The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature

Rogante, E.,  et al. (2024).

Healthcare, 12(2), 169.

https://doi.org/10.3390/healthcare12020169

Abstract

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

Here are some thoughts. I used this research in a recent article.

This systematic review explores the role of emotion dysregulation in understanding suicide risk among adults, analyzing 44 studies that assess the association between emotional regulation difficulties—measured primarily by the Difficulties in Emotion Regulation Scale (DERS)—and suicidal ideation and behavior. The findings largely support a significant positive correlation between emotion dysregulation and suicidal ideation across both clinical and nonclinical populations. Specific dimensions of emotion dysregulation, such as impulsivity, lack of emotional clarity, and ineffective use of regulatory strategies, were particularly linked to increased suicidal thoughts. However, results regarding suicide attempts were more inconsistent, with some studies showing a strong link while others found no significant associations.

The review also highlights the mediating role of emotion dysregulation between various risk factors (e.g., childhood trauma, psychopathy, depression) and suicidal outcomes. Emotion dysregulation appears to amplify suicide risk by influencing how individuals cope with psychological pain and stress. Despite methodological limitations—including reliance on self-report measures, sample heterogeneity, and limited longitudinal data—the evidence suggests that improving emotional regulation could be a valuable target for suicide prevention strategies. The authors recommend further research using robust statistical methods and comprehensive assessments to better understand causal pathways and enhance intervention effectiveness.

Relationship between empathy and burnout as well as potential affecting and mediating factors from the perspective of clinical nurses: a systematic review

Zhou H. (2025).

BMC nursing, 24(1), 38.

https://doi.org/10.1186/s12912-025-02701-0

Abstract

Background

Burnout is prevalent in healthcare professionals, especially among nurses. This review aims to examine the correlation between empathy and burnout as well as the variables that influence and mediate them.

Methods

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, to present a systematic evaluation of literature. A literature search of four electronic databases including CINAHL (EBSCO), EMBASE, PubMed, and Google Scholar was conducted from 2014 to 2024. A total of 1081 articles were identified in the initial search. After screening the title, abstract, and context of these articles, 16 eligible articles were finally included in this review.

Results

This review identified a number of factors related to empathy and burnout levels. The included studies showed consistent results that empathy and burnout were generally negatively related. When considering the different components of empathy or burnout independently, as well as the mediating factors involved, relations between empathy and burnout may alter.

Conclusions

This study provided an excellent summary of some important research on the mediating and affecting factors associated with burnout and empathy. These results can facilitate further

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This systematic review found that higher empathy levels among clinical nurses are generally associated with lower burnout, although specific subcomponents of empathy influenced burnout dimensions differently.

While greater empathic concern and perspective-taking were linked to reduced depersonalization and increased personal accomplishment, high personal distress was correlated with greater emotional exhaustion.

Burnout prevalence varied across settings, with moderate levels common among Chinese nurses and high burnout rates observed in trauma and emergency care units in the U.S. and Spain. Factors such as female gender, specialty area, permanent employment, and fixed shifts were associated with higher empathy and lower burnout, whereas longer working hours and rural practice environments contributed to increased burnout. Organizational climate, coping strategies, job commitment, secondary traumatic stress, and workplace spirituality were important mediators. Overall, the findings emphasize the protective role of empathy against burnout and support interventions targeting workplace environment and personal coping to enhance nurse well-being.

A systematic review of research on empathy in health care.

Nembhard, I. M., et al. (2023).

Health services research, 58(2), 250–263.

https://doi.org/10.1111/1475-6773.14016

Abstract

Objective

To summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes.

Data Source

We searched MEDLINE, MEDLINE In‐Process, PsycInfo, and Business Source Complete to identify empirical studies of empathy involving health care personnel in English‐language publications up until April 20, 2021, covering the first five decades of research on empathy in health care (1971–2021).

Study Design

We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines.

Data Collection/Extraction Methods

Title and abstract screening for study eligibility was followed by full‐text screening of relevant citations to extract study information (e.g., study design, sample size, empathy measure used, empathy assessor, intervention type if applicable, other variables evaluated, results, and significance). We classified study predictors and outcomes into categories, calculated descriptive statistics, and produced tables to summarize findings.

Principal Findings

Of the 2270 articles screened, 455 reporting on 470 analyses satisfied the inclusion criteria. We found that most studies have been survey‐based, cross‐sectional examinations; greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). Of the 128 intervention studies, 103 (80%) found a positive and significant effect. With four exceptions, interventions were educational programs focused on individual clinicians or trainees. No organizational‐level interventions (e.g., empathy‐specific processes or roles) were identified.

Conclusions

Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational‐level interventions for systematic improvement are lacking.

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Here are some thoughts:

The systematic review explores the significance of empathy in health care, analyzing its predictors, outcomes, and interventions to enhance it among health care professionals. The review, which spans 455 studies from 1971 to 2021, reveals that empathy is predominantly studied through cross-sectional, survey-based methods, with a focus on physicians, medical students, and nurses. Empathy is positively linked to better clinical outcomes, patient experiences, and provider performance, including improved adherence to treatment plans and reduced burnout. Key predictors of empathy include provider demographics, characteristics like personality traits and well-being, and behaviors such as communication skills. Educational interventions, particularly training programs and workshops, have proven effective in boosting empathy levels, though organizational-level interventions remain underexplored.

How do clinical psychologists make ethical decisions? A systematic review of empirical research

Grace, B., Wainwright, T., et al. (2020). 

Clinical Ethics, 15(4), 213–224.

https://doi.org/10.1177/1477750920927165

Abstract

Given the nature of the discipline, it might be assumed that clinical psychology is an ethical profession, within which effective ethical decision-making is integral. How then, does this ethical decision-making occur? This paper describes a systematic review of empirical research addressing this question. The paucity of evidence related to this question meant that the scope was broadened to include other professions who deliver talking therapies. This review could support reflective practice about what may be taken into account when making ethical decisions and highlight areas for future research. Using academic search databases, original research articles were identified from peer-reviewed journals. Articles using qualitative (n = 3), quantitative (n = 8) and mixed methods (n = 2) were included. Two theoretical models of aspects of ethical decision-making were identified. Areas of agreement and debate are described in relation to factors linked to the professional, which impacted ethical decision-making. Factors relating to ethical dilemmas, which impacted ethical decision-making, are discussed. Articles were appraised by two independent raters, using quality assessment criteria, which suggested areas of methodological strengths and weaknesses. Comparison and synthesis of results revealed that the research did not generally pertain to current clinical practice of talking therapies or the particular socio-political context of the UK healthcare system. There was limited research into ethical decision-making amongst specific professions, including clinical psychology. Generalisability was limited due to methodological issues, indicating avenues for future research.

Here are some thoughts:

This article is a systematic review of empirical research on how clinical psychologists and related professionals make ethical decisions. The review addresses the question of how professionals who deliver psychotherapy make ethical decisions related to their work. The authors searched academic databases for original research articles from peer-reviewed journals and included qualitative, quantitative, and mixed-methods studies. The review identified two theoretical models of ethical decision-making and discussed factors related to the professional and ethical dilemmas that impact decision-making. The authors found that the research did not generally pertain to current clinical practice or the socio-political context of the UK healthcare system and that there was limited research into ethical decision-making among specific professions, including clinical psychology. The authors suggest that there is a need for further up-to-date, profession-specific, mixed-methods research in this area.

Education is Effective in Improving Students’ Ethical and Moral Outcomes: A Systematic Review and Meta-Analysis

Basarkod, G., Cahill, L., et al. (2024, November 20).

https://doi.org/10.31234/osf.io/xv536

Abstract

Addressing society's greatest challenges, such as climate change, requires us to act as moral agents. If effective, interventions within schools and universities could cultivate ethical and moral attributes in millions of people. In this pre-registered systematic review and meta-analysis, we synthesized evidence from 66 randomized controlled trials of interventions at primary, secondary, and tertiary education levels (k=246; 9,978 students). Educational interventions effectively improved students’ moral outcomes of sensitivity, judgment, motivation, and character compared to control groups (g = 0.54; n = 45; k = 133). Interventions involving student discussions were more effective than those relying solely on unidirectional or passive transfer of information. This finding was confirmed through studies comparing two alternate ethics interventions (n = 38; k = 113). Overall, our review shows that educational interventions can improve students’ ethical and moral attributes and provides insights for prioritizing and planning future interventions to increase these attributes at scale.

Here are some thoughts:

This pre-print manuscript details a meta-analysis of 66 randomized controlled trials investigating the effectiveness of ethics interventions in educational settings. The study, conducted across various educational levels and disciplines, found that interventions incorporating student discussions significantly improved students' moral outcomes compared to control groups or interventions solely using didactic methods. The analysis also explored moderators such as education level, intervention style, and risk of bias, revealing nuanced insights into the effectiveness of different approaches to ethics education. Importantly, the researchers emphasized the need for further research to improve study design and broaden geographical representation.

A General Model of Cognitive Bias in Human Judgment and Systematic Review Specific to Forensic Mental Health

Neal, T. M. S., Lienert, P., Denne, E., & 

Singh, J. P. (2022).  

Law and Human Behavior, 46(2), 99–120.

https://doi.org/10.1037/lhb0000482

Abstract

Cognitive biases can impact experts’ judgments and decisions. We offer a broad descriptive model of how bias affects human judgment. Although studies have explored the role of cognitive biases and debiasing techniques in forensic mental health, we conducted the first systematic review to identify, evaluate, and summarize the findings. Hypotheses. Given the exploratory nature of this review, we did not test formal hypotheses. General research questions included the proportion of studies focusing on cognitive biases and/or debiasing, the research methods applied, the cognitive biases and debiasing strategies empirically studied in the forensic context, their effects on forensic mental health decisions, and effect sizes.

Public Significance Statement

Evidence of bias in forensic mental health emerged in ways consistent with what we know about human judgment broadly. We know less about how to debias judgments—an important frontier for future research. Better understanding how bias works and developing effective debiasing strategies tailored to the forensic mental health context hold promise for improving quality. Until then, we can use what we know now to limit bias in our work.

From the Discussion section

Is Bias a Problem for the Field of Forensic Mental Health?

Our interpretation of the judgment and decision-making literature more broadly, as well as the results from this systematic review conducted in this specific context, is that bias is an issue that deserves attention in forensic mental health—with some nuance. The overall assertion that bias is worthy of concern in forensic mental health rests both on the broader and the more specific literatures we reference here.

The broader literature is robust, revealing that well-studied biases affect human judgment and social cognition (e.g., Gilovich et al., 2002; Kahneman, 2011; see Figure 1). Although the field is robust in terms of individual studies demonstrating cognitive biases, decision science needs a credible, scientific organization of the various types of cognitive biases that have proliferated to better situate and organize the field. Even in the apparent absence of such an organizational structure, it is clear that biases influence consequential judgments not just for laypeople but for experts too, such as pilots (e.g., Walmsley & Gilbey, 2016), intelligence analysts (e.g., Reyna et al., 2014), doctors (e.g., Drew et al., 2013), and judges and lawyers (e.g., Englich et al., 2006; Girvan et al., 2015; Rachlinski et al., 2009). Given that forensic mental health experts are human, as are these other experts who demonstrate typical biases by virtue of being human, there is no reason to believe that forensic experts have automatic special protection against bias by virtue of their expertise.

The research is here.

The ConTraSt database for analysing and comparing empirical studies of consciousness theories

Yaron, I., Melloni, L., Pitts, M. et al.

Nat Hum Behav (2022).

https://doi.org/10.1038/s41562-021-01284-5

Abstract

Understanding how consciousness arises from neural activity remains one of the biggest challenges for neuroscience. Numerous theories have been proposed in recent years, each gaining independent empirical support. Currently, there is no comprehensive, quantitative and theory-neutral overview of the field that enables an evaluation of how theoretical frameworks interact with empirical research. We provide a bird’s eye view of studies that interpreted their findings in light of at least one of four leading neuroscientific theories of consciousness (N = 412 experiments), asking how methodological choices of the researchers might affect the final conclusions. We found that supporting a specific theory can be predicted solely from methodological choices, irrespective of findings. Furthermore, most studies interpret their findings post hoc, rather than a priori testing critical predictions of the theories. Our results highlight challenges for the field and provide researchers with an open-access website (https://ContrastDB.tau.ac.il) to further analyse trends in the neuroscience of consciousness.

Discussion

Several key conclusions can be drawn from our analyses of these 412 experiments: First, the field seems highly skewed towards confirmatory, as opposed to disconfirmatory, evidence which might explain the failure to exclude theories and converge on an accepted, or at least widely favored, account. This effect is relatively stable over time. Second, theory-driven studies, aimed at testing the predictions of the theories, are rather scarce, and even rarer are studies testing more than one theory, or pitting theories against each other – only 7% of the experiments directly compared two or more theories’ predictions. Though there seems to be an increasing number of experiments that test predictions a-priori in recent years, a large number of studies continue to interpret their findings post-hoc in light of the theories. Third, a close

relation was found between methodological choices made by researchers and the theoretical interpretations of their findings. That is, based only on some methodological choices of the researchers (e.g., using report vs. no-report paradigms, or studying content vs. state consciousness), we could predict if the experiment will end up supporting each of the theories.

A pdf is here.

Editor's note: Consistent with other forms of confirmation bias: the design of the experiment largely determines its result.  Consciousness remains a mystery, and in the eye of the scientific beholder.

A systematic review of therapist effects: A critical narrative update and refinement to Baldwin and Imel's (2013) review

Robert G. Johns, Michael Barkham, Stephen Kellett, & David Saxon.
Clinical Psychology Review
Volume 67, February 2019, Pages 78-93

Abstract

Objective

To review the therapist effects literature since Baldwin and Imel's (2013) review.

Method

Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included studies conducted.

Results

Twenty studies met inclusion criteria (3 RCTs; 17 practice-based) with 19 studies using multilevel modeling. TEs were found in 19 studies. The TE range for all studies was 0.2% to 29% (weighted average = 5%). For RCTs, 1%–29% (weighted average = 8.2%). For practice-based studies, 0.2–21% (weighted average = 5%). The university counseling subsample yielded a lower TE (2.4%) than in other groupings (i.e., primary care, mixed clinical settings, and specialist/focused settings). Therapist sample sizes remained lower than recommended, and few studies appeared to be designed specifically as TE studies, with too few examples of maximising the research potential of large routine patient datasets.

Conclusions

Therapist effects are a robust phenomenon although considerable heterogeneity exists across studies. Patient severity appeared related to TE size. TEs from RCTs were highly variable. Using an overall therapist effects statistic may lack precision, and TEs might be better reported separately for specific clinical settings.

The research is here.