Ecological momentary assessment of the relationships between social activity and mood in bipolar disorder

Abstract

Abstract Bipolar disorder is associated with significant impairment in social functioning. The temporal sequence of day-to-day interrelationships between mood and social activity is not well understood, yet could inform targets for cognitive behavioral interventions. The present study examined associations between mood and social activity in real-time through ecological momentary assessments administered via smartphones. In all, 41 outpatients with bipolar disorder were provided with smartphones for 11 weeks and completed twice-daily surveys about affective symptoms and social activity. We assessed the ways in which symptoms at baseline are related to the frequency and type of social interactions in the EMA period. Furthermore, we analyzed the associations between social activity, concurrent and lagged self-ratings of mood state, and momentary positive and negative affect ratings. Participants’ mean (and SD) age was 46.9 (11.8) years, with 53.7% being women. Participants spent an average of 42% of their sampled time alone. The average time spent alone was lower for hypo/manic symptoms (36%) than for depressive symptoms (45%) with euthymic mood intermediate between the two (40%). Positive affect was higher and negative affect (e.g., sadness, anger) was lower during concurrent social interactions. Positive affect was lower during time spent alone, but negative affect did not differ from time spent alone or from other interactions. Lagged models indicated a stronger association between prior social activity and subsequent mood than the converse. Social activity tracked mood polarity over several months. More support was found for social activity influencing mood state compared to the converse. Monitoring social activity may facilitate targeted cognitive behavioral interventions in bipolar disorder.