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The effect of suppressing and not accepting emotions on depressive symptoms:
Is suppression different for men and women?
Jessica J. Flynn
a
, Tom Hollenstein
b,*
, Allison Mackey
c
a
Kent State University, OH, USA
b
Queen’s University, Department of Psychology, 220 Craine Hall, Kingston, Ontario, Canada K7L 3N6
c
Rotman Research Institute, Toronto, Ontario, Canada
article info
Article history:
Received 13 November 2009
Received in revised form 13 May 2010
Accepted 18 May 2010
Available online 11 June 2010
Keywords:
Suppression
Gender differences
Non-acceptance
Emotion regulation
Depressive symptoms
abstract
Suppression of emotional expression has been associated with depressive symptoms. However, men sup-
press emotions more than women but women experience more symptoms of depression. The present
study examined gender and emotional non-acceptance (thinking of emotions as bad and to be avoided)
as moderators of the suppression-depression relationship. Participants were males (n= 118) and females
(n= 210) aged 17–24. As expected, men reported suppressing emotions more than women and women
reported more depressive symptoms. However, suppression was only related to depression in men and
not women. Hierarchical regressions revealed a 3-way interaction among gender, suppression, and
non-acceptance. Lower acceptance of emotions was associated with the highest depressive symptoms
regardless of suppression or gender. With greater acceptance of emotions, suppression was related to
more depressive symptoms in men but fewer depressive symptoms in women. These findings suggest
that suppressing emotions may have different functions and may be more useful for understanding
depressive symptoms in men rather than women.
Ó2010 Elsevier Ltd. All rights reserved.
1. Introduction
Based on his model of emotional regulation (Gross, 1998, 2007),
James Gross and colleagues have examined the functions and asso-
ciations of two strategies: expressive suppression, or inhibiting out-
ward expression when emotionally aroused (e.g., not crying when
sad), and cognitive reappraisal, or reframing an emotional situation
as less emotional (e.g., thinking of a performance as a learning
opportunity rather than a potential failure; Gross, 2008a, 2008b;
Gross & John, 2003). On the one hand, reappraisal is associated
with positive outcomes such as low levels of negative emotions
and high levels of well-being (Gross & John, 2003; John & Gross,
2004). On the other hand, suppression is related to negative out-
comes such as depression (Gross & John, 2003; John & Gross,
2004), negative social consequences (Butler et al., 2003; Gross &
John, 2003) and greater experience of negative emotions (Butler,
Lee, & Gross, 2007). Although Gross and colleagues are careful
not to conclude that one strategy is necessarily better than the
other, reappraisal is generally thought of as an adaptive emotion
regulation strategy and suppression as a maladaptive emotion reg-
ulation strategy.
1.1. Gender differences in the suppression–depression link
Research in western societies has revealed many gender differ-
ences in how men and women experience and express emotions.
For example, women express more emotion than men (Gross &
John, 1995, 1997; Kring & Gordon, 1998), women ruminate more
than men (Butler & Nolen-Hoeksema, 1994), men tend to display
more anger-related emotions and women tend to display more
dysphoric and self-conscious emotions than men (Brody, 1993).
Thus, women experience greater levels of negative emotionality
in the form of depressive symptoms (Kessler et al., 1994; Nolen-
Hoeksema, 2001; Regier et al., 1993; Young, Fogg, Scheftner, Keller,
& Fawcett, 1990), yet men suppress emotions more than women
(Gross & John, 2002, 2003). This reveals a previously unexamined
conundrum: if men suppress emotions more than women and sup-
pression is related to depression then why is it that men do not
experience higher levels of negative affect or depressive symptoms
than women? This conundrum suggests that when men suppress
emotions it may not have effects that are as deleterious as those
for women; hence, gender may moderate the relationship between
suppression and depression. The present study was designed to ad-
dress this conundrum by considering the moderating effects of
gender and then to try to explain these differences in terms of
how men and women approach or process emotional experiences.
Specifically, we considered whether accepting versus rejecting
0191-8869/$ - see front matter Ó2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.paid.2010.05.022
*Corresponding author. Tel.: +1 613 533 3288; fax: +1 613 533 2499.
E-mail address: Tom.Hollenstein@queensu.ca (T. Hollenstein).
Personality and Individual Differences 49 (2010) 582–586
Contents lists available at ScienceDirect
Personality and Individual Differences
journal homepage: www.elsevier.com/locate/paid
emotions was a key factor in the suppression–depression
connection.
1.2. Non-acceptance
Emotional acceptance is the willingness to fully experience all
emotions, even negative ones (Campbell-Sills, Barlow, Brown, &
Hoffman, 2006; Eifert & Heffner, 2003; Hayes et al., 1999; Levitt,
Brown, Orsillo, & Barlow, 2004). Non-acceptance manifests as not
wanting to feel any emotion appraised as ‘‘bad’’ (Gratz & Roemer,
2004) and is positively associated with suppression as well as
symptoms of depression (Campbell-Sills et al., 2006; Gratz & Roe-
mer, 2004; Hayes et al., 1999). Thus, non-acceptance may also af-
fect how suppression relates to depression. In fact, some
researchers seem to equate suppression and non-acceptance
(Campbell-Sills et al., 2006; Cioffi & Holloway, 1993; Masedo &
Esteve, 2007). However, we argue that non-acceptance and sup-
pression are distinct because: (1) non-acceptance is a value judg-
ment about the experience of emotions whereas suppression is
an act taken to control the expression of emotion, (2) it is possible
to accept one’s emotions but choose to suppress their expression
for other reasons (e.g., social desirability) and (3) suppression can
be theoretically assumed to have positive outcomes in some con-
texts (Butler et al., 2003; Elias, 1978) whereas non-acceptance
has only been associated with negative outcomes (Bach & Hayes,
2002;Hayes, Strosahl, & Wilson, 1999; Heffner, Eifert, Parker, Her-
nandez, & Sperry, 2003; McCracken, 1998). Thus, non-acceptance is
a good candidate to explain the moderation of gender on the sup-
pression–depression link.
1.3. The present study
The first objective of the present study was to replicate the
gender differences found in previous studies of the suppression–
depression link by testing the following hypotheses: (a) suppres-
sion will be positively related to symptoms of depression, (b)
women will have more symptoms of depression than men, and
(c) men will suppress more than women. The second objective
was to examine the moderating effects of non-acceptance and gen-
der on the relationship between suppression and symptoms of
depression. We expected both gender and non-acceptance would
moderate this relationship.
2. Method
2.1. Participants and procedure
Participants were 328 undergraduate students aged 17–24
(M= 19.29), 64% female. Ethnic backgrounds were European–Cana-
dian (67%), East Asian (20%), Other (7%), South Asian (5%) or African
or First Nations Canadian (<1%). Participants were recruited from
undergraduate classes at a university in southern Ontario, Canada.
Participants completed a questionnaire booklet taking 25 min
and were compensated with $5.
2.2. Measures
2.2.1. Emotion Regulation Questionnaire (ERQ; Gross & John, 2003)
Participants indicate agreement with items on a scale from 1
(strongly disagree) to 7 (strongly agree). The 4-item Suppression
scale (Cronbach’s
a
= .78) includes items such as ‘‘I control my
emotions by not expressing them.’’ The 6-item Reappraisal scale
(Cronbach’s
a
= .83) includes items such as ‘‘When I want to feel
less negative emotion (such as sadness or anger), I change what
I’m thinking about’’. The square root of Reappraisal was used in
analyses to correct for skewness.
2.2.2. Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer,
2004)
The 6-item subscale measuring ‘‘Non-Acceptance of Emotional
Responses’’ reliably differentiates those who accept negative emo-
tions from those who do not. Participants report the frequency of
Non-Acceptance for statements beginning with the phrase: ‘‘When
I’m upset’’ followed by six different ways of feeling about being up-
set such as ‘‘I feel like I am weak’’ and ‘‘I feel embarrassed for feel-
ing that way’’ on a 5-point scale from ‘‘almost never’’ to ‘‘almost
always’’ (Cronbach’s
a
= .81). The log of Non-Acceptance was used
in analyses to correct for skewness.
2.2.3. Mood and Anxiety Symptom Questionnaire (MASQ; Keogh &
Reidy, 2000)
For the 12-item General Distress: Depressive Symptoms sub-
scale, respondents indicated how much during the past seven
weeks they experienced symptoms (e.g., ‘‘I felt like a failure’’) on
a 5-point scale from ‘‘not at all’’ to ‘‘extremely’’ (Cronbach’s
a
= .93). Levels of Depressive Symptoms were below the clinical
range in this sample. The log of Depressive Symptoms was used
in analyses to correct for skewness.
3. Results
Means and correlations are displayed in Table 1. As predicted,
Reappraisal was negatively related to Depressive Symptoms and
Non-Acceptance was positively related to Depressive Symptoms.
Unexpectedly, in the full sample, Suppression was not related to
Depressive Symptoms. t-Tests were conducted on all variables (Ta-
ble 2) to test for expected gender differences. Reappraisal was not
different by gender. As expected, women reported more Depres-
sive Symptoms and Non-Acceptance, whereas men reported
greater Suppression. It was also expected that the processes of sup-
pression would be different in men and women, thus correlations
among Suppression and Non-Acceptance within each gender were
calculated separately (Table 3). For men, Suppression and
Non-Acceptance were positively related to Depressive Symptoms.
However, in women, Suppression was not related to Depressive
Symptoms and Non-Acceptance was positively related to Depres-
sive Symptoms. Thus, unexpectedly, Suppression was related to
Non-Acceptance only in women but not in men.
To examine the second objective of this study, hierarchical
regression analyses were performed on the dependent variable
(Depressive Symptoms) using Suppression, Non-Acceptance and
Gender as independent variables. All interaction variables were
created with standardized variables. As shown in Table 4, the main
effects of Gender, Suppression and Non-Acceptance accounted for
21% of the variance in Step 1. Surprisingly, there was not a signif-
icant amount of unique variance of Suppression associated with
Table 1
Correlations among all variables with means (and standard deviations) on diagonal.
Suppression Reappraisal Non-
acceptance
Depressive
symptoms
Suppression 3.43 (1.21)
Reappraisal .04 1.38 (.41)
Non-
acceptance
.20
***
.01 2.17 (.87)
Depressive
symptoms
.10 .17
**
.44
***
.35 (.15)
**
p< .01.
***
p< .001.
J.J. Flynn et al. / Personality and Individual Differences 49 (2010) 582–586 583
Depressive Symptoms when Gender and Non-Acceptance were
included. All the 2-way interactions were added in Step 2 and ac-
counted for an additional 3% of the variance in Depressive
Symptoms. This increase in prediction appeared to be driven by
the interaction between Suppression and Non-Acceptance. Finally,
with the addition of the 3-way interaction in Step 3, the final mod-
el accounted for an additional 2% of the variance in Depressive
Symptoms. To probe this three-way interaction, the regression
model was restructured on high (one standard deviation above)
and low values (one standard deviation below) of Suppression
and Non-Acceptance (Aiken & West, 1991). This interaction is illus-
trated in Fig. 1.
4. Discussion
The goals of this study were to: (1) replicate gender differences
in suppression and (2) examine gender and non-acceptance as
moderators of the relationship between suppression and depres-
sion. Some gender differences in our sample were consistent with
previous research: men suppressed more than women (Gross &
John, 1995, 1997, 2002, 2003; Kring & Gordon, 1998) and women
reported more depressive symptoms than men (Kessler et al.,
1994; Nolen-Hoeksema, 2001; Regier et al., 1993; Young et al.,
1990). However, the suppression–depression association was not
present for women or the full sample but it was present for men.
Previous research has not reported separate associations for men
and women, but instead on the full sample regardless of gender
(Gross & John, 2003). Thus, it is possible that the males were driving
those positive bivariate correlations. This further implicates emo-
tion suppression as an important factor in male depression (Addis,
2008). Given the stark contrast between depressive affect and cul-
tural norms of masculinity, suppression may be a consequence of
depressive symptoms as men try to avoid rejection for being unable
to ‘‘take it like a man’’ (e.g., Joiner, Alfano, & Metalsky, 1992). This
may also help to explain the strong correlation between non-accep-
tance of emotions and depressive symptoms for men.
Our moderation analyses illuminated these relations further.
Suppression was only related to depressive symptoms when mod-
erated by gender and/or non-acceptance. These results further
implicated separate emotional processes for men and women.
Lower acceptance of emotions in both men and women was asso-
ciated with more symptoms of depression and suppression had lit-
tle effect on this association. However, for women who accept their
emotions, more expressive suppression was associated with lower
depressive symptoms. Thus, these emotion-accepting women may
be constraining their emotional responses for more prosocial rea-
sons, rather than trying to stifle or deny painful emotional states.
Butler et al. (2007), for example, found that culturally-mediated
norms of emotional expressivity differentiated women’s suppres-
Table 2
t-Test comparison by gender with means (and standard deviations).
tdf Men Women
Suppression 4.52
***
273.96
a
3.80 (1.07) 3.21 (1.25)
Reappraisal .63 325 4.91 (.96) 4.93 (1.10)
Non-acceptance 2.17
*
325 2.02 (.76) 2.26 (.93)
Depressive symptoms 2.50
*
326 2.23 (.86) 2.45 (.86)
Note: All means are reported as raw values but tests were run on transformed
variables.
a
Df adjusted for unequal variances.
*
p< .05.
***
p< .001.
Table 3
Correlations among all variables for men (top right) and women (bottom left).
Suppression Reappraisal Non-
acceptance
Depressive
symptoms
Suppression .02 .07 .19
*
Reappraisal .06 .08 .10
Non-
acceptance
.31
***
.02 .51
***
Depressive
symptoms
.11 .22
**
.39
***
*
p< .05.
**
p< .01.
***
p< .001.
Table 4
Hierarchical regression results.
Step Predictors Total
R
2
R
2
change
bse b
1.21
***
.21
***
Gender .03
a
.02 .09
Suppression .01 .01 .03
Non-accept .07
***
.01 .44
2.24
***
.03
*
Gender .03 .02 .08
Suppression .03
a
.02 .17
Non-accept .08
***
.02 .55
Gender suppression .03
a
.02 .16
Gender non-accept .03 .02 .13
Suppression non-accept .02
*
.01 .11
3.26
***
.02
**
Gender .02 .02 .06
Suppression .02 .02 .13
Non-accept .11
***
.02 .69
Gender suppression .03 .02 .14
Gender non-accept .05
*
.02 .25
Suppression non-accept .03
a
.02 .22
Gender suppression non-
accept
.06
***
.02 .35
a
p< .10.
*
p< .05.
**
p< .01.
***
p< .001.
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
HighLow
Depressive Symptoms
Suppression
Men, Low NA Men, High NA
Women, Low NA Women, High NA
Fig. 1. Display of the 3-way interaction between gender, suppression and non-
acceptance on depressive symptoms. Note: NA = Non-acceptance.
584 J.J. Flynn et al. / Personality and Individual Differences 49 (2010) 582–586
sion as either an act of prosocial self-regulation associated with po-
sitive outcomes (with norms dictating low expressivity) or an iro-
nic process of unsuccessful regulation associated with elevated
negative affect and poor outcomes (with norms of high expressiv-
ity). In contrast, depressive symptoms in men who accept their
emotions appear to be exacerbated by suppression. When these re-
sults are taken together with those of the current study, different
patterns of emotion regulation by gender seem to be associated
with healthy outcomes (i.e., low depressive symptoms). The
healthiest outcomes for women were associated with accepting
and suppressing emotions and for men with accepting and not
suppressing emotions.
There is a strong theoretical and empirical basis for the role of
cognitive processes, such as negative schemas and dysfunctional
attitudes, in the onset and maintenance of depression (Beck,
1967). There is a less comprehensive understanding of the patterns
of emotional responding and expression associated with both
these cognitive patterns and symptoms of depression. Depression
has been associated with a rigid pattern of emotional expression
(i.e., suppression; Gross & John, 2003) and a flattening of emotional
responding (e.g., Rottenberg, Gross, & Gotlib, 2005). However,
other research has shown that suppression is not always related
to negative outcomes (Butler et al., 2007). Thus, the present results
confirm the complex interactions among negative emotionality,
emotion regulation habits, and various aspects of the social context
(e.g., cultural norms, social goals, expectations). Instead of being a
maladaptive strategy of emotional expression, suppression may be
one of many emotion regulation techniques whose outcomes de-
pend on other factors.
The present study was only preliminary. The next step is to go be-
yond self-report to examine these emotional processes in vivo. For
any study of emotion regulation, it is most useful to be able to distin-
guish emotional arousal processes from regulatory efforts to de-
crease that arousal (Cole, Martin, & Dennis, 2004). Experimental
manipulation of social goals and interaction partners may help to
disentangle these processes. From our data, for example, it is not
clear whether those who accept their emotions do so because their
emotions are less intense. Thus, suppression and low acceptance of
emotions may be functional or adaptive for those who experience in-
tense emotions. It could also be argued that because patterns of emo-
tion experience and expression are constrained by social and gender
norms (e.g., Brody, 1993) that these same forces also affected the
self-report of emotional experience and expression in this study.
Although this is possible, it does not preclude the possibility that
these results accurately represent emotional responding. However,
studies with experimental manipulation of strategies by sex will
provide a stronger evidence base for the conclusions of this paper.
Furthermore, instead of measuring suppression and non-acceptance
of emotions vaguely identified by valence, it would be useful in fu-
ture studies to distinguish between different emotional states. Per-
haps women are more likely to suppress socially accepted
emotions of men (e.g., anger) while men would suppress socially ac-
cepted emotions of women (e.g., sadness).
The impetus of this study was to resolve a conundrum. If men
suppress more than women and suppression is associated with
depressive symptoms, then why do women have more depressive
symptoms than men? Our results did not unequivocally resolve
this conundrum but instead indicated the possibility that the sup-
pression-depression link is more relevant for men than for women.
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