Understanding Adolescent Psychological Distress: The Impact of Rejection Sensitivity and Rumination

Background: Adolescents are particularly vulnerable to psychological distress due to heightened emotional reactivity and developmental transitions. While rejection sensitivity and rumination have been independently linked to adverse emotional outcomes, their combined effect on psychological distress remains underexplored, especially in non-Western populations. Objective: This study aimed to examine the interrelationship among rejection sensitivity, rumination, and psychological distress in adolescents, and to assess the predictive role of rejection sensitivity on rumination and both variables on psychological distress. Methods: A cross-sectional observational study was conducted involving 518 adolescents (ages 14–18) from government and private schools in Rawalpindi and Islamabad, selected using purposive sampling. Inclusion criteria included current enrollment in school and age between 14 and 18 years; individuals outside this age range or with incomplete data were excluded. Participants completed the Rejection Sensitivity Questionnaire, the Rumination-Reflection Questionnaire (rumination subscale), and the Depression Anxiety Stress Scale-21. Ethical approval was obtained from the institutional ethics committee, and all procedures complied with the Declaration of Helsinki. Data were analyzed using SPSS v27. Correlation and multiple regression analyses were employed to examine associations and predictive relationships among variables. Results: Rejection sensitivity showed a significant positive correlation with rumination (r = 0.28, p < .01) and psychological distress (r = 0.21, p < .01). Rumination also correlated positively with psychological distress (r = 0.13, p < .05). Regression analysis revealed that rejection sensitivity significantly predicted rumination (β = 0.108, p = .003), explaining 6% of its variance. Combined, rejection sensitivity and rumination accounted for 29% of the variance in psychological distress (R² = 0.29, p < .001), with rumination having a stronger predictive effect (β = 0.502, p < .001). Male adolescents reported significantly higher rumination levels than females (p < .001). Conclusion: Rejection sensitivity and rumination are significant, interrelated psychological mechanisms contributing to adolescent psychological distress. These findings highlight the importance of early identification and cognitive-emotional intervention strategies to mitigate distress and promote mental health in adolescents