Early warning signals in psychopathology: A replication studyOctober 2020
Early warning signals in psychopathology: what do they tell?
Schreuder, M. J., Hartman, C. A., George, S. V., Menne-Lothmann, C., Decoster, J., van Winkel, R., Delespaul, P., De Hert, M., Derom, C., Thiery, E., Rutten, B. P. F., Jacobs, N., van Os, J., Wigman, J. T. W. , Wichers, M.
Despite the increasing understanding of factors that might underlie psychiatric disorders, prospectively detecting shifts from a healthy towards a symptomatic state has remained unattainable. A complex systems perspective on psychopathology implies that such symptom shifts may be foreseen by generic indicators of instability, or early warning signals (EWS). EWS include, for instance, increasing variability, covariance, and autocorrelation in momentary affective states—of which the latter was studied. The present study investigated if EWS predict (i) future worsening of symptoms as well as (ii) the type of symptoms that will develop, meaning that the association between EWS and future symptom shifts would be most pronounced for congruent affective states and psychopathological domains (e.g., feeling down and depression).
A registered general population cohort of adolescents (mean age 18 years, 36% male) provided ten daily ratings of their affective states for 6 consecutive days. The resulting time series were used to compute EWS in feeling down, listless, anxious, not relaxed, insecure, suspicious, and unwell. At baseline and 1-year follow-up, symptom severity was assessed by the Symptom Checklist-90 (SCL-90). We selected four subsamples of participants who reported an increase in one of the following SCL-90 domains: depression (N=180), anxiety (N=192), interpersonal sensitivity (N=184), or somatic complaints (N=166).
Multilevel models showed that EWS in feeling suspicious anticipated increases in interpersonal sensitivity, as hypothesized. EWS were absent for other domains. While the association between EWS and symptom increases was restricted to the interpersonal sensitivity domain, post hoc analyses showed that symptom severity at baseline was related to heightened autocorrelations in congruent affective states for interpersonal sensitivity, depression, and anxiety. This pattern replicated in a second, independent dataset.
The presence of EWS prior to symptom shifts may depend on the dynamics of the psychopathological domain under consideration: for depression, EWS may manifest only several weeks prior to a shift, while for interpersonal sensitivity, EWS may already occur 1 year in advance. Intensive longitudinal designs where EWS and symptoms are assessed in real-time are required in order to determine at what timescale and for what type of domain EWS are most informative of future psychopathology.
- early warning signals
- momentary affective states
- experience sampling
- complex systems
- symptom development
Citation and link to full-text article
Schreuder, M.J., Hartman, C.A., George, S.V., Menne-Lothmann, C., Decoster, J., van Winkel, R., Delespaul, P., De Hert, M., Derom, C., Thiery, E., Rutten, B.P.F., Jacobs, N., van Os, N., Wigman, J.T.W., Wichers, M. (2020). Early warning signals in psychopathology: what do they tell? BMC Medicine, _18(269), 1-11. 10.1186/s12916-020-01742-3.
TRAILS TRANS-ID: a six-month daily diary study in young adults at increased risk for mental health problemsJuli 2020
Measuring psychopathology as it unfolds in daily life: addressing key assumptions of intensive longitudinal methods in the TRAILS TRANS-ID study
Schreuder, M.J., Groen, R.N., Wigman, J.T.W., Hartman, C.A., Wichers, M.
Intensive longitudinal (IL) designs provide the potential to study symptoms as they evolve in real-time within individuals. This has promising clinical implications, potentially allowing conclusions at the level of specific individuals. The current study aimed to establish the feasibility of IL designs, as indicated by self-rated burden and attrition, in the context of psychiatry. Additionally, we evaluated three core assumptions about the instruments (diary items) used in IL designs. These assumptions are: diary items (1) reflect experiences that change over time within individuals (indicated by item variability), (2) are interpreted consistently over time, and (3) correspond to retrospective assessments of psychopathology.
TRAILS TRANS-ID is an add-on IL study in the clinical cohort of the TRAILS study. Daily diaries on psychopathological symptoms for six consecutive months were completed by 134 at risk young adults (age 22.6 ± 0.6 years). At baseline, immediately after the diary period, and one year after the diary period, participants completed a diagnostic interview.
Excellent compliance (88.5% of the diaries completed), low participant burden (M = 3.21; SD = 1.42; range 1–10), and low attrition (8.2%) supported the feasibility of six-month IL designs. Diary items differed in their variability over time. Evaluation of the consistency of diary item interpretations showed that within-individual variability in scores could not be attributed to changing interpretations over time. Further, daily symptom reports reasonably correlated with retrospective assessments (over a six month period) of psychopathology obtained with the diagnostic interview, suggesting that both measures might complement each other.
The current study is the first to show that IL designs over extensive periods (i.e., multiple months) in psychiatry are feasible, and meet three core assumptions to study change in psychopathology. This might allow for addressing novel and promising hypotheses in our field, and might substantially alter how we treat and study mental ill-health.
- daily diary studies
- transdiagnostic psychopathology
- at risk mental state
- intensive longitudinal methods
- personalized designs
- young adulthood
Citation and link to full-text article
Schreuder, M.J., Groen, R.N., Wigman, J.T.W., Hartman, C.A., Wichers, M. (2020). Measuring psychopathology as it unfolds in daily life: addressing key assumptions of intensive longitudinal methods in the TRAILS TRANS-ID study. BMC Psychiatry, 20(351), 1-14. 10.1186/s12888-020-02674-1.
Sudden gains in day-to-day changeFebruary 2020
Revealing nonlinear patterns of individual improvement in depression
Helmich, M. A., Wichers, M., Olthof, M., Strunk, G., Aas, B., Aichhorn, W., Schiepek, G. Snippe, E.
We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response.
Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score ≤1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory.
138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders.
At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles.
- treatment response
- idiographic change pattern
- sudden gains
- daily assessments
Citation and link to full-text article
Helmich, M. A., Wichers, M., Olthof, M., Strunk, G., Aas, B., Aichhorn, W., Schiepek, G. Snippe, E. (2020). Sudden gains in day-to-day change: Revealing nonlinear patterns of individual improvement in depression. Journal of Consulting and Clinical Psychology, 88(2), 119–127. 10.1037/ccp0000469
As of May 1st 2017 the TRANS-ID project has officially started. People can now sign up for participation in the TRANS-ID Tapering and TRANS-ID Recovery projects.
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Interview: Marieke WichersDecember 6th, 2016
Op 6 december 2016 hield Marieke Wichers, hoogleraar Dynamiek van emotieregulatie en psychopathologie bij het ICPE (RUG) haar oratie met als titel “Durven zoeken in het donker; op weg naar een kantelpunt in de psychiatrie”.
Is er een kans dat u een psychiatrische stoornis ontwikkelt? En zo ja, is dan te voorspellen wanneer er weer verbetering optreedt? Hoogleraar Marieke Wichers gaat de symptomen van stoornissen live volgen om dat uit te zoeken.