Introduction: The frequent comorbidity of somatic symptoms, anxiety, and depression in adolescence is well-documented, yet underlying mechanisms remain under-investigated. Emotion regulation difficulties (ERD; comprising awareness, clarity, non-acceptance, goals, impulse, and strategies) are hypothesized to be a critical transdiagnostic process linking these symptoms.
Purpose: Guided by the theory of constructed emotion, this three-wave longitudinal study examined bidirectional relationships between somatic symptoms, anxiety, depression, and ERD in Chinese adolescents. We tested the mediating role of ERD, explored potential gender differences, and investigated the dynamic contributions of specific ERD domains.
Method: A sample of 1,687 adolescents (M_age = 14.46, SD = 1.34; 51.2% female) completed surveys at three time points. We employed a random intercept cross-lagged panel model (RI-CLPM) to disentangle within-person dynamics from stable between-person differences, followed by longitudinal mediation analyses. Cross-Lagged Panel Network Analysis (CLNA) was then used to identify temporal dynamics among ERD domains.
Results: RI-CLPM showed distinct pathways: somatic symptoms predicted ERD, which in turn predicted anxiety, indicating indirect-only effects. Depression demonstrated reciprocal links with both ERD and somatic symptoms, with ERD mediating these associations. Gender differences emerged in the stable, trait-level associations for depression: these constructs were largely independent in males but showed significant covariance in females. CLNA revealed that certain domains, notably clarity and strategies, were contemporaneously tied to both symptoms, with clarity prospectively predicting anxiety.
Conclusions: Emotion regulation difficulties function as a crucial mechanistic bridge between somatic and internalizing symptoms in adolescents, although its architecture differs for anxiety and depression. These findings underscore ERD as a key transdiagnostic target for interventions, and suggesting that targeting emotional clarity may be particularly effective in preventing the maintenance of anxiety among adolescents with somatic symptoms.