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About 17% of humanity goes through an episode of major depression at some point in their lifetime. Despite the enormous societal costs of this incapacitating disorder, it is largely unknown how the likelihood of falling into a depressive episode can be assessed. Here, we show for a large group of healthy individuals and patients that the probability of an upcoming shift between a depressed and a normal state is related to elevated temporal autocorrelation, variance, and correlation between emotions in fluctuations of autorecorded emotions. These are indicators of the general phenomenon of critical slowing down, which is expected to occur when a system approaches a tipping point. Our results support the hypothesis that mood may have alternative stable states separated by tipping points, and suggest an approach for assessing the likelihood of transitions into and out of depression.

Background The experience sampling method (ESM) builds an intensive time series of experiences and contexts in the flow of daily life, typically consisting of around 70 reports, collected at 8–10 random time points per day over a period of up to 10 days. Methods With the advent of widespread smartphone use, ESM can be used in routine clinical practice. Multiple examples of ESM data collections across different patient groups and settings are shown and discussed, varying from an ESM evaluation of a 6‐week randomized trial of mindfulness, to a twin study on emotion dynamics in daily life. Results Research shows that ESM‐based self‐monitoring and feedback can enhance resilience by strengthening the capacity to use natural rewards. Personalized trajectories of starting or stopping medication can be more easily initiated and predicted if sensitive feedback data are available in real time. In addition, personalized trajectories of symptoms, cognitive abilities, symptoms impacting on other symptoms, the capacity of the dynamic system of mental health to “bounce back” from disturbance, and patterns of environmental reactivity yield uniquely personal data to support shared decision making and prediction in clinical practice. Finally, ESM makes it possible to develop insight into previous implicit patterns of thought, experience, and behavior, particularly if rapid personalized feedback is available. Conclusions ESM enhances clinical practice and research. It is empowering, providing co‐ownership of the process of diagnosis, treatment evaluation, and routine outcome measurement. Blended care, based on a mix of face‐to‐face and ESM‐based outside‐the‐office treatment, may reduce costs and improve outcomes.

This study examined the structure, reliability, and convergent validity of the adolescent version of the Mental Health Continuum-Short Form (Dutch MHC-SF-A), a self-report questionnaire for positive mental health assessment. This questionnaire was completed by 459 Dutch adolescents (178 boys and 281 girls) between the ages of 11 and 18 years at baseline and at a 4-week follow-up. Results revealed the 3-factor structure in emotional, psychological, and social well-being, a high internal reliability and a moderate test–retest reliability. Findings suggest that mental illness and well-being represent two related but distinct continua of mental health. Fostering adolescents’ well-being is important. Promoting positive emotions, creating a supportive and loving parent–adolescent relationship, and a supportive school environment will contribute to this.HighlightsWell-being and mental illness are two related but distinct indicators of mental health in Dutch adolescents.The MHC-SF-A was shown to be a reliable and valid instrument to measure well-being among Dutch adolescents, measuring emotional, psychological and social well-being.Both measures of mental illness and well-being, such as the MHC-SF-A, are needed to map mental health in adolescents and to monitor intervention or therapy outcomes in adolescents.The findings suggest that promoting positive emotions, creating a supportive and loving parent–adolescent relationship, and a supportive school environment contribute to adolescents’ mental health.

Companion animals have been identified as a unique source of social support and as contributors to mental wellbeing. This study uses the Experience Sampling Method to test whether this effect is due to stress-buffering. A total of 159 dog and cat owners responded to a series of randomly scheduled questionnaires on their smartphones. At each measurement moment, they reported in whether a pet is present at that moment and to what extent they have interacted with the pet. They also reported on stressful activities and events and on their current positive (PA) and negative (NA) affect. Multilevel regression analyses showed that when a companion animal was present (vs. absent) the negative association between stress and PA is less pronounced (event stress: B = 0.13, p = 0.002, 95% CI = 0.05; 0.21 activity stress: B = 0.08, p < 0.001, 95% CI = 0.04; 0.12). No additional main effect was revealed when tested in a subsample of records that reported low or no stress. Main effects were found for the presence of a companion animal on negative affect (B = 0.08, p < 0.001; 95% CI = 0.12; 0.05) and for interacting with a companion animal on positive affect (B = 0.06, p < 0.001; 95% CI = 0.04; 0.08). This shows that the presence of a companion animal buffers against the negative consequences of stress on positive affect, indicating stress-buffering as a mechanism behind the pet-effect. It is, however, not the only mechanism and more research is required to further elucidate how companion animals contribute to human wellbeing.

Background Previous studies have suggested that culture impacts the experience of psychosis. The current study set out to extend these findings by examining cultural variation in subclinical positive psychotic experiences in students from The Netherlands, Nigeria, and Norway. Positive psychotic experiences were hypothesized to (i) be more frequently endorsed by, and (ii) cause less distress in Nigerian vs. Dutch and Norwegian students. Methods Psychology students, aged 18 to 30 years, from universities in the Netherlands ( n  = 245), Nigeria ( n  = 478), and Norway ( n  = 162) were assessed cross-sectionally with regard to the frequency of subclinical positive psychotic experiences and related distress, using the Community Assessment of Psychic Experiences (CAPE-42). Multi-group confirmatory factor analysis and multivariate analysis of covariance were performed to assess measurement invariance of the positive symptom dimension (CAPE- Pos ) and compare mean frequency and associated distress of positive psychotic experiences across study samples. Results Only CAPE- Pos items pertaining to the dimensions ‘strange experiences’ and ‘paranoia’ met assumptions for (partial) measurement invariance. Frequencies of these experiences were higher in the Nigerian sample, compared to both the Dutch and Norwegian samples, which were similar. In addition, levels of experience-related distress were similar or higher in the Nigerian sample compared to respectively the Dutch and Norwegian samples. Conclusion Although positive psychotic experiences may be more commonly endorsed in non-Western societies, our findings do not support the notion that they represent a more benign, and hence less distressing aspect of human experience. Rather, the experience of psychotic phenomena may be just as, if not more, distressing in African than in European culture. However, observed differences in CAPE- Pos frequency and distress between samples from different cultural settings may partly reflect differences in the measure rather than in the latent trait. Future studies may therefore consider further cross-cultural adaptation of CAPE-42, in addition to explicitly examining cultural acceptance of psychotic phenomena, and environmental and other known risk factors for psychosis, when comparing and interpreting subclinical psychotic phenomena across cultural groups.

Introduction There is growing evidence that mental disorders behave like complex dynamic systems. Complex dynamic systems theory states that a slower recovery from small perturbations indicates a loss of resilience of a system. This study is the first to test whether the speed of recovery of affect states from small daily life perturbations predicts changes in psychopathological symptoms over 1 year in a group of adolescents at increased risk for mental disorders. Methods We used data from 157 adolescents from the TWINSSCAN study. Course of psychopathology was operationalized as the 1-year change in the Symptom Checklist-90 sum score. Two groups were defined: one with stable and one with increasing symptom levels. Time-series data on momentary daily affect and daily unpleasant events were collected 10 times a day for 6 days at baseline. We modeled the time-lagged effect of daily unpleasant events on negative and positive affect after each unpleasant event experienced, to examine at which time point the impact of the events is no longer detectable. Results There was a significant difference between groups in the effect of unpleasant events on negative affect 90 min after the events were reported. Stratified by group, in the Increase group, the effect of unpleasant events on both negative ( B  = 0.05, p  < 0.01) and positive affect ( B  = − 0. 08, p  < 0.01) was still detectable 90 min after the events, whereas in the Stable group this was not the case. Conclusion Findings cautiously suggest that adolescents who develop more symptoms in the following year may display a slower affect recovery from daily perturbations at baseline. This supports the notion that mental health may behave according to the laws of a complex dynamic system. Future research needs to examine whether these dynamic indicators of system resilience may prove valuable for personalized risk assessment in this field.

Background Personal Growth Initiative (PGI) a multi-dimensional construct, conceptualised as a skill set that helps individuals to intentionally grow is considered an important construct throughout the life span. Coping with the challenges, transitions, experiences and stressors of life requires an active growth orientation. In previous empirical research, the construct has been measured by either the PGIS-I or PGIS-II, of which only the latter takes account of the theoretically established multi-dimensionality of the construct. This paper describes the protocol for conducting a systematic review of published peer-reviewed empirical research articles on the multi-dimensional construct of PGI. The aim of this review is threefold: (1) to better understand the multi-dimensional construct PGI in different contexts and populations, (2) to improve our understanding of the reliability and validity of the PGIS-II in various research populations and (3) to obtain an overview of its associations with relevant psychosocial factors. Methods For the development of this protocol, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) reporting guidelines were used. Four databases and one registry will be searched using a predetermined search strategy for relevant studies. Studies will be screened, by two reviewers independently, against the established inclusion criteria. During the data extraction process, the quality of the included studies will be assessed using the Quality Assessment for Survey Studies in Psychology (Q-SSP). The collected data will then be analysed and reported in both narrative and tabular form according to the PRISMA 2020 statement guidelines and flow diagram. Discussion The findings of this study will increase our understanding of the dynamics of PGI throughout the lifespan, its associations with other psychosocial factors and the psychometric properties of the PGIS-II. It will also clarify where additional research is needed. The objectives of the proposed review can provide a basis for the development of practical applications and interventions. Systematic review registration PROSPERO CRD42022377342.

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.

Subclinical psychotic experiences at the level of the general population are common, forming an extended psychosis phenotype with clinical psychosis. Persistence of subclinical experiences is associated with transition to later mental disorder. Increased daily life stress reactivity is considered an endophenotype for psychotic disorders. We examined, in a longitudinal framework, whether baseline momentary assessment markers of stress reactivity would predict persistence of subclinical psychotic experiences over time. In a general population sample of female twins (N = 566), the Experience Sampling Method (ESM; repetitive random sampling of momentary emotions, psychotic experiences and context) was used to assess (emotional and psychotic) daily life stress reactivity. Persistence of subclinical psychotic experiences was based on the Community Assessment of Psychic Experiences (CAPE), assessed three times over 14 months post-baseline. It was investigated whether baseline daily life emotional and psychotic stress reactivity predicted persistence of psychotic experiences over time. Higher levels of emotional stress reactivity (a decrease in positive and an increase in negative affect in response to stress), and increased psychotic reactivity to daily stress was found in individuals with persistent psychotic experiences over time compared to individuals with transient psychotic experiences. The results suggest that markers of daily life stress reactivity may predict \"macro-level\" persistence of normally transient expression of psychotic liability over time. Linking daily life markers of altered reactivity in terms of emotions and psychotic experiences to longitudinal persistence of psychotic experiences, associated with increased risk of transition to overt mental disorder, may contribute to earlier and more accurate diagnosis of risk.

Positive affect (PA) is closely linked to prevention of, and recovery from, depression. Previous studies have investigated PA reactivity to pleasant situations with respect to its protective properties in relation to mood disorder. The purpose of this study was to examine, and replicate, whether moment-to-moment transfer of PA in daily life (PA persistence) is relevant to the prediction of future course of depression. Individuals from three different studies (one general population sample (n=540), and two patient samples (n=43 and n=50) with matching controls (n=39 and n=21, respectively)) participated in an Experience Sampling Method (ESM) study. Time-lagged multilevel analyses were used to assess the degree of transfer (or persistence) of momentary positive affective states over time, in relation to naturalistic outcome (study 1) or treatment outcome (studies 2 and 3). Depressive symptoms were measured using the Symptom Checklist (SCL-90R) in sample 1 and the Hamilton Depression Rating Scale (HDRS) in samples 2 and 3. In study 1, participants with greater momentary PA persistence were less likely to show depressive symptoms at follow-up. In study 2, patients were more likely to respond to treatment if they displayed greater momentary PA persistence, particularly in those with recurrent depression. In study 3, patients with greater momentary PA persistence were similarly more likely to respond to treatment, especially when treated with imipramine rather than placebo. The ability to transfer PA from one moment to the next is an important factor in the prevention of and recovery from depressive symptoms. Patients with recurrent depression and those who receive antidepressants rather than placebo may benefit most from this effect. The results suggest that treatment-induced improvement in depression is mediated by increased levels of momentary transfer of PA in daily life, acquisition of which may be contingent on duration of exposure to depressive experience.