Emotion regulation as a transdiagnostic mechanism of mental health in Parkinson’s disease: Linking alexithymia and apathy

Objectives: Alexithymia and apathy are prevalent non-motor symptoms in Parkinson’s Disease (PD) and are independently associated with poor mental health outcomes. Difficulties in emotion regulation (ER) are increasingly recognized as transdiagnostic mechanisms underpinning mental health vulnerability across clinical populations; however, their role in linking alexithymia and apathy to mental health outcomes in PD remains poorly understood. This study investigated whether cognitive and behavioral ER strategies mediate the relationship between alexithymia, apathy, and mental health outcomes in individuals with PD. Design: Cross-sectional observational study using self-report measures. Setting: Community-based and online recruitment in the United Kingdom. Participants: A sample of one hundred and seven individuals with PD. Measurements: Participants completed self-report measures assessing alexithymia, apathy, anxiety, depression, mental wellbeing, and the use of cognitive and behavioral ER strategies. Multiple mediation models were conducted, adjusting for covariates including age, education, illness duration, and motor aspects of daily living. Results: Higher levels of alexithymia and apathy were associated with greater anxiety and depression and poorer mental wellbeing. Mediation analyses indicated that reduced use of adaptive ER strategies, including Actively Approaching, Refocus on Planning, Seeking Social Support, and Positive Reappraisal, alongside greater use of Withdrawal, partially explained these associations. Withdrawal emerged as the most consistent maladaptive mediator across outcomes. Conclusions: Findings highlight ER as a key transdiagnostic mechanism linking alexithymia and apathy to mental health outcomes in PD. Interventions targeting ER processes may offer a clinically meaningful avenue for improving psychological wellbeing in PD beyond motor symptom management.