Sage Journals: Discover world-class research

Abstract

Due to their physical discomfort and functional constraints, orthopedic patients frequently experience elevated depressive symptoms, and previous studies indicate that rumination worsens these symptoms. Nonetheless, studies on the mechanisms that mitigate this deleterious impact of rumination on depressive symptoms in this population are sparse. In the present study, we investigated the moderating role of dispositional mindfulness in the relationship between rumination and depressive symptoms among orthopedic patients. Three hundred and eighty-seven (387) orthopedic outpatients (males: n = 224, 57.9%; females: 163, 42.1%; mean age = 38.88 years, SD = 12.78) were drawn from a national orthopedic hospital in Nigeria using a cross-sectional approach and a convenient sampling technique. These participants completed the seven-item Rumination Scale, the Five-Facet Mindfulness Questionnaire, and the Center for Epidemiologic Studies-Depression Scale. Results revealed that higher scores on intrusive rumination were associated with heightened depressive symptoms, whereas higher deliberate rumination was associated with fewer depressive symptoms. Dispositional mindfulness was negatively associated with depressive symptoms but did not moderate the relationship between intrusive rumination and depressive symptoms. However, dispositional mindfulness, instead of acting as a buffer, amplified the beneficial impact of deliberate rumination in reducing depressive symptoms. Interventions may do well to target deliberate rumination by building dispositional mindfulness to lessen depressive symptoms among orthopedic patients.

Keywords

Buffering depressive symptoms dispositional mindfulness orthopedic patients rumination

Get full access to this article

View all access options for this article.

References

Adesina

S. A.

Amole

I. O.

Adefokun

I. G.

Adegoke

A. O.

Odekhiran

E. O.

Ekunrin

O. T.

Akinwumi

A. I.

Ojo

S. A.

Durodola

Awotunde

O. T.

Ikem

I. C.

Eyesan

S. U.

(2024). Epidemiology of geriatric orthopaedic injuries in a tertiary hospital in southwestern Nigeria. Scientific Reports, 14(1), 18913. https://doi.org/10.1038/s41598-024-70108-z

Alayande

Chu

K. M.

Jumbam

D. T.

Kimto

O. E.

Musa Danladi

Niyukuri

Banguti

Roy

Smith

E. R.

O’Neill

K. M.

McQueen

K. A.

Riviello

R. R.

(2022). Disparities in access to trauma care in sub-Saharan Africa: A narrative review. Current Trauma Reports, 8(3), 66–94.

Allen

N. B.

Knight

W. E.

(2005). Mindfulness, compassion for self, and compassion for others: Implications for understanding the psychopathology and treatment of depression. In Gilbert

(Ed.), Compassion (pp. 239–262). Routledge.

Amadi

Chukworji

Odinka

Nwadinigwe

Ndukuba

Muomah

(2017). Psychological distress and its associated socio-demographic factors among amputees in an orthopaedic hospital in south-eastern Nigeria. Gender and Behaviour, 15(3), 9607–9617.

Amanambu

Allard

(2024). Assessing mindfulness facets to interrogate the “well-being paradox” in Nigeria. Innovation in Aging, 8(Suppl. 1), 608. https://doi.org/10.1093/geroni/igae098.1993

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Andersson

Cuervo-Cazurra

Nielsen

B. B.

(2020). Explaining interaction effects within and across levels of analysis. Research Methods in International Business, 331–349. https://doi.org/10.1007/978-3-030-22113-3_16

Ardern

C. L.

Taylor

N. F.

Feller

J. A.

Whitehead

T. S.

Webster

K. E.

(2015). Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: A prospective follow-up of physical function and psychological factors in 122 athletes. The American Journal of Sports Medicine, 43(4), 848–856. https://doi.org/10.1177/0363546514563282

10.

Arnold

E. M.

Yalch

M. M.

Christodoulou

Murphy

D. A.

Swendeman

Rotheram-Borus

M. J.

& Adolescent Medicine Trials Network CARES Study Team. (2023). Rumination influences the relationship between trauma and depression over time among youth living with HIV. Journal of Affective Disorders, 322, 9–14. https://doi.org/10.1016/j.jad.2022.11.010

11.

Baer

Strauss

(2022). Five Facet Mindfulness Questionnaire (FFMQ). In Medvedev

O. N.

Krägeloh

C. U.

Siegert

R. J.

Singh

N. N.

(Eds.), Handbook of assessment in mindfulness research. Springer. https://doi.org/10.1007/978-3-030-77644-2_15-1

12.

Baer

R. A.

Smith

G. T.

Lykins

Button

Krietemeyer

Sauer

Walsh

Duggan

Williams

J. M. G.

(2008). Construct validity of the five-facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342. https://doi.org/10.1177/1073191107313003

13.

Bajaj

Pande

(2016). Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differences, 93, 63–67. https://doi.org/10.1016/j.paid.2015.09.005

14.

Bean

C. A.

Mueller

S. B.

Abitante

Ciesla

J. A.

Cho

S. J.

Cole

D. A.

(2024). Improved Scoring of the Center for Epidemiologic Studies Depression Scale–Revised: An item response theory analysis. Journal of Psychopathology and Behavioral Assessment, 46(3), 783–792. https://doi.org/10.1007/s10862-024-10155-y

15.

Beck

A. T.

Steer

R. A.

Brown

(1996). Beck depression inventory–II. Psychological Assessment.

16.

Beck

Whitaker

Cropley

(2023). Is rumination associated with psychological distress after a cancer diagnosis? A systematic review. Journal of Psychosocial Oncology, 41(5), 584–609. https://doi.org/10.1080/07347332.2022.2145925

17.

Bonanno

G. A.

Burton

C. L.

(2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591–612.

18.

Brooks

J. M.

Muller

Sánchez

Johnson

E. T.

Chiu

C. Y.

Cotton

B. P.

Lee

E. J.

Chan

(2020). Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia. Journal of Mental Health. https://doi.org/10.1080/09638237.2017.1417555

19.

Brown

K. W.

Ryan

R. M.

Creswell

J. D.

(2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237. https://doi.org/10.1080/10478400701598298

20.

Calhoun

L. G.

Cann

Tedeschi

R. G.

(2010). The posttraumatic growth model: Sociocultural considerations. In Weiss

Berger

(Eds.), Posttraumatic growth and culturally competent practice: Lessons learned from around the globe (pp. 1–14). John Wiley & Sons. https://doi.org/10.1002/9781118270028.ch1

21.

Calhoun

L. G.

Cann

Tedeschi

R. G.

McMillan

(2000). A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 13(3), 521–527. https://doi.org/10.1023/A:1007745627077

22.

Cann

Calhoun

L. G.

Tedeschi

R. G.

Solomon

D. T.

(2010). Posttraumatic growth and depreciation as independent experiences and predictors of well-being. Journal of Loss and Trauma, 15(3), 151–166.

23.

Cann

Calhoun

L. G.

Tedeschi

R. G.

Triplett

K. N.

Vishnevsky

Lindstrom

C. M.

(2011). Assessing posttraumatic cognitive processes: The event related rumination inventory. Anxiety, Stress, & Coping, 24(2), 137–156. https://doi.org/10.1080/10615806.2010.529901

24.

Carvalho

S. A.

Gillanders

Palmeira

Pinto-Gouveia

Castilho

(2018). Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance. Journal of Clinical Psychology, 74(12), 2094–2106. https://doi.org/10.1002/jclp.22689

25.

Carver

C. S.

Scheier

M. F.

(1982). Control theory: A useful conceptual framework for personality–social, clinical, and health psychology. Psychological Bulletin, 92(1), 111–135. https://doi.org/10.1037/0033-2909.92.1.111

26.

Carver

C. S.

Scheier

M. F.

(1998). On the self-regulation of behavior. Cambridge University Press.

27.

Castillo

R. C.

Raja

S. N.

Frey

K. P.

Vallier

H. A.

Tornetta

III Jaeblon

Pollak

A. N.

MacKenzie

E. J.

Bosse

M. J.

O’Toole

R. V.

(2017). Improving pain management and long-term outcomes following high-energy orthopaedic trauma (PAIN study). Journal of Orthopaedic Trauma, 31, S71–S77. https://doi.org/10.1097/BOT.0000000000000793

28.

Chukwuorji

J. C.

Ifeagwazi

C. M.

Eze

J. E.

(2018). Prolonged grief disorder symptoms in bereaved internally displaced Tiv persons in Nigeria: Associations with rumination, rebirth concerns and gender. Mental Health, Religion & Culture, 21(6), 549–563. https://doi.org/10.1080/13674676.2018.1505838

29.

Clark

D. A.

(2020). The negative thoughts workbook: CBT skills to overcome the repetitive worry, shame, and rumination that drive anxiety and depression. New Harbinger Publications.

30.

Cohen

Wills

T. A.

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310

31.

Curtiss

J. E.

Levine

D. S.

Ander

Baker

A. W.

(2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184–189.

32.

Eze

J. E.

Ifeagwazi

C. M.

Chukwuorji

J. C.

(2020). Core beliefs challenge and posttraumatic growth: Mediating role of rumination among internally displaced survivors of terror attacks. Journal of Happiness Studies, 21, 659–676. https://doi.org/10.1007/s10902-019-00105-x

33.

Field

(2013). Discovering statistics using IBM SPSS statistics. Sage.

34.

Field

(2024). Discovering statistics using IBM SPSS statistics. Sage.

35.

Garcia

G. H.

H. H.

Park

M. J.

Tjoumakaris

F. P.

Tucker

B. S.

Kelly

J. D.

IV Sennett

B. J.

(2016). Depression symptomatology and anterior cruciate ligament injury: Incidence and effect on functional outcome—A prospective cohort study. The American Journal of Sports Medicine, 44(3), 572–579. https://doi.org/10.1177/0363546515612466

36.

Strauss

Crane

Barnhofer

Karl

Cavanagh

Kuyken

(2016). Examining the factor structure of the 39-item and 15-item versions of the Five-Facet Mindfulness Questionnaire before and after Mindfulness-Based Cognitive Therapy for people with recurrent depression. Psychological Assessment, 28(7), 791–802. https://doi.org/10.1037/pas0000263

37.

Guan

Y. Y.

Phillips

Murphy

Crebbin

Le Grande

Worcester

M. U.

Jackson

(2021). Impact of rumination on severity and persistence of anxiety and depression in cardiac patients. Heart and Mind, 5(1), 9–16.

38.

Gunty

A. L.

(2021). On being a patient: Living with life-altering illness and injury [Doctoral dissertation, University of Minnesota]. University of Minnesota Digital Conservancy. https://hdl.handle.net/11299/220605

39.

Hayes

A. F.

(2018). Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4–40. https://doi.org/10.1080/03637751.2017.1352100

40.

Heath

N. L.

Carsley

De Riggi

M. E.

Mills

Mettler

(2016). The relationship between mindfulness, depressive symptoms, and non-suicidal self-injury amongst adolescents. Archives of Suicide Research, 20(4), 635–649. https://doi.org/10.1080/13811118.2016.1162243

41.

Hui

W. U.

Zhang

Cheng

Ying

L. I. N.

Qian

W. A. N. G.

(2017). Factors related to acute anxiety and depression in inpatients with accidental orthopaedic injuries. Shanghai Archives of Psychiatry, 29(2), 77. https://doi.org/10.11919%2Fj.issn.1002-0829.216070

42.

Jones

Stephens

Gatchel

R. J.

(2018). Musculoskeletal pain and disability disorders. In Handbook of rehabilitation in older adults (pp. 125–143). https://doi.org/10.1007/978-3-030-03916-5_6

43.

Kebede

Y. N.

Denu

Z. A.

Aytolign

H. A.

Mersha

A. T.

(2022). Magnitude and factors associated with preoperative depression among elective surgical patients at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia: A cross-sectional study. Annals of Medicine and Surgery, 75, Article 103341. https://doi.org/10.1016/j.amsu.2022.103341

44.

Kiken

L. G.

Lundberg

K. B.

Fredrickson

B. L.

(2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness, 8, 1280–1290. https://doi.org/10.1007/s12671-017-0704-3

45.

Kim

J. N.

Grunig

J. E.

(2011). Problem solving and communicative action: A situational theory of problem solving. Journal of Communication, 61(1), 120–149.

46.

Kokou-Kpolou

C. K.

Iorfa

S. K.

Park

Chinweuba

D. C.

Cénat

J. M.

Chukwuorji

J. C.

(2022). The Center for Epidemiologic Studies Depression Scale–Revised (CESD-20-R): Factorial validity and gender invariance among Nigerian young adults. Current Psychology, 41, 7888–7897. https://doi.org/10.1007/s12144-020-01231-z

47.

Lam

C. N.

Larach

D. B.

Chou

C. P.

Black

D. S.

(2024). Mindful attention is inversely associated with pain via mediation by psychological distress in orthopaedic patients. Pain Medicine, 25(1), 63–70. https://doi.org/10.1093/pm/pnad119

48.

Lewinsohn

P. M.

Seeley

J. R.

Roberts

R. E.

Allen

N. B.

(1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12(2), 277. https://psycnet.apa.org/doi/10.1037/0882-7974.12.2.277

49.

(2022a). How mindfulness affects life satisfaction: Based on the mindfulness-to-meaning theory. Frontiers in Psychology, 13, Article 887940. https://doi.org/10.3389/fpsyg.2022.887940

50.

Kong

Cao

Wang

(2022b). Rumination and “hot” executive function of middle school students during the COVID-19 pandemic: A moderated mediation model of depression and mindfulness. Frontiers in Psychiatry, 13, Article 989904. https://doi.org/10.3389/fpsyt.2022.989904

51.

Liang

Dong

Zhao

Song

Yang

(2022). Mindfulness and life satisfaction: The moderating effect of self-control and the moderated moderating effect of resilience. Personality and Individual Differences, 185, 111241. https://doi.org/10.1016/j.paid.2021.111241

52.

Liao

Ren

(2015). Research status of psychological problems in trauma patients. Zhongguo Xian Dai Hu Li Za Zhi, 16(15), 1858–1860.

53.

Liu

Wang

Lian

Qiao

(2024). Longitudinal impact of perfectionism on suicidal ideation among Chinese college students with perceived academic failure: The roles of rumination and depression. Archives of Suicide Research, 28(3), 830–843.

54.

Mamat

(2023). The Relation Among Thought Suppression, Forgetting, and Mental Health [Doctoral dissertation].

55.

Muili

A. O.

Kuol

P. P.

Jobran

A. W.

Lawal

R. A.

Agamy

A. A.

Bankole

N. D. A.

(2024). Management of traumatic brain injury in Africa: Challenges and opportunities. International Journal of Surgery, 110(6), 3760–3767.

56.

Musa

Z. A.

Soh

K. L.

Mukhtar

Soh

K. Y.

Oladele

T. O.

Soh

K. G.

(2021). Effectiveness of mindfulness-based cognitive therapy among depressed individuals with disabilities in Nigeria: A randomized controlled trial. Psychiatry Research, 296, 113680. https://doi.org/10.1016/j.psychres.2020.113680

57.

Muscatelli

Spurr

O’Hara

N. N.

O’Hara

L. M.

Sprague

S. A.

Slobogean

G. P.

(2017). Prevalence of depression and posttraumatic stress disorder after acute orthopaedic trauma: A systematic review and meta-analysis. Journal of Orthopaedic Trauma, 31(1), 47–55. https://doi.org/10.1097/BOT.0000000000000664

58.

Mwaungulu

Noah

Philipo

G. S.

Mpanga

C. C.

(2024). Patterns of orthopedic injuries among motorcycle trauma patients in Malawi. East and Central African Journal of Surgery, 29(4).

59.

Obayemi

J. E.

Card

E. B.

Shirima

Massawe

Mandari

Pallangyo

Lefaive

Haonga

B. T.

Morshed

Sheth

N. P.

(2020). Psychosocial health of patients receiving orthopaedic treatment in northern Tanzania: A cross-sectional study. Annals of Medicine and Surgery, 50, 49–55. https://doi.org/10.1016/j.amsu.2019.10.020

60.

Oflazoglu

Mellema

J. J.

Menendez

M. E.

Mudgal

C. S.

Ring

Chen

N. C.

(2016). Prevalence of and factors associated with major depression in patients with upper extremity conditions. The Journal of Hand Surgery, 41(2), 263–269. https://doi.org/10.1016/j.jhsa.2015.11.019

61.

Omoke

N. I.

Ekumankama

F. O.

(2020). Incidence and pattern of extremity fractures seen in accident and emergency department of a Nigerian teaching hospital. Nigerian Journal of Surgery, 26(1), 28–34.

62.

Omondi

M. P.

(2024). Epidemiology of orthopaedic injuries among inpatients admitted at a tertiary teaching and referral hospital in Kenya: A retrospective cross-sectional study. BMC Musculoskeletal Disorders, 25(1), 670. https://doi.org/10.1186/s12891-024-07793-4

63.

Onu

D. U.

Obi-keguna

C. N.

Oguguam

O. N.

Ajaero

C. K.

Igwe

E. J.

(2025). Social support may Buffer, to an extent, the impact of stigma on health-related quality of life among type 2 diabetes mellitus patients. Discover Public Health, 22(1), 29. https://doi.org/10.1186/s12982-025-00415-x

64.

Onu

D. U.

Orjiakor

T. C.

Prince

A. O.

(2024). Does social support buffer the impact of stress on health among people living with sickle cell disease? A cross-sectional study. Journal of Health Psychology. Advance online publication. https://doi.org/10.1177/13591053241309498

65.

Ozbas

E. S.

Kutlu

Demircioglu

Cavdar

(2018). Determining anxiety and depression levels of the relatives of patients undergoing the major orthopaedic surgery. International Journal of Caring Sciences, 11(2).

66.

Ozor

O. T.

Ifeagwazi

C. M.

Chukwuorji

J. C.

Obi-Keguna

C. N.

Igwe

E. J.

Onu

D. U.

(2025). Does self-compassion buffer the impact of fear of COVID-19 on health-related quality of life for people living with HIV? Journal of Health Psychology. Advance online publication. https://doi.org/10.1177/13591053251317370

67.

Parmentier

F. B.

García-Toro

García-Campayo

Yañez

A. M.

Andrés

Gili

(2019). Mindfulness and symptoms of depression and anxiety in the general population: The mediating roles of worry, rumination, reappraisal and suppression. Frontiers in Psychology, 10, 506. https://doi.org/10.3389/fpsyg.2019.00506

68.

Pei

Chen

Zhang

Wang

. . . Dou

(2022). Pain catastrophizing and associated factors in preoperative total knee arthroplasty in Lanzhou, China: A cross-sectional study. BMC Musculoskeletal Disorders, 23(1), 507. https://doi.org/10.1186/s12891-022-05435-1

69.

Pelham

W. E.

III Gonzalez

Metcalf

S. A.

Whicker

C. L.

Scherer

E. A.

Witkiewitz

Wilson

A. D.

Prince

M. A.

Leffingwell

T. R.

Roesch

S. C.

Mackinnon

D. P.

(2019). Item response theory analysis of the Five Facet Mindfulness Questionnaire and its short forms. Mindfulness, 10(8), 1615–1628. https://doi.org/10.1007/s12671-019-01105-x

70.

Radloff

(1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

71.

Radloff

L. S.

Locke

B. Z.

(1986). The community mental health assessment survey and the CES-D scale. In Weissman

M. M.

Myers

J. K.

Ross

C. E.

(Eds.), Community surveys of psychiatric disorders (pp. 177–189). Rutgers University Press.

72.

Raes

Williams

J. M. G.

(2010). The relationship between mindfulness and uncontrollability of ruminative thinking. Mindfulness, 1, 199–203. https://doi.org/10.1007/s12671-010-0021-6

73.

Sawe

H. R.

Mulwafu

Chokotho

Croke

Chamanga

Mohammed

Nicks

B. A.

Reynolds

T. A.

Wang

Mmbaga

B. T.

Lutge

Theis

Kachapulula

Hosseinipour

M. C.

Milusheva

(2023). Fall injuries in Sub-Saharan Africa: Analysis of prospective injury registry from 23 health facilities in Malawi and Tanzania. BMC Emergency Medicine, 23(1), Article 42. https://doi.org/10.1186/s12873-023-00805-x

74.

Shakked

McDonald

Sutton

Lynch

M. K.

Nicholson

Raikin

S. M.

(2018). Influence of depressive symptoms on hallux valgus surgical outcomes. Foot & Ankle International, 39(7), 795–800. https://doi.org/10.1177/1071100718762137

75.

Sibghat-ullah

Batool

(2020). Mindfulness and depressive symptoms: Mediating role of rumination. Pakistan Journal of Social and Clinical Psychology, 18(2), 27–31.

76.

Siddaway

A. P.

Wood

A. M.

Taylor

P. J.

(2017). The Center for Epidemiologic Studies-Depression (CES-D) scale measures a continuum from well-being to depression: Testing two key predictions of positive clinical psychology. Journal of Affective Disorders, 213, 180–186. https://doi.org/10.1016/j.jad.2017.02.015

77.

Smith

(2015). Coping with the psychological effects of illness: Strategies to manage anxiety and depression. SPCK.

78.

Sobol

Wozny

Czubak-Paluch

(2021). Emotion regulation and social support as related to depressive symptoms: A study of healthy and hospitalized adolescents. Personality and Individual Differences, 174, 110665. https://doi.org/10.1016/j.paid.2021.110665

79.

Squires

S. D.

Milev

R. V.

Poppenk

(2022). The impact of non-infection pandemic stress on depression and anxiety severity: Investigating mediation by intrusive and deliberate rumination. Journal of Affective Disorders, 310, 291–295. https://doi.org/10.1016/j.jad.2022.05.039

80.

Strohmaier

Jones

F. W.

Cane

J. E.

(2021). Effects of length of mindfulness practice on mindfulness, depression, anxiety, and stress: A randomized controlled experiment. Mindfulness, 12, 198–214. https://doi.org/10.1007/s12671-020-01512-5

81.

Taku

Cann

Tedeschi

R. G.

Calhoun

L. G.

(2009). Intrusive versus deliberate rumination in posttraumatic growth across US and Japanese samples. Anxiety, Stress, & Coping, 22(2), 129–136. https://doi.org/10.1080/10615800802317841

82.

Tsai

Treves

I. N.

Bauer

C. C.

Scherer

Caballero

West

M. R.

Gabrieli

J. D.

(2024). Dispositional mindfulness: Dissociable affective and cognitive processes. Psychonomic Bulletin & Review, 31(4), 1798–1808. https://doi.org/10.3758/s13423-024-02462-y

83.

Vago

D. R.

Silbersweig

D. A.

(2012). Self-awareness, self-regulation, and self-transcendence (S-ART): A framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, Article 296.

84.

Vincent

H. K.

Horodyski

Vincent

K. R.

Brisbane

S. T.

Sadasivan

K. K.

(2015). Psychological distress after orthopaedic trauma: Prevalence in patients and implications for rehabilitation. PM&R, 7(9), 978–989. https://doi.org/10.1016/j.pmrj.2015.03.007

85.

Von Hippel

Tyre

M. J.

(1995). How learning by doing is done: Problem identification in novel process equipment. Research Policy, 24(1), 1–12.

86.

Watkins

E. R.

Roberts

(2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy, 127, 103573. https://doi.org/10.1016/j.brat.2020.103573

87.

World Health Organization. (2018). Global status report on road safety 2018. https://www.who.int/publications/i/item/9789241565684

88.

Wright

D. W.

(2015). Personality resilience indicators of dispositional mindfulness and self-regulation in college athletes. Texas A&M University.

89.

Jiang

Zhou

(2019). Intrusive rumination, deliberate rumination, and posttraumatic growth among adolescents after a tornado: The role of social support. The Journal of Nervous and Mental Disease, 207(3), 152–156. https://doi.org/10.1097/NMD.0000000000000926

Rumination impacts depressive symptoms among orthopedic patients: analysis of the buffering role of dispositional mindfulness

Abstract

Keywords

Get full access to this article

References