Monitoring Emotional Intensity and Variability to Forecast Depression Recurrence in Real Time in Remitted Adults

• Published in: Journal of consulting and clinical psychology 2024-08, Vol.92 (8), p.505-516
• Main Authors: Schreuder, Marieke J., Schat, Evelien, Smit, Arnout C., Snippe, Evelien, Ceulemans, Eva
• Format: Article
• Language: English
• Subjects: Arousal; Emotional regulation; Emotions; Female; Human; Male; Mental depression; Negative Emotions; Positive Emotions; Recurrence; Recurrent; Recurrent Depression; Statistical process control; Warnings
• ISSN: 0022-006X; 1939-2117; 1939-2117
• DOI: 10.1037/ccp0000871

Objective: Recurrent depressive episodes are preceded by changing mean levels of repeatedly assessed emotions (e.g., feeling restless), which can be detected in real time using statistical process control (SPC). This study investigated whether monitoring changes in the standard deviation (SD) of emotions and negative thinking improves the early detection of recurrent depression. Method: Formerly depressed adults (N = 41) monitored their emotions five times a day for 4 consecutive months. During the study, 22 individuals experienced recurrent depression. We used SPC to detect warning signs (i.e., changing means and SDs) of four emotions (positive and negative affect with high or low arousal) and negative thinking. Results: SD-based warning signs only preceded 23%-36% of recurrences, but almost never reflected a false alarm (0%-16%). Correspondingly, SD-based warnings had a high specificity (at the cost of sensitivity), while mean-based warnings had a higher sensitivity (but lower specificity). There was little overlap in mean- and SD-based warning signs. For the majority of emotions, monitoring for high SDs alongside monitoring changes in mean levels improved the detection of depression (p < .015) compared to when only monitoring for changing mean levels. Conclusions: Warning signs for depression manifest not only in changing mean levels of emotions and cognitions but also in increasing SDs. These warnings could eventually be used to detect not just who is at increased risk for depression but also when risk is rising. Further research is needed to evaluate the clinical utility of depression SPC. What is the public health significance of this article? Changes in the mean levels of self-reported emotions precede recurrent depressive episodes and are therefore considered warning signals. This study shows that the early detection of recurrent depression improves when warning signals are not only tracked in the mean but also in the variability of emotions. Thus, monitoring for both changes in emotional intensity and variability may aid the early detection, and possibly the prevention, of depression.