Repetitive Negative Thinking as a Pathway from Rejection Sensitivity to Poorer Mental Health: The Role of Expectancy Versus Concern

Abstract Background Rejection sensitivity (RS) has widely been considered unidimensional: the product sum of elevated (i) concern and (ii) expectation of rejection in social situations. Recent research suggests that rejection concern and expectancy are distinct constructs. This study aims to explore the role of Repetitive negative thinking (RNT) as a mediator between rejection concern versus expectancy and clinical outcomes, hypothesising distinct relationships for each RS construct. Methods Data were collected as part of the Horizon2020 project “Assessing and Enhancing Emotional Competence for Well-Being in the Young: A principled, evidence-based, mobile-health approach to prevent mental disorders and promote mental well-being.” In Data Collection 1 ( N = 605; age 15–20 years; Belgium) and Data Collection 2 ( N = 1199; age 15–22 years; Belgium, UK, Germany, Spain) Confirmatory Factor Analysis contrasted unidimensional and bi-lateral models of RS, conceptualised via the Adult Rejection Sensitivity Questionnaire (A-RSQ). Next, pathway models examined whether RNT mediated the relationship between rejection concern/expectancy and depression, anxiety, and mental well-being. Results The two-factor model assessing the structure of the A-RSQ with rejection concern and expectancy as separate constructs had the best overall fit in both datasets. Rejection concern was most strongly linked to anxiety and depression, with RNT mediating this relationship. Rejection expectancy was more directly related to clinical outcomes, especially mental well-being. Depression was most strongly related to rejection expectancy in the first Belgian sample, equally strongly to rejection expectancy and concern in the second Belgian sample, and to rejection concern in all other countries. Conclusions Our findings support the need to treat rejection concern and expectancy as distinct constructs, as they relate to different clinical outcomes and the pathways leading to these outcomes may be different. Considering them as two aspects of one unidimensional construct could obscure meaningful differences in mental health research and practice.