How Perceived Stress Leads to Depression: Emotion Regulation Strategies and Sex Differences

Background: Prolonged exposure to collective stressors, such as public health crises, has been shown to heighten individuals' perceived stress and depressive symptoms. However, the mechanisms linking distinct stress representations to depression, particularly through emotion-regulation pathways, remain insufficiently understood. Objective: This study investigated how two core dimensions of perceived stress—Perceived Distress and Perceived Coping Difficulty—were associated with depressive symptoms through Cognitive Reappraisal and Expressive Suppression, and whether sex moderated these associations. Methods: A cross-sectional survey was administered to 2,308 university students (820 males, 1,488 females; aged 18–27 years, M = 22.89 ±1.18). Data were collected during a period of sustained collective stress, characterized by social restrictions and health-related uncertainties. Participants completed the Perceived Stress Scale, Emotion Regulation Questionnaire, and Patient Health Questionnaire-9. Data were analyzed using PROCESS Model 5 (Hayes, 2022) with 5,000-sample bootstrapping and 95% confidence intervals, controlling for age and quarantine experience. Results: Perceived Distress was positively associated with depressive symptoms and indirectly linked to higher depressive levels via increased Expressive Suppression. Perceived Coping Difficulty showed positive associations with depression and negative relations with both emotion-regulation strategies, producing opposite-direction indirect pathways. Cognitive Reappraisal related inversely, and Expressive Suppression positively, to depressive symptoms. Males exhibited stronger distress-related depressive associations than females, whereas no sex moderation appeared for coping difficulty. Conclusions: Distinct forms of perceived stress were differentially related to depressive symptoms through unique emotion-regulation pathways.