Investigating the transdiagnostic nature of rumination across depressive, anxiety and eating disorders: A meta-analysis.

Investigating transdiagnostic factors across mental disorders is of high importance as transdiagnostic factors can be targeted for both diagnosis and treatment in a diagnostically mixed sample. Rumination is one such potential transdiagnostic factor, whereby one repetitively and passively fixates on symptoms, causes and consequences of distress in a maladaptive way that does not lead to taking action (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). As depression, anxiety and eating disorders are highly comorbid illnesses that share a multitude of risk factors (McGrath et al., 2020), it is important to understand the relationship between these disorders and rumination.

In this meta-analysis we examined whether rumination, and it’s subcomponents brooding and reflection, differed between patients with depression, anxiety and eating disorders and healthy controls. We also examined correlations between psychopathology and rumination, brooding and reflection.

Systematic searches were performed on four electronic databases from July 2008 to December 2021. To be included, papers needed to contain at least one measure of rumination in a sample of participants between 18 and 65 with a primary diagnosis of depression, anxiety or an eating disorder. 585 abstracts were identified as eligible for full text review, of which 99 were included in the meta-analysis. Data were able to be extracted for 78 healthy control groups, 83 major depressive disorder (MDD) groups, 16 generalised anxiety disorder (GAD) groups, 13 social anxiety disorder (SAD) groups, 7 panic disorder (PD) groups, and 5 anorexia nervosa (AN) groups.

Total rumination was found to be significantly higher in MDD, GAD, SAD and AN groups than in healthy controls, however this significant difference was not observed when comparing the PD group to healthy controls. Furthermore, brooding was significantly higher in MDD, GAD and SAD groups than in healthy controls, as was reflection in MDD and SAD groups. Additionally, medium to large positive correlations between psychopathology and total rumination were observed in MDD, GAD, SAD and AN groups. This relationship was also found for brooding in the MDD and SAD groups and reflection in the MDD group. These findings must be taken with caution, however, as significant heterogeneity was observed in some comparisons and correlations, and publication bias may not always have been accurately detected due to small sample sizes.

These findings support the utility of investigating specific diagnostic groups and investigating brooding and reflection across diagnostic groups. In addition, they highlight the need for further research examining rumination-focused treatments in depression, anxiety and eating disorders.













Target Article

Rickerby, N., Krug, I., Fuller-Tyszkiewicz, M., Forte, E., Davenport, R., Chayadi, E., & Kiropoulos, L. (2022). Rumination across depression, anxiety, and eating disorders in adults: A meta-analytic review. Clinical Psychology: Science and Practice.

Discussion Questions

  • Is the process of rumination found in other mental health disorders?
  • To what extent can targeting rumination across depressive, anxiety and eating disorders assist in the assessment and treatment of these disorders?
  • What is the role of brooding and reflection in other mental health disorders?

About the Authors

Nicole C. Rickerby, BPsychScHons, MCR, is a PhD candidate in the School of Psychology at The University of Queensland. Nicole completed a Bachelor of Behavioural Science (Honours) at The University of Queensland in 2018, before going on to complete a Master of Clinical Research at The University of Melbourne, graduating in 2021. Nicole can be contacted at

Litza A. Kiropoulos BEd, BSc(Honours)Psychology, Master of Clinical Psychology, PhD is a senior research and teaching academic and linical psychologist and leads the Mood and Anxiety Disorders Lab in the School of Psychological Sciences, University of Melbourne, Victoria, Australia. For more information on the lab please see: Dr Kiropoulos can be contacted on

Isabel Krug, PhD, is an Associate Professor in Clinical Psychology in the School of Psychological Sciences at the University of Melbourne. She also leads the Eating Disorder Lab within the School of Psychological Sciences. For more details on the lab, please visit A/Prof Krug can be contacted at:

Matthew Fuller-Tyszkiewicz, PhD, is a Professor and Associate Head of School (Research) in the School of Psychology at Deakin University. He is also the Lead for the Data Science Unit within Deakin University’s Strategic Research Centre for Social and Early Emotional Development.

Elizabeth C. Forte, BA, LLB, GDipPsych, GDipPsych(Adv), is a Master’s student in the School of Psychology at Curtin University. Studying at The University of Western Australia, Elizabeth completed a Bachelor of Arts (Communication Studies) in 2005 and a Bachelor of Laws in 2009. Subsequently, Elizabeth studied at The University of Melbourne, completing a Graduate Diploma in Psychology in 2019 and a Graduate Diploma in Psychology (Advanced) in 2020.

Rebekah A. Davenport, BA-Psych(Hons), is a PhD and Master of Clinical Psychology candidate in The University of Melbourne’s School of Psychological Sciences, and a AHPRA registered provisional psychologist. Rebekah’s research is focused on understanding psychiatric comorbidity and sexual dysfunction in chronic inflammatory disease populations. Rebekah can be contacted at

Ellentika Chayadi Master of Clinical Psychology has graduated with a Master of Clinical Psychology from the Melbourne School of Psychological Sciences, University of Melbourne. Ellentika’s research focused on understanding factors relating to depression in oncology populations.

References Cited

McGrath, J. J., Lim, C. C. W., Plana-Ripoll, O., Holtz, Y., Agerbo, E., Momen, N. C., Mortensen, P. B., Pedersen, C. B., Abdulmalik, J., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bruffaerts, R., Bunting, B., de Almeida, J. M. C., de Girolamo, G., De Vries, Y. A., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., Hu, C., Karam, E. G., Kawakami, N., Kiejna, A., Kovess-Masfety, V., Lee, S., Mneimneh, Z., Navarro-Mateu, F., Orozco, R., Posada-Villa, J., Roest, A. M., Saha, S., Scott, K. M., Stagnaro, J. C., Stein, D. J., Torres, Y., Viana, M. C., Ziv, Y., Kessler, R. C., & de Jonge, P. (2020). Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries. Epidemiology and Psychiatric Sciences, 29, e153.

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400-424.