Abstract
Background: Major Depressive Disorder (MDD) is a highly prevalent, recurrent, and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD.Methods: Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD, and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties.Results: Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges' g = 1.3), rumination (g = 2.1), and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g = −1.0), problem solving (g = −1.0), and reappraisal (g = −0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g = 1.45), lower emotional awareness (g = −0.95), emotional clarity (g = −1.50) and emotional tolerance (g = −1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6), and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation.Conclusion: The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions.
Highlights
Major Depressive Disorder (MDD) is characterized by symptoms of sustained depressed mood and anhedonia (American Psychiatric Association, 2013)
And remitted MDD individuals report using more maladaptive emotion regulation strategies compared to healthy controls
Due to a limited number of studies involving adaptive emotion regulation strategies in persons with remitted MDD, the null results of acceptance and problem solving should be interpreted with caution
Summary
Major Depressive Disorder (MDD) is characterized by symptoms of sustained depressed mood and anhedonia (American Psychiatric Association, 2013). Given the magnitude of this public health issue, it is imperative to identify risk factors and underlying mechanisms to inform preventive and therapeutic interventions (Farb et al, 2014). One potential mechanism in the development and maintenance of depression is difficulties with emotion regulation (Donofry et al, 2016). Individuals prone to depression may use maladaptive emotion regulation strategies, where attempts to manage aversive experiences backfire and maintain or increase symptoms. They may be less aware of emotions, have difficulties understanding them, as well as a limited capacity to tolerate them. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is imperative.
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