(PS6-19) Emotion Dysregulation Mediates the Relationship between Sexual and/or Gender Minority Stress and Psychopathology: a Meta-Analytic Structural Equation Modeling Approach

Sexual and/or gender minoritized (SGM) individuals face elevated risk for psychopathology, including depression, anxiety, substance use, and suicide. Identifying mechanisms contributing to these disparities is essential for developing effective treatments. Research over the past 20 years suggests that minority stress worsens mental health via heightened emotion dysregulation. Conducting a systematic review and meta-analysis on this topic is a crucial next step to strengthen our understanding of associations between these constructs and identify opportunities for further refinement of research and intervention. We aimed to conduct a systematic review and meta-analysis to examine emotion dysregulation as a mediator of the link between SGM minority stress and psychopathology. Additionally, we examined if effects varied depending on age, country of origin, and whether studies included gender minorities.

Searches were conducted in PsycINFO and PubMed for articles published up to 06/30/2024. Titles, abstracts, and full-texts were examined. Studies were included if they: were peer-reviewed; included SGM individuals; assessed SGM minority stress, emotion regulation, and/or psychopathology; had available data (if unavailable, authors were contacted). Pearson correlation coefficients from eligible studies were extracted and aggregated for analyses. Mediation was examined using one-stage meta-analytic structural equation modeling.

37 studies (n=12,763, M_age=29.98) met inclusion criteria. Studies examined a range of distal (e.g., discrimination) and proximal (e.g., internalized stigma) minority stress, and psychopathology (e.g., depression, anxiety, substance use, suicidality, disordered eating). Emotion dysregulation was indexed as self-reported emotion regulation difficulties or use of emotion regulation strategies (e.g., rumination, reappraisal, distraction, mindful attention). Across 37 studies, emotion dysregulation was a significant mediator: minority stress was associated with higher emotion dysregulation (b=.23, p< .001), predicting more severe psychopathology (b=.37, p< .001), indirect effect=.08, 95% CI [.06, .11]. Follow-up analyses indicated that emotion regulation difficulties (k=13, indirect effect=.09, 95% CI [.06, .14]), rumination (k=20, indirect effect=.09, 95% CI [.06, .14]), and mindfulness (k=7, indirect effect=.05, 95% CI [.01, .12]) were significant mediators, but not reappraisal (k=6) or distraction (k=4). Moderation analyses indicated that these effects did not vary by age or country, although effects were stronger among studies that included (vs. did not include) gender minorities, p=.049.

Our results suggest that minority stress exacerbates emotion dysregulation that, in turn, worsen psychopathology. Notably, minority stress may uniquely impact emotion regulatory processes involving negative self-reference (e.g., rumination, lack of mindful attention). Addressing negative self-referential processing may be crucial for enhancing treatment outcomes for SGM individuals.