Affect fluctuations examined with ecological momentary assessment in patients with current or remitted depression and anxiety disorders

R A Schoevers*, C D van Borkulo, F Lamers, M N Servaas, J A Bastiaansen, A T F Beekman, A M van Hemert, J H Smit, B W J H Penninx, H Riese

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: There is increasing interest in day-to-day affect fluctuations of patients with depressive and anxiety disorders. Few studies have compared repeated assessments of positive affect (PA) and negative affect (NA) across diagnostic groups, and fluctuation patterns were not uniformly defined. The aim of this study is to compare affect fluctuations in patients with a current episode of depressive or anxiety disorder, in remitted patients and in controls, using affect instability as a core concept but also describing other measures of variability and adjusting for possible confounders.

METHODS: Ecological momentary assessment (EMA) data were obtained from 365 participants of the Netherlands Study of Depression and Anxiety with current (n = 95), remitted (n = 178) or no (n = 92) DSM-IV defined depression/anxiety disorder. For 2 weeks, five times per day, participants filled-out items on PA and NA. Affect instability was calculated as the root mean square of successive differences (RMSSD). Tests on group differences in RMSSD, within-person variance, and autocorrelation were performed, controlling for mean affect levels.

RESULTS: Current depression/anxiety patients had the highest affect instability in both PA and NA, followed by remitters and then controls. Instability differences between groups remained significant when controlling for mean affect levels, but differences between current and remitted were no longer significant.

CONCLUSIONS: Patients with a current disorder have higher instability of NA and PA than remitted patients and controls. Especially with regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation.

Original languageEnglish
Article number0033291720000689
Pages (from-to)1906-1915
Number of pages10
JournalPsychological Medicine
Issue number11
Early online date1-Apr-2020
Publication statusPublished - Aug-2021


  • Affect variability
  • anxiety disorder
  • depressive disorder
  • ecological momentary assessment
  • MOOD
  • LIFE

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