Is perfectionism a vulnerability factor for depressive symptoms, a complication of depressive symptoms, or both? A meta-analytic test of 67 longitudinal studies

Decades of research implicates perfectionism in depressive symptoms. Yet, inconsistent findings, underpowered studies, and the tendency for researchers to assume one direction of influence have clouded understanding of whether perfectionism is a vulnerability factor for depressive symptoms, a complication of depressive symptoms, or both. Our primary aim was to address this by using meta-analytic structural equation modeling to test cross-lagged reciprocal relations between depressive symptoms and two perfectionism factors: perfectionistic concerns and perfectionistic strivings. Our secondary aim was to catalyze a search for moderators that might explain heterogeneity by conducting a bivariate random-effects meta-analysis. The literature search yielded 67 longitudinal studies (N = 20,583) composed of undergraduates, community members, medical students, treatment-seeking adults, and patients with mental health problems. The relationship between perfectionistic concerns and depressive symptoms was reciprocal, with perfectionistic concerns predicting increased depressive symptoms and vice versa. In contrast, the relationship between perfectionistic strivings and depressive symptoms was unidirectional, with perfectionistic strivings conferring vulnerability for depressive symptoms, but not the reverse. Clinicians who overlook the reciprocal relationship between perfectionistic concerns and depressive symptoms might miss information vital to accurate conceptualization, assessment, and treatment. Perfectionistic strivings may be distinguishable from perfectionistic concerns by being more in line with classical models of personality vulnerability.