Emotion suppression differentially moderates the link between stress and cardiovascular disease risk in Japanese and Americans.
Level 3 - non-randomized controlled study
Cross-sectional comparative cohort analysis using data from MIDJA and MIDUS
PubMed 40110442 · doi:10.1016/j.ijchp.2025.100555
What was done
Researchers evaluated whether emotion regulation strategies (expressive suppression and cognitive reappraisal, measured by the Emotion Regulation Questionnaire) differentially moderated the association between perceived stress (Perceived Stress Scale) and cardiovascular disease (CVD) risk across cultures. Data were analyzed from Japanese adults in the Midlife in Japan study (N = 315, mean age 59.22 years, 149 females) and American adults in the Midlife in the United States study (N = 524, mean age 51.98 years, 291 females) who had complete biomarker and psychological measures. CVD risk was indexed using a composite score of body mass index, C-reactive protein, interleukin-6, systolic blood pressure, and high-density lipoprotein cholesterol ratio. Linear regressions adjusted for age, sex, education, tobacco, alcohol, and prescription medication use.
What was found
Adjusted linear regressions revealed significant cultural differences among individuals with high suppression (r = -0.10, 95% CI [-0.19, -0.01]). In Americans, higher perceived stress was linked with higher CVD risk across all levels of reappraisal or suppression (r's > 0.11, p's < 0.07). In contrast, among Japanese adults with high suppression, higher stress was associated with lower CVD risk (r = -0.09, 95% CI [-0.23, 0.05]). Among Japanese adults with lower suppression, higher stress was associated with greater inflammation (r = 0.10, 95% CI [-0.07, 0.28]).
Why it matters
These findings challenge the assumption that expressive emotion suppression is universally harmful to health, indicating that the cardiovascular consequences of stress regulation strategies depend on cultural context.
Limits
The study is cross-sectional, preventing causal or directional inferences between emotion regulation, stress, and biological risk. Subgroup estimates in the Japanese cohort had 95% confidence intervals crossing zero. Outcomes were measured via a surrogate composite biomarker score rather than hard clinical cardiovascular events.
Cited by
- context Scientific data demonstrate that suppressing or internalizing emotional pain and shame is associated with the development of physical disease.
- context Expressing emotions promotes physical and mental health, whereas chronic emotional suppression is associated with increased mortality risk.