Focus on and venting of negative emotion mediates the 18-year bi-directional relations between major depressive disorder and generalized anxiety disorder diagnoses

Background: Myriad emotion regulation and coping theories have proposed that avoidant/emotion-oriented coping is a cause and consequence of anxiety and depression. However, few studies have investigated potential mechanisms underlying the prospective anxiety-depression disorder relation. The current study examined various coping strategies (i.e., denial, focus on and venting of emotion (FOAVE), and behavioral disengagement) as potential longitudinal mediators between generalized anxiety disorder (GAD) and major depressive disorder (MDD). Methods: In a nationally representative sample of adults (N = 3,294), MDD and GAD were assessed at Time 1 (T1) and Time 3 (T3) (Composite International Diagnostic Interview - Short-Form), and avoidant coping strategies (denial, behavioral disengagement, and FOAVE) were measured at Time 2 (T2) (Coping Questionnaire). Assessments occurred over 18 years, each spaced approximately 9 years apart. Structural equation modeling mediation analyses examined whether T1 MDD predicted T3 GAD (and vice versa), and if T2 avoidant coping mediated these relations, above and beyond baseline comorbidity. Results: FOAVE mediated the T1 MDD-T3 GAD association, and vice versa. Presence of T1 MDD and GAD predicted more T2 FOAVE, and greater T2 FOAVE forecasted T3 MDD and GAD, accounting for 16-21% of the longitudinal MDD-GAD relations. However, behavioral disengagement and denial did not mediate the prospective MDD-GAD relations. Also, T1 MDD and GAD forecasted greater T2 behavioral disengagement. Conclusions: The use of FOAVE, may be a mechanism by which MDD earlier in life may lead to GAD 18 years later, and vice versa. Theoretical and potential clinical implications are discussed.