Associations Between Transdiagnostic Psychological Processes and Global Symptom Severity Among Outpatients With Various Mental Disorders: A Cross-Sectional Study

OBJECTIVE: Knowledge about transdiagnostic factors associated with global symptom severity among patients diagnosed with various mental disorders remains limited. This study examined the cross-sectional associations between transdiagnostic processes including global emotion regulation and specific emotion regulation strategies (i.e., amount of physical activity and sedentary behaviour, repetitive negative thinking and sleep routines) with global symptom severity, while controlling for sociodemographic data (age, gender, employment status, relationship status, and educational level) and fear of the coronavirus. METHODS: Data from 401 outpatients, aged 42.08 years on average (SD = 13.26; 71.3% female), diagnosed with depressive disorders, non-organic primary insomnia, agoraphobia, panic disorder and/or post-traumatic stress disorder were examined. This study is a secondary analysis of a randomized controlled trial. Data were collected from 10 different study sites between March 2021 and May 2022 for cross-sectional analysis. The influence of predictors of global symptom severity was determined using three-step hierarchical multiple regression: (1) control variables, (2) global emotion regulation and (3) specific emotion regulation strategies. Global symptom severity was measured using the Global Severity Index, derived from the Brief Symptom Inventory-18. Predictors were measured using validated scales, and physical activity was additionally assessed via accelerometer-based sensors. RESULTS: In the first step, control variables accounted for 4% of variance in global symptom severity. The inclusion of global emotion regulation in the second step explained 26% of the outcome variance, and the incorporation of specific emotion regulation strategies in the third step increased the explained variance to 37%. Significant predictors included global emotion regulation (β = 0.28), repetitive negative thinking (β = 0.26) and sleep routines (β = 0.25). CONCLUSION: Global emotion regulation along with repetitive negative thinking and sleep routines as specific emotion regulation strategies are identified as transdiagnostic psychological processes that may serve as treatment targets for evidence-based interventions designed to enhance emotion regulation, particularly in transdiagnostic samples of stress-related disorders. Additional prospective longitudinal studies with transdiagnostic samples are necessary to explore possible causal relationships.