While his up u n had
al eady been eco ded p io o he COVID-19 pandemic, he heal h
c isis signi ican ly exace ba ed men al heal h p oblems in a ious
popula ions (B i o e al., 2022; Daniali e al., 2023; Zhang e al., 2022).
The WHO (Wo ld Heal h O ganiza ion, 2022a) epo ed a 25% ise
in he global p e alence o dep ession and anxie y diso de s du ing
he i s yea o he pandemic. This inc ease is due o ac o s such as
occupa ional s ess, lack o suppo ne wo ks and economic unce -
ain y, all o which may inc ease psychological ulne abili y. S udies
in a ious pa s o he wo ld ha e ound he younge popula ion o be
mos a ec ed, wi h a signi ican ise in he incidence o mood and
anxie y diso de s (Ma elli e al., 2021; Qiu e al., 2020; Solomou and
Cons an inidou, 2020). I has been sugges ed ha his ulne abili y in
young people may be ela ed o ac o s such as employmen insecu i y,
o e use o social media and lack o coping skills (Ozamiz-E xeba ia
e al., 2023). In many egions, s uc u al ac o s, such as lack o access
o men al heal h se ices and he s igma associa ed wi h men al dis-
o de s, ha e also con ibu ed o he men al heal h c isis (Wo ld Heal h
O ganiza ion, 2022b).
Gende - ela ed di e ences in men al illness ha e also been ex en-
si ely documen ed, in s udies showing ha women ha e highe a es
o anxie y, dep ession and ea ing diso de s, while men ha e a highe
p e alence o addic ion, a en ion de ici hype ac i i y diso de , psy-
chosis, schizoph enia and au ism spec um diso de s. These di e -
ences canno be explained by biological ac o s alone; a he , hey
appea o be p o oundly in luenced by gende inequali ies in socie y.
Women, o example, expe ience highe le els o s ess due o he
bu den o unpaid wo k, job insecu i y and gende -based iolence,
which all con ibu e o hei g ea e emo ional ulne abili y (Hu en
e al., 2021). In addi ion, he e is a eal issue wi h he medicaliza ion
o emale men al heal h, wi h a g ea e endency o diagnose dep es-
sion and anxie y among women and o p esc ibe psycho opic d ugs
mo e equen ly han among men, e en when hey p esen wi h simi-
la symp oms (A azcoz e al., 2018).
Se e al s udies ha e also shown a ela ionship be ween employ
-
men and men al heal h. Di e en dimensions o p eca ious employ-
men such as job insecu i y and seasonali y a e associa ed wi h men al
heal h p oblems (Rönnblad e al., 2019; U ze e al., 2020). In addi ion,
unemploymen is associa ed wi h impai ed men al heal h (Paul and
Mose , 2009), wi h men he mos a ec ed (Mu phy and A hanasou,
1999; Vi golino e al., 2022).
Ma i al s a us has also been obse ed o play an impo an ole in
men al heal h (Ch is ensen e al., 2022). One s udy ound ha ma ied
people sco ed highe o psychological well-being due o he social
suppo and economic esou ces associa ed wi h ma iage (Si a
Kuma e al., 2019). O he s udies ound an associa ion be ween being
single and indica o s o men al illness (Si a Kuma e al., 2019).
Ma i al s a us (in his case, being ma ied) would he e o e appea o
be a p o ec i e ac o in men al heal h (Roh e e al., 2005).
None heless, a sepa a e s udy ound ha he ela ionship be ween
ma i al s a us and dep ession a ies by age and gende , wi h a lowe
isk among single, widowed and sepa a ed women and he isk
inc easing wi h age among single men (Bulloch e al., 2017).
Wi h ega d o educa ional le el, esea ch has shown ha a highe
le el o educa ion may be associa ed wi h a lowe a e o men al illness
(Li e al., 2023; Xu and Chen, 2024). Thus, he p e alence o men al
diso de s is g ea e among hose wi h lowe educa ional le els, sug-
ges ing ha highe le els o educa ion a e associa ed wi h be e
men al heal h ou comes. In addi ion, one s udy obse ed ha people
wi h a high le el o educa ion gene ally u ilize men al heal h se ices
mo e and ely less exclusi ely on medica ion; his could be in e p e ed
as a mo e comp ehensi e managemen o hei men al heal h (Halme
e al., 2023).
Finally, lea ning new languages could be iden i ied as a possible
p o ec i e ac o . Language lea ning has been desc ibed as being a
he apeu ic ac i i y ha can imp o e men al heal h (de Diego Alonso
and Isiegas, 2007). O he indings show ha anxie y is in e sely
ela ed o he numbe o languages lea ned (Thompson and Lee, 2013)
and ha pe cei ed language p o iciency is posi i ely ela ed o se e al
aspec s o psychological well-being (Luo e al., 2019), al hough his
associa ion has no been explo ed o any g ea deg ee. Mo eo e ,
men al heal h issues can make i di icul o lea n new languages (Wu,
2024). In any case, s udies in his a ea a e sca ce and he e is much ye
o be explo ed.
Conside ing he ele ance o hese a iables, his s udy seeks o
analyze he ela ionship be ween sociodemog aphic and linguis ic ac-
o s and men al heal h, p o iding empi ical e idence on he in luence
o gende , ma i al s a us, cohabi a ion, o sp ing, employmen s a us,
educa ional le el, and knowledge and sel -pe cep ion o language p o-
iciency on anxie y, dep ession and psycho ic symp oms.
Ma e ials and me hods
Pa icipan s and p ocedu es
The s udy sample consis ed o 521 bilingual (Basque/Spanish)
adul s om he gene al popula ion who pa icipa ed in a b oade
esea ch p ojec (E ko eka e al., 2025). Among hem, 383 pa icipan s
(73.5%) iden i ied as emale, 131 (25.1%) as male, and 7 (1.3%) as
non-bina y. The mean age o he sample was 26.58 yea s (SD = 7.67),
mos pa icipan s we e single (68.9%), and he majo i y we e wo king
o s udying a he ime o da a collec ion (83.7%). Pa icipan s li ed in
households wi h a mean o 3.37 cohabi an s (SD = 1.18). Educa ional
a ainmen was gene ally high, wi h 73.7% ha ing comple ed uni e -
si y s udies, 25.5% high school o oca ional aining, and less han
1% p ima y educa ion. A mino i y o pa icipan s (11.9%) epo ed
ha ing o sp ing. F om a linguis ic pe spec i e, pa icipan s epo ed
high sel -pe cei ed p o iciency in Basque and Spanish (mean = 73.32,
SD = 5.86), and 67% held an o icial quali ica ion in a leas one o -
eign language (Table 1).
Pa icipan s we e eligible i hey we e 18 yea s o age o olde ,
esided in he Basque Coun y, we e bilingual in Basque and Spanish,
and p o ided in o med consen . Indi iduals we e excluded i hey did
no comple e he ques ionnai es, p o ided inconsis en esponses, o
did no mee he bilingualism c i e ia.
Rec ui men was ca ied ou be ween No embe 2019 and
Janua y 2021 h ough con enience sampling, mainly ia uni e si y
mailing lis s, he BCBL olun ee da abase, and wo d o mou h. Those
in e es ed accessed he online o ms ia Google Fo ms, i s ag eeing
o he in o med consen o m and hen comple ing he sociodemo-
g aphic ques ionnai e and he clinical and linguis ic assessmen s. All
measu es we e comple ed in a single session, wi h an es ima ed du a-
ion o 20–30 min, and da a we e collec ed anonymously.
Ozamiz-E xeba ia e al. 10.3389/ psyg.2026.1690424
F on ie s in Psychology 03 on ie sin.o g
The s udy employed a c oss-sec ional, obse a ional, and co ela-
ional design, which was conside ed app op ia e o examining asso-
cia ions be ween sociodemog aphic and linguis ic a iables and
men al heal h indica o s in a non-clinical popula ion. Al hough causal
in e ences canno be made, his design allows he iden i ica ion o
po en ial isk and p o ec i e ac o s ele an o p e en ion and in e -
en ion s a egies.
Measu es and ins umen s
Gene alized Anxie y Diso de Scale-7 (GAD-7, Pa el e al., 2019):
This is a sel -adminis e ed ques ionnai e designed o assess he p es-
ence and in ensi y o gene alized anxie y diso de (GAD) symp oms
o e he p e ious 2 weeks, ollowing he diagnos ic c i e ia es ablished
in he DSM-IV-TR. I includes 7 i ems, each a ed on a 4-poin Like
scale. A h eshold sco e o 10 o highe has been sugges ed o de ec -
ing p obable cases o GAD. Sco es o 5, 10, and 15 a e commonly used
o ca ego ize anxie y as mild, mode a e, and se e e, espec i ely. The
measu e has demons a ed s ong psychome ic p ope ies ac oss
di e se languages and popula ions (Lee e al., 2022; V uble ska e al.,
2022), including excellen in e nal consis ency, wi h C onbach’s alpha
anging om 0.85 o 0.95.
Pa ien Heal h Ques ionnai e-9 (PHQ-9, K oenke e al., 2001):
This sel -adminis e ed ool comp ises 9 i ems, each co esponding o
one o he DSM-IV c i e ia o dep essi e diso de s, a ed on a 4-poin
Like scale. An addi ional i em assesses he deg ee o unc ional
impai men caused by he symp oms. A o al sco e o 10 o abo e is
ypically used as a cu -o o sugges he p esence o a po en ial dep es-
si e diso de . The ins umen has been alida ed ac oss mul iple lan-
guages and cul u al se ings (Fonseca-Ped e o e al., 2018;
Gómez-Gómez e al., 2023; Jomli e al., 2020; Lamela e al., 2020),
consis en ly demons a ing solid in e nal eliabili y, wi h C onbach’s
alpha coe icien s anging om 0.79 o 0.89.
P od omal Ques ionnai e-B ie Ve sion (PQ-B, Loewy e al.,
2011): This sc eening ool o psychosis isk is a sel - epo ques ion-
nai e comp ising 21 dicho omous (yes/no) i ems and is based on
symp om equency. The PQ-B is a sho ened e sion de i ed om
he o iginal 92-i em P od omal Ques ionnai e (Loewy e al., 2011).
When a esponden answe s “yes” o an i em, a ollow-up ques ion is
p esen ed o assess bo h he equency and le el o dis ess o unc-
ional impac associa ed wi h he expe ience, on a 5-poin Like - ype
scale. Va ious s udies ha e p oposed di e en cu -o sco es o he
equency and dis ess subscales, depending on he popula ion unde
s udy (Kaligis e al., 2018; Okewole e al., 2015; Pelizza e al., 2018). In
he case o he Spanish popula ion, alida ion s udies ha e ecom-
mended a h eshold sco e o 9 o o e on he equency scale
(Fonseca-Ped e o e al., 2018) and 29 o o e on he dis ess scale
(Fonseca-Ped e o e al., 2016). These alida ions also epo s ong
in e nal consis ency (C onbach’s alpha be ween 0.83 and 0.89) and
suppo a unidimensional ac o s uc u e o he ins umen .
TABLE 1 Desc ip ion o he sample.
Va iables Va iables Mean ± SD
To al (N = 521) Male (N = 131) Female (N = 383) Non-bina y
(N = 7)
Age*26.58 ± 7.67 25.55 ± 7.6 25.98 ± 7.6 22.29 ± 1.1
Numbe o cohabi an s 3.37 ± 1.18 3.25 ± 1.13 3.40 ± 1.20 3.71 ± 1.11
P o iciency in local
languages
73.32 ± 5.86 72.36 ± 6.66 73.68 ± 5.55 71.57 ± 4.92
GAD-7 6.48 ± 3.84 5.89 ± 3.95 6.67 ± 3.77 7.00 ± 4.47
PHQ-9 7.07 ± 5.10 5.57 ± 4.86 7.23 ± 5.17 7.86 ± 5.92
PQB 3.13 ± 3.35 2.88 ± 3.32 3.20 ± 3.36 4.06 ± 1.52
N(%)
O sp ing (yes) 62(11.9) 20 (15.3) 42 (11.0) 0 (0)
Ma i al s a us Single 359 (68.9) 88 (67.2) 266 (69.6) 5(71.4)
Ma ied/pa ne 106 (20.3) 29 (22.1) 77 (20.2) 0 (0)
Di o ced 3(0.6) 1 (0.8) 2 (0.5) 0 (0)
O he s 53 (10.2) 13 (9.9) 37 (9.7) 2 (28.6)
Occupa ion No wo king 85 (16.3) 15 (11.5) 69 (18) 1 (14.3)
Wo king/S udying 436 (83.7) 116 (88.5) 314 (82) 6 (85.7)
Educa ion P ima y 4(0.8) 1 (0.8) 3 (0.8) 0
High school/
Voca ional
133 (25.5) 32 (24.4) 99 (25.8) 2 (28.6)
Uni e si y 384 (73.7) 98 (74.8) 281 (73.4) 5 (71.4)
Fo eign language
quali ica ion (yes)
349 (67) 90(68.7) 256 (66.8) 3(42.9)
GAD-7, Gene alized Anxie y Diso de Scale-7; PHQ-9, Pa ien Heal h Ques ionnai e-9; PQB, P od omal Ques ionnai e-B ie Ve sion.
*S a is ically signi ican esul s we e obse ed be ween males’ and emales’ sco es, wi h no di e ences ega ding non-bina y people.
Ozamiz-E xeba ia e al. 10.3389/ psyg.2026.1690424
F on ie s in Psychology 04 on ie sin.o g
BCBL language compe ence ques ionnai e: This ques ionnai e
was de eloped by he Basque Cen e on Cogni ion, B ain and
Language as a ool o making a comp ehensi e linguis ic assessmen
o an indi idual. Among o he a iables, i collec s in o ma ion on he
languages spoken by he pe son, hei exposu e, sel -es ima ed p o i-
ciency in each language, and whe he hey ha e o icial quali ica ions
in any o he languages hey know. This s udy conside ed sel -es i-
ma ed p o iciency in local languages (Basque and Spanish) as a sum
o he wo sco es anging om 40 o 80 and whe he he indi idual
has any o icial quali ica ion in a o eign language (E ko eka e
al., 2025).
Da a analysis
We i s pe o med uni a ia e analyses o s udy he associa-
ions be ween sociodemog aphic and linguis ic a iables and he
sco es on he h ee scales. We used Pea son’s co ela ion o s udy
he ela ionship be ween quan i a i e a iables and S uden ’s es
o quali a i e a iables. Secondly, we c ea ed h ee linea eg es-
sion models, in which he dependen a iable was he sco e on he
scale s udied (GAD7, PHQ-9 and PQ-B) and he independen
a iables we e hose sociodemog aphic and linguis ic a iables
which had shown a signi ican (p < 0.1) associa ion in he uni a i-
a e analyses. We used IBM SPSS S a is ics 29.0 o he s a is ical
analyses.
Resul s
Table 2 shows he esul s ob ained in he 3 linea eg ession
models. Wi h ega d o symp oms o anxie y, he only a iables o
show an associa ion in he uni a ia e analyses we e sociodemog aphic
(o sp ing, age and educa ional le el), bu none o hese su i ed when
included join ly in he eg ession model. A end can be seen in educa-
ion le el, sugges ing ha he highe he educa ion le el, he less he
anxie y expe ienced, bu wi hou a aining he es ablished le el o s a-
is ical signi icance.
Wi h ega d o clinical dep ession, mul iple sociodemog aphic
a iables (o sp ing, job, educa ional le el, age) and linguis ic a iables
( o eign language ce i ica ion, p o iciency in local languages) showed
a ela ionship wi h he PHQ-9 sco e in uni a ia e analyses. When, in
a p elimina y s ep, all he a iables a e inco po a ed in o he eg es-
sion model, i is e iden ha only he educa ion le el con inues o
show a signi ican associa ion, and a end can be obse ed in ha ing
o sp ing. In he second s ep, we emo ed he a iables o which he
associa ion did no endu e, showing ha educa ional le el and o -
sp ing we e signi ican ly ela ed o dep essi e symp oma ology, such
ha a highe educa ional le el and ha ing child en we e associa ed
wi h lowe sco es o dep ession. These wo a iables explain 4.5% o
he a iabili y o he PHQ-9 sco e.
Finally, wi h ega d o he s udy o psycho ic symp oms, he e was
again ound o be a ela ionship be ween bo h sociodemog aphic and
linguis ic a iables (age, le el o educa ion, o sp ing, o eign language
quali ica ion and p o iciency) and he PQ-B sco e. Inco po a ing all
o hese in o he eg ession model, we obse ed ha he signi ican
e ec o educa ional le el, p o iciency and age su i es he con ol o
mul iple a iables, wi h he model explaining 7.4% o he a iabili y
in he PQ-B sco e. Highe educa ional le el, g ea e language
p o iciency in local languages and olde age a e associa ed wi h lowe
sco es o psycho ic symp oma ology.
Discussion
This s udy analyzed he ela ionship be ween se e al sociolinguis-
ic ac o s and men al heal h, p o iding e idence o hei impac on
he symp oms s udied.
To begin wi h, he esul s ob ained in he uni a ia e analyses indi-
ca e ha gende is no signi ican ly associa ed wi h he men al heal h
indica o s assessed by PHQ-9, GAD-7 and PQ-B. These indings con-
as wi h hose o p e ious s udies ha ha e iden i ied gende di e -
ences (Hu en e al., 2021; Eugene e al., 2025) in he p e alence o
men al illness. One possible explana ion is ha because hey measu e
gene al symp oms o men al heal h, he ools used in his s udy may
no cap u e gende -speci ic nuances, such as di e en ways o exp ess-
ing o mani es ing psychological dis ess, which migh limi he de ec-
ion o di e ences among he popula ion e alua ed.
Occupa ion and ma i al s a us ha e no been ound o in luence
symp oma ology ei he . This inding con as s wi h hose o p e ious s ud-
ies (Begum, 2025; Compe nolle and Zheng, 2025; Mu phy and A hanasou,
1999; Paul and Mose , 2009; Vi golino e al., 2022). Howe e , wi h ega d
o ma i al s a us, i may be due o he ac ha he mean age o ou popula-
ion was qui e young (26.58 yea s), and as al eady no ed in p e ious s ud-
ies (Bulloch e al., 2017; Solomou and Cons an inidou, 2020), he in luence
o his ac o appea s o inc ease wi h age. As o he in luence o occupa-
ion, one possible explana ion migh be ha he young people in his
sample ha e jobs wi h mo e a o able o less demanding condi ions,
which ha e a subsequen ly educed impac on hei well-being.
Wi h ega d o age, an in e se associa ion wi h all indica o s o he
symp oma ology was obse ed in he uni a ia e analyses, bu his ela-
ionship emained signi ican only in he model adjus ed o psycho ic
symp oma ology. This inding is consis en wi h ecen s udies ha
indica e an inc eased ulne abili y o subclinical psycho ic expe i-
ences among he younge popula ion (Fonseca-Ped e o e al., 2009;
Lemos-Gi áldez e al., 2011; Ozdemi e al., 2025).
O all he i ems s udied, educa ional le el appea s o be he mos
de e minan o he h ee spec a o symp oms. In he pos -hoc s udy
ca ied ou a e he uni a ia e analysis, we ound ha he di e ence
was mainly be ween he high school/VT g oup and uni e si y s u-
den s o all h ee ques ionnai es, wi h a U-shaped pa e n, al hough
he eg ession models indica e ha he highe he le el o s udies, he
lowe he a e o symp oms obse ed. Se e al s udies ha e shown ha
a highe educa ional le el is associa ed wi h be e men al heal h
(B acke e al., 2014; Ga iépy e al., 2022; Kondi olli and Sunde , 2022;
Ses i e al., 2022; Spe andei e al., 2023; Xu and Chen, 2024). This sug-
ges s ha educa ion may ac as a p o ec i e ac o agains men al dis-
o de s by p omo ing he de elopmen o pe sonal, p o essional and
social esou ces ha con ibu e o psychological well-being.
In ou s udy, p o iciency in an addi ional hi d o ou h language
was no ound o be signi ican ly ela ed o educed symp oma ology,
as desc ibed in p e ious esea ch highligh ing he cogni i e and emo-
ional bene i s o language lea ning (de Diego Alonso and Isiegas, 2007;
Thompson and Lee, 2013). Howe e , he e was an in e se ela ionship
be ween sel -pe cep ion o p o iciency in local languages (Basque and
Spanish) and PQ-B, indica ing ha he be e he pe cep ion o p o i-
ciency in hei habi ual languages o communica ion, he lowe he a e
Ozamiz-E xeba ia e al. 10.3389/ psyg.2026.1690424
F on ie s in Psychology 05 on ie sin.o g
o psycho ic symp oma ology. This would be an impo an inding o
his s udy, ein o cing and expanding upon aspec s desc ibed in o he
p e ious s udies ha ound ha language p o iciency was posi i ely
ela ed o se e al aspec s o psychological well-being and men al heal h
(Luo e al., 2019; Mon emi o e al., 2021).
As a inal sociodemog aphic a iable o in e es , we ound ha
ha ing child en appea s o ha e a p o ec i e e ec agains symp oms
o dep ession. This is especially ele an gi en ha mos p e ious
s udies ha e ocused on analyzing how dep ession in luences he
p obabili y o ha ing child en, gene ally iden i ying a nega i e asso-
cia ion be ween he wo (Golo ina e al., 2023; Kailaheimo-Lönnq is
e al., 2024). Ou s udy he e o e o e s a complemen a y pe spec i e,
and al hough he c oss-sec ional design does no allow us o es ablish
causali y, i does poin o a no el and in e es ing associa ion be ween
pa en hood and g ea e psychological well-being.
This s udy has some limi a ions ha mus be aken in o accoun .
To begin wi h, pa icipa ion in his s udy is highe among women and
he numbe o non-bina y indi iduals is negligible. None heless, i is
impo an o no e ha he e a e no signi ican di e ences among he
h ee g oups ac oss he dep essi e, anxious and psycho ic symp om-
a ology, as add essed by hese widely used ins umen s. The ac ha
he e a e mo e women han men in he samples is qui e common in
many s udies (Ganguli e al., 1998), and e en mo e so in s udies on
psychology, educa ion, and men al heal h. The opics o many men al
heal h s udies end o a ouse g ea e in e es o iden i ica ion among
women, which inc eases hei pa icipa ion (P oye and Häusle , 2007).
Cul u al and social ac o s also play a ole, as women may eel mo e
com o able o less s igma ized when alking abou emo ions and psy-
chological well-being (Deng e al., 2016). Finally, ec ui men o sam-
pling me hods h ough uni e si ies, associa ions o social ne wo ks
may a o he ec ui men o women, as hese a e a eas whe e hey a e
mo e p esen . The e a e no o icial igu es on he p e alence o people
who iden i y as non-bina y in ou se ing, so we canno en u e o
de e mine whe he hey a e o e - o unde ep esen ed in ou sample.
Ano he limi a ion o his s udy is he age ange o he pa ici-
pan s. The sample included young people and young adul s, mainly
anging om 18 o 33 yea s o age. The e o e, in he con ex o his
s udy, pa icipan s who all in o he ca ego y o ‘young adul s’ acco d-
ing o he WHO classi ica ion (2023) a e included. Fo his eason, he
conclusions o his s udy mus be limi ed o ha age ange.
I is also impo an o men ion ha despi e mos da a was col-
lec ed be o e he COVID-19 pandemic, he ec ui men pe iod was
ex ended un il 2021, and we know ha young people’s men al heal h
has wo sened du ing he pandemic (Idoiaga e al., 2022; Ozamiz-
E xeba ia e al., 2023). The e o e, and al hough dispe sion o he
sco es on he PHQ-9 and GAD-7, which assess symp oms ha may
ha e inc eased due o he pandemic, is wi hin he usual ange o hese
ins umen s, we canno ule ou ha hey may be o e sized in he
mon hs ollowing he pandemic.
Finally, he way in which he s udy has been dissemina ed, mainly
h ough mailing lis s, may a o sel -selec ion bias ( hose who a e
mo e engaged, ha e mo e ee ime, o eel mo e s ongly abou a opic
may be o e ep esen ed). The use o sel -adminis e ed ques ionnai es
may also be associa ed wi h biases such as social desi abili y, ecall
bias, o ex eme esponse bias. Howe e , we mus bea in mind ha
he ools used, mainly he PHQ-9 and he GAD-7, a e s ongly sup-
po ed and a e, in ac , he main assessmen ins umen s used in
men al heal h esea ch.
Conclusion
In conclusion, his s udy p o ides e idence ha educa ional le el
may play a cen al ole in men al heal h, ac ing as a p o ec i e ac o
agains symp oms o dep ession, anxie y, and psychosis.
Highe educa ion appea s o con ibu e o psychological well-
being, likely h ough he de elopmen o pe sonal, social, and p o es-
sional esou ces.
Addi ionally, ha ing o sp ing was associa ed wi h lowe dep es-
si e symp oma ology, sugges ing ha pa en hood may o e emo ional
bene i s, al hough his inding should be in e p e ed cau iously due o
he c oss-sec ional na u e o he s udy. In e ms o psycho ic symp-
oms, olde age and highe sel -pe cei ed p o iciency in local lan-
guages (Basque and Spanish) we e linked o lowe symp om a es,
highligh ing a no el po en ial p o ec i e ole o language p o iciency
in habi ual communica ion.
No signi ican associa ions we e ound wi h gende , ma i al s a us,
o employmen , which may be ela ed o he p edominan ly young,
educa ed, and uni e si y-based na u e o he sample.
O e all, hese esul s unde sco e he impo ance o ocusing on
he men al heal h o young adul s and sugges ha in e en ions
aiming o imp o e psychological well-being could bene i om p o-
mo ing access o highe educa ion, suppo ing pa en hood, and
enhancing language p o iciency. Fu u e esea ch should examine hese
associa ions longi udinally, explo e unde lying mechanisms, and
TABLE 2 Reg ession models.
Models Va iables β pAdjus ed
R2
GAD-7 (1) Cons an 9.977 <0.001 0.014
Educa ion −0.077 −1.727 0.085
Age −0.052 −0.958 0.339
O sp ing −0.065 −1.217 0.224
PHQ-9 (1) Cons an 5.405 <0.001 0.048
Educa ion −0.150 −3.355 <0.001
Age −0.044 −0.805 0.421
O sp ing −0.095 −1.813 0.070
P o iciency −0.065 −1.463 0.144
Occupa ion −0.043 −0.990 0.323
Fo eign qual. −0.056 −1.244 −214
PHQ-9 (2) Cons an 12.530 <0.001 0.045
Educa ion −0.176 −4.088 <0.001
O sp ing −0.120 −2.795 0.005
PQB (1) Cons an 6.196 <0.001 0.074
Educa ion −0.175 −3.983 <0.001
O sp ing 0.018 0.347 0.729
P o iciency −0.105 −2.406 0.016
Fo eign qual. −0.065 −1.482 0.139
Age −0.145 −2.718 0.007
GAD-7, Gene alized Anxie y Diso de Scale-7; PHQ-9, Pa ien Heal h Ques ionnai e-9;
PQB, P od omal Ques ionnai e-B ie Ve sion.

Ozamiz-E xeba ia e al. 10.3389/ psyg.2026.1690424
F on ie s in Psychology 06 on ie sin.o g
in es iga e whe he hese indings gene alize o b oade and mo e
di e se popula ions.
Da a a ailabili y s a emen
The da a ha suppo he indings o his s udy a e a ailable om
he co esponding au ho upon easonable eques .
E hics s a emen
The p esen s udy was app o ed by he Basque E hics Commi ee
(code: PI2019052). The s udies we e conduc ed in acco dance wi h he
local legisla ion and ins i u ional equi emen s. All pa icipan s p o-
ided hei in o med consen o pa icipa e in his s udy.
Au ho con ibu ions
NO-E: W i ing– o iginal d a , W i ing– e iew & edi ing. LE:
W i ing– o iginal d a , W i ing– e iew & edi ing. SM: W i ing –
e iew & edi ing.
Funding
The au ho (s) decla ed ha inancial suppo was ecei ed o his
wo k and/o i s publica ion. This p ojec was unded by he Heal h
Depa men o he Basque Go e nmen . Edi ing o his pape was
unded by he Resea ch Uni o Galdakao-Usansolo Uni e si y Hospi al.
Acknowledgmen s
The au ho s would like o hank he pa icipan s o hei in ol e-
men in his s udy.
Con lic o in e es
The au ho (s) decla ed ha his wo k was conduc ed in he
absence o any comme cial o inancial ela ionships ha could be
cons ued as a po en ial con lic o in e es .
Gene a i e AI s a emen
The au ho (s) decla ed ha Gene a i e AI was no used in he
c ea ion o his manusc ip .
Any al e na i e ex (al ex ) p o ided alongside igu es in his
a icle has been gene a ed by F on ie s wi h he suppo o a i icial
in elligence and easonable e o s ha e been made o ensu e accu acy,
including e iew by he au ho s whe e e possible. I you iden i y any
issues, please con ac us.
Publishe ’s no e
All claims exp essed in his a icle a e solely hose o he
au ho s and do no necessa ily ep esen hose o hei a ilia ed
o ganiza ions, o hose o he publishe , he edi o s and he
e iewe s. Any p oduc ha may be e alua ed in his a icle, o
claim ha may be made by i s manu ac u e , is no gua an eed o
endo sed by he publishe .
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