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Published in: BMC Medicine 1/2020

Open Access 01-12-2020 | Mood Disorders | Research article

Early warning signals in psychopathology: what do they tell?

Authors: Marieke J. Schreuder, Catharina A. Hartman, Sandip V. George, Claudia Menne-Lothmann, Jeroen Decoster, Ruud van Winkel, Philippe Delespaul, Marc De Hert, Catherine Derom, Evert Thiery, Bart P. F. Rutten, Nele Jacobs, Jim van Os, Johanna T. W. Wigman, Marieke Wichers

Published in: BMC Medicine | Issue 1/2020

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Abstract

Background

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).

Methods

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).

Results

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.

Conclusions

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.
Appendix
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Footnotes
1
Throughout the rest of this article, EWS will refer to autocorrelations.
 
2
Multilevel model to investigate the association between autocorrelation in affective states and shifts in psychopathology:
$$ {\mathrm{affect}}_{tij}={\beta}_{0 ij}+{\beta}_{1 ij}\left({\mathrm{affect}}_{t-1 ij}-{\mu}_i\right)+{\beta}_{2 ij}{P}_i+{\beta}_{3 ij}\left({P}_i\times \ast \left({\mathrm{affect}}_{t-1 ij}-{\mu}_i\right)\right)+{\varepsilon}_{ij} $$
This equation translates to R code as follows: affectt~(affectt − 1 − μi) + P + (P × (affectt − 1 − μi)) + (1 + (affectt − 1 − μi) | twinID/ID), where twinID denotes the factor that distinguishes between twin pairs and ID represents the individual.
 
3
Marginal R2 reflects the variance explained by the fixed effects; conditional R2 reflects the variance explained by the full model (i.e., fixed and random effects).
 
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Metadata
Title
Early warning signals in psychopathology: what do they tell?
Authors
Marieke J. Schreuder
Catharina A. Hartman
Sandip V. George
Claudia Menne-Lothmann
Jeroen Decoster
Ruud van Winkel
Philippe Delespaul
Marc De Hert
Catherine Derom
Evert Thiery
Bart P. F. Rutten
Nele Jacobs
Jim van Os
Johanna T. W. Wigman
Marieke Wichers
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-020-01742-3

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