CPR5

Clinical Psychology Review 95 (2022) 102174
Contents lists available at ScienceDirect
Clinical Psychology Review

journal homepage: www.elsevier.com/locate/clinpsychrev
Review
Associations between dispositional parental emotion regulation and youth

mental health symptoms: A systematic review and meta-analysis
Jacob B.W. Holzman a, b, *, Sarah M. Kennedy a, b, Hannah L. Grassie c, Jill Ehrenreich-May c
a
Department of Psychiatry, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO 80045, USA
b
Pediatric Mental Health Institute, Children's Hospital of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA
c
Department of Psychology, University of Miami, Coral Gables, FL, USA
A R T I C L E I N F O A B S T R A C T
Keywords: Theoretical perspectives propose that parents' dispositional emotion regulation (ER) tendencies are likely asso
Emotion regulation ciated with youth mental health concerns. The aim of the current study was to conduct a systematic review and
Parent meta-analysis to evaluate the relationship between parental dispositional ER tendencies – both maladaptive and
Mental health
adaptive – and youth mental health symptoms. Regarding maladaptive parental ER, 32 unique studies (N =
Youth
6399) with 126 effects were included. A significant, small-to-moderate, effect was observed (r = 0.25) such that
higher maladaptive parental ER was linked to heightened youth mental health symptoms. No differences were
observed based on youth age or psychiatric risk status, yet effects were stronger when drawn from the same
informant in contrast to different informants. Further, 12 studies (N = 4241) including 28 effects were identified
and a significant, albeit small, relation (r = − 0.16) between adaptive parental ER and youth mental health
symptoms occurred. A narrative review of these studies evaluating adaptive parental ER and youth mental health
symptoms was performed due to the limited number of effects found beyond parental dispositional mindfulness.
These findings generally support the notion that parental dispositional ER tendencies are modestly associated
with youth mental health concerns. Future directions and clinical implications are discussed.
1. Introduction ER tendencies (Bariola, Gullone, & Hughes, 2011; Bridgett et al., 2015;
Morris et al., 2007), which has led to increasing scientific inquiry on
Several conceptual models highlight that parental dispositional associations between parental dispositional ER tendencies and youth
emotion regulation (ER) tendencies are likely involved in the etiology of mental health concerns.
youth mental health concerns (Bridgett, Burt, Edwards, & Deater- Despite considerable interest in these relations, a meta-analytic re
Deckard, 2015; Morris, Silk, Steinberg, Myers, & Robinson, 2007). view examining the effect sizes of the relationship between dispositional
These conceptual models propose numerous pathways from parental ER parental ER tendencies and youth mental health symptoms has yet to be
to youth mental health symptoms spanning genetic, neurobiological, completed. Further, there is limited understanding of the magnitude of
and environmental mechanisms. Environmental mechanisms include this association, which may shed light on the relative importance for
influences that occur directly within parent-child interactions as well as considering, and potentially targeting, parental ER tendencies within
indirectly via the broader family environment. Specifically, links be the context of prevention and intervention work addressing youth
tween dispositional parental ER tendencies and youth mental health mental health symptoms. For example, evidence of a link between
concerns are likely to occur directly within parent-child interactions (e. dispositional parental ER tendencies and youth mental health concerns
g., child observing parental ER; parental ER affecting parenting prac would provide necessary justification for evaluating whether expanding
tices; parental ER affecting emotion socialization practices) as well as mental health service arrays to support parents in using effective ER
indirectly through more distal mechanisms, such as inter-parental strategies carries indirect benefits to youth mental health concerns.
relationship quality and emotional family climate. These models Thus, an integrative, systematic review that summarizes and evaluates
converge such that youth mental health concerns are an outcome of this research is important to guide future research investigating how
multiple mechanistic pathways stemming from dispositional parental factors underlying parental mental health and well-being may be
* Corresponding author at: Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA.
E-mail address: [email protected] (J.B.W. Holzman).
https://doi.org/10.1016/j.cpr.2022.102174
Received 7 December 2021; Received in revised form 31 March 2022; Accepted 20 May 2022
Available online 25 May 2022
0272-7358/© 2022 Published by Elsevier Ltd.
J.B.W. Holzman et al. Clinical Psychology Review 95 (2022) 102174
associated with youth mental health as well as identify important im array of familial factors (e.g., inter-parental relationship quality, inti
plications for enhancing clinical interventions. mate partner violence, family emotional climate) that are uniquely
linked to youth mental health concerns (see Bridgett et al., 2015; Morris
1.1. Conceptualization and key definitions et al., 2007; Morris, Criss, Silk, & Houltberg, 2017, for a review).
Considering that dispositional parental ER tendencies – hereafter
1.1.1. Dispositional adult ER tendencies referred to as parental ER tendencies – may link to youth mental health
The conceptual understanding of ER in adults has a significant his concerns through a variety of direct and indirect environmental mech
tory of debate, with limited consensus on the exact definition (e.g., Cole, anisms, the current review focused on evaluating links between parental
Martin, & Dennis, 2004; Tull & Aldao, 2015). Numerous theoretical ER tendencies and youth mental health symptoms.
perspectives offer a variety of ways to conceptualize ER, with three
broad categories emerging as the leading explanatory models. These 1.1.2. Youth mental health symptoms
models conceptualize ER by: (a) characterizing ER in accordance with Literature on youth mental health typically characterizes symptoms
the temporal process of emotional experience (e.g., Gross & John, 2003), occurring across dimensions of internalizing and externalizing concerns
(b) focusing on the use of specific ER strategies across varying contexts (e. (e.g., Lahey et al., 2008). Evidence supports the structure of youth
g., Aldao, 2013; Aldao & Nolen-Hoeksema, 2012), or (c) defining ER as psychopathology includes broad latent factors capturing internalizing
an underlying ability to regulate emotions (e.g., Gratz & Roemer, 2004). It and externalizing concerns that are associated due to underlying
is common for these models to differentiate ER occurring across cogni mechanisms (e.g., genetic influences, Lahey, Van Hulle, Singh, Wald
tive levels (e.g., reappraisal, rumination) and behavioral levels (e.g., man, & Rathouz, 2011; p-factor, Shields, Giljen, España, & Tackett,
avoidance; Webb, Miles, & Sheeran, 2012). Further, adult dispositional 2021). Further, both internalizing and externalizing concerns are asso
ER tendencies are considered to be a distinct from, yet underlying ciated with underlying mechanisms, particularly youth tendencies to use
multiple, heterogeneous forms of adult psychopathology occurring varying ER processes as well as coping processes (Compas et al., 2017).
across dimensions of internalizing and externalizing concerns (Aldao, Given internalizing and externalizing concerns co-occur and parental ER
Nolen-Hoeksema, & Schweizer, 2010; Gross & Jazaieri, 2014; Sheppes, tendencies are proposed to correlate with youth mental health due to
Suri, & Gross, 2015). similar underlying mechanisms (e.g., youth ER), the current review
A recent meta-analytic review evaluated the underlying structure of collapsed effects across internalizing and externalizing dimensions to
ER strategies to clarify issues of conceptualization and measurement investigate the overall relation between parental ER tendencies and
(Naragon-Gainey, McMahon, & Chacko, 2017). Findings from this meta- youth mental health symptoms.
analytic investigation did not support a single-factor solution of ER,
which suggested there is limited evidence for aggregating “adaptive” 1.2. Parental ER tendencies and youth mental health symptoms: potential
and “maladaptive” ER approaches within the same dimension. Naragon- moderators
Gainey et al.’ (2017) findings supported a three-factor solution under
lying adult ER, including two factors reflecting maladaptive ER ten It is common in meta-analytic reviews to observe significant het
dencies (Disengagement: high behavioral avoidance, high experiential erogeneity among effect sizes as well as evaluate whether certain factors
avoidance, high distraction, high expressive suppression, and low account for such variability. Thus, this review evaluated the direct as
mindfulness; Aversive Cognitive Perseveration: high experiential sociations between parental ER tendencies and youth mental health
avoidance, high rumination, low acceptance, and low distraction) and symptoms as well as factors that may moderate this link. Specifically,
one factor reflecting adaptive ER tendencies (Adaptive Engagement: this review evaluated youth age, psychiatric risk status, and the infor
high mindfulness, high problem-solving, high reappraisal). Disposi mant source (i.e., same-informant, different informants) as potential
tional mindfulness loaded across maladaptive and adaptive factors in moderators.
consistent directions (i.e., negative loading on one maladaptive ER
factor; positive loading on the adaptive ER factor). Taken together, the 1.2.1. Age
extant literature has various definitions of adult ER, yet recent evidence Developmental psychopathology research often draws from trans
highlights that most dispositional ER tendencies among adults can be actional models that highlight how bidirectional influences between
conceptualized as distinct maladaptive and adaptive processes. parents and youth affect the development of youth internalizing and
A key conceptual distinction pertinent to this review is considering externalizing concerns (Pardini, 2008). Transactional models emphasize
dispositional parental ER tendencies as broader, trait-like characteristics that parents influence youth, while youth also influence parents, and
that are distinguished from more direct influences occurring within such bidirectional influences often exacerbate youth underlying pre
parent-child interactions, such as emotional socialization or parenting disposition toward mental health concerns (e.g., Patterson, 1982, 2002).
practices. A large body of literature focused on direct influences within The extant literature evaluating bidirectional influences largely focuses
parent-child interactions draws from Eisenberg and colleagues' emotion on the development of externalizing psychopathology (e.g., Mackler
socialization theory (Eisenberg, Cumberland, & Spinrad, 1998) by et al., 2015; Pinquart, 2017; Serbin, Kingdon, Ruttle, & Stack, 2015)
evaluating links between parents' engagement in emotion socialization which tends to emerge earlier in development than internalizing con
practices, their child's ER, and the development of child mental health cerns (e.g., Gilliom & Shaw, 2004). Less research has found evidence of
concerns (e.g., Cole, Dennis, Smith-Simon, & Cohen, 2009; Meyer, bidirectional influences between parents and youth internalizing con
Raikes, Virmani, Waters, & Thompson, 2014; Perry, Dollar, Calkins, cerns, although increasing inquiry has identified potential bidirectional
Keane, & Shanahan, 2020). Additionally, there is a wealth of literature influences within parental accommodation (e.g., Jones, Lebowitz,
demonstrating that parenting practices occurring within parent-child Marin, & Stark, 2015; Storch et al., 2015) and co-rumination (e.g.,
interactions (e.g., rejection, warmth, over-control, harshness, and Waller & Rose, 2010, 2013) practices. Links between parental ER ten
autonomy-granting) are linked to youth mental health concerns across dencies and youth mental health symptoms are observed across the span
both internalizing and externalizing dimensions (e.g., McLeod, Weisz, & of youth development (e.g., Cheung, Chan, & Chung, 2020; Davis,
Wood, 2007; McLeod, Wood, & Weisz, 2007; Pinquart, 2017). Empirical Suveg, & Shaffer, 2015; Han et al., 2016), yet findings are mixed in
evidence supports that dispositional parental ER tendencies are distinct, magnitude. Studies including younger children have shown moderate to
yet linked to emotion socialization practices (i.e., Hughes & Gullone, strong effects (e.g., Davis et al., 2015) whereas studies including youth
2010; Kehoe, Havighurst, & Harley, 2014; Yan, Han, & Li, 2016) as well within the school-age and adolescent range demonstrate small-to-
as parenting practices (e.g., Lorber, 2012; Lorber & O'Leary, 2005). moderate effects (e.g., Cheung et al., 2020; Han et al., 2016). Given
Further, dispositional parental ER tendencies are linked to a broader that extant literature focuses on bidirectional parent-child effects
2
involved in the etiology of externalizing concerns, which emerge earlier whether a heterogeneous effect emerges across studies and, if so,
in development, and some effects appear strong in younger samples, whether potential moderator variables account for heterogeneity.
stronger links were anticipated to occur when samples included younger We anticipated that moderator analyses would yield evidence for a
youth. heterogenous distribution of effect sizes. Methodological and sample
characteristics were evaluated as potential moderators, including youth
1.2.2. Youth psychiatric risk age, youth psychiatric status, informant source, and the source of effect
Relations between parental ER tendencies and youth mental health size collection (i.e., published vs requested). We anticipated that effects
concerns might depend on the clinical severity of youth mental health would be stronger when the informant matched across measures (i.e.,
concerns. One study observed that the link between parental emotion parent-reported ER and parent-reported youth symptoms) than when
dysregulation and youth internalizing concerns was amplified when effects were drawn from different informants (e.g., parent-reported ER
children showed greater levels of emotion dysregulation (Han & Shaffer, and self-reported youth symptoms). Effects were hypothesized to be
2013). It is possible that children who experience greater severity of stronger in samples of younger, relative to older, youth. We anticipated
mental health concerns are more susceptible to the influence of parental that effects would be stronger in clinical, relative to healthy, youth
ER tendencies. Numerous meta-analyses have demonstrated that youth samples. Finally, we anticipated that effects would be stronger when
are at greater risk for exhibiting mental health concerns when their collected through data available within published reports than when
parents struggle with a variety of psychiatric disorders, including anxi obtained by directly requesting authors for effect sizes not available
ety (Lawrence, Murayama, & Creswell, 2019), depression (Ayano, Betts, within published reports.
Maravilla, & Alati, 2020), bipolar disorder (Ayano, Betts, Maravilla, &
Alati, 2021), and schizophrenia (Rasic, Hajek, Alda, & Uher, 2014). 2. Method
Further, amplified risk for youth mental health concerns occurs in the
context of parental psychopathology spanning across internalizing (e.g., 2.1. Literature search
Jami, Hammerschlag, Bartels, & Middeldorp, 2021) and externalizing
domains (e.g., Ayano et al., 2021). Considering increased risk for youth The electronic databases PsycINFO and Web of Science were
mental health cuts across both domains of parental psychopathology, searched for published reports existing at any timepoint up to September
mechanisms underlying adult psychopathology, such as ER tendencies, 2021 that examined the relationship between parental ER tendencies
may show stronger links to youth mental health concerns when youth and youth mental health symptoms. Searches were initially conducted in
are experiencing more severe mental health concerns. As such, this re May 2020 and then again in May 2021 and September 2021 to remain
view evaluated whether the relationship between parental ER ten updated. Search terms were developed by compiling terms used within
dencies and youth mental health symptoms was amplified among several meta-analyses assessing relations among these constructs (i.e.,
samples including youth with greater risk for psychiatric concerns. Aldao et al., 2010; Compas et al., 2017; Naragon-Gainey et al., 2017).
The first, second, and third author engaged in several 1–2 hour meetings
1.2.3. Informant-related moderators to establish search terms. Databases were searched using every combi
Informant discrepancies are very common when assessing youth nation of an ER term (i.e., emotion regulation, emotion dysregulation,
mental health concerns (for a review see De Los Reyes & Kazdin, 2005), reappraisal, suppression, rumination, acceptance, distraction, avoidance,
which may affect the strength of the relationship between parental ER problem-solving, and mindfulness) AND youth AND every combination of a
tendencies and youth mental health symptoms. A meta-analysis evalu youth psychopathology term (i.e., internalizing, anxiety, depression,
ating the correspondence between different informants' report of the posttraumatic stress, eating, bulimia, anorexia, binge, alcohol, substance,
same youth mental health symptoms found low-to-moderate correla externalizing, oppositional, irritability, disruptive behavior, and conduct
tions between informants (De Los Reyes et al., 2015). The authors offer a problems). As a secondary search strategy, reference lists from prominent
variety of explanations to account for informant discrepancies, reviews (i.e., Bariola et al., 2011; Bridgett et al., 2015) were reviewed
including clinical severity of mental health concerns, rater biases, for titles/abstracts to limit missing studies meeting inclusion criteria.
measurement error, and contextual saliency of concerns being rated. Fig. 1 depicts the PRISMA flow-diagram of the study selection process.
Across these various explanations, evidence consistently finds that re
lationships between psychological constructs are weaker when ratings 2.2. Study selection and data extraction
are provided by different informants (Hoyt, 2000). As such, it was
anticipated that the informant providing youth mental health ratings (i. The search process described above yielded a total of 6304 poten
e., same informant; different informants) would moderate the relation tially relevant articles. Titles and relevant abstracts were systematically
between parental ER tendencies and youth mental health concerns, such examined by the first and third author to determine whether an article
that relations would be weaker when effects were based on different was subsequently reviewed in full-text format based on the following
informants. criteria: (a) the study was empirical and peer-reviewed, (b) the study
was written in English, (c) the study included human participants, (d)
1.3. Current study the study reported measurement of youth mental health concerns (e.g.,
internalizing, externalizing, psychopathology, adjustment concerns)
On the basis of prominent conceptual perspectives (Bridgett et al., and (e) the study reported measurement of parental psychosocial char
2015; Morris et al., 2007), a number of studies now examine associations acteristics. Screening point (e) was purposely broad to value sensitivity
between parental ER tendencies and youth mental health concerns. in capturing studies that may have included effects based on parental ER
However, no prior study has systematically examined this literature and tendencies. The first and third authors double-coded 100 titles/abstracts
quantitatively summarized the relation between parental ER tendencies to ensure reliability before independent screening. The first, second, and
and youth mental health symptoms through the use of meta-analysis. third authors engaged in biweekly meetings to maintain consensus
Therefore, the aim of the current study was to examine the relation building and resolve questions about titles/abstracts that were unclear.
between parental ER tendencies and youth mental health symptoms in Screening found 385 studies that met full-text review criteria.
order to (a) test hypotheses from two conceptual perspectives (i.e., The 385 studies were examined to determine if they met inclusion
Bridgett et al., 2015; Morris et al., 2007) that parental ER tendencies, criteria for analysis in the current study. Inclusion criteria consisted of:
including adaptive ER and maladaptive ER, are related to youth mental (a) self-reported measurement of parental ER tendencies using a reliable
health symptoms, (b) generate an understanding the magnitude of this measure including more than 3 or more items (see Aldao et al., 2010 and
relation (i.e., small, moderate, or large effect size), and (c) determine Naragon-Gainey et al., 2017 for similar approaches), (b) reported
3
Identification
Studies identified from:
Database Searches (n = 11,005) Studies removed before screening:
Secondary Screening Duplicate records removed
(n = 1,404) (n = 6,105)
Studies screened Studies excluded

(n = 6,304) (n = 5,919)
Studies assessed for eligibility Studies excluded:

(n = 385) No report of parental ER tendencies (n = 296)
Screening
No reliable report of youth symptoms (n = 12)

Outside age range (n = 2)
No baseline effects; only longitudinal (n = 1)
Studies eligible for inclusion Combination of above reasons (n = 21)
(n = 53)
Studies requested Studies not received:

(n = 23) (n = 9)
Included
Studies included in review

(n = 44)
Note: ER = Emotion Regulation.
Fig. 1. PRISMA study selection flow diagram.

Note: ER = Emotion Regulation.
measurement of youth internalizing or externalizing symptoms using a 2.3. Study coding

reliable measure (see Compas et al., 2017 for a similar approach), and
(c) youth were between ages of 2–17 years. Studies that defined ER as an The following characteristics of each study were coded: (a) source of
outcome of emotion dysregulation (e.g., parental distress) were not study (published, requested), (b) research design (cross-sectional,
included. Effects based on measurement of parental ER only occurring treatment/experimental, longitudinal), (c) sample size, (d) youth mean
within the context of parenting (e.g., emotion socialization practices, age, (e) parent mean age, (f) percentage of youth participants identified
mindful parenting) were excluded. Cross-sectional, longitudinal, and as female, (g) percentage of mothers in sample, (h) distribution of fa
treatment studies were included, though effects were restricted to as milial race/ethnicity backgrounds, (i) country of data collection, (j)
sociations at baseline (e.g., excluded longitudinal effects; excluded post- family income, (k) parental education level, (l) youth psychiatric risk
treatment effects). Studies that contained the same sample and data status (at-risk, healthy), (m) type of ER measured (i.e., maladaptive,
were also identified at this stage. Effect sizes from different publications adaptive, both), (n) specific facet of ER measured (i.e., maladaptive:
though based on the same sample were aggregated, such that each
sample only contributed one effect size to ensure statistical
independence.
Authors of studies that met inclusion criteria, but did not provide
effect size information, were emailed to request the needed information.
Authors were contacted regarding 23 articles, which led to 14 authors
(60.87% of those sent data requests) who provided relevant data. A total
of 44 studies met inclusion criteria and were retained for use in the
current study. Of these 44 studies, 32 unique studies (35 published re
ports including samples with aggregated effects) reported on data
regarding maladaptive parental ER tendencies and youth mental health
symptoms (N = 6399, k # of independent effects = 126), while 12
unique studies reported on data regarding adaptive parental ER ten
dencies and youth mental health symptoms (N = 4241, k # of inde
pendent effects = 28). Five studies reported effects pertinent to both
maladaptive and adaptive parental ER tendencies and were included in
separate analyses.
4
avoidance, rumination, suppression, nonspecific1; adaptive: reappraisal, (Hedges & Vevea, 1998; Lipsey & Wilson, 2001).
problem-solving, mindfulness2), (o) broad dimension of youth mental
health concerns (i.e., internalizing, externalizing, combined), (p) spe 2.4.3. Moderator analyses
cific facet of youth mental health symptoms measured (i.e., depression, Two approaches were used to evaluate whether the overall effect size
anxiety, somatic, eating concerns, aggression, conduct problems, sub reflected a heterogeneous distribution of effects. A significant Q statistic
stance use, inattention and/or hyperactivity/impulsivity, obsessions/ indicates the overall effect size demonstrates significant heterogeneity
compulsions, dissociation, trauma, or nonspecific), (q) youth mental within the effect size distribution. Additionally, the I2 statistic – which
health symptom informant (i.e., same informant; different informants), represents the proportion of total variation in the estimates due to het
and (r) effect size statistic. Youth psychiatric risk status was determined erogeneity rather than chance – was evaluated with the following
by studies reporting purposeful sampling of a population at-risk for descriptive interpretations: 25% reflecting small heterogeneity, 50%
psychopathology (e.g., recruited from mental health treatment center) reflecting medium heterogeneity, and 75% reflecting large heteroge
and/or greater than 20% of their sample being diagnosed with a psy neity (Higgins & Thompson, 2002). In the event of significant hetero
chiatric condition or reporting an at-risk elevation (t-score > 60) on a geneity, moderator analyses were planned to either compare effects
corresponding measure of psychopathology (e.g., Child Behavior across coded categories or use meta-regression techniques (i.e., evalu
Checklist; Achenbach, 1991). See Appendices 1 and 2 for descriptive ating whether sample mean youth age was linked to the effect size).
summaries of included studies, Appendix 3 for coding of moderator Further, to maintain statistical independence, a systematic approach
analyses, and Appendix 4 for a list of included studies. was used for studies that included effects based on ratings from the same
The second and third authors were each randomly assigned to code informant and different informants by randomly assigning each study to
60% of the studies that met full-text review, allowing for 20% of the have only one ES entered for the respective moderator comparison
sample to be randomly assigned for overlapping coding. Inter-rater analysis. For example, a hypothetical study may have reported 2 effects
reliability was calculated and demonstrated strong reliability such that using the same informant and 2 effects using different informants, which
the mean kappa between raters was 0.95. The first author double-coded would lead to one effect being randomly chosen and included in the
every article that met inclusion criteria. During data coding, the first appropriate level for analysis. Moderator categories and results of
three authors met on a biweekly basis to maintain consensus building randomization are depicted in Appendix 3.
and resolve any conflicts in data coding.
2.4.4. Publication bias
Several analyses were conducted to evaluate the possibility of pub
2.4. Data analytic plan
lication bias. First, the impact of publication bias was evaluated by
computing Rosenthal's (1979) Fail-Safe N, which identifies the approx
2.4.1. Effect size calculation
imate number of studies observing a null effect needed to reduce the
Pearson's r was used as the effect size (ES) metric in the current study
overall effect to a non-significant level. Visual examination of the funnel
(Borenstein, Hedges, Higgins, & Rothstein, 2009). ES estimates within
plot for each effect size was also evaluated and asymmetrically
each study were averaged so that only one ES for a given study
appearing distributions indicated potential publication bias warranting
contributed to the analysis of the overall mean ES to maintain statistical
further analysis. Egger's test was conducted for each analysis with po
independence. ES estimates were transformed using Fisher's Z trans
tential asymmetry to evaluate the significance of funnel plot asymmetry.
formation to adjust for sampling error due to discrepant sample sizes
across studies (Lipsey & Wilson, 2001). ESs were interpreted based on
3. Results
Cohen's (1988) guidelines such that effects at the 0.10 level were
considered small, effects at the 0.25 level were considered moderate,
3.1. Maladaptive parental ER tendencies and youth mental health
and effects at the 0.40 level were considered large.
symptoms
2.4.2. Random-order effects model
3.1.1. Included studies descriptive information and main effect
Comprehensive Meta-Analysis software version 3.3.070 (Borenstein,
Study descriptive information, number of independent effects, sam
Hedges, Higgins, & Rothstein, 2013) was used to conduct analyses. A
ple size, and pertinent effect size statistics are presented in Table 1.
random-effects model was used to analyze the main effect and moder
Included studies were published between 2007 and 2021 with the ma
ator comparisons given the assumption that the effect sizes collected
jority of studies (n = 27) published following 2015. The majority of
from studies examined reflect effects with heterogeneous distributions
studies utilized a cross-sectional design (n = 18), followed by effects
drawn from the baseline of treatment studies (n = 7) or longitudinal
1 studies (n = 7). Across studies, samples included similar proportions of
Nonspecific aspects of ER represented effects that were based on scores that
male/female youth (i.e., average = 46.7% female), while studies tended
aggregated multiple aspects of ER. The majority of these effects were based on
studies employing the Difficulties in Emotion Regulation Scale total scale (Gratz
to primarily include mothers (i.e., average = 82.1% mothers). Most
& Roemer, 2004). studies included in the maladaptive parental ER analysis either included
2
Naragon-Gainey et al. (2017) meta-analysis found evidence that disposi effects reflecting both internalizing and externalizing concerns (n = 17)
tional mindfulness had a significant, positive loading on the adaptive ER factor or a measure of youth mental health concerns that combined internal
labeled Adaptive Engagement as well as significant, negative loading on the izing and externalizing domains (n = 6). Only 9 studies solely measured
maladaptive ER factor labeled Disengagement. Given this finding, we ran an one facet of youth mental health concerns, and 6 of these 9 studies
alyses including effects based on mindfulness in the parental maladaptive ER included effects only pertinent to internalizing concerns (e.g., anxiety,
analysis. In these post-hoc analyses, effects based on mindfulness were reversed depression). Further, a large number of effects (i.e., 63/126 effects;
such that effects were in the same direction (e.g., lower levels of mindfulness 50.0%) reflecting maladaptive parental ER tendencies were based on the
being linked to greater youth mental health concerns) as other maladaptive ER
Difficulties in Emotion Regulation total scale (DERS; Gratz & Roemer,
tendencies (e.g., higher levels of experiential avoidance being linked to more
2004). Considering this scale is a nonspecific measure of maladaptive
youth mental health concerns). The results of these post-hoc analyses were
consistent with the a-priori pattern of findings such that the main effect size was parental ER tendencies, all effects were aggregated within a single
modest (r = 0.24, p < .001) and significantly heterogeneous (Q(36) = 153.35, p analysis corresponding to maladaptive parental ER tendencies. The
< .001). Moderator analyses rendered the same pattern of findings. Informant overall weighted ES of the relation between maladaptive parental ER
status was the only significant moderator while youth age and psychiatric risk tendencies and youth mental health concerns was significant, r = 0.25,
were nonsignificant. (95% CI = 0.20 to 0.30, p < .001).2
5
Table 1 tendencies and youth mental health concerns was significant across both
Study effect size statistics within maladaptive parental emotion regulation age groups (0–12 years: r = 0.27, p < .001; 13–17 years: r = 0.19, p <
analysis. .001). Additionally, a meta-regression analysis using a mixed-effects
Study first Year k Sample Pearson's Fisher's unrestricted maximum likelihood approach was conducted. A nonsig
author size r transformed R nificant relation was observed between youth age and the strength of
Bonifacci 2020 8 50 0.24 0.24 effect sizes, beta = − 0.01, p = .16. The scatterplot graph corresponding
Brassell 2016 6 615 0.35 0.37 to this meta-regression analysis is depicted in Fig. 2.
Buckholdt 2014 2 80 0.15 0.15
Casline 2020 1 350 0.42 0.45
3.1.4. Moderator analysis: informant status
Cheung 2020 4 343 0.18 0.18
Crespo 2017 4 454 0.22 0.22 Informant status significantly moderated the relation between mal
Davis 2015 2 95 0.39 0.41 adaptive parental ER tendencies and youth mental health symptoms,
Feinberg 2018 2 45 0.61 0.71 QB(1) = 12.93, p < .001. Significant relations occurred across both
Feldman 2007 1 178 0.21 0.21 informant status categories, though relations were stronger when in
Gershy 2017 / 7 70 0.12 0.12
2020
formants for ER and youth mental health symptoms were the same (i.e.,
Han 2013 2 64 0.24 0.24 parent informant completed both measures), r = 0.30, p < .001, than
Han 2016 7 73 0.18 0.18 when informants were different, r = 0.16, p < .001.
Havewala 2019 1 177 0.17 0.17
Havighurst 2009 1 218 0.19 0.19
3.1.5. Moderator analysis: youth psychiatric risk status
Havighurst 2015 10 224 0.25 0.26
Kehoe 2015 / - - - - Samples with youth exhibiting higher psychiatric risk did not
2020 significantly differ from healthy samples with respect to the relationship
Haydicky 2015 12 15 − 0.04 − 0.04 between maladaptive parental ER tendencies and youth mental health
Highlander 2021 2 79 − 0.10 − 0.10 symptoms, QB(1) = 0.10, p = .75. The relation between maladaptive
Ip 2021 12 73 0.21 0.21
parental ER tendencies and youth mental health symptoms was signif
Johnco 2018 4 440 0.39 0.41
Lewis 2020 1 68 0.47 0.51 icant in samples with heightened psychiatric risk and healthy samples,
Lieneman 2020 3 66 0.19 0.19 r's = 0.24 and 0.26, p's < 0.001, respectively.
Lin 2019 2 239 0.14 0.14
Mellick 2017 1 146 0.31 0.32
3.1.6. Moderator analysis: reported effects vs requested effects
O'Connor 2020 6 53 0.18 0.18
Oddo 2019 3 247 0.15 0.15 Comparing effects reported within publications versus effects
Pat- 2015 1 431 0.27 0.28 requested from publications did not lead to differing relations between
Horenczyk maladaptive parental ER tendencies and youth mental health symptoms,
Polusny 2011 1 288 0.07 0.07 QB(1) = 0.97, p = .33. The relation between maladaptive parental ER
Powers 2021 1 105 0.32 0.33
tendencies and youth mental health symptoms was significant when
Shorer 2020 7 351 0.27 0.28
Yang 2021 2 442 − 0.02 − 0.02 based on effects that were reported and effects that were requested, r's =
Zhang 2020 6 181 0.17 0.17 0.23 and 0.33, p's < 0.001, respectively.
Zimmer- 2019 4 139 0.19 0.19
Gembeck
3.2. Adaptive parental ER tendencies and youth mental health symptoms:
Note: k reflects the number of independent effects within each sample aggre main effect
gated to produce the sample effect size.
Study descriptive information, number of effects, sample size, and
3.1.2. Moderator analyses: heterogeneity of effect sizes pertinent effect size statistics are presented in Table 3. The overall
A significant Q statistic, 123.16 (31), p < .001, was observed, which weighted ES of the relation between adaptive parental ER tendencies
indicated that the distribution of effect sizes was not homogeneous and and youth mental health concerns was significant, r = − 0.16, (95% CI =
further evaluation of moderators was warranted. The I2 statistic was − 0.26 to − 0.07, p < .01). The number of effects (k = 28) was small and
74.83, indicating that a moderate-to-large amount of the distribution largely dependent on effect sizes drawn from relations between parental
was due to heterogeneity rather than chance. Moderator analyses are dispositional mindfulness and youth mental health symptoms. Due to
described below. See Table 2 for a depiction of analyses evaluating this limitation found upon reviewing the literature, we elected not to
potential moderators of the link between maladaptive parental ER ten conduct moderator analyses with respect the relations between adaptive
dencies and youth mental health symptoms. parental ER tendencies and youth mental health concerns. Rather, these
effects are further narratively reviewed to provide contextual informa
3.1.3. Moderator analyses: youth age tion relevant to this effect size beyond the main effect analysis.
The strength of the relation between maladaptive parental ER ten
dencies and youth mental health concerns was compared across devel 3.3. Adaptive parental ER tendencies and youth mental health symptoms:
opmental periods of childhood (0–12 years) and adolescence (13–17 narrative systematic review
years).3 This analysis yielded a nonsignificant moderating effect, QB(1)
= 2.09, p = .15. The relation between maladaptive parental ER 3.3.1. Mindfulness
The current review identified 7 studies with 21 unique effects (n =
3441) that evaluated the baseline relation between parental disposi
3
tional mindfulness and youth mental health symptoms. Across these
An omnibus comparison was conducted comparing whether relations studies, all effects were inversely correlated with the exception of one
differed based on youth developmental periods (i.e., early childhood: 2–5 years,
effect (r = 0.06) observed in the study conducted by Zhang, Palmer,
middle childhood: 6–12 years, and adolescence: 13–17 years). The omnibus test
Zhang, and Gewirtz (2020). The aggregated effect for each study ranged
was not significant (QB(2) = 2.38, p = .30). Comparisons between each
developmental period did not yield significant differences (i.e., early childhood from − 0.39 to − 0.05, and sample sizes varied widely from 39 to 2237
vs. middle childhood: QB(1) = 0.19, p = .66; early childhood vs. adolescence participants. Further, 3 of the 7 aggregated effects included independent
QB(1) = 2.32, p = .13; middle childhood vs. adolescence: QB(1) = 1.37, p = effects collected through requests to the author(s). The below narrative
.24). Effects were significant at each developmental period (r's = 0.28, 0.26, description of studies is organized to report published effects first, fol
and 0.18 for early childhood, middle childhood, and adolescence, respectively). lowed by effects collected through requests made to authors.
6
Table 2
Moderator comparison findings within maladaptive parental emotion regulation analysis.
Unit of analysis ES source k Mean ES 95% CI I2 Within Q Between Q
All Studies All Studies 126 0.25* 0.20–0.30 74.83 123.16 –

Child Age Child 96 0.27* 0.22–0.33 – – 2.09
Adolescent 30 0.19* 0.09–0.29 – –
Psychiatric Risk Healthy 66 0.24* 0.17–0.31 – – 0.10
At-Risk 60 0.26* 0.18–0.33 – –
Informant Same Informant 70 0.30* 0.25–0.36 – – 12.93*
Different Informant 32 0.16* 0.10–0.21 – –
Source Reported 89 0.23* 0.18–0.28 – – 0.97
Requested 37 0.33* 0.14–0.49 – –
Note: k reflects the number of independent effects within each unit of analysis.
ES = Effect Size.
*
p < .05.
Regression of Fisher's Z on Child Age

1.00
0.80
0.60
0.40
Fisher's Z
0.20
0.00
-0.20
-0.40
-0.60
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0
Child Age
Fig. 2. Meta-regression evaluating link between child age and effect size within maladaptive parental emotion regulation analysis.
Bluth and Wahler (2011) found significant inverse relations between

Table 3
maternal mindfulness – measured using the Mindfulness Attention and
Study effect size statistics within adaptive parental emotion regulation analysis.
Awareness Scale (MAAS) – and mother-reported adolescent external
Study first Year(s) k Sample Pearson's Fisher's izing (r = − 0.37) and internalizing (r = − 0.41) symptoms within a
author size r transformed R
community sample of 118 mothers using a cross-sectional design. Sig
Belschner 2020 2 39 − 0.05 − 0.05 nificant inverse relations were also observed between parent mindful
Bluth 2011 2 118 − 0.39 − 0.41 ness – measured using the Five Factor Mindfulness Questionnaire
Emerson 2021 3 89 − 0.23 − 0.23
Feldman 2007 1 178 0.05 0.05
(FFMQ) – and youth externalizing (r = − 0.15) and internalizing (r =
Han 2019 2 2237 − 0.15 − 0.15 − 0.15) concerns within a large sample (n = 2237) of Chinese elemen
Oruche 2018 1 19 − 0.41 − 0.44 tary school age youth (mean age = 9.4 years; Han et al., 2019). In a
Palermo 2016 2 61 − 0.02 − 0.02 sample of 162 parents receiving a family, group-based cognitive-beha
Parent 2010 4 162 − 0.17 − 0.17
vioral intervention to prevent youth depression, parental mindfulness –
Parent 2016 / 5 615 − 0.38 − 0.40
2021 measured with the MAAS – was significantly, inversely associated at
Yang 2021 2 442 − 0.12 − 0.12 baseline with youth internalizing (r = − 0.21) and externalizing (r =
Zhang 2020 3 181 − 0.09 − 0.09 − 0.16) symptoms that were aggregated based on both parent and youth
Zimmer- 2019 2 139 0.04 0.04 report (Parent et al., 2010). Parent and colleagues (2016) also conducted
Gembeck
a longitudinal evaluation in a community sample of 615 parents, which
Note: k reflects the number of independent effects within each sample aggre found significant associations at the initial timepoint between parental
gated to produce the sample effect size. mindfulness – measured using the MAAS – and parent-reported youth
7
internalizing (r = − 0.37) and externalizing concerns (r = − 0.33). 3.4. Publication bias

Further, in a study conducted by Zhang and colleagues (2020), 181
military parents receiving a parenting-focused treatment for youth The Fail-Safe N regarding the maladaptive parental ER tendencies
mental health concerns (mean age 8.43 years) reported on their mind and youth mental health concerns analysis was 2809. Thus, 2809 studies
fulness through the FFMQ and youth mental health concerns at baseline. with null results would be needed to reduce the observed relationship to
Youth also reported on their own depression symptoms. Parental a non-significant effect. In addition, the funnel plot was visually
mindfulness was significantly, inversely related to youth externalizing inspected, and seven of the aggregated effects (out of 32 in total) were
(r = − 0.13) and internalizing (r = − 0.20) when the informant matched; outside of the funnel plot. Egger's test was conducted to evaluate plot
however, nonsignificant relations occurred between parental mindful asymmetry and was non-significant (regression intercept = − 0.19, 95%
ness and youth depression (r = 0.06) when youth reported on their own CI [− 2.11, 1.72], p = .84).
depression symptoms. The Fail-Safe N regarding the adaptive parental ER tendencies and
Requests for effect sizes resulted in 3 studies providing correlations youth mental health concerns analysis was 250. Thus, 250 studies with
between parental mindfulness and youth mental health concerns. null results would be needed to reduce the observed relationship to a
Belschner and colleagues (2020) examined the relation between non-significant effect. In addition, the funnel plot was visually inspec
parental mindfulness using the MAAS and youth OCD symptomatology ted, and four of the aggregated effects (out of 12 in total) were outside of
and a nonsignificant, though inverse in direction, aggregated correlation the funnel plot; Egger's test evaluating plot asymmetry was non-
occurred (r = − 0.05) among 39 parent-adolescent dyads. Additionally, significant (regression intercept = 0.20, 95% CI [− 2.61, 3.01], p =
baseline associations between parental mindfulness using the FFMQ and .88). See Fig. 3 for a depiction of funnel plot analyses.
youth mental health concerns (i.e., CBCL-ADHD scale,
CBCL-Internalizing Scale, and CBCL-Externalizing scale) were signifi 4. Discussion
cant (r's = − 0.26, − 0.25, and − 0.17, respectively) in a sample of 89
parents of children with a variety of mental health diagnoses (e.g., The purpose of the current study was to evaluate the relation be
ADHD; anxiety; autism spectrum disorder) living in the Netherlands tween parental ER tendencies and youth mental health symptoms, and
prior to receiving mindfulness parent training (Emerson, Aktar, de determine the magnitude of this relationship, via a systematic review
Bruin, Potharst, & Bögels, 2021). Finally, Parent, Dale, McKee, and and meta-analysis of the extant literature. An additional aim was to
Sullivan (2021) provided effects for the sample described above (i.e., determine whether these relations were affected by potential modera
Parent, McKee, Rough, & Forehand, 2016) which included 3 significant, tors to clarify factors that may contribute to heterogeneity in the
inverse relations between parental mindfulness – measured with the observed effect sizes. Results revealed a significant, small-to-moderate
MAAS – and youth internalizing (r's = − 0.44 and − 0.39) and exter relation between maladaptive parental ER tendencies and youth
nalizing (r = − 0.39) concerns. mental health concerns. In addition, only informant status significantly
moderated the relation between maladaptive parental ER tendencies
3.3.2. Reappraisal and youth mental health symptoms. Furthermore, findings were
The current review identified 2 studies with 4 independent effects (n consistent with a significant, albeit small relation between adaptive
= 581) based on the relation between parental reappraisal tendencies parental ER tendencies and youth mental health concerns, although this
and youth mental health symptoms. One of these aggregated effects was link was less clear because it was based on a small number of indepen
collected through a data request (Zimmer-Gembeck et al., 2019). Yang, dent samples (8 of 12 studies) that primarily included effects for
Chen, Qu, and Zhu (2021) found significant, inverse relations between parental dispositional mindfulness.
parental reappraisal and youth internalizing concerns (i.e., Short Mood Maladaptive parental ER tendencies were significantly, inversely
and Feelings Questionnaire Depression Ratings r = − 0.14 and Gener related to youth mental health symptoms across both domains of
alized Anxiety Disorder 7-item Scale Ratings r = − 0.10) within a sample internalizing and externalizing concerns. This finding remained signif
of 442 adolescents (mean-age = 13.35 years) using a cross-sectional icant across all levels of moderator analyses and analyses indicated this
study during the COVID-19 pandemic. Zimmer-Gembeck and col effect remains robust to potential publication bias (i.e., high Fail-Safe N
leagues (2019) found nonsignificant relations between parental reap finding, non-significant Egger's test). Thus, findings support general
praisal and youth mental health concerns (i.e., CBCL-Internalizing r = propositions from conceptual perspectives that maladaptive parental ER
0.04 and CBCL-Externalizing r = 0.01) in a sample of 139 young children tendencies are significantly associated with youth mental health con
(mean age = 4.44 years) and their parents prior to engaging in cerns. One general observation was the limited ability to evaluate the
Parent-Child Interaction Therapy. relation between specific maladaptive ER processes and youth mental
health symptoms, considering that a large number of effects (i.e., 63/
3.3.3. Problem-solving 126 effects; 50.00%) were based on the DERS total scale (DERS; Gratz &
The current review identified 3 studies with 3 unique effects (n = Roemer, 2004), which aggregates numerous specific maladaptive ER
258) that evaluated the relation between parental problem-solving and strategies. Several studies included in this review (e.g., Brassell et al.,
youth mental health symptoms. Feldman and colleagues (2007) re 2016) found significant relations between youth mental health concerns
ported a nonsignificant relation between parental problem-solving– and specific types of maladaptive parental ER tendencies, particularly
measured using the Ways of Coping Scale – and parent-reported child avoidance (26/126 effects; 20.65%). However, very few effects evalu
overall mental health concerns (r = 0.05) among a sample of 178 parents ated relations between youth mental health concerns and dispositional
of young children at high risk for or diagnosed with developmental tendencies for parents to engage in expressive suppression (4/126 ef
delays. In a sample of 19 parent-adolescent dyads enrolled in a pilot fects; 3.18%) or rumination (9/126 effects; 7.14%). Future research
clinical trial of family-based therapy, parental problem-solving – would benefit from examining whether specific maladaptive parental ER
measured using the Social Problem Solving Inventory – Revised (SPSI:R) tendencies are uniquely related with youth mental health concerns.
– was significantly, inversely associated at baseline with youth exter Moderator analyses only indicated that the main effect significantly
nalizing (r = − 0.41) concerns (Oruche et al., 2018). Finally, a nonsig varied based on informant status. This finding is in line with literature
nificant, albeit inverse, relation was observed between parental identifying that discrepant informant ratings of youth mental health
problem-solving ratings on the SPSI:R and youth depression ratings (r symptoms weakly correlate, which is likely due to a variety of factors (e.
= − 0.02). Of note, the last two effects (i.e., Oruche et al., 2018; Palermo g., rater biases, measurement error, cross-situational or contextual
et al., 2016) were collected via data requests. variation in symptoms and functioning; Achenbach, 2011; De Los Reyes
et al., 2015). The stronger relationship between parental ER tendencies
8
a. Funnel Plot of Standard Error by Fisher’s Z: Maladaptive Parental Emotion Regulation

0.0
0.1
Standard Error
0.2
0.3
0.4
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0
b. Funnel Plot of Standard Error by Fisher’s Z: Adaptive Parental Emotion Regulation
0.0
0.1
Standard Error
0.2
0.3
0.4
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0
Fig. 3. Funnel plots across maladaptive parent emotion regulation and adaptive parent emotion regulation main effect analyses.
a. Funnel Plot of Standard Error by Fisher's Z: Maladaptive Parental Emotion Regulation
b. Funnel Plot of Standard Error by Fisher's Z: Adaptive Parental Emotion Regulation
and youth symptoms when the informant was the same (i.e., parent samples of youth exhibiting greater psychiatric risk. The rationale for
completing both measures) may indicate that symptom expression in the anticipating a stronger effect among younger youth samples relied on
home context may be more strongly linked to parental ER tendencies the wealth of literature identifying parent-child effects on the develop
than symptom expression in other contexts that may influence youth- ment of externalizing concerns which tend to emerge earlier than
reported symptom ratings (e.g., school, peer contexts). This hypothesis internalizing concerns (Mackler et al., 2015; Pinquart, 2017; Serbin
should be explored in future studies and, if supported, may indicate that et al., 2015). However, since findings did not demonstrate differing re
interventions addressing parent ER may have context-specific effects on lations between healthy and at-risk samples as well as both categorical
youth mental health symptoms. It should be noted that although infor (i.e., child vs. adolescent) and continuous (i.e., meta-regression) age-
mant status was a significant moderator, effects based on ratings from based analyses, it appears that the association between maladaptive
different informants and ratings from the same informant were signifi parental ER tendencies and youth mental health symptoms is robust
cant, which further validates the robustness of the relation between across the period of 2 to 17 years of age.
youth mental health concerns and maladaptive parental ER tendencies. The relation between adaptive parental ER tendencies and youth
Further research may investigate whether more objective methods of mental health concerns was less clear. A significant, albeit small, effect
measuring adult ER show similar associations between parental ER was observed such that greater levels of adaptive parental ER tendencies
tendencies and youth mental health concerns. were linked to lower youth mental health concerns. However, this
Surprisingly, neither youth age or psychiatric risk status moderated finding was less robust considering evidence of a small fail-safe N sta
the association between maladaptive parental ER tendencies and youth tistic (i.e., 250) and the main effect largely drew from effects collected
mental health symptoms. Effects were significant in both child and through data request (5 of 12 studies; 12 of 28 independent effects).
adolescent populations as well as across both healthy samples and Further, parental dispositional mindfulness accounted for the majority
9
of independent effects (k = 21/28) in this analysis. It is less clear perpetrate intimate partner violence (e.g., Berke, Reidy, Gentile, &
whether greater levels of mindfulness represent a facet of adaptive ER or Zeichner, 2019; Shorey, McNulty, Moore, & Stuart, 2015). Further,
the lack of mindfulness reflects maladaptive ER tendencies (Naragon- maladaptive parental ER tendencies are linked with more negativity and
Gainey et al., 2017). Post-hoc analyses were conducted to include effects less positivity being expressed in the broad family context (Are &
based on parental dispositional mindfulness in the maladaptive parental Shaffer, 2016). Youth from families exhibiting more negativity and
ER analysis. Yet, these post-hoc analyses led to the same pattern of re interparental conflict are at greater risk for mental health concerns (e.g.,
sults regardless of including or excluding mindfulness-based effects. Carpenter & Stacks, 2009; Olaya, Ezpeleta, de la Osa, Granero, &
Furthermore, excluding parental mindfulness from the adaptive Doménech, 2010; Ravi & Black, 2020). Taken together, parental ER
parental ER meta-analysis restricted the number of studies (n = 5) and tendencies appear linked to distal environmental factors occurring
effects (k = 7) able to be evaluated. Effects evaluating the link between outside of parent-child interactions (e.g., interparental relationship
youth mental health symptoms and other specific adaptive ER ten quality, intimate partner violence, family emotional climate) that may
dencies were limited (i.e., problem-solving: 3 studies, k effects = 3; act as mechanisms that, at least partially, account for the link between
reappraisal: 2 studies, k effects = 4). These findings underscore the need parental ER tendencies and youth mental health concerns.
for future research to evaluate links between adaptive parental ER Both Morris and colleagues' tripartite model of familial influence
tendencies and youth mental health concerns. (2007, 2017) and Bridgett and colleagues' intergenerational trans
It is important to note that correlational findings do not offer ex mission of self-regulation model (2015) suggest that environmental
planations of causation or directionality. Conceptual models highlight mechanisms outlined above are likely to affect youth mental health
that parental ER tendencies may influence the development of youth concerns through their effect on youth ER. Empirical evidence strongly
mental health concerns through a variety of mechanisms both within supports the notion that youth ER is linked to youth mental health
parent-child interactions (e.g., parenting practices, emotion socializ concerns (Compas et al., 2017). There is a strong basis of empirical
ation practices) and distal to such interactions (e.g., Bridgett et al., 2015 support that environmental factors occurring within parent-child in
; Morris et al., 2007). Yet, it is possible that the experience of parenting teractions (e.g., emotion socialization, Spinrad, Stifter, Donelan-McCall,
youth exhibiting more mental health concerns may lead to difficulties in & Turner, 2004) and outside of parent-child interactions (e.g., intimate
parents' ability to regulate their emotions in an adaptive manner, or partner violence, Bender et al., 2022), are directly linked to youth ER.
result in parents being likelier to display more maladaptive ER ten Morris and colleagues' tripartite model of familial influence (2007,
dencies. Most longitudinal research relevant to this area focuses on 2017) specifies that environmental influences within parent-child in
transactional influences between youth ER and aspects of parent-child teractions (e.g., observational learning, parenting practices) and in the
interactions, such as parent-child reciprocity (Feldman, 2015) and broader family environment (e.g., emotional family climate) may
parenting practices (e.g., Van Lissa, Keizer, Van Lier, Meeus, & Branje, impact youth mental health concerns beyond effects explained by youth
2019), with very limited research exploring transactional influences ER. An important direction for future research will be to evaluate
between parental ER and youth mental health symptoms. Future whether parental ER tendencies link to youth mental health concerns
research employing longitudinal designs is needed to test the direction through multiple pathways beyond youth ER or whether the association
of associations between parental ER tendencies and youth mental health is fully explained by youth ER. Moreover, both models (i.e., Bridgett
symptoms. et al., 2015; Morris et al., 2007) propose that youth ER is linked to other
An important distinction was between dispositional parental ER ten adjustment-related outcomes (i.e., social competence, academic func
dencies – the focus of the current review – and parental ER occurring tioning). Future research is needed to examine whether parental ER
within parent-child interactions (e.g., emotion socialization practices). tendencies are associated with other aspects of youth adjustment beyond
While dispositional parental ER tendencies and emotion socialization mental health concerns.
practices are distinct, there is growing evidence that parents with Findings from the current study have important clinical implications
greater tendencies to use maladaptive ER strategies are likelier to use of for the integration of parental ER tendencies into prevention and
non-supportive responses to child negative emotion (Yan et al., 2016). intervention efforts addressing youth mental health concerns. The
Additionally, parents with greater difficulties in ER tend to dismiss their notion of targeting parental ER tendencies has been increasingly
child's emotions more often (Kehoe et al., 2014). Moreover, parents with considered in parenting-focused interventions (Maliken & Katz, 2013;
greater tendencies to use adaptive ER (i.e., reappraisal) often express Sanders, Turner, & Metzler, 2019). The Positive Parenting Program
more supportive responses to child negative emotion, whereas greater (Triple-P) is a behavioral parent training program which offers a version
tendencies to use maladaptive ER (i.e., suppression) are linked to with an enhanced focus on helping parents cope with their own distress
showing more non-supportive responses to child negative emotion (Sanders, Markie-Dadds, Tully, & Bor, 2000). Emotion-focused
(Hughes & Gullone, 2010). Meta-analytic findings suggests that parents' parenting programs, including Tuning in to Kids (TIK; Havighurst, Wil
engagement in supportive emotion socialization practices are associated son, Harley, & Prior, 2009; Havighurst, Wilson, Harley, Prior, & Kehoe,
with youth externalizing problems (Johnson, Hawes, Eisenberg, 2010) and Tuning in to Teens (TINT; Havighurst, Kehoe, & Harley, 2015),
Kohlhoff, & Dudeney, 2017). Empirical evidence shows that non- are group-based interventions that focus on parental emotion awareness
supportive responses to child negative emotion are both concurrently and management techniques to enhance parental emotional socializ
related to and predict youth internalizing concerns (e.g., Hooper, Wu, ation practices. A recent study found improvements in parental ER
Ku, Gerhardt, & Feng, 2018; Silk et al., 2011). Thus, the current findings tendencies mediated effects observed within the TINT program (Kehoe,
may be, at least partially, explained by parental ER tendencies leading to Havighurst, & Harley, 2020). Beyond parenting programs, cognitive-
supportive or non-supportive emotion socialization practices, which, in behavioral interventions for youth, such as the Unified Protocol for the
turn, decrease or increase risk for youth mental health concerns. Transdiagnostic Treatment of Emotional Disorders in Children and Adoles
Conceptual models also highlight distal factors outside of parent- cents, have shown efficacy when including components addressing ER
child interactions that may account for the association between for both youth and their parents (e.g., Holmqvist, Andersson, Stern, &
parental ER tendencies and youth mental health concerns (Bridgett Zetterqvist, 2020; Tonarely, Kennedy, Halliday, Sherman, & Ehrenreich-
et al., 2015; Morris et al., 2007). There is a growing body of literature May, 2021). It is also possible that supporting effective adult ER beyond
demonstrating that adult ER tendencies have cascading effects on the the context of parent-child interactions may carry indirect benefits to
broader family emotional climate. Adult ER is associated with relational youth. Adult-only treatments have been developed to target ER (e.g.,
functioning and conflict resolution among couples (Holley, Haase, Chui, Gratz, Weiss, & Tull, 2015), which may be utilized in prevention efforts
& Bloch, 2018; Low, Overall, Cross, & Henderson, 2019). Additionally, to buffer against worsening mental health outcomes for youth at risk.
individuals with greater maladaptive ER tendencies are likelier to Moreover, addressing youth mental health symptoms may lead to
10
improvements in parents' ER. There is emerging evidence that parental the association between parental ER tendencies and youth mental health
ER improves alongside reductions in youth mental health concerns concerns. While the link between maladaptive parental ER and youth
following parenting-focused interventions (Lieneman, Girard, Quetsch, mental health symptoms remained significant even when differing in
& McNeil, 2020) as well when parents are included in youth cognitive- formants provided ratings on youth mental health, future research
behavioral therapy (Tonarely et al., 2021). Altogether, future research is should explore whether associations remain while accounting for state-
needed to explore the direction of effects following clinical interventions based factors (e.g., state anxiety) or when using objective methods.
including youth and/or their parents and the potential benefit of tar In sum, our findings are in line with conceptual models suggesting
geting parental ER tendencies across prevention and intervention that parental ER tendencies are associated with youth mental health
efforts. concerns in expected directions. Greater maladaptive parental ER ten
A notable limitation of the current review was the absence of ana dencies and lower adaptive parental ER tendencies were linked to more
lyses evaluating whether sociodemographic factors (e.g., race, ethnicity, youth mental health concerns. Future research should evaluate whether
family socioeconomic status, parent gender) moderated the relation parental ER tendencies lead to cascading effects both within parent-
between parental ER tendencies and youth mental health concerns. child interactions and more broadly (e.g., broader rearing environ
Research suggests that links between parental characteristics and youth ment, family emotional climate) that may explain mechanisms under
mental health concerns depends on contextual sociodemographic fac lying the links observed. It is notable that the maladaptive parental ER
tors (e.g., socioeconomic status, race/ethnicity; Masarik & Conger, tendencies demonstrated an overall small-to-moderate effect size while
2017) The lack of a moderator analysis evaluating race/ethnicity and adaptive parental ER tendencies demonstrated a small effect size. More
broader cultural backgrounds occurred because most studies included in studies evaluating the relation between adaptive parental ER tendencies
the maladaptive parent ER analysis were based on samples that pre (e.g., reappraisal, problem-solving) and youth mental health concerns
dominantly reflected White/Caucasian and Non-Hispanic populations. are clearly needed. Further, the relation between maladaptive parental
Specifically, only 6 study samples in this analysis included a majority of ER tendencies and youth mental health concerns was qualified by only
participants who identified as Non-White or Latinx (n = 553; 8.6% of the one moderator (i.e., informant-status). Future research should continue
sample). Further, only 4 study samples included a majority of partici to examine factors that may moderate the association between parental
pants identified as Chinese while only 3 study samples included a ma ER tendencies and youth mental health concerns. Finally, these findings
jority of participants identified as Israeli. In addition, most studies have important clinical implications and highlight a critical need for
included samples representative of well-educated families with average prevention and intervention efforts addressing youth mental health
or higher income levels. Specifically, only 5 study samples in this concerns to consider targeting parental ER tendencies to potentially
analysis included a majority of participants with a yearly family income enhance their efficacy.
lower than $30,000 (n = 398; 6.2% of the sample). Finally, the samples
were predominantly composed of mothers (i.e., average sample was Author contributions
composed of 82.1% mothers); thus, the findings are limited in repre
senting relations between fathers ER tendencies and youth mental First author (JH) contributed to study design, conceptualization,
health concerns. Future research will benefit from increasing the methodology, and writing the original draft. First, second, and third
representativeness of samples across under-represented sociodemo authors (JH, SK, HG) contributed to conceptualization, conducting
graphic groups to examine whether relations between parental ER ten literature searches, and reviewing studies. Fourth author (JEM)
dencies and youth mental health concerns vary depending on the contributed to conceptualization. All authors contributed to manuscript
sociocultural context. review and editing.
As described above, a clear limitation was the lack of studies eval
uating associations between adaptive parental ER tendencies and youth Funding
mental health concerns. It is possible that studies with relevant effects
were missed. However, our search strategy was comprehensive, and This research did not receive any specific grant from funding
significant effort was put into attaining effects that were not originally agencies in the public, commercial, or not-for-profit sectors.
reported. Another limitation was the lack of analyses testing whether the
type of youth mental health concerns (i.e., internalizing or external Declaration of Competing Interest
izing) moderated the relation between parental ER tendencies and youth
mental health concerns. This limitation occurred due to the statistical Sarah Kennedy, PhD and Jill Ehrenreich-May, PhD receive
assumption of meta-analysis that effect sizes within moderator analysis compensation for providing training and consultation on the Unified
remain independent. Finally, this analysis only utilized effects based on Protocols for Transdiagnostic Treatment of Emotional Disorders in Children
self-reported measurement of parental ER tendencies, which precluded and Adolescents. Sarah Kennedy, PhD and Jill Ehrenreich-May, PhD also
testing whether state-based influences and measurement factors affect receives royalties from the sale of these treatment manuals.
Appendix 1. Descriptive characteristics of studies included in the current meta-analysis
Study first Year Sample Design Youth Parent % Sample % Sample Youth Youth symptom ER type (measure)b
author(s) size mean mean age youth parent symptom measurea
age female mother type
Belschner 2020 39 Treatment 15.90 49.20 51.0% 84.6% Internal CYBOCS-PR Adaptive (MAAS)
Bluth 2011 118 Cross- N/A N/A 48.0% 100.0% Both SAC-R Adaptive (MAAS)
Sectional
Bonifacci 2020 50 Cross- 9.98 N/A 60.0% 50.0% Both MASC-PS; MASC-SA; Maladaptive (RRS)
Sectional MASC-SA/P; MASC-HA;
SDQ-TP; SDQ-EP; SDQ-
CP; SDQ-H
615 9.45 35.84 43.1% 54.4% Both BPC Both (AAQ-2; MAAS)
(continued on next page)
11
(continued )
Brassell 2016/ Cross-

Parent 2016/ sectional
2021
Buckholdt 2014 80 Cross- 13.60 N/A N/A 93.0% Both YSR-INT/EXT Maladaptive (DERS)
Sectional
Casline 2020 350 Cross- 9.78 37.64 47.7% 68.9% Internal SCAS-PR and PARS Maladaptive (PTQ)
Sectional
c
Cheung 2020 343 Longitudinal 13.64 45.84 51.7% 55.2% Internal SDQ-Internalizing Maladaptive (DERS)
Crespo 2017 454 Cross- 5.50 33.38 48.0% 100.0% Both CBCL-INT/EXT Maladaptive (DERS)
Sectional
Davis 2015 95 Cross- 3.52 30.38 41.5% 100.0% Both CBCL—INT/EXT Maladaptive (DERS)
Sectional
Emerson 2021 89 Treatment 10.17 43.36 34.9% 77.2% Both CBCL-INT/EXT/ADHD Adaptive (FFMQ)
Feinberg 2018 45 Cross- 4.84 38.00 N/A 100.0% Internal PAS-R, SCAS-PR Maladaptive (AAQ-
Sectional II)
Feldman 2007 178 Cross- 2.04 33.61 42.3% 98.0% Both CBCL Both (WCQ)
Sectional
Gershy 2017/ 70 Treatment 9.63 N/A 18.9% 57.0% Both CBCL-INT/EXT/TOT Maladaptive (DERS)
2020
Han 2013 64 Cross- 9.45 37.27 59.4% 100.0% Both CBCL-INT/EXT Maladaptive (DERS)
Sectional
Han 2016 73 Longitudinal 9.51 N/A 43.8% 75.3% Both CBCL-INT/EXT, Maladaptive (DERS)
SCARED
Han 2019 2237 Cross- 9.40 38.46 48.1% 77.0% Both BPM-PR Adaptive (FFMQ)
Sectional
Havewala 2019 177 Longitudinal 16.05 51.33 42.0% 100.0% Internal RCADS Maladaptive (DERS)
Havighurst 2009 218 Treatment 4.69 36.52 42.0% 96.0% External ECBI Maladaptive (DERS)
Havighurst 2015/ 224 Longitudinal 12.01 44.10 51.3% 88.9% Both CBCL Somatic, SCAS- Maladaptive (DERS,
Kehoe 2015/ PR/CR, CDI-P/C, SDQ DERS-IC)
2020
Haydicky 2015 15 Treatment 15.50 N/A 27.8% 94.4% Both Conners-Inattention/ Maladaptive (AAQ)
Hyperactive-
Impulsive/ODD;
RCADS
Highlander 2021 79 Treatment 4.00 36.00 44.3% 92.4% External ECBI Maladaptive
(DERS)
Ip 2021 73 Cross- 5.97 35.58 57.5% 100.0% Internal CBCL-Anxiety, CBCL- Maladaptive
Sectional Depression (DERS, DERS-NA,
DERS-IC, DERS-LA,
DERS-LS, DERS-LC)
Johnco 2018 440 Cross- 14.85 43.13 46.4% 71.1% Both SMFQ, CBCL-ODD/ Maladaptive (DERS)
Sectional ADHD, SCAS-PR
d
Lewis 2020 68 Longitudinal 4.00 N/A 46.0% 100.0% Combined CBCL Preschool Maladaptive (DERS)
Dissociation
Lieneman 2020 66 Treatment 3.75 34.76 30.3% 87.0% External, CBCL-TOT, ECBI Maladaptive (DERS)
Combined
Lin 2019 239 Cross- 9.60 37.20 28.0% 61.9% Both CES-D Chinese Maladaptive (DERS)
Sectional translation, CBS-
Aggression
Mellick 2017 146 Cross- 13.07 40.16 100.0% 100.0% Internal MFQ Maladaptive (AAQ)
Sectional
O'Connor 2020 53 Cross- 11.33 45.68 50.0% 50.0% Both MASC, CBCL-Ext Maladaptive (DERS)
Sectional
Oddo 2019 247 Longitudinal 13.06 44.09 44.0% 100.0% Both RCADS, DBD Checklist Maladaptive (DERS)
Oruche 2018 19 Treatment 15.32 46.68 60.0% 90.0% External CBCL-EXT Adaptive (SPSI-R)
Palermo 2016 61 Longitudinal 14.34 N/A 80.3% 98.4% Internal BAPQ Adaptive (SPSI-R)
Parent 2010 162 Cross- 11.49 41.89 49.8% 89.5% Both CBCL-EXT/INT, YSR Adaptive (MAAS)
Sectional
Pat- 2015 431 Cross- 3.92 34.55 N/A 100.0% Combined CBCL Dysregulation Maladaptive (DERS)
Horencyzk Sectional
Polusny 2011 288 Cross- 15.30 43.00 59.0% 84.3% Combinedd IES-R Maladaptive (AAQ)
Sectional
d
Powers 2021 105 Cross- N/A N/A N/A 100.0% Combined UCLA-PTSD Index Maladaptive (DERS)
Sectional (8–12 (18–65
year year
range) range)
Shorer 2020 351 Cross- 4.82 37.92 50.1% 88.0% Combinedd SRC Maladaptive
Sectional (DERS, DERS-DG,
DERS-NA, DERS-IC,
DERS-LA, DERS-LS,
DERS-LC)
Yang 2021 442 Longitudinal 13.35 41.80 50.0% 70.0% Internal SMFQ, GAD-7 Both (ERQ-S/R)
Zhang 2020 181 Treatment 8.43 37.76 53.7% 0.0% Both BASC-2-INT/EXT, CDI- Both (FFMQ, AAQ-II,
SF DERS)
12
(continued )
Zimmer- 2019 139 Treatment 4.44 34.20 30.0% 92.8% Both BASC-2 Both (ERQ-S/R,
Gembeck DERS)
Note: Abbreviations: ER = Emotion Regulation. N/A = Not Available.
a
Youth symptom measures: BASC-2 = Behavior Assessment System for Children, 2nd Edition; BAPQ = Bath Adolescent Pain Questionnaire; BPM-PR = Brief
Problem Monitor—Parent Report; BPC = Brief Problems Checklist; CBCL = Child Behavior Checklist; CBCL-ADHD = Attention-Deficit/Hyperactivity Disorder sub
scale; CBCL-EXT = Externalizing subscale; CBCL-INT = Internalizing subscale; CBCL-ODD = Oppositional Defiant Disorder subscale; CBCL-TOT = Total Scale; CBS =
Child Behavior Scale; CDI-SF = Child Depression Inventory Short Form; CES-D = Center for Epidemiological Studies—Depression; CYBOCS-PR = Children's Yale
Brown Obsessive Compulsive Scale—Parent Report; DBD Checklist = Disruptive Behavior Disorders Checklist; ECBI = Eyberg Child Behavior Inventory; IES-R =
Impact of Event Scale – Revised; GAD-7 = Generalized Anxiety Disorder 7-item Scale; MASC = Multidimensional Anxiety Scale for Children; MASC subscales: MASC-
PS = Physical Symptoms; MASC-SA = Social Anxiety; MASC-SA/P = Separation Anxiety / Panic; MASC-HA = Harm Avoidance; MFQ = Mood and Feelings Ques
tionnaire; PARS = Pediatric Anxiety Rating Scale; PAS-R = Preschool Anxiety Scale—Revised; RCADS = Revised Children's Anxiety and Depression Scale; SAC-R =
Short-form Assessment for Children-Revised; SCAS-PR = Spence Children's Anxiety Scale, Parent Report; SCAS-CR = Spence Children's Anxiety Scale, Child Report;
SCARED = Screen for Child Anxiety and Related Disorders; SDQ = Strengths and Difficulties Questionnaire; SDQ-TP = Total Problems subscale; SDQ-EP = Emotional
Problems subscale; SDQ-CD = Conduct Problems subscale; SDQ-H = Hyperactivity subscale; SMFQ = Short Mood and Feelings Questionnaire; SRC = Stress Reaction
Checklist; YSR = Youth Self Report.
b
Parent Emotion Regulation Measures: AAQ = Acceptance and Action Questionnaire; AAQ-2 = Acceptance and Action Questionnaire, 2nd Version; DERS = Dif
ficulties in Emotion Regulation Scale – Total Scale; DERS-DG = DERS-Difficulties with Goals Subscale; DERS-NA = DERS-Non-Acceptance Subscale; DERS-IC = DERS-
Impulse Control Subscale; DERS-LA = DERS-Lack of Awareness Subscale; DERS-LS = DERS-Limited Access to Strategies Subscale; DERS-LC = DERS-Lack of Clarity
Subscale; ERQ-S/R = ERQ Expressive Suppression/Reappraisal; FFMQ = Five Facet Mindfulness Questionnaire; MAAS = Mindful Attention Awareness Scale; RRS =
Rumination Response Scale; PTQ = Perseverative Thinking Questionnaire; SPSI-R = Social Problem-Solving Skills Inventory-Revised; WCQ = Ways of Coping
Questionnaire.
c
Effects were reported separately for mother-adolescents (n = 378) and father-adolescent dyads (n = 307). Effects were aggregated within each study; therefore, the
mean n was used as the sample size (n = 343) for this study. The percentage of mothers was based on calculating the number of mothers within the total sample (378
out of 685 parents).
d
Youth mental health symptoms were measured through trauma symptoms. Considering trauma symptoms cut across internalizing and externalizing domains, these
measures were reported as combined for symptom domains.
Appendix 2. Sociodemographic characteristics of included studies
Study first Year(s) Reported distribution of race/ Country of data Yearly family income2 Parent education2
author(s) ethnicity in sample1 collection
Belschner 2020 Caucasian: 74.4% Canada N/A High school or less: 8.1%
Asian: 15.4% Some college / trade school:
Caucasian/Asian Mixed: 10.2% 18.9%
Aboriginal: 2.6% College degree: 48.6%
Other: 2.6% Graduate degree: 24.3%
Bluth 2011 White: >50% USA Upper middle class: >50% College degree: >50%
Bonifacci 2020 N/A Italy N/A N/A
Brassell 2016 White: 77.3% USA <$30,000: 24.3% High school or less: 15.2%
Parent 2016 / Black: 13.1% $30,000–$49,999: 20.4% Some college: 32.5%
2021 Latino/a: 4.4% $50,000–$99,999: 29.6% College degree: 38.1%
Asian: 4.1% >$100,000: 8.6% Graduate degree: 14.2%
Other: 1.1%
Buckholdt 2014 Caucasian: 17.0% USA N/A High school or less: 22.0%
African-American: 79.0% Some college: 15.0%
Asian: 1.0% College degree: 22.5%
Biracial: 3.0% Graduate degree: 12.5%
Casline 2020 White/Caucasian: 84.9% USA <$50,000: 41.3% N/A
Unknown: 15.1% >$50,000: 58.7%
Cheung 2020 Hong Kong Chinese: 100.0% Hong Kong China <HK$120,001: 13.5% Primary education or less:
HK$120,000-240,000: 30.6% -Mothers (11.9%); Fathers
HK$240,000-360,000: 19.2% (9.1%)
HK$360,000-HK$600,000: 16.6% Secondary education:
>HK$600,000: 6.2% -Mothers (66.8%); Fathers
(56.2%)
Tertiary education or more:
-Mothers (10.9%); Fathers
(9.8%)
Crespo 2017 Caucasian: 75.0% USA <$10,000: 7.3% N/A
African-American: 11.0% >$10,001 & < $30,000: 36.6%
Hispanic: 9.0% >$30,000 & < $60,000: 29.3%
Asian: 1.0% >$60,000 & < $80,000: 11.1%
American Indian/Alaskan Native: >$80,000: 10.5%
2.0%
Other: 2.0%
Davisa 2015 Caucasian: 39.4% USA <$30,000: 53.3% High school or less: 29.8%
Black: 51.1% >$30,000 & < $50,000: 14.5% Some college: 21.3%
Hispanic: 3.2% >$50,000 & < $70,000: 7.8% College degree: 26.6%
>$70,000: 24.4%
13
(continued )
Asian: 1.1% Graduate degree: 20.2%

Other: 5.3% Other: 2.1%
Emerson 2021 Dutch: 84.1% Netherlands N/A Lower vocational: 38.5%
English: 6.8% Higher vocational/
Other: 10.3% university: 51.3%
Other: 10.3%
Feinberg 2018 Non-Hispanic, White: 80.5% USA <$100,000: 44.4% N/A
$100,000–$200,000: 37.8%
>$200,000: 17.8%
Feldman 2007 N/A Canada Mean range: $40,000-49,999 Mean years of education:
Primary caregiver: 13.67
Secondary caregiver: 13.60
Gershy 2017 Jewish-Israeli: 100.0% Israel N/A Mean years of education:
2020 Mothers: 15.29; Fathers:
14.47
Hana 2013 Caucasian: 40.6% USA <$20,000: 46.9% Some college or more:
African-American: 51.6% $20,000–$29,999: 15.6% 59.4%
Hispanic: 3.1% $30,000–$80,000: 25.0%
Asian: 1.6% >$80,000: 12.5%
Other: 3.1%
Han 2016 Chinese: 100.0% Mainland China < ~$20,000: 32.9% High school or less: 6.8%
~$20,000- ~ $40,000: 37.0% College degree: 69.9%
> ~ $60,000: 30.1% Graduate school: 23.3%
Han 2019 Chinese: 100.0% Mainland China At or above average family income for Urban College degree or more:
Han Nationality: 93.8% Chinese families: 70.3% 56.4%
Havewala 2019 White: 53.6% USA N/A N/A
Black: 41.6%
Native American/Alaska Native:
0.6%
Other: 0.6%
Multiracial / multiethnic: 3.6%
Havighurst 2009 N/A Australia <AUD $40,000: 19.8% Less than high school:
AUD $40,000-99,999: 62.8% 21.8%
>AUD $100,000: 14.2% Post-school only: 25.2%
Unknown: 3.2% Non-university
qualification: 29.8%
College degree or more:
44.9%
Havighurst 2015 Caucasian: 89.7% Australia <AUD $40,000: 9.8% Completed high school:
Kehoe 2015 / African: 2.2% AUD $40,000–$59,000: 15.1% 75.6%
2020 Asian: 8.1% AUD $60,000–$99,999: 32.0% Non-university
>AUD $100,000: 38.7% qualification: 38.2%
43.5%
Haydicky 2015 North America / Europe: Canada N/A College program
71.0% (mothers); 65.0% (fathers) completion:
Asian: − 35.0% (mothers); 12.0%
18.0% (mothers); 24.0% (fathers) (fathers)
Caribbean: Bachelor's degree:
12.0% (mothers); 6.0% (fathers) − 35.0% (mothers); 47.0%
(fathers)
Graduate degree:
− 18.0% (mothers); 24.0%
(fathers)
Highlander 2021 White: 83.5% USA Mean: $77,604 Less than high school: 2.5%
Black/African-American: 10.1% At or below poverty level: 13.9% Some college: 15.2%
Hispanic/Latino: 6.3% College degree: 45.6%
Asian/Pacific Islander: 1.3% Advanced degree: 36.7%
More than one race: 5.1%
Ip 2021 Caucasian: 66.0% USA Median range: $70,000–$74,999 High school or GED: 3.0%
African-American: 11.0% Some college / trade school:
Latino: 4.0% 25.0%
Asian/Pacific Islander: 11.0% College degree: 40.0%
Bi-racial: 4.0% Graduate degree: 33.0%
Other: 4.0%
Johnco 2018 Caucasian: 83.6% USA: 52.3% <AUD $18,200: 6.6% Secondary school: 15.9%
Asian: 8.2% Australia: 42.7% AUD $18,200-37,000: 14.6% TAFE/Trade certificate:
Other: 8.2% India: 2.5% AUD $37,001-80,000: 28.0% 11.6%
Indonesia: 0.4% AUD $80,001-180,000: 33.9% College degree: 39.1%
Europe: 0.7% >AUD $180,000: 16.6% Graduate degree: 32.1%
Other: 1.4%
Lewisa 2020 European-American: 63.2% USA <$17,000: 25.0% N/A
African-American: 1.5% $17,000–$29,000: 25.0%;
Latino/Hispanic: 5.9% $29,001–$50,000: 25.0%
Multiracial/ethnic: 29.4% >$50,000: 25.0%
14
(continued )
Lienemana 2020 White / European: 24.2% USA <$20,000: 40.9% N/A

African-American: 4.5% $20,001-40,000: 30.3%
Hispanic/Latino: 63.6% $40,001-60,000: 7.6%
Multiple race/ethnicity: 7.6% >$60,000: 7.6%
Lin 2019 Chinese: 100.0% Mainland China < CNY $24,000: 7.9% Middle school or less:
CNY $24,000-60,000: 35.3% − 23.1% (mothers), 20.8%
CNY $60,000-120,000: 31.2% (fathers)
>CNY $120,000: 25.6% High school:
− 19.7% (mothers), 18.2%
(fathers)
Junior college:
− 21.0% (mothers), 21.6%
(fathers)
− 36.2% (mothers), 39.4%
(fathers)
Mellick 2017 Caucasian: 40.4% USA Mean: $41,400 N/A
African-American: 21.9%
Hispanic: 57.0%
Asian / Pacific Islander: 1.4%
American Indian or Alaskan Native:
3.4%
Multiracial: 13.7%
Not Reported: 19.2%
O'Connor 2020 White: 87.5% USA >$100,000: 61.0% N/A
African-American: 1.6%
Asian: 1.6%
Other: 6.3%
Unknown: 3.1%
Oddo 2019 White/Caucasian: 52.5% USA Mean: $102,498 College degree: 29.0%
Black/African-American: 37.7% Advanced degree: 33.0%
Asian: 1.6%
Other: 8.2%
Oruchea 2018 African-American: 84.7% USA <$19,000: 55.0% Less than high school:
Mixed Race: 5.3% $20,000-39,000: 35.0% 15.0%
$40,000-69,000: 10.0% High school: 25.0%
Some college: 45.0%
College degree: 15.0%
Palermo 2016 White: 93.4% USA $10,000-29,999: 9.8% High school or less: 9.8%
Black or African-American: 1.6% $20,000-49,999: 18.0% Some college: 24.6%
Asian: 1.6% $50,000-69,999: 9.8% College degree: 44.4%
Other: 3.3% $70,000-100,000: 24.6 Graduate school: 21.3%
>$100,000: 29.5%
Unknown: 8.2%
Parent 2010 Caucasian: 81.5% USA <$25,000: 23.9% High school or less: 14.2%
Unknown: 18.5% $25,000-39,999: 20.6% Some college: 30.9%
$40,000-59,000: 17.4% College degree: 30.9%
>$60,000: 38.0% Graduate education: 24.1%
Pat-Horencyzk 2015 Jewish: 74.01% Israel N/A Less than high school: 5.1%
Arab: 25.99% High school: 36.1%
Vocational: 14.2%
Academic: 44.5%
Polusny 2011 White: 99.0% USA <$20,000: 9.0% College degree: 45.6%
$20,001-50,000: 46.0% Unknown: 44.4%
>$50,000: 45.0%
Powersc 2021 African-American: 100.0% USA <$24,000: 76.9% Less than high school:
23.0%
High school: 33.2%
Some college: 20.0%
23.8%
Shorer 2020 Jewish: 97.4% Israel Below average: 6.8% Mean: 16.71 years
Average: $31.9%
Above average: 55.3%
Yangb 2021 Chinese: 100.0% Mainland China N/A Less than high school:
− 33.0% (mothers), 29.0%
(fathers)
High school:
− 20.0% (mothers), 19.0%
(fathers)
− 47.0% (mothers), 52.0%
(fathers)
Zhang 2020 Caucasian: 82.9% USA $ > $60,000: 67.4% College degree or more:
African-American: 2.8% 52.0%
15
(continued )
Asian/Pacific Islander: 2.8%

Multiracial: 5.0%
Unknown: 6.6%
Zimmer- 2019 Born in Australia or New Zealand: Australia Median range: Less than high school:
Gembeckb 79.1% AUD $50,000-75,000 23.0%
First people of Australia/New High school: 43.0%
Zealand: 3.0% Some college or more:
Other country of origin: 17.9% 34.0%
Note: N/A = Not available.
1
The race/ethnicity descriptions reported in this table match the information reported by the original published article. Further, samples varied in what family
members (e.g., youth, parent, broad family) corresponded to the reported race/ethnicity characteristics. This table depicts the race/ethnicity representation reported
in reference to either parent(s) or the broad family unit. Samples that only reported race/ethnicity characteristics of youth are listed in italics.
2
Studies widely varied in the reporting of socioeconomic status. The descriptions match information reported in the original published article. Further, coding was
conducted to identify samples that included a majority of participants with high socioeconomic adversity. High socioeconomic adversity status was defined by the
average participant/family having either (a) a family income status of <$30,000 or (b) an educational level of high school or less.
a
Sample exhibited high socioeconomic adversity based on income.
b
Sample exhibited high socioeconomic adversity based on educational attainment.
c
Sample exhibited high socioeconomic adversity based on income and educational attainment.
Appendix 3. Moderator category coding for included studies
Study author(s) Year(s) Youth psychiatric risk status Informant source Effect size source
Belschner 2020 At-Risk Same Requested

Bluth 2011 Healthy Same Publication
Bonifacci 2020 At-Risk Same and Different Requested
Brassell 2016/ Healthy Same Publication and Requested
Parent 2016/
2021
Buckholdt 2014 Healthy Different Publication
Casline 2020 Healthy Same Publication
Cheung 2020 Healthy Different Publication
Crespo 2017 Healthy Same Publication
Davis 2015 Healthy Same Publication
Emerson 2021 At-Risk Same Requested
Feinberg 2018 At-Risk Same Requested
Feldman 2007 At-Risk Same Publication
Gershy 2017 2020 At-Risk Differenta Publication and Requested
Han 2013 Healthy Same Publication
Han 2016 Healthy Same and Different Publication
Han 2019 Healthy Same Publication
Havewala 2019 Healthy Different Publication
Havighurst 2009 Healthy Same Publication
Havighurst 2015 Healthy Same and Different Publication and Requested
Kehoe 2015 / 2020
Haydicky 2015 At-Risk Same and Different Requested
Highlander 2021 At-Risk Same Publication
Ip 2021 Healthy Same Publication
Johnco 2018 At-Risk Same Requested
Lewis 2020 Healthy Same Publication
Lieneman 2020 At-Risk Same Publication
Lin 2019 At-Risk Different Publication
Mellick 2017 At-Risk Different Publication
O'Connor 2020 At-Risk Same and Different Publication
Oddo 2019 Healthy Same and Different Publication
Oruche 2018 At-Risk Same Requested
Palermo 2016 At-Risk Different Requested
Parent 2010 At-Risk Same and Different Publication and Requested
Pat-Horencyzk 2015 At-Risk Same Publication
Polusny 2011 Healthy Different Publication
Powers 2021 At-Risk Different Publication
Shorer 2020 Healthy Same Publication
Yang 2021 Healthy Different Publication
Zhang 2020 At-Risk Differenta Publication
Zimmer-Gembeck 2019 At-Risk Same Requested
Note: Bolded words indicate the moderator category the sample was randomly assigned to represent in the moderator comparison analysis corresponding to mal
adaptive parental emotion regulation and youth mental health symptoms. Moderator analyses were not conducted for studies/effects that only reported links between
adaptive parental emotion regulation tendencies and youth mental health symptoms.
a
In these studies, two parents provided separate ratings of their own emotion regulation, but both parents' scores on the youth symptom measure were aggregated.
Effects were coded into the different informant category. The informant status moderator analysis rendered the same patterns of findings when these studies were
coded in the same-informant category.
16
Appendix 4. References of studies included in meta-analysis
Belschner, L., Lin, S. Y., Yamin, D. F., Best, J. R., Edalati, K., McDermid, J., & Stewart, S. E. (2020). Mindfulness-based skills training group for
parents of obsessive-compulsive disorder-affected children: A caregiver-focused intervention. Complementary Therapies in Clinical Practice, 39,
101,098. doi: https://doi.org/10.1016/j.ctcp.2020.101098
Bluth, K., & Wahler, R. G. (2011). Does effort matter in mindful parenting?. Mindfulness, 2, 175–178. doi: https://doi.org/10.1007/s12671-011-00
56-3
Bonifacci, P., Tobia, V., Marra, V., Desideri, L., Baiocco, R., & Ottaviani, C. (2020). Rumination and Emotional Profile in Children with Specific
Learning Disorders and Their Parents. International Journal of Environmental Research and Public Health, 17, 389. doi: https://doi.org/10.3390/ijerph
17020389
Brassell, A. A., Rosenberg, E., Parent, J., Rough, J. N., Fondacaro, K., & Seehuus, M. (2016). Parent's psychological flexibility: Associations with
parenting and child psychosocial well-being. Journal of Contextual Behavioral Science, 5, 111–120. doi: https://doi.org/10.1016/j.jcbs.2016.03.001
Buckholdt, K. E., Parra, G. R., & Jobe-Shields, L. (2014). Intergenerational transmission of emotion dysregulation through parental invalidation of
emotions: Implications for adolescent internalizing and externalizing behaviors. Journal of Child and Family Studies, 23, 324–332. doi: https://doi.
org/10.1007/s10826-013-9768-4
Casline, E., Patel, Z. S., Timpano, K. R., & Jensen-Doss, A. (2020). Exploring the link between transdiagnostic cognitive risk factors, anxiogenic
parenting behaviors, and child anxiety. Child Psychiatry & Human Development, 52, 1032–1043. doi: https://doi.org/10.1007/s10578-020-01078-2
Cheung, R. Y., Chan, L. Y., & Chung, K. K. (2020). Emotion dysregulation between mothers, fathers, and adolescents: Implications for adolescents'
internalizing problems. Journal of Adolescence, 83, 62–71. doi: https://doi.org/10.1016/j.adolescence.2020.07.001
Crespo, L. M., Trentacosta, C. J., Aikins, D., & Wargo-Aikins, J. (2017). Maternal emotion regulation and children's behavior problems: The
mediating role of child emotion regulation. Journal of Child and Family Studies, 26, 2797–2809. doi: https://doi.org/10.1007/s10826-017-0791-8
Davis, M., Suveg, C., & Shaffer, A. (2015). The value of a smile: Child positive affect moderates relations between maternal emotion dysregulation
and child adjustment problems. Journal of Child and Family Studies, 24, 2441–2452. doi: https://doi.org/10.1007/s10826-014-0047-9
Emerson, L. M., Aktar, E., de Bruin, E., Potharst, E., & Bögels, S. (2021). Mindful parenting in secondary child mental health: key parenting
predictors of treatment effects. Mindfulness, 12, 532–542. doi: https://doi.org/10.1007/s12671-019-01176-w
Feinberg, L., Kerns, C., Pincus, D. B., & Comer, J. S. (2018). A preliminary examination of the link between maternal experiential avoidance and
parental accommodation in anxious and non-anxious children. Child Psychiatry & Human Development, 49, 652–658. doi: https://doi.org/10.1007/s10
578-018-0781-0
Feldman, M., McDonald, L., Serbin, L., Stack, D., Secco, M. L., & Yu, C. T. (2007). Predictors of depressive symptoms in primary caregivers of young
children with or at risk for developmental delay. Journal of Intellectual Disability Research, 51, 606–619. Doi: https://doi.org/10.1111/j.1365-2788.
2006.00941.x
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Clinical Psychology Review 95 (2022) 102174

Contents lists available at ScienceDirect

Clinical Psychology Review

Associations between dispositional parental emotion regulation and youth

Studies screened Studies excluded

Studies assessed for eligibility Studies excluded:

No reliable report of youth symptoms (n = 12)

Studies requested Studies not received:

Studies included in review

Note: ER = Emotion Regulation.

Fig. 1. PRISMA study selection flow diagram.

measurement of youth internalizing or externalizing symptoms using a 2.3. Study coding

All Studies All Studies 126 0.25* 0.20–0.30 74.83 123.16 –

Regression of Fisher's Z on Child Age

Bluth and Wahler (2011) found significant inverse relations between

internalizing (r = − 0.37) and externalizing concerns (r = − 0.33). 3.4. Publication bias

a. Funnel Plot of Standard Error by Fisher’s Z: Maladaptive Parental Emotion Regulation

-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0

b. Funnel Plot of Standard Error by Fisher’s Z: Adaptive Parental Emotion Regulation

-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0

Appendix 1. Descriptive characteristics of studies included in the current meta-analysis

Brassell 2016/ Cross-

Appendix 2. Sociodemographic characteristics of included studies

Asian: 1.1% Graduate degree: 20.2%

Lienemana 2020 White / European: 24.2% USA <$20,000: 40.9% N/A

Asian/Pacific Islander: 2.8%

Appendix 3. Moderator category coding for included studies

Belschner 2020 At-Risk Same Requested

Appendix 4. References of studies included in meta-analysis

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