The Association Between Distress Tolerance and Depressive Symptoms in Children and Adolescents: A Three-level Meta-analysis

Distress tolerance encompasses perceived and behavioral capacities essential for enduring adverse emotional experiences. Previous findings suggest that distress tolerance is correlated with depressive symptoms in children and adolescents. However, no meta-analysis has synthesized the available evidence to reach a consensus. This study aimed to provide meta-analytic evidence on this association in children and adolescents. An exhaustive search across multiple databases on February 4, 2024, yielded 56 studies with 39,492 participants and 155 effect sizes. Using a three-level random-effects meta-analysis, the results revealed a significant negative correlation between distress tolerance and depressive symptoms (r = − 0.364; 95% CI [ − 0.413, − 0.314]). Perceived distress tolerance demonstrated a stronger correlation with depressive symptoms compared to behavioral distress tolerance. Furthermore, associations were more robust when distress tolerance was self-reported rather than assessed by parents. The effect size of the correlation across different dimensions of the Distress Tolerance Scale also varied. This study provides evidence for the link between distress tolerance and depressive symptoms, with implications for understanding depressive symptoms of children and adolescents.