Cited by 233Child and Adolescent Psychosocial and Emotional DevelopmentChild Abuse and TraumaAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis

Open access
Miu, Andrei C., Szentágotai-Tătar, Aurora, Balázsi, Róbert, Nechita, Diana, Bunea, Ioana, Pollak, Seth D.·2022·Clinical Psychology Review

Abstract

Childhood adversity is a major risk factor for multiple forms of psychopathology, and recent efforts have focused on understanding the underlying psychological mechanisms. One outstanding candidate is emotion regulation, which has been associated with both childhood adversity, and psychopathology. Based on the available evidence, the present meta-analysis set out to investigate the mechanistic involvement of emotion regulation in the relation between childhood adversity and psychopathology. Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 215 eligible studies. Using meta-analytic structural equation modeling, we fitted a partial mediation model to the available data across studies, in which childhood adversity was related to psychopathology both directly and through emotion regulation. Multiple emotion regulation dimensions were analyzed, including emotion regulation difficulties and the habitual use of rumination, distraction, reappraisal, and suppression. Measures of psychopathology included a wide range of internalizing and externalizing symptoms in both clinical and non-clinical samples. The results indicated that childhood adversity was positively associated with emotion regulation difficulties, as well as the habitual use of rumination and suppression. In turn, these measures of emotion regulation were positively associated with psychopathology. Habitual reappraisal use showed negative relations with both childhood adversity and psych…

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Crossref · 10.1016/j.cpr.2022.102141

Cites

Statistics

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Claims the paper makes

0 of 54 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Suppression mediates the relation between childhood adversity and psychopathology.

    “All these emotion regulation measures were supported as mediators in the relation between childhood adversity and psychopathology.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The causal ordering in the mediation model (childhood adversity influences emotion regulation, which influences psychopathology) is valid for interpreting the meta-analytic associations as mediation.
  • Findingown data

    Distraction does not mediate the relation between childhood adversity and psychopathology.

    “In contrast, distraction was not related to childhood adversity or psychopathology, and its mediator role was not supported.”
    Quote in the paperSubstantial claim
  • Findingown data

    Childhood adversity is positively associated with emotion regulation difficulties.

    “The results indicated that childhood adversity was positively associated with emotion regulation difficulties, as well as the habitual use of rumination and suppression.”
    Quote in the paperSubstantial claim
  • Findingown data

    Emotion regulation difficulties are positively associated with psychopathology.

    “In turn, these measures of emotion regulation were positively associated with psychopathology.”
    Quote in the paperSubstantial claim
  • Findingown data

    Reappraisal mediates the relation between childhood adversity and psychopathology.

    “All these emotion regulation measures were supported as mediators in the relation between childhood adversity and psychopathology.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The causal ordering in the mediation model (childhood adversity influences emotion regulation, which influences psychopathology) is valid for interpreting the meta-analytic associations as mediation.
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 15
  • May combine two claims.

    Findingown data

    The hypothesized indirect effect of childhood adversity on psychopathology was supported by both broad measures of emotion regulation difficulties and measures of the habitual use of specific emotion regulation strategies.

    “The hypothesized indirect effect of childhood adversity on psychopathology was supported by both broad measures of emotion regulation (i.e., difficulties), and measures of the habitual use of specific emotion regulation strategies.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The modeled direction of effects—childhood adversity influencing emotion regulation, which in turn influences psychopathology—reflects the causal process underlying the observed associations.
    • Rests on an assumption: Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.
  • May combine two claims.

    Findingown data

    For suppression, all paths and the indirect effect were replicated in both high- and low-quality studies, but there was a significant difference between models.

    “Similarly, all paths and the indirect effect were replicated in both high- and low-quality studies on suppression, but there was a significant difference between models.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Among process measures, both higher habitual use of typically maladaptive strategies (rumination, suppression) and lower habitual use of typically adaptive strategies (reappraisal) played a mediator role in the relation between childhood adversity and psychopathology.

    “Furthermore, among process measures, both higher habitual use of typically maladaptive strategies (i.e., rumination, suppression) and lower habitual use of typically adaptive strategies (i.e., reappraisal) played a mediator role in the relation between childhood adversity and psychopathology.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The modeled direction of effects—childhood adversity influencing emotion regulation, which in turn influences psychopathology—reflects the causal process underlying the observed associations.
    • Rests on an assumption: Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.
  • May combine two claims.

    Findingown data

    Findings on emotion regulation difficulties, habitual rumination, and habitual suppression held in both high- and low-quality studies, but the mediator role of reappraisal was replicated only in high-quality studies.

    “While our findings on emotion regulation difficulties, habitual rumination and habitual suppression held in both high- and low-quality studies, the mediator role of reappraisal was replicated only in high-quality studies.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Correlations between habitual suppression use and psychopathology, and between habitual distraction use and psychopathology, tended to be homogenous.

    “Correlations between habitual suppression use and psychopathology, as well as those between habitual distraction use and psychopathology tended to be homogenous.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    The path from reappraisal to psychopathology, and the indirect effect of childhood adversity on psychopathology through reappraisal, were not significant in the low-quality subgroup.

    “The path from reappraisal to psychopathology, and the indirect effect of childhood adversity on psychopathology through reappraisal were not significant in the low-quality subgroup.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    For reappraisal, all paths and the indirect effect were replicated only in the high-quality studies subgroup, and the difference between models in the high- and low-quality subgroups was significant.

    “In studies on reappraisal, all paths and the indirect effect were replicated only in the high-quality studies subgroup, and the difference between models in the high- and low-quality subgroups was significant.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    For emotion regulation difficulties and rumination, the original results were replicated in both high- and low-quality subgroups, and the difference between models was not significant.

    “In which emotion regulation difficulties and rumination were concerned, we replicated the original results in both subgroups and the difference between models was not significant.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In the high-quality subgroup, the path from distraction to psychopathology became significant, while the path from childhood adversity to distraction and the indirect effect remained non-significant.

    “In the high-quality subgroup, however, the path from distraction to psychopathology became significant, while the path from childhood adversity to distraction and the indirect effect remained non-significant.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingnone given

    Most studies failed to substantiate clinical status in putatively non-clinical samples, to use representative samples, and to use multiple informants in childhood adversity assessments.

    “Specifically, most studies failed to substantiate clinical status in putatively non-clinical samples, to use representative samples, and to use multiple informants in childhood adversity assessments.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Childhood adversity was positively associated with emotion regulation difficulties, habitual rumination use, and habitual suppression use.

    “Specifically, childhood adversity was positively associated with emotion regulation difficulties, habitual rumination use, and habitual suppression use.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.
  • May combine two claims.

    Findingown data

    Emotion regulation difficulties, rumination, and suppression showed medium and large associations, whereas reappraisal showed small associations with both childhood adversity and psychopathology.

    “In terms of effect sizes, emotion regulation difficulties, rumination and suppression showed medium and large associations, whereas reappraisal showed small associations with both childhood adversity and psychopathology.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    The paths from childhood adversity to emotion regulation, and from emotion regulation to psychopathology, were significant in the analyses on all emotion regulation outcomes except distraction.

    “The paths from both childhood adversity to emotion regulation, and emotion regulation to psychopathology were significant in the analyses on all emotion regulation outcomes except distraction.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The modeled direction of effects—childhood adversity influencing emotion regulation, which in turn influences psychopathology—reflects the causal process underlying the observed associations.
    • Rests on an assumption: Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.
  • May combine two claims.

    Findingown data

    The association between childhood adversity and habitual use of distraction was not significant in the present analyses, and neither was the indirect effect of childhood adversity on psychopathology through distraction.

    “The association between childhood adversity and the habitual use of distraction was not significant in the present analyses (see also Gruhn & Compas, 2020), and neither was the indirect effect of childhood adversity on psychopathology through distraction.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gruhn & Compas, 2020

      Not checked in the free run.

    • Rests on an assumption: The modeled direction of effects—childhood adversity influencing emotion regulation, which in turn influences psychopathology—reflects the causal process underlying the observed associations.
    • Rests on an assumption: Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.
  • May combine two claims.

    Findingown data

    In the distraction sample, all paths except that from childhood adversity to psychopathology, and the indirect effect, were not significant in the low-quality subgroup, replicating the original analysis.

    “In the distraction sample, all paths (except that from childhood adversity to psychopathology) and the indirect effect were not significant in the low-quality subgroup, replicating the original analysis.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Emotion regulation difficulties, habitual rumination use, and habitual suppression use were positively associated with psychopathology.

    “Emotion regulation difficulties, habitual rumination use, and habitual suppression use were positively associated with psychopathology.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Emotion regulation and psychopathology measures from different studies are sufficiently comparable to be pooled into common correlation matrices.
  • May combine two claims.

    Premisecitation

    Two-stage structural equation modeling takes into account sample size differences across elements of the pooled correlation matrix and gives more weight to estimates with higher precision.

    “it takes into account sample size differences across the elements of the pooled correlation matrix, and gives more weight to estimates with higher precision (i.e., smaller standard error based on higher N) (Cheung & Chan, 2009);”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cheung & Chan, 2009

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The effect of maltreatment on aggression becomes non-significant when controlling for emotional lability/negativity.

    “The effect of maltreatment on aggression became non-significant when controlling for emotional lability/negativity, which suggested that the latter may play a mediator role (Shields & Cicchetti, 1998).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Shields & Cicchetti, 1998

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Childhood adversity may negatively interfere with emotion regulation development through both premature activation of biological stress systems and maladaptive social learning.

    “In summary, childhood adversity may negatively interfere with emotion regulation development through both premature activation of biological stress systems and maladaptive social learning.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lupien et al., 2009 source

      Not checked in the free run.

    • cites McCrory et al., 2012 source

      Not checked in the free run.

    • cites Kiel & Kalomiris, 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Both emotion regulation approaches (difficulties/ability and strategies) have been used in research on childhood adversity and provide complementary information that needs to be analyzed separately.

    “Overall, both approaches (i.e., difficulties/ability, and strategies) have been used in research on childhood adversity, and provide complementary information that needs to be analyzed separately.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The follow-up analyses focused only on a subset of quality criteria.

    “Furthermore, these follow-up analyses focused only on a subset of quality criteria.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some relations (e.g., suppression and psychopathology) were found to be larger in adults compared to children and adolescents.

    “It is noteworthy that some of these relations (e.g., suppression and psychopathology) were found to be larger in adults compared to children and adolescents (Aldao et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Aldao et al., 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lavi et al. (2019) meta-analysis found maltreated youth showed increased emotion regulation difficulties.

    “maltreated youth showed increased difficulties, as indexed by a variety of outcomes related to both emotion regulation, and coping (Lavi, Katz, et al., 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lavi, Katz, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The remaining quality criteria were met by a small number of studies, and using them would have resulted in too few high-quality studies to run the analyses.

    “The remaining criteria were met by a small number of studies and using them would have resulted in too few high-quality studies to run the analyses.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    File drawer effects may have influenced the findings because publication bias could not be investigated.

    “File drawer effects may have also influenced our findings considering that, in the absence of an established method in two-stage structural equation modeling, we could not investigate publication bias.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationreasoning

    Together, the included studies suggest that the negative consequences of childhood adversity on emotion regulation and psychopathology are not limited to childhood maltreatment and warrant a broader perspective on the dimensions of adversity.

    “Together, these studies suggest that the negative consequences of childhood adversity on emotion regulation and psychopathology are not limited to childhood maltreatment and warrant a broader perspective on the dimensions of adversity.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.
  • May combine two claims.

    Premisecitation

    Leitenberg et al. (1992) found suppression was used more frequently than other strategies and negatively associated with psychological adjustment after controlling for abuse characteristics.

    “results indicated that, in this sample, suppression was used more frequently than other strategies, and it was negatively associated with psychological adjustment after controlling for multiple characteristics (e.g., age when abuse began, duration) of sexual abuse (Leitenberg et al., 1992).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Leitenberg et al., 1992 source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Both previous meta-analyses left out studies in adults and excluded forms of childhood adversity other than maltreatment.

    “However, both left out studies in adults, which are the largest part of the empirical literature, and excluded forms of childhood adversity other than maltreatment.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Gruhn & Compas (2020) meta-analysis found positive relations between maltreatment and emotional suppression (and expression), but not distraction.

    “Significant associations were also found at the strategy level, including positive relations between maltreatment and emotional suppression (as well as expression), but not distraction (Gruhn & Compas, 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gruhn & Compas, 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    No relations were found at the factor level in Gruhn & Compas (2020).

    “No relations were found at the factor level.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gruhn & Compas, 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Parental emotion regulation may fully account for the impact of childhood adversity on children's emotion regulation.

    “but the former may fully account for the impact of childhood adversity on children’s emotion regulation (Milojevich, Machlin, & Sheridan, 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Milojevich, Machlin, & Sheridan, 2020 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The data reported in this paper complement and extend previous meta-analyses on childhood adversity and emotion regulation.

    “The data reported in this paper complement and extend previous meta-analyses on childhood adversity and emotion regulation (Gruhn & Compas, 2020; Lavi, Katz, et al., 2019).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Gruhn & Compas, 2020

      Not checked in the free run.

    • cites Lavi, Katz, et al., 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A limitation of the present study is that it examined a saturated model with perfect fit to the data and could not compare alternative models.

    “One of the limitations of the present study is that we examined a saturated model (i.e., including all possible pathways between variables), which has perfect fit to the data, and we could not compare alternative models.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Study quality was also assessed based on the inclusion of non-clinical controls in studies that included clinical samples, because exclusive focus on clinical samples is likely to give a skewed perspective on the childhood adversity-psychopathology correlation.

    “In addition, we assessed study quality based on the inclusion of non-clinical controls in studies that included clinical samples (i.e., meeting established criteria for mental disorders in a clinical interview) considering that the exclusive focus on the latter category is likely to give a skewed perspective on the correlation between childhood adversity and psychopathology (e.g., up to 80-90% of”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Saunders & Adams, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data from each study were independently extracted by three authors, disagreements were resolved by discussion, and interrater reliability was 97.2%.

    “Data from each study were independently extracted by three authors, and disagreements were resolved by discussion (97.2% interrater reliability).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All studies were independently evaluated by at least two authors.

    “All studies were independently evaluated by at least two authors.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Two-stage structural equation modeling uses full information maximum likelihood estimation to handle missing data, robust against MCAR and MAR.

    “uses the full information maximum likelihood estimation to handle missing data (studies missing one or more sets of correlations), a method which is robust against both data missing completely at random and missing at random (Enders, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Enders, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Failure to preregister the meta-analysis is a potential limitation.

    “Finally, we acknowledge the failure to preregister the meta-analysis as a potential limitation.”
    Quote in the paperNot a substantial claim
38 of 38
  • The paper relies on this without support.

    Most forms of psychopathology start to emerge in adolescence and adulthood.

    “Most forms of psychopathology start to emerge in adolescence and adulthood, so it is not surprising that studies investigating the involvement of childhood adversity and emotion regulation in risk of psychopathology have overly focused on adults.”
  • The paper relies on this without support.

    The causal ordering in the mediation model (childhood adversity influences emotion regulation, which influences psychopathology) is valid for interpreting the meta-analytic associations as mediation.

    “we fitted a partial mediation model to the available data across studies, in which childhood adversity was related to psychopathology both directly and through emotion regulation.”
    “The present model thus included both the indirect (i.e., childhood adversity to psychopathology via emotion regulation) and direct pathways between childhood adversity and psychopathology.”
  • The paper relies on this without support.

    The modeled direction of effects—childhood adversity influencing emotion regulation, which in turn influences psychopathology—reflects the causal process underlying the observed associations.

    “We fitted a path model to the pooled Stage 1 correlation matrices, in which childhood adversity predicted psychopathology both through each of the emotion regulation dimensions (separately), and directly.”
  • The paper relies on this without support.

    Emotion regulation and psychopathology measures from different studies are sufficiently comparable to be pooled into common correlation matrices.

    “In Stage 1, the random effects model was used to obtain a pooled correlation matrix among all coded variables”
  • The paper relies on this without support.

    Different types of childhood adversity can be combined into a single childhood adversity construct for the meta-analytic associations.

    “The majority of studies (65.44%) focused on childhood maltreatment, while the rest (34.56%) examined a wider array of childhood adverse experiences.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Emotion-regulation counts disagree on the number of effect sizes

    Minor

    The counts by emotion-regulation dimension add to 285. But the stated numbers of studies reporting one, two, three, or four distinct outcomes imply 283 effect sizes (170 + 2×31 + 3×13 + 4×3).

1 of 1

The citation lists haven’t been fetched yet

References 104 · Cited by 233

Research works printed but not linked: 1

  1. Nolen-Hoeksema, 2004, The response styles theory, Vol. 107, 107

Authors
Miu, A. C., Szentágotai-Tătar, A., Balázsi, R., Nechita, D., Bunea, I., & Pollak, S. D.
Affiliations
  • Babeș-Bolyai University (RO)
  • University of Wisconsin–Madison (US)
Corresponding author
  • Miu, Andrei C.
  • Szentágotai-Tătar, Aurora
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2022-04
Volume
93
Pages
102141
ISSN
0272-7358 (ISSN-L)
OpenAlex
W4212812362
Cited by
233
References
104
Citations by year
2026: 76 · 2025: 77 · 2024: 48 · 2023: 27 · 2022: 5
FWCI
6.55
Type
journal article
Language
en
Open access
Locations
  • Clinical Psychology Review (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01MH061285)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD090256)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
emotion regulation, childhood adversity, psychopathology, mediation, rumination, emotional suppression, cognitive reappraisal, distraction, internalizing problems, externalizing problems, developmental risk factors
MeSH terms
Adverse Childhood Experiences, Emotional Regulation, Emotions, Humans, Psychopathology, Risk Factors

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