Negative Affect as Mediator between Emotion Regulation and Medically Unexplained Symptoms

Background: Research on emotion regulation (ER) in medically unexplained physical symptoms (MUS) is rare. Purpose: The goal of this study was to compare ER skills between MUS-patients without comorbid depression, MUS-patients with comorbid depression (MUS + MDD), patients with major depressive disorder (MDD), and healthy controls. Additionally, we examined the mediating effect of depression and anxiety on the relationship between ER and somatization. Methods: The Emotion-Regulation Skills Questionnaire (ERSQ) and other self-report measures were completed by 138 MUS-patients, 114 MUS + MDD-patients, 106 MDD-patients, and 100 healthy controls. Multiple mediation analyses were applied to investigate the role of depression and anxiety as potential mediators. Results: A MANCOVA and post-hoc test with age, sex and education as covariates indicated 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). 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 effect on the relationship between ER and somatization (b = −0.23, 95% bias-corrected CI: −0.30, –0.17). The direct effect of ER on somatization was no longer significant when controlling for the mediating variables (b = 0.07, p = 0.083). Conclusions: Our study reveals that patients with MUS + MDD have higher deficits in ER skills than MUS patients without MDD. Additionally, deficits in ER in MUS-patients are influenced by depression and anxiety. This indicates that MUS-patients with comorbid mental disorders might benefit from an emotion regulation training.