Behavioral mediators of stress-related mood symptoms in adolescence & young adulthood

• Published in: Journal of affective disorders 2021-11, Vol.294, p.94-102
• Main Authors: Peterson, Elena C., Rosenberg, Benjamin M., Hough, Christina M., Sandman, Christina F., Neilson, Chiara, Miklowitz, David J., Kaiser, Roselinde H.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Affect; Behavior; Bipolar Disorder; Depression; Humans; Impulsive Behavior; Mediation; Mood; Stress; Young Adult
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2021.06.079

•Social withdrawal mediates the relationship between daily stress and anhedonia.•Impulsivity mediates the relationship between daily stress and manic symptoms.•Data-driven clustering reveals subgroups with distinct profiles of stress reactivity.•Stress-reactivity subgroups extend and complement diagnostic categories.•Clustering reveals prevalence of mixed symptom courses within unipolar diagnoses. Stress is a risk factor for unipolar and bipolar mood disorders, but the mechanisms linking stress to specific symptoms remain elusive. Behavioral responses to stress, such as impulsivity and social withdrawal, may mediate the associations between stress and particular mood symptoms. This study evaluated behavioral mediators of the relationship between self-reported intensity of daily stress and mood symptoms over up to eight weeks of daily diary surveys. The sample included individuals with unipolar or bipolar disorders, or with no psychiatric history (n = 113, ages 15–25). Results showed that higher daily stress was related to higher severity of mania, and this pathway was mediated by impulsive behaviors. Higher stress also predicted higher severity of anhedonic depression, and social withdrawal mediated this relationship. A k-means clustering analysis revealed six subgroups with divergent profiles of stress-behavior-symptom pathways. Given the observational study design, analyses cannot determine causal relationships amongst these variables. Further work is needed to determine how relationships between these variables may vary based on stressor type, at different timescales, and within different populations. Findings support a theoretical model in which impulsivity and social withdrawal act as behavioral mediators of the relationship between stress and mood symptoms. Additionally, distinct patterns of reactivity distinguished subgroups of people vulnerable to particular types of mood symptoms. These results provide novel information about how stress-reactive behaviors relate to specific mood symptoms, which may have clinical relevance as targets of intervention.