Ecological monitoring of emotional intensity, variability, and instability in individuals with schizophrenia spectrum disorders: Results of a multicentre study

Abstract

Background: Evaluating emotional experiences in the life of people with Schizophrenia Spectrum Disorder (SSD) is fundamental for developing interventions aimed at promoting well-being in specific times and contexts. However, little is known about emotional variability in this population. In DiAPAson project, we evaluated between- and within-person differences in emotional intensity, variability, and instability between people with SSD and healthy controls, and the association with psychiatric severity and levels of functioning.

Methods: 102 individuals diagnosed with SSD (57 residential patients, 46 outpatients) and 112 healthy controls were thoroughly evaluated. Daily emotions were prospectively assessed with Experience Sampling Method eight times a day for a week. Statistical analyses included ANOVA, correlations, and generalized linear models.

Results: Participants with SSD, and especially residential patients, had a higher intensity of negative emotions when compared to controls. Moreover, all people with SSD reported a greater between-person-variability of both positive and negative emotions and greater intra-variability of negative emotions than healthy controls. In addition, the emotion variability in people with SSD does not follow a linear or quadratic trend but is more "chaotic" if compared to controls.

Conclusions: Adequate assessments of positive and negative emotional experiences and their time course in people with SSD can assist mental health professionals with well-being assessment, implementing targeted interventions through the identification of patterns, triggers, and potential predictors of emotional states.

Keywords: emotional instability; emotional variability; experience sampling method; prospective design; psychosis.

FIGURE 1

Color‐coded of Positive and Negative Emotions' ratings of patients with schizophrenia spectrum disorders (SSD) and healthy controls over the 7‐Day monitoring. Each row represents a subject, and each square represents an hourly slot (starting from left: 8–10, 10–12…). The colors range from dark green (corresponding to Positive Emotions between 80 and 100 and Negative Emotions between 0 and 20) to dark red (corresponding to Positive Emotions between 0 and 20 and Negative Emotions between 80 and 100).

FIGURE 2

Anti‐correlation between Positive and Negative Emotion ratings. r = −0.578, p < 0.001. Each data point represents a single evaluation, with a total of 8578 filled prompts out of 13,496 hypothetically available prompts, resulting in a response rate of 63.6%. The evaluations were collected from 241 individuals who received 8 daily prompts over a period of 7 days; this number also includes those subjects who were subsequently excluded from the final analyses for not meeting the criterion of at least 30% of replies to daily prompts. As anticipated, there were minimal instances where participants simultaneously reported high levels of both Positive and Negative Emotions, as indicated by the scarcity of data points in the lower left and upper right regions of the graph.

FIGURE 3

(a) Individual differences in emotions mean ratings between residential patients with schizophrenia spectrum disorders (SSD), outpatients with SSD and healthy controls during the daily hours. (b) Individual differences in emotions mean ratings between residential patients with SSD, outpatients with SSD and healthy controls during the daily hours.

FIGURE 4

(a) Individual differences in emotions mean ratings between residential patients with schizophrenia spectrum disorders (SSD), outpatients with SSD, and healthy controls during the week. (b) Individual differences in emotions mean ratings between residential patients with SSD, outpatients with SSD, and healthy controls during the week.