Emotion dysregulation mediates the relationship between sexual and gender minority stress and psychopathology: A meta-analytic structural equation modeling approach.

Sexual and gender minoritized (SGM) people face unique stressors related to marginalization (i.e., minority stress) that are postulated to elevate risk for psychopathology at disproportionately higher rates. Understanding the mechanisms underlying this disparity is critical for advancing knowledge surrounding etiology, prevention, and treatment. Growing evidence suggests that emotion dysregulation, as indicated by greater difficulties with emotion regulation and/or the inflexible use of putatively maladaptive strategies (e.g., rumination) --where short-term relief undermines long-term emotional well-being, is a crucial transdiagnostic process that may explain the link between minority stress and psychopathology. This pre-registered study was a meta-analysis examining emotion dysregulation as a mediator of the relationship between minority stress and a broad range of psychopathology known to be elevated in SGM people (e.g., depression, anxiety, substance use, suicidality). Utilizing one-stage meta-analytic structural equation modeling, we synthesized data from 47 studies (N = 15,810; Mage = 29.51 years). Overall, consistent with our hypotheses, emotion dysregulation mediated the minority stress and psychopathology link. Similar findings emerged when examining emotion regulation difficulties (k = 18) and strategy use as separate mediators. Among emotion regulation strategies, rumination (k = 25), mindfulness (k = 10), and suppression (k = 3) were significant mediators, but not reappraisal and distraction. Exploratory analyses found relatively consistent mediation effects regardless of the type of minority stress and psychopathology, as well as age, gender minority status, and country. There was also evidence of longitudinal mediation. Findings highlight emotion dysregulation, particularly processes involving heightened self-focus, as a transdiagnostic process relevant for understanding and treating SGM mental health concerns.