Normative reference interval for youths on the Difficulties in Emotion Regulation Scale (DERS)

Background The Difficulties in Emotion Regulation Scale (DERS) is widely used in both clinical and non-clinical research to assess emotional regulation difficulties. To guide interpretation of scores, establishing thresholds for normative DERS scores is informative. However, despite its widespread use, to date no study has provided such threshold for youths. This literature review aimed to fill this gap by examining the 90% reference interval for the DERS in youths aged 11-19 years.Methods We conducted a systematic search on PubMed (MEDLINE) on 12 March 2024, to identify studies reporting DERS-36 total scores (DERS-T) in youths aged 11-19 years from either community-based populations or healthy volunteers.Results A total of 34 studies were included; 20 studies included community-based participants (n = 6,960), while the remaining 14 studies included healthy volunteers (n = 766), resulting in a total of 7,726 participants. The 90% reference interval for DERS-T from all included participants had a threshold of 121.8 normative emotion regulation in youths.Conclusion and significance This threshold is considerably higher than DERS-T scores reported in most clinical studies and a substantial variation in reference intervals across studies is observed. We identify five main methodological factors related to the DERS-36 and discuss their potential impact on the validity, reliability, and generalizability of findings. Given the DERS-T range of 36-180, we conclude that the 90% reference interval derived from our review is not sufficiently robust to guide clinical or scientific interpretations. Our work is not exhaustive, and further research is needed to validate and test the reliability of this reference interval.