Poor emotion regulation in early schizophrenia tied to depressive symptoms

Emotion dysregulation during early schizophrenia spectrum disorder (SSD) appears to be linked to different cognitive risk factors which, in turn, compound depressive symptoms, according to a recent Singapore study.

Researchers enrolled 150 patients (mean age, 26.5±6.20 years; 56.7 percent male) newly diagnosed with SSD. All were enrolled in the Early Psychosis Intervention Programme and were being treated at the Institute of Mental Health in Singapore. Emotion regulation strategies were assessed using the short version of the Cognitive Emotion Regulation Questionnaire (CERQ), while the Difficulties with Emotion Regulation Scale-Short Form (DERS-SF) was used to determine challenges in regulation.

Bivariate analysis revealed several significant correlations of CERQ and DERS-SF subdomains with positive and negative SSD symptoms and depressive symptoms. Particularly, global emotional dysregulation was significantly correlated with both positive (p<0.01) and depressive (p<0.05) symptoms. [Early Interv Psychiatry 2019;doi:10.1111/eip.12895]

Multivariate regression analysis adjusted for sex, psychiatric comorbidities and other psychiatric symptoms found that only global emotional dysregulation was significantly associated with severe depressive symptoms (β, 0.30±0.02, 95 percent confidence intervals [CI], 0.02–0.10; p=0.002).

The same was true for severe positive SSD symptoms (β, 0.24±0.03; 95 percent CI, 0.01–0.011; p=0.03). Notably, depressive symptoms also emerged as a significant predictor of positive symptoms (β, 0.24±0.12; 95 percent CI, 0.17–0.64; p≤0.001) and vice versa (β, 0.27±0.07, 95 percent CI, 0.10–0.37; p≤0.001).

In contrast, none of the CERQ (rumination, catastrophizing, self-blame and other blame) or DERS-SF (acceptance, perspective-taking, positive appraisal and positive refocus) subdomains were significantly correlated with positive, negative and depressive symptoms.

Gender emerged as a significant factor for negative SSD symptoms (β, 0.21±0.53; 95 percent CI, 0.15–2.25; p≤0.05).

“As hypothesized, maladaptive cognitive emotion regulation strategies and global emotion dysregulation were correlated with both psychotic and depressive symptoms in our sample,” said researchers. “[T]he present study extends the literature by identifying the specific aspect of emotion dysregulation that may be more relevant to depressive/positive symptoms.”

“Although the present study has demonstrated an association between global emotion dysregulation and more severe depressive/positive symptoms, our findings have also revealed a significant interaction between self-certainty and global emotion dysregulation in predicting depressive symptoms in early SSD,” they added.

Indeed, moderation analyses in the present study revealed a significant effect of self-certainty on the link between global emotion dysregulation and depressive symptoms (p<0.001). Specifically, this correlation was only significant in participants who demonstrated high self-certainty (p<0.001) and was attenuated in those with low self-certainty (p=0.25).

“Our findings suggest the presence of a transdiagnostic effect of global emotion dysregulation that should be further elucidated in a wider range of psychotic disorders,” the researchers said. “[These] highlight the importance of early intervention in addressing emotion dysregulation in early SSD, before they become habitual and chronic as the illness progresses.”