Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder

Abstract

Background and objectives: Dysregulated affect is a hallmark feature of acute episodes of bipolar disorder (BD) and persists during inter-episode periods. Its contribution to course of illness is not yet known. The present report examines the prospective influence of inter-episode affect dysregulation on symptoms and functional impairment in BD.

Methods: Twenty-seven participants diagnosed with inter-episode bipolar I disorder completed daily measures of negative and positive affect for 49 days (±8 days) while they remained inter-episode. One month following this daily assessment period, symptom severity interviews and a measure of functional impairment were administered by telephone.

Results: More intense negative affect and positive affect during the inter-episode period were associated with higher depressive, but not manic, symptoms at the one-month follow-up assessment. More intense and unstable negative affect, and more unstable positive affect, during the inter-episode period were associated with greater impairment in home and work functioning at the follow-up assessment. All associations remained significant after controlling for concurrent symptom levels.

Limitations: The findings need to be confirmed in larger samples with longer follow-up periods. A more comprehensive assessment of functional impairment is also warranted.

Conclusions: The findings suggest that a persistent affective dysregulation between episodes of BD may be an important predictor of depression and functional impairment. Monitoring daily affect during inter-episode periods could allow for a more timely application of interventions that aim to prevent or reduce depressive symptoms and improve functioning for individuals with BD.

Keywords: Affect; Bipolar disorder; Depressive symptoms; Illness course; Longitudinal study.

Figure 1

Flow chart demonstrating measures used to assess participants at each assessment point. SCID-IV = Structured Clinical Interview for DSM–IV; IDS-C = Inventory of Depressive Symptomatology – Clinician Rating; YMRS = Young Mania Rating Scale; WSAS = Work and Social Adjustment Scale.