Bidirectional associations among positive affect, anhedonia and meaning in life during major depressive episode: ecological momentary assessment study in unipolar and bipolar individuals and healthy controls

Abstract

BackgroundDiagnostic accuracy is an unmet need for major depressive disorder (MDD) and major depressive episode (MDE) in bipolar disorder. Very limited research has evaluated bipolar disorder/MDE and MDD using ecological momentary assessment (EMA) time-series data.AimsWe aimed to examine differentiating phenomenological characteristics in positive affect dynamics, and temporal relationships with pleasure towards current activity and meaning in life (MIL), among MDD, MDE/bipolar disorder and healthy controls using EMA.MethodParticipants (N = 88, mean age 28.7 years, 69% female), including individuals with MDD (n = 29) and MDE/bipolar disorder (n = 29) and healthy controls (n = 30), were assessed for positive affect, pleasure and MIL 5 times daily over a 2-week period. Multilevel modelling analysis was conducted, with estimation of first-order autoregressive model structure and time-lagged relationship between pleasure and positive affect.ResultsFrom 4632 EMA observations, positive affect dynamics (inertia, variability and instability) did not differ significantly across groups (all P > 0.05). Although all groups demonstrated a bidirectional relationship between positive affect and pleasure, for MDE/bipolar disorder, both pleasuret − 1 (β = −0.11, t[51.09] = −2.31, P = 0.025) and positive affectt − 1 (β = −0.13, t[56.54] = −2.30, P = 0.025) predicted subsequent MIL less significantly than for MDD and healthy controls.ConclusionIndividuals with MDE/bipolar disorder, but not MDD, had less self-reported MIL from positive affect and pleasure. There is little evidence that emotional experience alone characterises the pathophysiology between MDD and MDE/bipolar disorder; such investigation may be limited by within-group heterogeneity. Our findings provide a new perspective on using a time-series approach beyond bimodal measures in EMA to differentiate bipolar disorder/MDE and MDD.