Abstract
There is increasing interest in day-to-day affect fluctuations of patients with depressive and anxiety disorders. Few studies have compared repeated assessments of positive affect (PA) and negative affect (NA) across diagnostic groups, and fluctuation patterns were not uniformly defined. The aim of this study is to compare affect fluctuations in patients with a current episode of depressive or anxiety disorder, in remitted patients and in controls, using affect instability as a core concept but also describing other measures of variability and adjusting for possible confounders. Ecological momentary assessment (EMA) data were obtained from 365 participants of the Netherlands Study of Depression and Anxiety with current (n = 95), remitted (n = 178) or no (n = 92) DSM-IV defined depression/anxiety disorder. For 2 weeks, five times per day, participants filled-out items on PA and NA. Affect instability was calculated as the root mean square of successive differences (RMSSD). Tests on group differences in RMSSD, within-person variance, and autocorrelation were performed, controlling for mean affect levels. Current depression/anxiety patients had the highest affect instability in both PA and NA, followed by remitters and then controls. Instability differences between groups remained significant when controlling for mean affect levels, but differences between current and remitted were no longer significant. Patients with a current disorder have higher instability of NA and PA than remitted patients and controls. Especially with regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation.
Highlights
Depressive and anxiety disorders as they are currently classified (DSM diagnosis) are heterogeneous in terms of symptomatology (Fried, 2017), underlying pathophysiological mechanisms, and clinical course (Jentsch et al, 2015; Verduijn et al, 2017)
The group with a current disorder consisted of 28.4% who had only had a depressive disorder, 40% only an anxiety disorder, and 31.6% with combined disorders
The aim of this paper was to describe affect fluctuations, and affect instability of positive affect (PA) and negative affect (NA), in a large and wellphenotyped cohort of patients with depressive and anxiety disorders and controls. We examined whether these patterns of affect fluctuations are different for patients who are in a current episode, remitted patients and healthy controls
Summary
Depressive and anxiety disorders as they are currently classified (DSM diagnosis) are heterogeneous in terms of symptomatology (Fried, 2017), underlying pathophysiological mechanisms, and clinical course (Jentsch et al, 2015; Verduijn et al, 2017). Depressive and anxiety disorders often co-occur (Kessler et al, 2003) and patients with different diagnoses may show overlapping symptom profiles (Wardenaar & de Jonge, 2013) This lack of diagnostic specificity likely plays a role in the overall modest efficacy of current psychological and pharmacological treatments (Driessen, Hollon, Bockting, Cuijpers, & Turner, 2015; Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008). To add to this complexity, symptoms that patients experience may show considerable variation over time (Ben-Zeev & Young, 2010; Thompson et al, 2012). With regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation
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