DOI: 10.1002/jad.12226 ISSN: 0140-1971

Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: A gender‐sensitive structural equation modeling approach

Francesca Locati, Ilaria Maria Antonietta Benzi, Alberto Milesi, Chloe Campbell, Nicholas Midgley, Peter Fonagy, Laura Parolin
  • Psychiatry and Mental health
  • Developmental and Educational Psychology
  • Social Psychology
  • Pediatrics, Perinatology and Child Health



Mentalization, operationalized as reflective functioning (RF), allows individuals to interpret actions as caused by intentional mental states. Previous research highlighted the gender‐specific associations between adolescents' internalizing and externalizing difficulties and mentalizing impairments. In addition, research suggested that mentalizing facilitates the creation of epistemic trust (ET) to evaluate social information as accurate, reliable, and relevant. However, few investigations explored the concurrent associations between RF, ET, and adolescent psychopathology.


A sample of 447 Italian cisgender adolescents (57% assigned females at birth; age range 12–19 years old; Mage = 15.54, SD = 1.98) self‐reported RF (RFQY‐5), ET towards mother, father, and peers (IPPA) and mental health problems (YSR‐112). Gender‐specific structural equation modeling explored the associations between RF, ET, and internalizing/externalizing problems.


Results suggested an excellent fit for the theoretical model and revealed gender‐related associations. In females, findings suggest that ET mediates the association between RF and psychopathology, with indirect associations from RF through ET to lower internalizing and externalizing problems. However, in males, RF and ET display independent associations with psychopathology.


Overall, findings suggest that ET might be a transdiagnostic factor playing different roles associated with adolescent psychopathology. Indeed, links between RF and ET might help to explore gender differences in mental health problems in this developmental phase.

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