Depression and interpersonal stress: The mediating role of emotion regulation

Prospective Relations between Life Stress, Emotional Clarity, and Suicidal Ideation in an Adolescent Clinical Sample

OBJECTIVE

Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample.

METHODS

The sample consisted of 180 youths (Mage = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest.

RESULTS

At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R2 = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress.

CONCLUSIONS

Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth's understanding of their emotional experiences may reduce subsequent suicidal ideation.

Network analysis of emotion regulation and reactivity in adolescents: identifying central components and implications for anxiety and depression interventions

Difficulties in emotion regulation (DER) and emotion reactivity (ER) are important causes and consequences of psychiatric disorders such as depression and anxiety, and previous research suggests that there are many interactions between them. Understanding the structure of their relationship, and which components may play a key role, will help provide insight into emotion disorders in adolescents and provide guidance for clinical interventions. In this study, we collected data from 483 adolescents and used network analysis methods to explore the relationship between DER and ER, specifically looking for core nodes. The results showed that "limited access to emotion regulation strategies" was the most central node in the network. Furthermore, by adding nodes for depression and anxiety to this network, we found that anxiety had the strongest relationship with ER, while depression had a stronger relationship with DER. Thus, our findings suggest that for anxiety disorders, the strong association with ER highlights a potentially promising area for intervention development, whereas for depression, the association with DER points to the possibility of clarifying emotions and exploring coping strategies, acknowledging the complex interplay between depressive and anxious symptoms.

Contextual influence of the COVID-19 pandemic on pregnant women's emotional regulation abilities

INTRODUCTION

Emotional regulation is a key factor that could determine the quality of becoming a parent. Since pregnancy is accompanied by changes in the emotional system, fluctuations in emotional regulation may also occur during this period. In 2020, the COVID-19 pandemic had major psychological repercussions on the general population which could have also affected emotional regulation capacities.

OBJECTIVE

The objective of this study was to determine whether emotional regulation has characteristics during pregnancy and to evaluate the influence of the COVID-19 pandemic on the emotional regulation of pregnant women.

METHOD

One hundred fifty-one women aged between 19 and 42 years old participated in this study. Their emotional regulation abilities were assessed using the Difficulties Emotion Regulation Scale before and during the pandemic. A two-factor multivariate analysis of covariance, "parental status" (pregnant vs. childless) and "time of data collection" (before vs. during COVID-19), was conducted to compare the emotional regulation abilities of pregnant women with those of childless women before and during the pandemic.

RESULTS

(1) Prior to the pandemic, pregnant women exhibited better emotional regulation skills than childless women, characterized by greater acceptance and understanding of their emotions. (2) During the pandemic: (a) pregnant women's emotional regulation scores were comparable to those of women without children. (b) They also had more difficulty than pre-pandemic pregnant women in identifying their emotions.

CONCLUSION

The lack of improvement in emotional regulation skills in pregnant women during the COVID-19 pandemic is a specific impact of COVID on this population. This could affect their mental health, as well as the emotional adjustment of the mother towards her baby.

The impact of social support and emotion dysregulation on COVID-19 depressive symptoms

Introduction

Stress resulting from the global COVID-19 pandemic has been linked to psychological consequences, such as depressive symptoms, for individuals worldwide. Outbreaks and pandemics are known to accentuate stressors or generate new ones owing to health-related worries, reduced mobility, and social activity due to quarantine, and sudden life changes. Although post-lockdown U.S. research findings suggest a greater risk of depression among 18- to 25-year-olds, familiarity with technology and virtual socializing may offer college students some protective effect, warranting research with such groups.

Methods

The current study thus explored emotion dysregulation (ED) and perceived social support (PSS) as potential mechanisms for the relationship between COVID-19 stress and depressive symptoms among students at a southern university in the United States. Participants (N = 489) completed a cross-sectional survey assessing their current levels of COVID-19 stress, ED, PSS, and depressive symptoms.

Results

Path analysis showed that PSS buffered the effect of ED on depressive symptoms. The results support the explanatory role of ED in the relationship between COVID-19 stress and depressive symptoms.

Discussion

The perceived social connection may be an essential factor for psychological outcomes during periods of stress and isolation, particularly for those reporting high ED.

Cyberaggression victimization on anxiety and depression in college students: the role of emotion regulation, social media, social support, and biological sex

Objective: To test a conceptual model by which emotion dysregulation mediates the association between cyberaggression victimization (CAV) and symptoms of depression and anxiety among college students. Participants: Undergraduate students (N = 459) aged 18 to 29 years. Methods: Participants responded to an online questionnaire assessing CAV and distress associated with these experiences. Participants reported on emotion dysregulation, social media use integration, social support, and depression and anxiety symptoms. Results: As expected, emotion dysregulation mediated the relationship between CAV and depressive and anxiety symptoms. Contrary to expectations, biological sex and social media integration did not moderate the relationship between CAV and emotion dysregulation. Social support reduced the negative effects of emotion dysregulation on depressive and anxiety symptoms. Conclusion: These findings point to the need for colleges to invest in prevention and intervention efforts to reduce exposure to CAV and the impact of those experiences on the health and well-being of students.

Relationship Satisfaction and Well-being During the COVID-19 Pandemic: Examining the Associations with Interpersonal Emotion Regulation Strategies

Background

The COVID-19 pandemic has changed our interpersonal relationships drastically. However, few research studies have examined pandemic-induced stress and its impact on relationship quality. The current research aimed to examine COVID-19 related stress and anxiety in relation to relationship satisfaction, well-being (i.e., positive affect and life satisfaction), and interpersonal emotion regulation strategies (i.e., perspective-taking, enhancing positive affect, social modeling, and soothing), to understand the effects of pandemic-induced stress on both an individual and a relational well-being. The moderating effect of interpersonal emotion regulation strategies toward COVID-19 related stress was also examined.

Methods

The sample consisted of 877 married Turkish adults (N_female = 613, M_age = 35.00; N_male = 264, M_age = 39.21). Data were analyzed with structural equation modeling, and moderation effects were tested.

Results

As hypothesized, structural equation modeling revealed that greater COVID-19 related stress was associated with lower well-being, and that this relationship was mediated by relationship satisfaction. Findings indicated that IER strategy of increasing positive emotions was associated with greater relationship satisfaction and well-being. Unexpectedly, interpersonal emotion regulation strategies moderated neither the relationship between COVID-19 related stress and relationship satisfaction nor the relationship between COVID-19 stress and well-being.

Conclusions

Our findings support the vulnerability-stress-adaptation framework and draw attention to the importance of examining the effects of COVID-19 stress and relationship satisfaction.

Young Adults' Loneliness and Depression During the COVID-19 Pandemic: A Moderated Mediation Model

Since the outbreak of the COVID-19 pandemic in December 2019, millions of people have been infected with the disease. The COVID-19 pandemic also produced severe mental health problems, such as loneliness and depression. The present study aimed to examine the mediating role of cognitive reappraisal and moderating role of resilience in the relationship between young adults’ loneliness and depression during the pandemic by adopting a cross-sectional research approach. In March 2020, 654 young adults (18–29 years old) were recruited to complete the measures for loneliness, depression, emotion regulation, and resilience. Results found that loneliness was positively and moderately associated with depression (r = 0.531, p < 0.001), and that both loneliness and depression were separately negatively associated with cognitive reappraisal (r = −0.348, p < 0.001; r = −0.424, p < 0.001) and resilience (r = −0.436, p < 0.001; r = −0.419, p < 0.001). The results indicated that both loneliness and depression were not associated with expressive suppression (r = 0.067, p = 0.087; r = −0.002, p = 0.961). The moderated mediation model results revealed that only cognitive reappraisal partially mediated the relationship between loneliness and depression (b = −0.301; Boot 95% CI = −0.388, −0.215). In addition, the results of the moderated mediation model indicated that resilience moderated the association between loneliness and depression (b = 0.035, p < 0.001, Boot 95% CI = 0.014, 0.055), while also moderated the impact of cognitive reappraisal on depression (b = −0.031, p < 0.001, Boot 95% CI = −0.058, −0.005). These findings have practical implications that broaden our understanding of depression in young adults and shed light on how to enhance cognitive reappraisal and resilience as a means of combating depression in this age group during the COVID-19 pandemic.

Suicidal Behavior and Problems with Emotion Regulation

We examined in two independent samples whether: (1) difficulties with emotion regulation predict suicide ideation and (2) depressed adults with a history of attempting suicide report and exhibit more emotion dysregulation compared to healthy and depressed controls. Difficulties with emotional clarity and relationship status were significant predictors of suicide ideation (Study 1). In Study 2, when compared to controls, depressed attempters reported significantly more difficulties with emotional clarity and emotional impulsivity. Attempters had significantly more difficulty than controls returning to heart rate baseline following a stressful task. Problems with emotions are therefore differentially connected to suicidal behaviors.

Emotion Regulation Protects Against Recurrence of Depressive Symptoms Following Inpatient Care for Major Depressive Disorder

Relapse following response in psychotherapy for major depressive disorder (MDD) is a major concern. Emotion regulation (ER) has been discussed as a putative emerging and maintaining factor for depression. The purpose of the present study was to examine whether ER protects against recurrence of depression over and above residual symptoms of depression following inpatient care for MDD. ER skills (ERSQ-ES) and depression (HEALTH-49) were assessed in 193 patients with MDD (age, M = 47.4, SD = 9.6, 75.1% female, 100% Caucasian) at treatment discontinuation, 3 and 12 months after treatment. Multiple hierarchical regressions were used to examine general and specific ER as predictors of depressive symptoms at follow-ups. Higher general ER predicted lower depression over and beyond residual symptoms of depression at 3-month follow-up among treatment responders but not among treatment nonresponders. With regard to specific ER skills, readiness to confront and acceptance of undesired emotions predicted lower depressive symptoms beyond residual symptoms of depression 12 months, respectively 3 and 12 months after treatment. Findings of the present study indicate that targeting general ER might be more important for remitted and less important for nonremitted patients. Enhancing ER should hence be realized in a sequential treatment design, in which a continuation phase treatment with a specific focus on ER directly follows, once patients sufficiently responded to treatment. Acceptance of undesired emotion and readiness to confront situations that cue these emotions appear to be particularly important for protecting against recurrence of depression. Future research should clarify whether findings can be generalized to outpatient care.

Adolescent Depression and Negative Life Events, the Mediating Role of Cognitive Emotion Regulation

BACKGROUND

Depression during adolescence is a serious mental health problem. Difficulties in regulating evoked emotions after stressful life events are considered to lead to depression. This study examined if depressive symptoms were mediated by various cognitive emotion regulation strategies after stressful life events, more specifically, the loss of a loved one, health threats or relational challenges.

METHODS

We used a sample of 398 adolescents (Mage = 16.94, SD = 2.90), including 52 depressed outpatients, who all reported stressful life event(s). Path analyses in Mplus were used to test mediation, for the whole sample as well as separately for participants scoring high versus low on depression, using multigroup analyses.

RESULTS

Health threats and relational challenging stressful life events were associated with depressive symptoms, while loss was not. More frequent use of maladaptive strategies was related to more depressive symptoms. More frequent use of adaptive strategies was related to less depressive symptoms. Specific life events were associated with specific emotion regulation strategies. The relationship between challenging, stressful life events and depressive symptoms in the whole group was mediated by maladaptive strategies (self-blame, catastrophizing and rumination). No mediation effect was found for adaptive strategies.

CONCLUSION

The association between relational challenging, stressful life events and depressive symptoms was mediated by maladaptive, cognitive emotion regulation strategies.

Emotional Reactivity and Internalizing Symptoms: Moderating Role of Emotion Regulation

Emotion dysregulation has been associated with increases in many forms of psychopathology in adolescents and adults. The development of effective emotion regulation skills is important during adolescence, especially as stressful life events increase during this time. The current study examined two emotion regulation strategies, cognitive reappraisal and affective suppression, in interaction with self-report and biological measures of emotional reactivity as predictors of internalizing symptoms. A community sample of adolescents (n = 127), at an age of risk for depression and anxiety, completed self-report measures of emotional reactivity and internalizing symptoms. In addition, they completed a modified social stress task and were assessed on biological measures of reactivity and regulation. Findings suggested that the trait tendency to reappraise was associated with a reduced impact of emotional reactivity on depressive, but not anxiety symptoms. Implications for shared and specific aspects of emotional reactivity and regulation are discussed.

An Experimental Examination of the Interaction between Mood Induction Task and Personality Psychopathology on State Emotion Dysregulation

While emotion dysregulation has been investigated as a key variable in the development and persistence of personality psychopathology, few studies have explored state emotion dysregulation among individuals with personality disorders (PDs). The current study addresses this void in the literature through a laboratory investigation of state emotion dysregulation among participants with and without PDs. To facilitate this goal, participants were matched to pairs based on similar personality features and were randomized to one of two behavioral analogues; either the Paced Auditory Serial Addition Task-Computerized (PASAT-C) or an interpersonally based mood induction. As hypothesized, PD participants in the PASAT-C reported significantly more difficulty with impulsivity and emotion regulation strategies. Contrary to expectations, the PD group in the interpersonal task demonstrated significantly less difficulty with non-acceptance of emotion and emotional clarity and significantly greater positive affect compared to non-PD participants. Implications for these findings and directions for future research are discussed.

Predicting symptoms of depression from social anhedonia and emotion regulation

The literature examining social anhedonia, emotion regulation, and symptoms of depression in psychiatric inpatients has been limited. However, some studies have shown that difficulties in emotion regulation and social anhedonia were independently associated with depression. The current study attempted to examine the effects of these two potential predictors of unipolar depressed mood. Fifty-nine (73% female) psychiatric inpatients were given the measures of emotion regulation, symptoms of anxiety and depression, and social anhedonia. Results showed that difficulties in emotion regulation, specifically dysfunctional emotion regulation strategies and emotional clarity, served as significant predictors of depressive symptoms above and beyond contributions from social anhedonia. These results highlight the importance of attending to emotion regulation in the study and treatment of depression in inpatient samples.

Emotion dysregulation mediates the relationship between lifetime cumulative adversity and depressive symptomatology

Repeated exposure to stressful events across the lifespan, referred to as cumulative adversity, is a potent risk factor for depression. Research indicates that cumulative adversity detrimentally affects emotion regulation processes, which may represent a pathway linking cumulative adversity to vulnerability to depression. However, empirical evidence that emotion dysregulation mediates the relationship between cumulative adversity and depression is limited, particularly in adult populations. We examined the direct and indirect effects of cumulative adversity on depressive symptomatology in a large community sample of adults (n = 745) who were further characterized by risk status: never-depressed (n = 638) and "at-risk" remitted mood-disordered (n = 107). All participants completed the Cumulative Adversity Inventory (CAI), the Difficulties in Emotion Regulation Scale (DERS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Bootstrapped confidence intervals were computed to estimate the indirect effect of emotion dysregulation on the relationship between cumulative adversity and depressive symptomatology and to test whether this indirect effect was moderated by risk status. Emotion dysregulation partially and significantly mediated the relationship between cumulative adversity and depressive symptomatology independent of risk status. Overall, cumulative adversity and emotion dysregulation accounted for 50% of the variance in depressive symptomatology. These findings support the hypothesis that disruption of adaptive emotion regulation processes associated with repeated exposure to stressful life events represents an intrapersonal mechanism linking the experience of adverse events to depression. Our results support the utility of interventions that simultaneously emphasize stress reduction and emotion regulation to treat and prevent depressive vulnerability and pathology.