Determinants of depressive mood states in everyday life: An experience sampling study

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

BACKGROUND

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.

METHODS

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

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.

LIMITATIONS

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.

CONCLUSIONS

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.

Predictors of affect following discharge from partial hospitalization: a two-week ecological momentary assessment study

BACKGROUND

Little is known about the everyday experiences of individuals transitioning from acute to outpatient psychiatric care, an important period of risk for mood symptom relapse. This study used ecological momentary assessment (EMA) to examine whether specific daily experiences were related to momentary affective states following discharge from a partial hospitalization program (PHP).

METHODS

A sample of 114 adults (Mage = 36 years old, 52% female, 83% White) completed four brief EMA surveys every day for 2 weeks assessing intensity/type of stressful events and social contact, as well as positive/negative affect (PA/NA). Half of participants reported therapeutic skills use.

RESULTS

Stress severity ratings prospectively predicted increased NA. NA predicted spending less time with close relationships. However, interacting with close relationships predicted increased positive affect (PA). Finally, PA predicted spending time with more people. The use of two skills (behavioral activation and interpersonal effectiveness) was concurrently, but not prospectively, associated with improved affect.

CONCLUSIONS

Examining daily experiences of individuals discharging from partial hospitalization provides important information about factors that may influence affective states during the transition from acute to outpatient care. Findings from this study can be used to help prepare patients for discharge and develop interventions for the post-acute period.

Body image in and out of the lab: Correspondence between lab-based attentional bias data and body shape dissatisfaction experiences in daily life

Accumulating lab-based studies have identified attentional biases in processing of negative appearance-related information among individuals with elevated trait body shape and weight dissatisfaction (BD). How these biases translate into experiences of BD in daily life remains unclear and, hence, was the focus of the present study. Thirty-eight women aged between 18-40 years completed a baseline survey and modified dot-probe task with both fat and thin appearance-related stimuli in a laboratory setting. Participants also downloaded a smartphone app that prompted them 10 times per day for 7 days to rate current body dissatisfaction. Results revealed that heightened BD in daily life tended to be transitory, and followed by a substantially lower rating of BD by the next survey (∼1-2 h later). For individuals with elevated trait BD and facilitated attention towards thin body images, this reduction in state BD was more gradual. Surprisingly, delayed disengagement towards thin body images was associated with greater reduction in state BD. Consistent with the hypothesis, moderating effects were not observed when initial state BD level was low. Susceptibility for immediate, short-term attentional biases towards appearance-related information may be a vulnerability factor for the prolonged persistence of negative body image experiences in daily life.

Body image states in everyday life: Evidence from ecological momentary assessment methodology

This review highlights the contributions of Professor Thomas Cash to the scholarship of body image experiences in daily life, including his influence on subsequent research in this field. Cash's arguments for capturing a broad range of state-based body image experiences have been heeded, with recent studies exploring positive body image constructs as well as the more studied negative body image experiences. Appearance comparisons are the most commonly studied contextual influence on body image, and they seem to have a consistent effect. However, the experiences of body image in sexual contexts, and among adolescents, those who are pregnant, or have other physical characteristics that may increase the salience of appearance warrant further attention. Findings generally support Cash's contention that trait body image relates to likelihood and level of experience of body image in daily life, though the moderating effects of trait aspects on state-based relationships remains unclear. The discussion concludes with consideration of the impact of assessment schedules on obtained results. It is also discussed how accumulated knowledge regarding state-based body image experiences may be leveraged in treatment contexts, particularly in light of clear evidence that repeated assessment of body image in daily life increases self-awareness of one's body image characteristics.

Trait body image flexibility as a predictor of body image states in everyday life of young Australian women

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons, drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.

Appearance comparison and other appearance-related influences on body dissatisfaction in everyday life

Although appearance comparisons, self-monitoring, and appearance-related comments have been linked to body dissatisfaction in prior studies, the combined and unique influences of these variables on state body dissatisfaction in daily life has yet to be explored. The present study addressed this gap, and also evaluated whether these state-based effects were stronger for individuals with trait-level body image disturbances (internalization and body dissatisfaction). Eighty-four women completed baseline measures of trait internalization and body dissatisfaction, and then reported momentary experiences of body dissatisfaction, appearance self-monitoring, appearance-related comments, and appearance-based comparisons at up to 10 random times daily for seven days. Multilevel analyses confirmed that both appearance comparisons and commentary (both negative and positive) were predictive of changes in state body dissatisfaction when modelled individually as well as in a combined (full) model. Appearance self-monitoring was not a significant predictor, either individually or in the full model. These within-person relationships were not moderated by individual differences in trait body dissatisfaction and internalization of appearance standards. Accordingly, experiences of body dissatisfaction in daily life may be a common reaction to negative appearance comments and unflattering comparisons, yet positive comments and/or efforts to avoid appearance-based comparisons may have a positive effect on one's body image.

Ecological Momentary Assessment Using Smartphone-Based Mobile Application for Affect and Stress Assessment

Objectives

This study aimed to describe the process of utilizing a mobile application for ecological momentary assessment (EMA) to collect data on stress and mood in daily life setting.

Methods

A mobile application for the Android operating system was developed and installed with a set of questions regarding momentary mood and stress into a smartphone of a participant. The application sets alarms at semi-random intervals in 60-minute blocks, four times a day for 7 days. After obtaining all momentary affect and stress, the questions to assess the usability of the mobile EMA application were also administered.

Results

The data were collected from 97 police officers working in Gyeonggi Province of South Korea. The mean completion rate was 60.0% ranging from 3.5% to 100%. The means of positive and negative affect were 18.34 of 28 and 19.09 of 63. The mean stress was 17.92 of 40. Participants responded that the mobile application correctly measured their affect (4.34 ± 0.83) and stress (4.48 ± 0.62) of 5-point Likert scale.

Conclusions

Our study investigated the process of utilizing a mobile application to assess momentary affect and stress at repeated times. We found challenges regarding adherence to the research protocol, such as completion and delay of answering after alarm notification. Despite this inherent issue of adherence to the research protocol, the EMA still has advantages of reducing recall bias and assessing the actual moment of interest at multiple time points that improves ecological validity.