The Multifaceted Role of Emotion Regulation in Suicidality: Systematic Reviews and Meta-Analytic Evidence.

Despite the number of empirical contributions on the topic, scientists have offered contrasting perspectives on the role of adaptive versus maladaptive emotion regulation (ER) strategies in suicidality. Moreover, suicidal attempts and suicidal ideation are likely to be differentially related to single ER strategies. To provide more systematic knowledge that can be used to draw sound conclusions and formulate clinical indications, we carried out a systematic review and meta-analysis that we reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (Moher et al., 2009). From an initial pool of 16,530 articles retrieved from scientific databases (APA PsycInfo, APA PsycArticles, Medline, Scopus, Web of Science, and PubMed) and a search for gray literature, 226 articles were selected to perform 15 meta-analyses. In addition, metaregressions were carried out to test a series of moderators, including the type of suicidality investigated. Among adaptive strategies, results evidenced the role of reappraisal, mindfulness, and several aspects of problem solving. In contrast to our hypothesis, reflective attitude was positively associated with suicidality, calling into question the traditional distinction between adaptive and maladaptive strategies. Regarding maladaptive ER strategies, suppression, avoidance, rumination, brooding, negative problem orientation, and both impulsive and avoidant problem solving proved to be significantly associated with suicidality. Finally, several moderation effects involving age, gender composition, and type of suicidality were observed, supporting the importance of adopting a complex perspective when approaching the topic. Despite the interesting preliminary results, additional research is needed to provide a greater understanding of the interplay between the different ER strategies and suicidality and to develop effective protocols of intervention. Public Significance Statement: The systematic search for studies investigating the links between emotion regulation (ER) and suicidality identified more than two thousands of contributions. Meta-analytic elaboration of quantitative data identified several ER strategies that account for suicidal ideation and/or suicidal behavior. Their relevance sometimes varies according to the population's characteristics stressing the need to clarify the psychological contexts in which the links between ER and suicidality explicate in order to better tailor clinical interventions for suicidality. [ABSTRACT FROM AUTHOR]