Anticipating Transitions in Mental Health in At-Risk Youths: A 6-Month Daily Diary Study Into Early-Warning Signals

Marieke J. Schreuder*, Catharina A. Hartman, Robin N. Groen, Arnout C. Smit, Marieke Wichers*, Johanna T.W. Wigman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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If psychopathology behaves like a complex dynamic system, sudden onset or worsening of symptoms may be preceded by early-warning signals (EWSs). EWSs could thus reflect personalized warning signals for impending psychopathology. We empirically investigated this hypothesis in at-risk youths (N = 122, mean age = 23.6 ± 0.7 years, 57% males) from the clinical cohort of Tracking Adolescents’ Individual Lives Survey (TRAILS-CC), who provided daily emotion assessments for 6 months. We analyzed whether EWSs (rising autocorrelations and standard deviations in emotions) preceded transitions toward psychopathology. Across indicators and a range of analytical options, EWSs had low sensitivity (M = 26%, SD = 11%) and moderate specificity (M = 75%, SD = 14%). Thus, in the present sample, the proposed generic nature and clinical utility of EWSs could not be substantiated. Given this finding, we call for a more nuanced view on the application of complex-dynamic-systems principles to psychopathology and lay out key questions to be addressed in the future.

Original languageEnglish
Pages (from-to)1026–1043
Number of pages18
JournalClinical Psychological Science
Issue number6
Publication statusPublished - Nov-2023


  • at-risk mental state
  • diary studies
  • early-warning signals
  • personalized psychiatry
  • psychopathology
  • transitions in mental health

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