The Interrelation between Major Depressive Symptoms and Ambivalence Over Emotional Expression among College Students: A Network Perspective on Gender Differences

Xiangxiang Chen^*

• The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China

Major depressive disorder is a common and severe mental disorder. Moreover, depressive symptoms and ambivalence over emotional expression are closely linked at the total-score level, yet few studies have examined their relationship at the symptom level, limiting understanding of hindering the development of targeted interventions. To address this gap, the current study employed a network approach to identify the interrelation between depressive symptoms and ambivalence over emotional expression among college students. Initially, 2,103 college students were recruited and completed the patient health questionnaire (PHQ) -9 and the ambivalence over emotional expression questionnaire (AEQ). In the final analysis, 1,362 college students passed the attention check and were included (674 men; age: Mean = 18.61, SD = 0.84). The symptom network approach was employed to examine the interrelation between depressive symptoms and ambivalence over emotional expression and to compare networks across gender. In the overall sample, the strongest cross-construct edges were between "concentration difficulties" (PHQ7) and "emotional rumination" (AEQ1) and between "guilt" (PHQ6) and "regret expressing" (AEQ5). Within the ambivalence domain, the edge between "inhibit positive emotion expression" (AEQ3) and "inhibit negative emotion expression" (AEQ4) was the highest in both men's and women's networks, indicating a shared structure. The primary bridging symptoms between depressive symptoms and ambivalence over emotional expression were PHQ7, AEQ1, PHQ6, and AEQ5 (Z scores > 1), with "guilt" (PHQ6) serving as the strongest common bridge across genders. Dissimilarities also emerged: relative to men, women showed stronger edges for AEQ1–AEQ4 (diff = 0.053, p = .010), PHQ2–PHQ8 (diff = 0.205, p = .059, marginal), and PHQ6–AEQ5 (diff = 0.092, p = .030), whereas PHQ1–PHQ8 was marginally stronger in men (diff = 0.114, p = .079). No gender differences were observed in node expected influence, but women exhibited higher bridge expected influence for "regret expressing" (AEQ5) than men (diff = 0.092, p = .040). These findings provide a symptom-level perspective on depression–ambivalence links and clarify gender similarities and differences. In light of these findings, interventions (e.g., cognitive control training, mindfulness-based approaches) targeting bridging symptoms may help decouple links between depression and ambivalence over emotional expression.