Depression, not stroke, is associated with greater expressive suppression while emotion identification is preserved

Stroke is followed both by frequent depression and by reported alterations in emotional processing, yet these are rarely examined jointly, leaving it unclear whether emotional disturbances reflect the lesion or the concurrent depression. We aimed to separate the contributions of depression and of mild right-hemisphere stroke to two distinct components of socioemotional functioning: habitual emotion regulation and facial emotion identification.

Sixty adults were studied in a 2 × 2 design crossing Stroke (survivors of mild right-hemisphere ischemic stroke with complete functional recovery, modified Rankin Scale = 0, vs. stroke-free) and Depression (clinically diagnosed vs. absent). Habitual regulation was assessed with the Emotion Regulation Questionnaire (cognitive reappraisal, expressive suppression) and identification with a six-emotion forced-choice task. Data were analyzed with factorial analyses of variance, with covariate-adjusted and non-parametric confirmation, and with a dimensional analysis relating depressive symptom severity to each outcome.

Depression, not stroke, was the principal correlate of habitual regulation. Participants with depression reported greater expressive suppression than those without (F = 7.50, p = .008, partial η² = .12; Cohen's d = 0.74), independently of stroke and robust to adjustment for age and cognition. The parallel effect on reappraisal was directionally consistent but non-significant. Dimensionally, symptom severity correlated with suppression only. Facial emotion identification was preserved and did not differ across groups, with no Stroke × Depression interaction on any outcome. Stroke effects that were large in our earlier, less fully recovered sample were absent here.

In well-recovered right-hemisphere stroke, depressive status rather than the lesion was associated with greater habitual reliance on expressive suppression, whereas emotion identification was intact. When emotional difficulties arise in such patients, concurrent depression rather than the lesion may warrant primary clinical attention. Given the modest sample and absence of lesion imaging, findings are provisional and require severity-stratified, imaging-informed replication.