Resumen
Contemporary models of mental health emphasize the fundamental role of emotion regulation (ER) difficulties in psychopathology. However, the extent to which ER difficulties are universally present or vary in severity and type between mental disorders is largely unknown. To estimate standardized mean differences (SMD) across the range of psychopathologies, we conducted a systematic review and calculated preregistered multilevel meta-analyses. We compared adults with mental disorders to healthy controls (HC) on pre-defined ER questionnaires, including 517 studies with 34,789 clinical participants and 31,221 HC. Compared to HC, the clinical participants reported: a) increased general ER difficulties (SMD= 1.73), and b) differential use of specific ER strategies (decreased acceptance= -0.83, problem-solving= -0.61, and reappraisal= -0.63; increased avoidance= 1.02, rumination= 1.52, and suppression= 0.73). Separate analyses by mental disorder category indicated that general ER difficulties, decreased use of reappraisal, and increased use of rumination and suppression were transdiagnostically present. We also found unique patterns of ER difficulties compared to HC among mental disorders, with depressive disorders showing most pronounced differences in reappraisal and rumination, anxiety and obsessive-compulsive disorders in avoidance, and personality disorders in general ER difficulties and acceptance. The generalizability of these findings may be limited by the indirect comparisons between mental disorders, the search terms, and the selected questionnaires. Nevertheless, this study adds substantial evidence to the notion that ER difficulties are a transdiagnostic phenomenon, while also highlighting disorder-specific impairments. Differentiating between global and disorder-specific impairment hold important implications for refining etiological models and formulating effective strategies for prevention and intervention.
