Research Methods Homework

Emotion Regulation in Current and Remitted
Depression: A Systematic Review and Meta-Analysis

Introduction
Major Depressive Disorder (MDD) is characterized by symptoms of sustained
depressed mood and anhedonia (American Psychiatric Association, 2013). 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 actually maintain or increase symptoms. In
sum, emotion regulation could be a factor that may contribute to development of
both onset and recurrence of depressive episodes.
To our knowledge, there is no meta-analytic evidence of differences in self-reported
emotion regulation including both individuals with a diagnosis of MDD and
individuals remitted from MDD. The main aim of the current study was to address
this knowledge gap by conducting a systematic review of published research on self-
reported emotion regulation, and to quantify self-reported emotion regulation
difficulties in people with current and remitted MDD compared to healthy controls
through meta-analytic procedures.
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
Study Selection
A total of 72 studies involving 91 trials were identified for inclusion in our review.
Sixty-nine trials involved participants with MDD, and 22 trials involved participants
recovered or remitted from MDD. As result, 276 full-text articles were reviewed in
more detail by the first and second author. Of these, 59 articles (21%) were rated
differently by the authors, and were discussed to reach agreement (in favor of the first
author: 32; in favour of the second author: 27). As a result of the rating process, 204
studies were excluded with following reasons: language not mastered by the authors
(n = 13), clinical group no MDD or history of MDD (n = 8), heterogeneous clinical
population (n = 20), participant age under 18 years (n = 9), clinical or healthy control
group not screened with diagnostic interview, or not reported applying such an
interview (n = 95), participants screened partially with diagnostic interview involving
only a few diagnostic modules (n = 12), control group not healthy (n = 5), no self-
report measure of emotion regulation (n = 17), questionnaire not validated (n = 3),
duplicate data (n = 5), experimental induction prior to assessment (n = 3), and
corresponding author not returning data on enquiry (n = 14).
Discussion
The general aim of this systematic review and meta-analysis was to examine and
summarize what is known to date about self-reported emotion regulation strategy use
and general emotion regulation ability in individuals with current and remitted MDD.
As a result, a considerably greater number of studies were identified, reviewed and
included, compared to earlier reviews (e.g., Aldao et al., 2010; Liu and Thompson,
2017).
At the same time, similar patterns of results as in previous reviews emerge.
Compared to healthy controls, individuals diagnosed with current MDD report
habitually using maladaptive emotion regulation strategies more frequently, and
adaptive emotion regulation strategies less frequently.
For individuals with remitted MDD, the present review is in line with Joormann and
Stanton (2016) and Liu and Thompson (2017) in that these individuals seem to use
maladaptive emotion regulation strategies more often than healthy controls.
However, no significant difference between individuals remitted from MDD and
healthy controls were found in adaptive emotion regulation strategy use. Moreover,
results from two studies indicate that remitted MDD individuals have limited general
emotion regulation abilities compared to healthy controls
Our meta-regression analyses found use of maladaptive emotion regulation strategies
for individuals with MDD to be positively associated with comorbid anxiety disorder.
This indicates that the presence of anxiety disorders along with depression increases
the probability of having difficulties with emotion regulation. Also, age of onset was
negatively associated with maladaptive emotion regulation use. This indicates that
early debut of the first episode of MDD may be linked to greater problems in
managing emotions
Conclusion
Individuals with both current and remitted MDD have difficulties with emotion
regulation. Currently and remitted MDD individuals report using more maladaptive
emotion regulation strategies compared to healthy controls. Currently depressed
individuals report using less adaptive emotion regulation strategies, and report
having limited general emotion regulation abilities, including emotional awareness,
clarity, and tolerance. 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. However, the studies that
include reappraisal suggest that there is no difference between individuals with
remitted MDD and healthy controls. Moreover, the studies indicate that individuals
with remitted MDD have limited general emotion regulation abilities compared to
healthy controls, although this result is also based on a limited number of studies.
Finally, duration of remission seems to be a protective factor of future relapse, as
longer duration of remission was associated with lesser maladaptive emotion
regulation use.
Clinically, the presence of emotion regulation deficiencies in both ongoing and
former depression points to the usefulness of addressing these issues both in
treatment and relapse prevention.

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Emotion Regulation in Current and Remitted

Depression: A Systematic Review and Meta-Analysis

Methods Seventy-two eligible studies were retrieved from databases through a

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