The Psychometric Properties of the Interpersonal Emotion Regulation Questionnaire Among Chinese Caregivers of Children With Neurodevelopmental Disorders

ER refers to the process by which people influence their own emotional experiences or those of others (Gross, 2002; Hofmann et al., 2016). Recent advancements in ER theories have transitioned from an intrapersonal perspective, centering on self-regulation of emotions, to an interpersonal perspective (Gross, 2015). Zaki and Williams (2013) and Hofmann (2014) introduced the concept of IER, which encompasses extrinsic IER—regulating the emotions of others—and intrinsic IER—regulating one’s own emotions through social interactions. This shift highlights the inherently social nature of ER, recognizing that emotional experiences and regulation often take place within social contexts and are influenced by the presence of others (Coan & Maresh, 2014).

Intrinsic IER has been identified as particularly influential on individuals’ mental health and well-being (Zaki & Williams, 2013), garnering considerable attention from researchers. Hofmann and colleagues (2016) developed the Interpersonal Emotional Regulation Questionnaire (IERQ) to measure four key areas of IER strategies: (a) enhancing positive emotional states, such as joy and happiness (enhancing positive affect); (b) aiding oneself in managing negative emotions by recognizing that others may be in worse situations (perspective-taking); (c) providing self-reassurance and understanding (soothing); and (d) reflecting on how others might handle situations that evoke negative emotions (social modeling).

Various studies have validated the factorial structure of the IERQ through confirmatory factor analysis, consistently finding fit indices that support the original four-factor structure across diverse samples, including those from the US (Hofmann et al., 2016), Spain (Anselmi et al., 2023), Turkey (Koç et al., 2019), Iran (Abasi et al., 2023), Italy (Messina et al., 2022), and India (Kanth & Indumathy, 2022). However, Sarısoy-Aksüt and Gençöz (2022) found that in the Turkish version, item 2 (“It helps me deal with my depressed mood when others point out that things aren’t as bad as they seem”) appears to load on both social modelling and perspective taking simultaneously (Sarısoy-Aksüt & Gençöz, 2022).

Existing research has presented inconsistent findings regarding the association between IER strategies and psychological well-being. While some studies have indicated that various IER strategies are positively correlated with difficulties in ER (Hofmann et al., 2016; Abasi et al., 2023) and mental health symptoms such as depression and anxiety (Hofmann et al., 2016; Abasi et al., 2023), others have suggested that IER can have a positive impact on reducing depression, anxiety and loneliness (Koç et al., 2019). This inconsistency is further underscored by research showing a negative association between IER and positive mental health indicators, such as psychological well-being and sociability (Abasi et al., 2023). Additionally, some studies have revealed mixed results, indicating that different subdimensions of IER have varying effects on internalizing symptoms and well-being across diverse cultural groups (Chan & Rawana, 2021). Therefore, further research is essential to clarify the relationship between IER strategies and various adaptive and maladaptive adjustment outcomes, particularly concerning indicators of well-being across cultures.

Hofmann et al. (2016) highlighted that IER may vary across ethnic and cultural groups, as it is closely tied to social norms and expectations. For instance, individuals from Turkish and Iranian societies, both of which are rooted in collectivist cultures, are more inclined to rely on others for emotional management and regulation (Koç et al., 2019; Abasi et al., 2023). They may view seeking emotional support as normal and acceptable, potentially benefiting more from IER compared to those in individualistic cultures. Similarly, Chinese culture emphasizes a collectivist orientation and Confucian values, prioritizing solidarity and social relationships (Abdullah & Brown, 2011). While collectivism is a shared characteristic across China, Turkey, and Iran, its underlying values, social structures, and expressions differ substantially due to distinct historical, cultural, and socio-political contexts. Firstly, the ‘strength’ of collectivism varies: China only scored 20 on Hofstede’s individualism/collectivism index (Hofstede, 2024), indicating a stronger emphasis on collectivist values compared to Turkey (37) and Iran (41). Secondly, Confucianism shapes collectivism in China, emphasizing vertical collectivism with its focus on social hierarchy, compliance, and sacrifice for group goals (e.g., family and community) (Kulich & Zhang, 2012). In contrast, Turkey and Iran, influenced by Islam, exhibit a stronger tendency towards horizontal collectivism, prioritizing communal support (Cukur et al., 2004; Kuntoro et al., 2017). Religion also plays a significant role in how individuals in Turkey and Iran cope with emotional challenges, often emphasizing sharing and mutual support within their communities. Thirdly, parenting experiences related to children with developmental issues also differ. Chinese parents, influenced by Confucianism’s emphasis on fulfilling parenting duties, may experience greater feelings of guilt and shame related to their child’s diagnosis (Hwang, 2001; Ji et al., 2022; Mak & Cheung, 2012; Ran et al., 2021). This is exacerbated by the prevailing social stigma surrounding mental illness in Chinese societies, where it is often perceived as an abnormality and a source of shame for the entire family (Mak & Chen, 2006).

Despite the emphasis on social relationships and collective solidary within Chinese culture, there are cultural values that may create barriers for Chinese caregivers to adopt IER strategies. For example, the strong stigma associated with mental illness, coupled with the emphasis on familial duties and caregiving responsibilities, can lead to feelings of guilt when seeking external help (Holland et al., 2010; Young et al., 2017). Furthermore, the cultural emphasis on emotional restraint in Chinese culture can inhibit the open sharing of positive emotions with others (Wei et al., 2013). Consequently, Chinese caregivers may be less inclined to seek support for emotional comfort or to share positive experiences.

On the other side, empirical studies have shown that strong social connections, close ties, and reciprocal bonds—integral to interpersonal and social support—help alleviate caregiver stress and burden (Chow & Ng, 2004; Hu et al., 2023) and contribute to better psychological health, greater quality of life, and positive parent–child interactions for Chinese caregivers (Liu et al., 2023; Yan et al., 2022). Mothers of children with ASD value sharing their joys, concerns, and hobbies with close friends and colleagues as a way to connect with the wider world (Chau & Furness, 2023; Ilias et al., 2017). Exchanging perspectives and experiences provides them with new coping strategies and reduces feelings of isolation. Similarly, research has indicated that parents of children with autism in China often utilize active coping mechanisms, such as seeking social support, particularly in contexts where educational resources for their children are limited (Wang et al., 2011).

Given the potential challenges and benefits associated with IER for Chinese parents of children with NDDs, it is crucial to investigate their use of specific IER strategies and how these strategies impact their well-being. This study aims to clarify how cultural and contextual factors influence the impact of IER on Chinese parents’ well-being.

A thorough literature review revealed that no study has validated the IERQ in a Chinese cultural context. Moreover, while previous studies have extensively emphasized intrapersonal ER in both Western and Chinese literature, there is a lack of studies exploring how IER may influence psychosocial well-being of people at risk of mental illness. This exploration of IER among Chinese caregivers of children with NDDs may be of particular importance because of their high mental health concerns and needs for social support. This study will address these research gaps by exploring how Chinese caregivers adopt culturally relevant ER strategies and the impact of these strategies on their quality of life. This will contribute to a deeper theoretical understanding of IER within this specific demographic group. Furthermore, the findings may inform strategies for engaging with Chinese parents’ social networks, strengthening their support systems, and developing more effective interventions to enhance their well-being.

The goal of the current study was to examine the psychometric properties of the Chinese version of the IERQ among Chinese caregiving parents of children with NDDs. First, the factor structure of the Chinese IERQ was examined. Second, the internal consistency of the Chinese IERQ was investigated. Third, the concurrent validity of the Chinese IERQ with cognitive ER was examined. Fourth, the explanatory power of the Chinese IERQ for quality of life beyond cognitive ER was investigated.

A power analysis indicated that with standardized factor loadings of 0.60, a sample size of 211 was sufficient to achieve adequate power (Koran, 2020). A sample of 293 Chinese parents of children with NDDs was recruited from two social service centers in Hunan Province, China (see Table 1). A purposive sampling strategy was employed. Two centers distributed invitations and questionnaire links to all agency members with children diagnosed with NDDs. The questionnaire, administered through SurveyMonkey (a widely used online survey platform in China), targeted participants who: (1) were 18 years or older, (2) could read Chinese, and (3) had at least one child under 12 years old with a professionally diagnosed NDD in China. For this study, NDDs included the following diagnoses, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, American Psychiatric Association, 2013): communication disorders, ASD, ADHD, specific learning disorder, intellectual developmental disorder, global developmental delay, motor disorders, and tic disorders. All participants provided informed consent for their involvement and received a gift valued at 10 RMB as compensation for their time. Ethics approval was granted by the Human Research Ethics Committee of the first author’s institution.

The mean age of the participants was 35.55 years (SD = 8.53), with over 67% identifying as female caregivers. The majority of participants were married, held secondary to tertiary education, reported a monthly income below 15,000 RMB, and had a child under the age of 12. The most common child NDD was ADHD (53.58%), followed by intellectual disability (45.73%), ASD (40.61%), visual/auditory/speech disabilities (38.57%), and other chronic conditions.

A series of confirmatory factor analyses (CFAs) were performed using Mplus 8 to examine the factor structure of the Chinese version of the IERQ. Prior validation studies on the IERQ found substantial correlations among the four factors (e.g., Hofmann et al., 2016; Koç et al., 2019; Messina et al., 2022; Sarısoy-Aksüt & Gençöz, 2022; Ray-Yol et al., 2023), suggesting that there may exist a general IER factor. Moreover, as Chinese culture is relationship-oriented and emphasizes social networks (Lam et al., 2016), Chinese people may regularly utilize their interpersonal networks in any ways to regulate their emotions. Hence, a general IER factor may be especially relevant in Chinese culture. In this light, this study examined several alternative factor models (one-factor, second-order, and bi-factor models) involving a general IER factor apart from the hypothesized four-factor model. The following factor models were tested: (a) a one-factor model in which all items loaded on a general factor, (b) the hypothesized four-factor model, (c) a second-order factor model in which the four first-order factors loaded on a second-order general factor, and (d) a bi-factor model in which all items loaded on both the four specific factors and a general factor.

A combination of fit indices was used for model evaluation. A CFA > 0.95, a TLI > 0.95, a RMSEA < 0.06, and a SRMR < 0.08 indicate an adequate model fit (Hu & Bentler, 1999). The Akaike information criterion (AIC), which can compare nested or non-nested models, was used for model comparison. A lower AIC value reflects a better model fit, with a change in AIC (ΔAIC) > 2 indicating a significant difference across two models (Burnham & Anderson, 2004; Li et al., 2024).

Internal consistency reliability of the IERQ factors were evaluated using Cronbach’s α and McDonald’s ω coefficients. The concurrent validity of the IERQ factors with cognitive ER was examined using correlations. The explanatory power of the IERQ factors for quality of life was examined using correlations and hierarchical regression analyses.

The results of the CFAs are summarized in Table 2. The bi-factor model yielded the smallest AIC value, which was significantly smaller than those of the one-factor model (ΔAIC = 147.87), four-factor model (ΔAIC = 18.53), and the second-order model (ΔAIC = 18.71), suggesting that the bi-factor model achieved the best model fit. The bi-factor model demonstrated an excellent goodness-of-fit, χ²(150) = 229.68, p <.001, CFI = 0.97, TLI = 0.96, RMSEA = 0.043, 90% CI [0.031, 0.053], SRMR = 0.034, AIC = 16087.36. The bi-factor model is depicted in Fig. 1. All standardized factor loadings on the general IERQ factor were > 0.30 (0.63 to 0.80) and were stronger than those on the four specific factors. These results provided support for the bi-factor structure of the Chinese version of the IERQ.

The descriptive statistics and reliability coefficients for the IERQ factors are presented in Table 3. High reliability coefficients were found for enhancing positive affect, soothing, perspective taking, social modeling, and the overall IERQ score (Cronbach’s αs = 0.82 to 0.95, McDonald’s ωs = 0.82 to 0.95). All items had item-rest correlations > 0.30 (0.56 to 0.76). The reliability coefficients could not be increased by dropping any item. These results demonstrated adequate internal consistency reliability for the Chinese version of the IERQ.

The concurrent validity of the IERQ factors was evaluated by investigating their correlations with the CERQ (see Table 4). The nine subscales of the CERQ and the two higher-order adaptative and maladaptive CERQ scales (Cronbach’s αs = 0.65 to 0.88, McDonald’s ωs = 0.65 to 0.88) exhibited acceptable internal consistency reliability (see Table 4). Enhancing positive affect was positively correlated with the CERQ factors (rs = 0.19 to 0.61, ps < 0.01) except other-blame (r =.11, p =.069). Soothing was positively correlated with the CERQ factors (rs = 0.27 to 0.52, ps < 0.001) except physical health (r =.09, p =.114). Perspective taking (rs = 0.28 to 0.63, ps < 0.001), social modeling (rs = 0.22 to 0.63, ps < 0.001), and the overall IERQ score (rs = 0.24 to 0.65, ps < 0.001) were positively correlated with all of the CERQ factors. Taken together, the results were supportive of the concurrent validity of the Chinese version of the IERQ with cognitive ER strategies.

The correlations between IERQ factors and the WHOQOL-BREF factors were examined. The four subscales and the overall scale of the WHOQOL-BREF (Cronbach’s αs = 0.68 to 0.92, McDonald’s ωs = 0.68 to 0.93) yielded acceptable internal consistency reliability (see Table 4). Soothing was positively correlated with the WHOQOL-BREF factors (rs = 0.21 to 0.33, ps < 0.001) except physical health (r =.09, p =.114). Enhancing positive affect (rs = 0.20 to 0.33, ps < 0.001), perspective taking (rs = 13 to 0.32, ps < 0.05), social modeling (rs = 0.16 to 0.34, ps < 0.01) and the overall IERQ score (rs = 0.16 to 0.36, ps < 0.01) were positively correlated with the WHOQOL-BREF factors.

To assess the IERQ factors’ explanatory power for overall quality of life above and beyond adaptative and maladaptive cognitive ER strategies, a series of hierarchical regression analyses were conducted. In each hierarchical regression model, adaptative and maladaptive CERQ subscales were entered in the first step, and an IERQ factor was entered in the second step. As shown in Table 5, enhancing positive affect (ΔR² = 0.02, β = 0.17, p =.010), soothing (ΔR² = 0.03, β = 0.19, p =.002), perspective taking (ΔR² = 0.02, β = 0.17, p =.013), social modeling (ΔR² = 0.02, β = 0.18, p =.007), and the overall IERQ score (ΔR² = 0.03, β = 0.22, p =.001) positively predicted overall quality of life after controlling for adaptative and maladaptive cognitive ER strategies. These results supported the explanatory power of the Chinese version of the IERQ for quality of life over the CERQ.

Regarding internal consistency, our results align with previous studies, demonstrating very good internal consistency for both the four subscales and the overall scale of the Chinese IERQ. Each item within the subscales contributes positively to internal consistency, as removing any single item did not enhance reliability. These findings confirm that the IERQ effectively measures the constructs being studied.

It can be concluded that the IERQ demonstrates good concurrent validity when examining its relationship with conceptually related but distinct constructs, such as intrapersonal ER. Our analysis extended the examination of associations between the IERQ and other cognitive ER strategies beyond reappraisal (Hofmann et al., 2016; Koç et al., 2019). We found that IER strategies strongly correlated with adaptive cognitive ER strategies (reappraisal, positive refocusing, acceptance, putting into perspective) and weakly with maladaptive strategies (other-blame, self-blame, catastrophizing, rumination). This supports the notion that individuals frequently employ both intrapersonal and interpersonal ER strategies in their daily lives (Zaki & Williams, 2013). Furthermore, the stronger associations observed between IER strategies and adaptive cognitive ER suggest that these strategies may facilitate the transmission of effective emotion management techniques across dynamic interpersonal interactions (Petrova & Gross, 2023).

The results of the CFAs indicated that the bi-factor model emerged as the best-fit model compared to alternative models (one-factor, four-factor, and second-order). This finding suggests that the Chinese version of the IERQ includes a general factor reflecting the overall use of IER strategies, alongside four specific grouping factors that measure distinct IER: enhancing positive affect, perspective-taking, soothing, and social modeling among Chinese caregivers. One possible explanation for this result is that Chinese individuals are relationship-oriented and place a high value on interpersonal relationships (Lam et al., 2016). Consequently, they may regularly rely on their social connections to regulate their emotions and employ a variety of IER strategies. This speculation merits further investigation. Notably, past validation studies of the IERQ have not examined a bi-factor structure despite substantial correlations among the four factors (e.g., Hofmann et al., 2016; Koç et al., 2019; Messina et al., 2022; Sarısoy-Aksüt & Gençöz, 2022; Ray-Yol et al., 2023). Future work is required to investigate whether the bi-factor structure of the IERQ observed in this study is applicable across different cultural contexts.

We compared the mean values of each of the four subscales of the IERQ observed in this study with those reported in previous studies (see Table 6). Our findings indicated that Chinese caregivers were less likely to utilize enhancing positive affect compared to Turkish and American general adult samples as well as Iranian clinical samples. Additionally, relatively lower utilization of soothing and social modeling was observed when compared to the Turkish general sample and the Iranian clinical sample. Interestingly, the utilization of perspective-taking was found to be comparable across all four samples. Abasi et al. (2023) highlighted that non-clinical groups scored significantly higher on enhancing positive affect and social modeling than clinical groups, suggesting that individuals experiencing heightened psychological distress may engage less in enhancing positive affect and social modeling. Our results may imply that Chinese caregivers of children with NDDs are at a high risk of developing clinical symptoms and may exhibit little intention to share their positive emotions and experiences with others.

Limited use of enhancing positive affect and social modeling among Chinese caregivers of children with NDDs may stem from social isolation and lack of support, exacerbated by the absence of comprehensive health coverage and rehabilitative services (Wang et al., 2013). Cultural factors may also be the reasons for the less utilization. Influenced by Confucianism, Chinese individuals often utilize emotion suppression to maintain social harmony (Soto et al., 2011). They may prioritize emotional control and experience lower arousal emotions compared to Western counterparts (Garrett-Peters & Fox, 2007), potentially reducing their tendency to share positive emotions. Moreover, “face concern” may further hinder help-seeking and open communication (Mak & Chen, 2006), contributing to low perceived social support and increased emotional difficulties, including exhaustion and dysregulation (Keleynikov et al., 2023). This highlights the urgent need for culturally sensitive support mechanisms that can address the unique challenges faced by Chinese caregivers, fostering an environment where they can seek help and express their emotions without fear of judgment.

We found that all four IER strategies significantly contributed to parental quality of life. The beneficial function of enhancing positive affect is consistent with previous studies (e.g., Hofmann et al., 2016; Chan & Rawana, 2021). Research on positive ER (Verzeletti et al., 2016) and the broaden-and-build theory (Fredrickson, 2004) suggests that cultivating positive emotions helps build lasting resources, and foster resilience against negative ones. Social sharing of positive emotions and experiences can amplify the savoring of these emotions, strengthen social connections, foster reciprocal friendship, and enhance a sense of belongness, contributing to a higher quality of life (Gable et al., 2018; Quoidbach et al., 2010). For example, a study among Israeli mothers of children with ASD found a negative association between social sharing of positive emotions and loneliness (Laslo-Roth et al., 2023).

The findings regarding the positive impacts of perspective-taking, social modeling, and soothing on quality of life, while echo some previous studies revealing positive effects of IER on well-being (Chan & Rawana, 2021; Yang & Maccann, 2024), contrast with other studies revealing a positive or null relationship between IER and mental health symptoms (e.g., Abasi et al., 2023). The inconsistent findings may arise from the distinct constructs of negative and positive indicators of mental health, as argued by Burns et al. (2022). While individuals experiencing more psychological symptoms, such as depression and anxiety, may employ more IER strategies to cope, this could lead to improved psychological and physical health, as well as better social relationships. Furthermore, the mechanisms linking IER strategies to well-being and negative symptoms warrant further investigation. One study conducted by Messina et al. (2023) found that greater use of IER strategies impact depressive symptoms via inducing difficulties with IER (e.g., venting and reassurance seeking), but the strategies themselves were not directly associated with symptoms. Future research should clarify whether the effects of IER on mental health outcomes are driven by the direct use of these strategies or by secondary adaptive/maladaptive psychosocial processes resulting from their use.

Cultural and socio-contextual factors may also contribute to the inconsistent findings. Most studies showing a positive relationship between IER strategies and negative mental health outcomes, or a negative relationship with well-being, have focused on Western populations (e.g., American and Italian samples; Hofman, 2016; Messina et al., 2022). Conversely, studies conducted in Asian, and especially Chinese, populations (Yang & Maccann, 2024; Chan & Rawana, 2021) have suggested a more positive role for IER strategies. This difference may stem from the greater value placed on interpersonal support in Chinese culture, rooted in collectivist values and an emphasis on interpersonal harmony. According to the stress and coping perspective (Lazarus & Folkman, 1984) and the model of thriving through relationships (Feeney & Collins, 2015), perceiving and receiving social support provide a safe environment for individuals to cope with frustration and depression, thereby easing parenting stress (Lederberg & Golbach, 2002). Such a supportive and secure environment is believed to be especially critical for the well-being of Chinese parents of children with NDDs, given the heightened levels of stress, isolation and social stigma they often face (Feaster & Franzen, 2020).

Our study showed a bi-factor model of IER among Chinese parents of children with developmental concerns, implying that Chinese people may generally use others in the social network to engage in ER. We also revealed that the four factors were positively associated with the quality of life of this group of parents. The findings could inform the development of interventions that target to enhance parents’ IER strategies. One effective approach to enhancing their utilization of IER is the establishment of community-based support networks. These networks can provide a platform for parents to share experiences, resources, and coping strategies. For instance, creating parent support groups that focus on shared experiences related to NDDs can foster a sense of belonging and understanding among participants, which is vital for emotional support (Faden et al., 2023; Flores-Buils & Andrés-Roqueta, 2022). Moreover, public campaigns that educate the community about the nature of NDDs and the challenges faced by affected families can foster a more supportive environment (Van Herwegen et al., 2018). This can encourage community members to engage with and support families, thereby expanding the social support network available to parents. For example, Anthony and Campbell (2020) proposed a collaborative framework for supporting families with a child having developmental concerns. This approach involves interdisciplinary collaboration among social workers, special educators, and other professionals. By fostering active family participation, establishing collaborative family goals, and creating a cohesive support network across home, school, and community settings, parents and caregivers will feel more confident and secure in navigating available resources and utilizing interpersonal strategies to regulate negative emotions and manage caregiving stress.

This study has several limitations that should be considered. First, the absence of negative measures of well-being makes it challenging to clarify the mixed relationships between the subscales of the IERQ and mental health symptoms within Chinese culture. Future research should further investigate how IER correlates with mental health symptoms among the Chinese population. Second, this study focused solely on Chinese caregivers of children with NDDs. To enhance the applicability of the scale and the generalizability of the findings, future studies should replicate this research among the broader Chinese population. Third, because of the limited number of male participants, this study could not explore potential gender differences in the use of IER strategies. Therefore, future research should aim to include a balanced number of male and female participants to investigate any gender-related variations in these strategies. Fourth, as this study adopted a cross-sectional design, the observed beneficial impacts of the IER strategies on quality of life were simply correlational rather than directly causative. Future longitudinal research is needed to clarify the causality of the relationship between IER strategies and quality of life.