Emotional Expressive Flexibility and Mental Health: A Systematic Review and Meta-Analysis

Background/Objectives: The relationship between expressive flexibility—the capacity to enhance and suppress visible emotional responses according to situational demands—and mental health has not been systematically synthesized. This systematic review examined associations across psychopathology, psychological well-being, resilience and adaptive functioning, and social functioning. Methods: Following preregistration on the Open Science Framework (10.17605/OSF.IO/BA5HD), PsycINFO, PsycArticles, and PubMed were searched on 23 June 2026, supplemented by citation searching and expert consultation. English-language, peer-reviewed studies of participants aged at least 12 years assessing expressive flexibility and mental health were eligible. Two reviewers independently selected studies and assessed methodological quality using design-specific JBI critical appraisal tools. Narrative synthesis, random-effects meta-analyses, and a structured narrative appraisal of the evidence for each outcome were conducted. Results: Twenty-nine studies were included (cumulative analytic sample: N = 8357). Appraisals identified limitations in confounding control, handling of incomplete follow-up, and methodological reporting. Greater overall expressive flexibility was generally associated with lower psychopathological symptom burden, greater psychological well-being, greater resilience and adaptive functioning, and better social functioning. Component findings varied. Pooled associations were inverse for depressive symptoms (k = 9, N = 3622, r = −0.14, 95% CI [−0.26, −0.01]) and, exploratorily, anxiety (k = 7, N = 3134, r = −0.13, 95% CI [−0.23, −0.03]). The positive association with life satisfaction was preliminary (k = 4, N = 1910, r = 0.27, 95% CI [0.02, 0.49]). Leave-one-out analyses indicated uncertainty across all three syntheses. Heterogeneity was substantial to very high and all prediction intervals included zero. Conclusions: Findings suggest that expressive flexibility is an emotion-expression capacity associated with several dimensions of mental health, primarily in non-clinical samples. Its potential transdiagnostic relevance warrants further investigation, but limited robustness, substantial heterogeneity, and predominantly cross-sectional evidence preclude firm conclusions about generalizability and causal effects.