Evyn M. Peters

The Relationship between Mood Instability and Suicidal Thoughts

The objective of this study was to determine whether affective instability predicts suicidal thoughts. Data from a Dutch panel study (N = 1686) was used. Affective instability was assessed with 7 items representing suddenly shifting moods. Suicidal thoughts were assessed by the occurrence of suicidal thoughts in the past week. Negative affect was indexed by anxious, depressed and angry moods extracted by factor analysis. Odds ratios using logistic regression modeling were calculated, adjusting for clinical and demographic variables. The study found that both males (OR: 1.14; 95% CI: 1.02–1.28) and females (OR: 1.11; 95% CI: 1.00–1.23) were more likely to experience suicidal thinking with higher affective instability. Affective instability and negative affect independently predict suicidal thoughts. Affective instability requires more attention in the assessment of suicide risk.

Mood instability underlies the relationship between impulsivity and internalizing psychopathology

Impulsivity, the tendency to act without adequate forethought, has been associated with various internalizing disorders. Mood instability, the tendency to experience rapid and intense mood swings, relates to both internalizing disorders and impulsivity. We hypothesized that the association between mood instability and impulsivity accounts for the relationship between impulsivity and internalizing psychopathology. We conducted two studies to test our hypothesis. In Study 1 we used data from the 2007 Adult Psychiatric Morbidity Survey to examine mood instability in the relationship between depression and impulsivity. Mood instability and impulsivity were assessed with the Structured Clinical Interview for DSM-IV Axis-II Personality Disorders and depression was assessed with the revised Clinical Interview Schedule. In Study 2 we used data from the 1984 and 1991 British Health and Lifestyle Surveys to examine mood instability in the longitudinal relationship between impulsivity and internalizing symptoms. Mood instability and impulsivity were measured with the Eysenck Personality Inventory and internalizing symptoms were assessed with the General Health Questionnaire. In both studies we used a sequential regression analysis to test our hypothesis. Results from Study 1 showed that participants with depression were more likely to report impulsivity, but this effect became nonsignificant when mood instability was included in the same regression model. In Study 2 impulsivity predicted internalizing symptoms seven years in the future, but this effect became nonsignificant after mood instability was included in the same regression model. We conclude that impulsivity relates to internalizing psychopathology largely by being associated with mood instability. Research and therapy for internalizing conditions might be more productively directed at mood instability rather than impulsivity.

Moods in Clinical Depression Are More Unstable than Severe Normal Sadness

Objective Current descriptions in psychiatry and psychology suggest that depressed mood in clinical depression is similar to mild sadness experienced in everyday life, but more intense and persistent. We evaluated this concept using measures of average mood and mood instability (MI). Method We prospectively measured low and high moods using separate visual analog scales twice a day for seven consecutive days in 137 participants from four published studies. Participants were divided into a non-depressed group with a Beck Depression Inventory score of ≤10 (n = 59) and a depressed group with a Beck Depression Inventory score of ≥18 (n = 78). MI was determined by the mean square successive difference statistic. Results Mean low and high moods were not correlated in the non-depressed group but were strongly positively correlated in the depressed group. This difference between correlations was significant. Low MI and high MI were weakly positively correlated in the non-depressed group and strongly positively correlated in the depressed group. This difference in correlations was also significant. Conclusion The results show that low and high moods, and low and high MI, are highly correlated in people with depression compared with those who are not depressed. Current psychiatric practice does not assess or treat MI or brief high mood episodes in patients with depression. New models of mood that also focus on MI will need to be developed to address the pattern of mood disturbance in people with depression.

Affective instability and impulsivity predict nonsuicidal self-injury in the general population: a longitudinal analysis

BackgroundImpulsivity and affective instability are related traits known to be associated with nonsuicidal self-injury, although few longitudinal studies have examined this relationship. The purpose of this study was to determine if impulsivity and affective instability predict future nonsuicidal self-injury in the general population while accounting for the overlap between these traits.MethodsLogistic regression analyses were conducted on data from 2344 participants who completed an 18-month follow-up of the 2000 British National Psychiatric Morbidity Survey. Affective instability and impulsivity were assessed at baseline with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Nonsuicidal self-injury was assessed at baseline and follow-up during semi-structured interviews.ResultsAffective instability and impulsivity predicted the onset of nonsuicidal self-injury during the follow-up period. Affective instability, but not impulsivity, predicted the continuation of nonsuicidal self-injury during the follow-up period. Affective instability accounted for part of the relationship between impulsivity and nonsuicidal self-injury.ConclusionsAffective instability and impulsivity are important predictors of nonsuicidal self-injury in the general population. It may be more useful to target affective instability over impulsivity for the treatment of nonsuicidal self-injury.

Examining the role of borderline personality traits in the relationship between major depression and nonsuicidal self-injury

BACKGROUND Depression and borderline personality disorder (BPD) are highly comorbid conditions that are both associated with nonsuicidal self-injury (NSSI). AIMS The purpose of this study was to determine if depression is associated with NSSI after controlling for BPD traits. A distinction was made between NSSI for emotional regulation and NSSI for interpersonal motives. METHOD Logistic regression analyses were conducted on cross-sectional data from a general population sample of 7370 adults who completed the 2007 Adult Psychiatric Morbidity Survey. Depressive symptoms were assessed with the revised Clinical Interview Schedule. NSSI and motives for NSSI were also assessed during clinical interviews. BPD traits were assessed with the participant-completed Structured Clinical Interview for DSM-IV Axis II Personality Disorders. RESULTS Participants in a major depressive episode were more likely to have engaged in emotional-regulation NSSI and interpersonal NSSI than participants without depression. After controlling for BPD traits depression remained associated with emotional-regulation NSSI, whereas the association with interpersonal NSSI became nonsignificant. There were statistically significant relationships between depression and both types of NSSI occurring indirectly through BPD traits. CONCLUSIONS BPD traits account for a significant portion of the cross-sectional relationship between depression and past NSSI that varies in size depending on the motive for NSSI. People with depression are more likely to have engaged in NSSI for emotional regulation even in the absence of prominent BPD traits. In contrast, BPD traits may be more prominent in people with depression who have engaged in interpersonal NSSI.

Mood Instability Is a Precursor of Relationship and Marital Difficulties: Results from Prospective Data from the British Health and Lifestyle Surveys

The DSM system implies that affective instability is caused by reactivity to interpersonal events. We used the British Health and Lifestyle Survey that surveyed community residents in 1984 and again in 1991 to study competing hypotheses: that mood instability (MI) leads to interpersonal difficulties or vice versa. We analyzed data from 5,352 persons who participated in both waves of the survey. Factor analysis of the Eysenck Personality Inventory neuroticism scale was used to derive a 4-item scale for MI. We used depression measures that were previously derived by factor analyzing the General Health Questionnaire. We tested the competing hypotheses by regressing variables at follow-up against baseline variables. The results showed that MI in 1984 clearly predicted the development of interpersonal problems in 1991. After adjusting for depression, depression becomes the main predictor of spousal difficulties, but MI remains a predictor of interpersonal difficulties with family and friends. Attempts to investigate the reverse hypothesis were ambiguous. The clinical implication is that when MI and interpersonal problems are reported, the MI should be treated first, or at least concurrently.

EPA-1185 – The relationship between mood instability and suicidal thoughts

Introduction Most people who commit suicide suffer from depression, but diagnostic categories and known personal and demographic factors do not adequately capture the distress that leads people to kill themselves. Mood Instability (MI) refers to sudden unpredictable fluctuations in mood often occurring within a day. Objective To determine whether MI predicts suicidal thoughts. Aims Hypothesis: That MI will predict suicidal thoughts even when negative affect (depression, anxiety, anger) are controlled. Method Data from the Dutch Imigrant panel of the Longitudinal Internet Studies for the Social Sciences (LISS-I) (N = 1686) were used. MI was assessed with 7 items from the International Personality Item Pool of Big Five Indicators. The Chronbachs alpha was 0.86. Suicidal thoughts were assessed by a single question referring to the past week. Depression, anxiety and anger were represented by 21 items derived by factor analysis from the 31-item Emotional Expressiveness Module. Odds ratios using logistic regression modeling were calculated, adjusting for negative affect, alcohol and substance abuse, and demographic variables (age, sex, income). Results MI predicts suicidal thoughts (Males OR: 1.14; 95% CI: 1.02-1.28 and females OR: 1.11; 95% CI: 1.00-1.23) along with negative affect. There was no interaction between MI and negative affect. Conclusions MI has been relatively neglected as a predictor of suicidal thoughts. It is likely that the unpredictable, sudden, severe descents in mood are particularly distressing and contribute to the feeling that life is intolerable. MI requires more attention in the assessment and treatment of suicide risk.