Table 1.
Studies included in the systematic review
| Study | N | Sample characteristics | Design | Transdiagnostic variable measure | Outcome measure | Key findings |
|---|---|---|---|---|---|---|
| Paulus et al. (2015) | 642 | Community | Cross-sectional |
IU (IUS) |
Depression (BDI-II) |
IU mediates the relationship between negative affect among several emotional disorders including depression |
| McEvoy and Erceg-Hurn (2016) | 108 | Community | Experimental |
IU (IUS-12) |
Depression (BDI-II) |
Changes in IU were associated with reductions in repetitive negative thinking, but not with depressive symptoms |
| Dar et al. (2017) | 120 | Clinical | Cross-sectional |
IU (IUS) |
Depression (BDI-II) |
Worry mediated and moderated the relationship between IU and symptoms of depression |
| Swee et al. (2018) | 221 | Undergraduate | Cross-sectional |
IU (IUS-12) |
Depression (BDI-II) |
IU is indirectly associated to depressive symptoms through worry and trait anxiety |
| Toro et al. (2018) | 506 | Community | Cross-sectional |
IU (IUS) |
Depression (BDI-II) |
Negative affect (state and trait) is a partial mediator of the relationship between II and depressive symptoms |
| Barry et al. (2019) |
66 48 |
Community Clinical |
Cross-sectional |
IU (IUS-12) |
Depression (BDI-II) |
IU and constructive and unconstructive rumination are predictors of depressive symptoms even when anxiety symptoms were accounted for. However, once anxiety symptoms were accounted for, they did not contribute to a depression diagnosis |
| Huang et al. (2019) |
494 321 |
Community |
Study 1 Cross-sectional Study 2 Longitudinal |
IU (IUS-12) |
Depression (PHQ-9) |
Rumination partially mediated the relationship between IU and depressive symptoms. However, rumination fully mediated this relationship over two months |
| Saulnier et al. (2019) | 374 | Clinical | Cross-sectional |
IU (IUS-12) |
Depression (BDI-II) |
IU general factor related with cognitive and affective/somatic depressive symptoms. While the inhibitory dimension of IU only related to the cognitive depressive symptoms |
| Del Valle et al. (2020) | 3805 | Community | Cross-sectional |
IU (IUS) |
Depression (BDI-II) |
IU was a significant predictor of depressive and anxiety symptoms in the context of COVID-19 pandemic |
| Voitsidis et al. (2021) | 2827 | Community | Cross-sectional |
IU (IUS) |
Depression (PHQ-9) |
Fear of COVID-19 partially mediated the association between IU and depressive symptoms |
| Chen et al. (2021) |
56 53 |
Community Clinical |
Cross-sectional |
IU (IUS-12) |
Depression (HAMD) |
Maladaptive negative metacognitive beliefs mediate the effect of IU on depression symptoms |
| Oglesby et al. (2016) | 50 | Undergraduate | Longitudinal |
IU (IUS) |
PTSD (PCL-C) |
Pre-trauma IU is a significant predictor of elevated post-trauma PTS symptoms following a campus shooting, even after covarying for pre-trauma levels of anxiety sensitivity |
| Boelen et al. (2016) | 134 | Community | Longitudinal |
IU (IUS-12) |
PTSD (PSS-SR) |
Inhibitory IU positively related to levels of PTS and depression symptoms, even when controlling for neuroticism, worry, and rumination. Prospective IU predicted prolonged grief disorder severity six month later but not PTSD or depression |
| Oglesby et al. (2017) | 126 | Community | Cross-sectional |
IU (IUS-12) |
PTSD (PCL-C) |
IU was associated with an increase in PTSD symptoms (except for re-experiencing), even after covarying for negative affect and anxiety sensitivity |
| Boelen (2019) | 193 | Undergraduate | Longitudinal |
IU (IUS-12) |
PTSD (PSS-SR) |
Inhibitory IU pre-event predicted post-event PTSD symptoms (except for the PTSD re-experiencing dimension) |
| Raudales et al. (2020) | 259 | Trauma exposed | Longitudinal |
IU (IUS) |
PTSD (PCL-C) |
Anxiety sensitivity, but not distress tolerance and intolerance of uncertainty, was a significant mediator between emotion dysregulation and 1‐month follow‐up PTSS |
| Badawi et al. (2021) | 123 | Clinical | Experimental |
IU (IUS-12) |
PTSD (PCL-5) |
Decreased in IU and inhibitory IU were associated with decreases in PTSD severity. However, prospective IU only associated with changes in re-experiencing, avoidance, and arousal PTSD symptom clusters |
| Abravanel and Sinha (2015) | 745 | Community | Cross-sectional |
ED (DERS) |
Depression (CES-D) |
Emotion dysregulation mediated the relationship between cumulative adversity and depressive symptoms independent of risk status |
| Ouimet et al. (2016) | 150 | Undergraduate | Cross-sectional |
ED (DERS) |
Depression (DASS) |
Emotion dysregulation and maladaptive belief about emotions mediated the relationship between anxiety sensitivity and depressive symptoms |
| Pickard et al. (2016) | 151 | Undergraduate | Cross-sectional |
ED (DERS) |
Depression (DASS) |
Mindfulness and emotional regulation fully mediated the relationship between three attachment styles (secure, preoccupied and dismissive) and depressive symptoms. However, fearful attachment partially mediated this relationship |
| Diedrich et al. (2017) | 69 | Clinical | Cross-sectional |
ER (ERSQ) |
Depression (BDI-II) |
The ability to tolerate negative emotions was the only emotional regulation skill that mediated the relationship between self-compassion and depressive symptoms |
| Mutz et al. (2017) | 364 | Community | Cross-sectional |
ER (ERQ) |
Depression (PHQ-9) |
Expressive suppression mediated the relationship between mental toughness and depressive symptoms |
| Khakpoor et al. (2019) | 26 | Clinical | Experimental |
ER (DERS) |
Depression (BDI-II) |
The Unified Protocol reduced depression in patients through improvement in emotion regulation. Difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores |
| Diehl et al. (2020) | 911 | Community | Cross-sectional |
ED (DERS) |
Depression (CUDOS) |
The relationship between emotion dysregulation and depression symptoms remained significant, when controlling for baseline mindfulness. However, when controlling for baseline emotion dysregulation, the association between mindfulness and depression was not significant in the majority of cases |
| Groarke et al. (2021) | 522 | Community | Longitudinal |
ED (DERS) |
Depression (PHQ-9) |
In the context of COVID-19 loneliness predicted higher depressive symptoms one month later, and depressive symptoms predicted higher loneliness one month later. This relationship was not mediated by emotion regulation difficulties. However, emotion regulation difficulties and depressive symptoms were reciprocally related |
| O’Bryan et al. (2015) | 297 | Undergraduate | Cross-sectional |
ED (DERS) |
PTSD (PDS) |
Difficulties with emotional acceptance significantly predicted greater avoidance and hyperarousal symptom severity above and beyond the effects of number of trauma types and negative affect. Emotion dysregulation was not significantly predictive of reexperiencing symptom severity |
| Short et al. (2016) | 746 | Trauma exposed | Cross-sectional |
ED (DERS) |
PTSD (PDS) |
Impulse control difficulties were associated across PTSS clusters (re-experiencing, avoidance, and hyperarousal), while lack of emotion regulation strategies and emotional clarity were uniquely associated with numbing symptoms, after covarying for neuroticism |
| Raudales et al. (2019) | 209 | Community | Cross-sectional |
ED (DERS) |
PTSD (PCL-C) |
Emotion dysregulation mediates the effects of trauma type on PTSD symptoms for sexual assault but no other trauma types, this effect remained significant after covarying for negative affect |
| Forbes et al. (2020) | 85 | Trauma exposed | Longitudinal |
ER (DERS) |
PTSD (PCL-5) |
Emotion dysregulation predicted PTSD symptom severity at 3 months, even after covarying other risk factors (age, gender, race, ethnicity, trauma type, childhood adversity or trauma exposure, and lifetime trauma exposure) and baseline PTSD symptoms |
| Pencea et al. (2020) | 135 | Trauma exposed | Longitudinal |
ER (EDS-short) |
PTSD (PSS) |
Emotion dysregulation predicted chronic PTSD symptom, even after controlling for trauma exposure, baseline PTSD and depressive symptoms |
| Fujisato et al. (2020) | 1794 | Community | Longitudinal |
ER (ERSQ) |
PTSD (PCL-5) |
Emotion regulation predicted PTSS 4-months later, even after controlling for symptoms at baseline |
| Post et al. (2021) | 200 | Clinical | Cross-sectional |
ER (ERQ) |
PTSD (PSS-I) |
Emotion regulation fully mediated the relationships between negative affect and PTSD and MDD, and negative mood regulation expectancies and PTSD and MDD |
| Iqbal and Dar (2015) | 77 | Clinical | Cross-sectional |
Rumination (RRS) |
Depression (BDI) |
Brooding and reflection rumination mediated the association between negative affect and depressive symptoms, but not anxiety |
| Vanderhasselt et al. (2016) | 92 | Undergraduate | Longitudinal |
Rumination (RRS) |
Depression (BDI-II) |
Co-variation of stressful events and rumination predicted depressive symptoms at 3 and 15 months. This effect remained even when statistically controlling for baseline depressive symptoms |
| Petrocchi and Ottaviani (2016) | 41 | Undergraduate | Longitudinal |
Rumination (RRS) |
Depression (CES-D) |
Rumination was a significant mediator of the relationship between nonjudge (mindfulness facet) and depressive symptoms after two years |
| Liu et al. (2017) | 87 | Clinical | Cross-sectional |
Rumination (RRS) |
Depression (HAMD) |
Rumination partially mediated the relationship between overgeneral autobiographical memory and depressive symptoms. Particularly, maladaptive brooding subtype of rumination |
| Vine and Marroquin (2017) | 100 | Clinical | Cross-sectional |
Rumination (RRS) |
Depression (MASQ AD) |
Rumination mediated associations of emotional clarity with depressive symptoms regardless of affect intensity |
| Schut and Boelen (2017) | 208 | Undergraduate | Longitudinal |
Rumination (RRS) |
Depression (BDI-II) |
Trait mindfulness, but not brooding, reflection, and experiential avoidance predicted depressive symptoms after one year, while controlling for baseline depression symptoms |
| Senra et al. (2017) | 438 | Community | Cross-sectional |
Rumination (RRS) |
Depression (BDI-II) |
Brooding-rumination and immature defenses mediated the relationship between perfectionism and depressive symptoms. Furthermore, brooding-rumination moderated the impact of perfectionism on depressive symptoms |
| Costa et al. (2018) |
70 70 |
Clinical Community |
Cross-sectional |
Rumination (RRS) |
Depression (DASS) |
Cognitive fusion, but not rumination and mindfulness, was the only significant mediator of the relationship between negative affect and depressive symptoms |
| Bakker et al. (2018) | 100 | Clinical | Cross-sectional |
Rumination (RRS) |
Depression (PHQ-9) |
Brooding rumination, experiential avoidance, and acceptance mediated the relationship between self-compassion and depressive symptoms |
| Whisman et al. (2020) | 5891 | Community | Longitudinal |
Rumination (RRS) |
Depression (PHQ-9) |
Rumination predicted residual change in depressive symptoms and depressive symptoms predicted residual change in rumination (4-year follow-up), suggesting that rumination and depressive symptoms influence one another in a bidirectionally |
| Liang et al. (2020) | 501 | Undergraduate | Cross-sectional |
Rumination (RRS) |
Depression (CES-D) |
Peace of mind and rumination fully-mediated the relationship between gratitude and depression, this mediation model did not differ by gender |
| Lyon et al. (2020) | 3043 | Community | Cross-sectional |
Rumination (RRS) |
Depression (BSI) |
Brooding mediated the effect of neuroticism, extroversion, conscientiousness and openness on depressive symptoms. Reflection mediated the effects of neuroticism, extroversion and openness on depressive symptoms |
| De Rosa et al. (2021) |
151 42 |
Undergraduate Clinical |
Cross-sectional |
Rumination (RRQ) |
Depression (BDI-II) |
Perfectionism is associated with rumination, in both the clinical and nonclinical populations. Rumination mediated the relationship between maladaptive perfectionism and depression |
| Spinhoven et al. (2015) | 359 | Trauma exposed | Longitudinal |
Rumination (RUM) |
PTSD (PSS-I) |
Pre-trauma depression severity and trait rumination (but not trait worry) predicted onset of PTSD during four-year follow-up. Cognitive appraisal of the traumatic event partially mediated the association between trait rumination and PTSD |
| Wu et al. (2015) | 318 | Trauma exposed | Cross-sectional |
Rumination (RRS) |
PTSD (M-PTSD) |
Brooding rumination and depressed-related rumination are related with higher level of PTSD |
| Basharpoor et al. (2015) | 99 | Trauma exposed | Cross-sectional |
Rumination (RRS) |
PTSD (M-PTSD) |
Experimental avoidance and rumination in the group with PTSD were higher than those without PTSD. Mindfulness was significantly lower in the group with PTSD than without PTSD |
| Roley et al. (2015) | 45 | Trauma exposed | Cross-sectional |
Rumination (RTSQ) |
PTSD (PCL-5) |
Repetitive rumination and anticipatory rumination moderates the relationship between PTSD and MDD symptoms |
| Seligowski et al. (2016) | 403 | Community | Cross-sectional |
Rumination (RRS) |
PTSD (PCL-5) |
Rumination was significantly related to each PTSD symptom clusters, even after controlling for negative affect |
| Viana et al. (2017) | 182 | Trauma exposed | Cross-sectional |
Rumination (RRS) |
PTSD (PDS) |
Mindful attention was a significant moderator of relations between rumination and all subfactors of PTSD symptoms (re-experiencing, avoidance, arousal, and total PTSD symptoms) |
| García et al. (2018) | 629 | Community | Cross-sectional |
Rumination (RRS) |
PTSD (SPRINT-E) |
Intrusive rumination mediated the relationship between negative rumination and posttraumatic stress symptoms |
| Pugach et al. (2019) | 90 | Community | Cross-sectional |
Rumination (RRS) |
PTSD (CAPS-5) |
Rumination fully mediated the relationship between overall emotional dysregulation and PTSD severity |
| Mathes et al. (2020) | 119 | Trauma exposed | Longitudinal |
Rumination (RRS) |
PTSD (PCL-C) |
Hostility temporally mediated the prospective association between rumination and PTSD symptoms, even when controlling depressive disorder diagnosis |
| Preston et al. (2021) | 204 | Trauma exposed | Longitudinal |
Rumination (RQ) |
PTSD (PDS) |
Interpersonal trauma moderated the relationship between baseline rumination and 1-month trauma symptoms, even after covarying for age and sex, treatment condition, negative affect, and number of previously experienced traumas |
IU Intolerance of uncertainty; ED Emotional dysregulation; ER Emotional; PTSD Posttraumatic stress disorder; IUS Intolerance of uncertainty scale; IUS-12 Intolerance of uncertainty scale short version; DERS Difficulties in emotion regulation scale; EDS-Short Emotion dysregulation scale, short version; ERSQ Emotion regulation skills questionnaire; BDI-II Beck depression inventory-II; PHQ-9 Patient health questionnaire-9; HAMD Hamilton depression rating scale; BSI Brief symptom inventory; CES-D Center for epidemiologic studies depression scale; DASS Depression anxiety stress scales, CUDOS Clinically useful depression outcomes scale; MASQ AD Anhedonic depression subscale of the mood and anxiety symptom questionnaire short form; PCL-5 Posttraumatic stress disorder checklist for DSM-5; PCL-C Posttraumatic stress disorder checklist; M-PTSD Mississippi post-traumatic stress disorder scale; PSS-I PTSD symptom scale—interview version; CAPS-5 Clinician‐administered PTSD scale‐5; PSS Posttraumatic stress disorder symptom scale; PSS-SR PTSD symptom scale–self-report version; PDS Posttraumatic diagnostic scale; SPRINT-E Short posttraumatic stress disorder rating interview; RRS Ruminative response scale; RUM Subscale rumination on sadness of the revised version of the Leiden index of depression sensitivity; RTSQ Ruminative thought style questionnaire; RQ Rumination questionnaire; RRQ Rumination reflection questionnaire