The intra-day dynamics of affect, self-esteem, tiredness, and suicidality in Major Depression

Abstract

Despite growing interest in the temporal dynamics of Major Depressive Disorder (MDD), we know little about the intra-day fluctuations of key symptom constructs. In a study of momentary experience, the Experience Sampling Method captured the within-day dynamics of negative affect, positive affect, self-esteem, passive suicidality, and tiredness across clinical MDD (N= 31) and healthy control groups (N= 33). Ten symptom measures were taken per day over 6 days (N= 2231 observations). Daily dynamics were modeled via intra-day time-trends, variability, and instability in symptoms. MDD participants showed significantly increased variability and instability in negative affect, positive affect, self-esteem, and suicidality. Significantly different time-trends were found in positive affect (increased diurnal variation and an inverted U-shaped pattern in MDD, compared to a positive linear trend in controls) and tiredness (decreased diurnal variation in MDD). In the MDD group only, passive suicidality displayed a negative linear trend and self-esteem displayed a quadratic inverted U trend. MDD and control participants thus showed distinct dynamic profiles in all symptoms measured. As well as the overall severity of symptoms, intra-day dynamics appear to define the experience of MDD symptoms.

Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies

“… 51 Similarly, daily suicide ideation predicted affective lability at baseline in individuals with BPD, 52 and associations between daily dissociations and suicide risks measured at baseline in adolescent girls with BPD. 53 Crowe, Daly 54 was one study that found people with MDD reported greater increases of daily affect and higher fluctuations in suicidality than people without MDD. Similarly, the study by Hallensleben, Glaesmer 55 found daily depressive symptoms, hopelessness, and perceived burdensomeness were significantly associated with passive and active suicidal ideation in people diagnosed with unipolar depression.…”

Possible Application of Ecological Momentary Assessment to Older Adults’ Daily Depressive Mood: Integrative Literature Review

“…The remainder of the reviewed studies used mixed samples of both younger and older adults, with ages ranging from 18 to 97 years. Some studies involved advanced age groups, such as middle-aged or older adults, with younger participants [ 6 , 7 , 9 , 10 , 13 - 33 ]. The sample size of surveyed studies ranged from 12 to 404, which varied according to study purpose, data collection method, and analysis plans.…”

“…The sample size of surveyed studies ranged from 12 to 404, which varied according to study purpose, data collection method, and analysis plans. Some studies specifically aimed to enroll study participants with depressive mood and relevant mental health problems (7/38, 18%) [ 7 , 9 , 13 , 17 , 23 , 24 , 34 ], other physical health problems or diseases (8/38, 21%) [ 6 , 29 , 31 , 36 , 40 , 43 - 45 ], or chronic pain (2/38, 5%) [ 16 , 25 ], which may be related to depressive mood. Some studies aimed to enroll study participants who had an alcohol or smoking habit (4/38, 11%) [ 22 , 28 , 33 , 46 ] or obesity (2/38, 5%) [ 19 , 20 ].…”

“…Most studies (22/38, 58%) examined depressive mood at baseline using a diverse array of clinically valid screening instruments or established diagnostic criteria. Several screening or diagnostic instruments were used: the Mini International Neuropsychiatric Interview [ 13 , 22 , 50 ]; Hamilton Rating Scale for Depression [ 13 , 29 , 51 ]; Beck Depression Inventory [ 7 , 13 , 48 , 52 , 53 ]; Patient Health Questionnaire (PHQ) [ 39 , 54 ]; Composite International Diagnostic Interview [ 40 , 55 ]; Montgomery-Asberg Depression Rating Scale [ 9 , 56 ]; Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) [ 7 , 17 , 23 , 34 , 57 , 58 ]; Structured Clinical Interview for the DSM-IV-Text Revision [ 10 , 25 , 59 ]; Patient-Reported Outcomes Measurement Information System (PROMIS) [ 34 , 60 ]; Center for Epidemiologic Studies Depression Scale (CES-D) [ 15 , 30 , 36 , 47 , 61 ]; Positive and Negative Affect Schedule (PANAS) [ 49 , 62 ]; Positive and Negative Syndrome Scale [ 24 , 63 ]; Hospital Anxiety and Depression Scale [ 16 , 43 , 64 , 65 ]; and Hamilton Depression Inventory [ 31 , 66 ]. The researchers of each study used this information to describe sample characteristics at baseline or included the data as a controlled variable in their analyses.…”

“…Moore et al [ 12 ] found compatible psychometrics between traditional pen-and-paper and smartphone versions of EMA in emotionally distressed older adults. Among the growing body of EMA research in this area, many studies involved mixed age groups, such as middle-aged or older adults with younger participants [ 6 , 7 , 9 , 10 , 13 - 33 ]. Thus, it is unclear how older adults’ characteristics were reflected during data collection and interpretation using EMA because older adults with mental health problems frequently have decreased self-confidence and less motivation to use new technology [ 34 ].…”