Schwarz J, et al. – The purposes of this study were to compare Emotion Regulation (ER) skills between medically unexplained physical symptoms (MUS)–patients without comorbid depression, MUS–patients with comorbid depression (MUS + MDD), patients with major depressive disorder (MDD), and healthy controls as well as to examine the mediating effect of depression and anxiety on the association between ER and somatization. The outcomes suggested that patients with MUS + MDD had higher deficits in ER skills than MUS patients without MDD. In addition, deficits in ER in MUS–patients were influenced by depression and anxiety. This shows that MUS–patients with comorbid mental disorders could benefit from an emotion regulation training.

Methods

• The Emotion-Regulation Skills Questionnaire (ERSQ) and other self-report measures were finished by one hundred thirty eight MUS-patients, one hundred fourteen MUS + MDD-patients, one hundred six MDD-patients, and one hundred healthy controls.
• Multiple mediation analyses were applied to examine the role of depression and anxiety as potential mediators.

Results

• A MANCOVA and post-hoc test with age, sex and education as covariates demonstrated that ER skills of the MUS-group were lower than the controls (p < 0.001–p = 0.047), but higher than the MDD- and MUS + MDD-group (p < 0.001–p = 0.042).
• It was observed in the findings that ER skills of the MDD-group and MUS + MDD-group did not differ (p = 0.78–p = 0.99), but were lower than controls (p < 0.001–p = 0.011).
• In the MUS-groups depression and anxiety had a mediating impact on the association between ER and somatization (b = -0.23, 95% bias-corrected CI: -0.30, –0.17).
• The study showed that the direct impact of ER on somatization was no longer significant when controlling for the mediating variables (b = 0.07, p = 0.083).