What is Affect (Psychology)?

Introduction

Affect, in psychology, refers to the underlying experience of feeling, emotion or mood.

Dimensions of Affect

Affective states are psycho-physiological constructs – meaning, largely, concepts that connect mental and physical processes. According to most current views, they vary along three principal dimensions: valence, arousal, and motivational intensity.

  • Valence is the subjective spectrum of positive-to-negative evaluation of an experience an individual may have had.
    • Emotional valence refers to the emotion’s consequences, emotion-eliciting circumstances, or subjective feelings or attitudes.
  • Arousal is objectively measurable as activation of the sympathetic nervous system, but can also be assessed subjectively via self-report.
  • Motivational intensity refers to the impulsion to act; the strength of an urge to move toward or away from a stimulus and whether or not to interact with said stimulus.
    • Simply moving is not considered approach (or avoidance) motivation.

It is important to note that arousal is different from motivational intensity. While arousal is a construct that is closely related to motivational intensity, they differ in that motivation necessarily implies action while arousal does not.

Affect Display

Affect is sometimes used to mean affect display, which is a facial, vocal, or gestural behaviour that serves as an indicator of affect.

Effects

In psychology, affect brings about an organism’s interaction with stimuli.

Affect can influence cognitive scope (the breadth of cognitive processes). Initially, it was thought that positive affects broadened whereas negative affects narrowed cognitive scope. However, evidence now suggests that affects high in motivational intensity narrow cognitive scope whereas affects low in motivational intensity broaden it. The construct of cognitive scope has proven valuable in cognitive psychology.

Affect Tolerance

According to a research article about affect tolerance written by psychiatrist Jerome Sashin (1985), “Affect tolerance can be defined as the ability to respond to a stimulus which would ordinarily be expected to evoke affects by the subjective experiencing of feelings.” Essentially it refers to one’s ability to react to emotions and feelings. One who is low in affect tolerance would show little to no reaction to emotion and feeling of any kind. This is closely related to alexithymia.

“Alexithymia is a subclinical phenomenon involving a lack of emotional awareness or, more specifically, difficulty in identifying and describing feelings and in distinguishing feelings from the bodily sensations of emotional arousal” (Glimcher & Fehr, 2014). At its core, alexithymia is an inability for an individual to recognise what emotions they are feeling – as well as an inability to describe them. According to Dalya Samur and colleagues (2013) people with alexithymia have been shown to have correlations with increased suicide rates, mental discomfort, and deaths.

Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, may be helped by mindfulness. Mindfulness refers to the practice of being hyper aware of one’s own feelings, thoughts, sensations, and the stimulus of the environment around you – not in an anxiety-inducing way, but in a gentle and pleasant way. Mindfulness has been shown to produce increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioural regulation.

Relationship to Behaviour and Cognition

The affective domain represents one of the three divisions described in modern psychology: the other two being the behavioural, and the cognitive. Classically, these divisions have also been referred to as the “ABC’s of psychology”. However, in certain views, the cognitive may be considered as a part of the affective, or the affective as a part of the cognitive; it is important to note that “cognitive and affective states … [are] merely analytic categories.”

Instinctive and Cognitive Factors in Causation of Affect

Affect can mean an instinctual reaction to stimulation that occurs before the typical cognitive processes considered necessary for the formation of a more complex emotion. Robert B. Zajonc (1980) asserts this reaction to stimuli is primary for human beings and that it is the dominant reaction for non-human organisms. Zajonc suggests that affective reactions can occur without extensive perceptual and cognitive encoding and be made sooner and with greater confidence than cognitive judgments.

Many theorists, such as Lazarus (1982) consider affect to be post-cognitive: elicited only after a certain amount of cognitive processing of information has been accomplished. In this view, such affective reactions as liking, disliking, evaluation, or the experience of pleasure or displeasure each result from a different prior cognitive process that makes a variety of content discriminations and identifies features, examines them to find value, and weighs them according to their contributions (Brewin, 1989). Some scholars, such as Lerner and Keltner (2000) argue that affect can be both pre- and post-cognitive: initial emotional responses produce thoughts, which produce affect. In a further iteration, some scholars argue that affect is necessary for enabling more rational modes of cognition (Damasio, 2006).

A divergence from a narrow reinforcement model of emotion allows other perspectives about how affect influences emotional development. Thus, temperament, cognitive development, socialisation patterns, and the idiosyncrasies of one’s family or subculture might interact in nonlinear ways. For example, the temperament of a highly reactive/low self-soothing infant may “disproportionately” affect the process of emotion regulation in the early months of life (Griffiths, 1997).

Some other social sciences, such as geography or anthropology, have adopted the concept of affect during the last decade. In French psychoanalysis a major contribution to the field of affect comes from André Green (1973). The focus on affect has largely derived from the work of Deleuze and brought emotional and visceral concerns into such conventional discourses as those on geopolitics, urban life and material culture. Affect has also challenged methodologies of the social sciences by emphasizing somatic power over the idea of a removed objectivity and therefore has strong ties with the contemporary non-representational theory.

Brief History

A number of experiments have been conducted in the study of social and psychological affective preferences (i.e., what people like or dislike). Specific research has been done on preferences, attitudes, impression formation, and decision making. This research contrasts findings with recognition memory (old-new judgements), allowing researchers to demonstrate reliable distinctions between the two. Affect-based judgements and cognitive processes have been examined with noted differences indicated, and some argue affect and cognition are under the control of separate and partially independent systems that can influence each other in a variety of ways (Zajonc, 1980). Both affect and cognition may constitute independent sources of effects within systems of information processing. Others suggest emotion is a result of an anticipated, experienced, or imagined outcome of an adaptational transaction between organism and environment, therefore cognitive appraisal processes are keys to the development and expression of an emotion (Lazarus, 1982).

Psychometric Measurement

Affect has been found across cultures to comprise both positive and negative dimensions. The most commonly used measure in scholarly research is the Positive and Negative Affect Schedule (PANAS) (Watson, Clark & Tellegen, 1988). The PANAS is a lexical measure developed in a North American setting and consisting of 20 single-word items, for instance excited, alert, determined for positive affect, and upset, guilty, and jittery for negative affect. However, some of the PANAS items have been found either to be redundant or to have ambiguous meanings to English speakers from non-North American cultures. As a result, an internationally reliable short-form, the I-PANAS-SF, has been developed and validated comprising two 5-item scales with internal reliability, cross-sample and cross-cultural factorial invariance, temporal stability, convergent and criterion-related validities.

Mroczek and Kolarz (1998) have also developed another set of scales to measure positive and negative affect. Each of the scales has 6 items. The scales have shown evidence of acceptable validity and reliability across cultures.

Non-Conscious Affect and Perception

In relation to perception, a type of non-conscious affect may be separate from the cognitive processing of environmental stimuli. A monohierarchy of perception, affect and cognition considers the roles of arousal, attention tendencies, affective primacy (Zajonc, 1980), evolutionary constraints (Shepard, 1984; 1994), and covert perception (Weiskrantz, 1997) within the sensing and processing of preferences and discriminations. Emotions are complex chains of events triggered by certain stimuli. There is no way to completely describe an emotion by knowing only some of its components. Verbal reports of feelings are often inaccurate because people may not know exactly what they feel, or they may feel several different emotions at the same time. There are also situations that arise in which individuals attempt to hide their feelings, and there are some who believe that public and private events seldom coincide exactly, and that words for feelings are generally more ambiguous than are words for objects or events. Therefore, non-conscious emotions need to be measured by measures circumventing self-report such as the Implicit Positive and Negative Affect Test (IPANAT; Quirin, Kazén & Kuhl, 2009).

Affective responses, on the other hand, are more basic and may be less problematic in terms of assessment. Brewin has proposed two experiential processes that frame non-cognitive relations between various affective experiences: those that are prewired dispositions (i.e. non-conscious processes), able to “select from the total stimulus array those stimuli that are causally relevant, using such criteria as perceptual salience, spatiotemporal cues, and predictive value in relation to data stored in memory” (Brewin, 1989, p.381), and those that are automatic (i.e. subconscious processes), characterised as “rapid, relatively inflexible and difficult to modify… (requiring) minimal attention to occur and… (capable of being) activated without intention or awareness” (Brewin1989 p.381). But a note should be considered on the differences between affect and emotion.

Arousal

Arousal is a basic physiological response to the presentation of stimuli. When this occurs, a non-conscious affective process takes the form of two control mechanisms: one mobilising and the other immobilising. Within the human brain, the amygdala regulates an instinctual reaction initiating this arousal process, either freezing the individual or accelerating mobilisation.

The arousal response is illustrated in studies focused on reward systems that control food-seeking behaviour (Balleine, 2005). Researchers have focused on learning processes and modulatory processes that are present while encoding and retrieving goal values. When an organism seeks food, the anticipation of reward based on environmental events becomes another influence on food seeking that is separate from the reward of food itself. Therefore, earning the reward and anticipating the reward are separate processes and both create an excitatory influence of reward-related cues. Both processes are dissociated at the level of the amygdala, and are functionally integrated within larger neural systems.

Motivational intensity and Cognitive Scope

Measuring Cognitive Scope

Cognitive scope can be measured by tasks involving attention, perception, categorisation and memory. Some studies use a flanker attention task to figure out whether cognitive scope is broadened or narrowed. For example:

  • Using the letters “H” and “N” participants need to identify as quickly as possible the middle letter of 5 when all the letters are the same (e.g. “HHHHH”); and
  • When the middle letter is different from the flanking letters (e.g. “HHNHH”).

Broadened cognitive scope would be indicated if reaction times differed greatly from when all the letters were the same compared to when the middle letter is different. Other studies use a Navon attention task to measure difference in cognitive scope. A large letter is composed of smaller letters, in most cases smaller “L”‘s or “F”‘s that make up the shape of the letter “T” or “H” or vice versa. Broadened cognitive scope would be suggested by a faster reaction to name the larger letter, whereas narrowed cognitive scope would be suggested by a faster reaction to name the smaller letters within the larger letter. A source-monitoring paradigm can also be used to measure how much contextual information is perceived: for instance, participants are tasked to watch a screen which serially displays words to be memorised for 3 seconds each, and also have to remember whether the word appeared on the left or the right half of the screen. The words were also encased in a coloured box, but the participants did not know that they would eventually be asked what colour box the word appeared in.

Main Research Findings

Motivation intensity refers to the strength of urge to move toward or away from a particular stimulus.

Anger and fear affective states, induced via film clips, conferred more selective attention on a flanker task compared to controls as indicated by reaction times that were not very different, even when the flanking letters were different from the middle target letter. Both anger and fear have high motivational intensity because propulsion to act would be high in the face of an angry or fearful stimulus, like a screaming person or coiled snake. Affects high in motivational intensity, thus, narrow cognitive scope making people able to focus more on target information. After seeing a sad picture, participants were faster to identify the larger letter in a Navon attention task, suggesting more global or broadened cognitive scope. The sad emotion is thought to sometimes have low motivational intensity. But, after seeing a disgusting picture, participants were faster to identify the component letters, indicative of a localised more narrow cognitive scope. Disgust has high motivational intensity. Affects high in motivational intensity, thus, narrow cognitive scope making people able to focus more on central information. whereas affects low in motivational intensity broadened cognitive scope allowing for faster global interpretation. The changes in cognitive scope associated with different affective states is evolutionarily adaptive because high motivational intensity affects elicited by stimuli that require movement and action should be focused on, in a phenomenon known as goal-directed behaviour. For example, in early times seeing a lion (fearful stimulus) probably elicited a negative but high motivational affective state (fear) in which the human being was propelled to run away. In this case the goal would be to avoid getting killed.

Moving beyond just negative affective states, researchers wanted to test whether or not the negative or positive affective states varied between high and low motivational intensity. To evaluate this theory, Harmon-Jones and Gable (2009) created an experiment using appetitive picture priming and the Navon task, which would allow them to measure the attentional scope with the detection of the Navon letters. The Navon task included a neutral affect comparison condition. Typically, neutral states cause broadened attention with a neutral stimulus. They predicted that a broad attentional scope could cause a faster detection of global (large) letters, whereas a narrow attentional scope could cause a faster detection of local (small) letters. The evidence proved that the appetitive stimuli produced a narrowed attentional scope. The experimenters further increased the narrowed attentional scope in appetitive stimuli by telling participants they would be allowed to consume the desserts shown in the pictures. The results revealed that their hypothesis was correct in that the broad attentional scope led to quicker detection of global letters and the narrowed attentional scope led to quicker detection of local letters.

Bradley and colleagues (2001) wanted to further examine the emotional reactions in picture priming. Instead of using an appetitive stimulus they used stimulus sets from the International Affective Picture System (IAPS). The image set includes various unpleasant pictures such as snakes, insects, attack scenes, accidents, illness, and loss. They predicted that the unpleasant picture would stimulate a defensive motivational intensity response, which would produce strong emotional arousal such as skin gland responses and cardiac deceleration. Participants rated the pictures based on valence, arousal and dominance on the Self-Assessment Manikin (SAM) rating scale. The findings were consistent with the hypothesis and proved that emotion is organised motivationally by the intensity of activation in appetitive or defensive systems.

Prior to research in 2013, Harmon-Jones and Gable (2009) performed an experiment to examine whether neural activation related with approach-motivation intensity (left frontal-central activity) would trigger the effect of appetitive stimuli on narrowed attention. They also tested whether individual dissimilarities in approach motivation are associated with attentional narrowing. In order to test the hypothesis, the researchers used the same Navon task with appetitive and neutral pictures in addition to having the participants indicate how long since they had last eaten in minutes. To examine the neural activation, the researchers used an electroencephalography and recorded eye movements in order to detect what regions of the brain were being used during approach motivation. The results supported the hypothesis suggesting that the left frontal-central hemisphere is relative for approach-motivational processes and narrowed attentional scope. Some psychologists were concerned that the individuals who were hungry had an increase in the left frontal-central due to frustration. This statement was proved false because the research shows that the dessert pictures increase positive affect even in the hungry individuals. The findings revealed that narrowed cognitive scope has the ability to assist us in goal accomplishment.

Clinical Applications

Later on, researchers connected motivational intensity to clinical applications and found that alcohol-related pictures caused narrowed attention for persons who had a strong motivation to consume alcohol. The researchers tested the participants by exposing them to alcohol and neutral pictures. After the picture was displayed on a screen, the participants finished a test evaluating attentional focus. The findings proved that exposure to alcohol-related pictures led to a narrowing of attentional focus to individuals who were motivated to use alcohol. However, exposure to neutral pictures did not correlate with alcohol-related motivation to manipulate attentional focus. The Alcohol Myopia Theory (AMT) states that alcohol consumption reduces the amount of information available in memory, which also narrows attention so only the most proximal items or striking sources are encompassed in attentional scope. This narrowed attention leads intoxicated persons to make more extreme decisions than they would when sober. Researchers provided evidence that substance-related stimuli capture the attention of individuals when they have high and intense motivation to consume the substance. Motivational intensity and cue-induced narrowing of attention has a unique role in shaping people’s initial decision to consume alcohol. In 2013, psychologists from the University of Missouri investigated the connection between sport achievement orientation and alcohol outcomes. They asked varsity athletes to complete a Sport Orientation Questionnaire which measured their sport-related achievement orientation on three scales – competitiveness, win orientation, and goal orientation (Weaver et al., 2013). The participants also completed assessments of alcohol use and alcohol-related problems. The results revealed that the goal orientation of the athletes were significantly associated with alcohol use but not alcohol-related problems.

In terms of psychopathological implications and applications, college students showing depressive symptoms were better at retrieving seemingly “nonrelevant” contextual information from a source monitoring paradigm task. Namely, the students with depressive symptoms were better at identifying the colour of the box the word was in compared to non-depressed students. Sadness (low motivational intensity) is usually associated with depression, so the more broad focus on contextual information of sadder students supports that affects high in motivational intensity narrow cognitive scope whereas affects low in motivational intensity broaden cognitive scope.

The motivational intensity theory states that the difficulty of a task combined with the importance of success determine the energy invested by an individual. The theory has three main layers.

  • The innermost layer says human behaviour is guided by the desire to conserve as much energy as possible. Individuals aim to avoid wasting energy so they invest only the energy that is required to complete the task.
  • The middle layer focuses on the difficulty of tasks combined with the importance of success and how this affects energy conservation. It focuses on energy investment in situations of clear and unclear task difficulty.
  • The last layer looks at predictions for energy invested by a person when they have several possible options to choose at different task difficulties.

The person is free to choose among several possible options of task difficulty. The motivational intensity theory offers a logical and consistent framework for research. Researchers can predict a person’s actions by assuming effort refers to the energy investment. The motivational intensity theory is used to show how changes in goal attractiveness and energy investment correlate.

Mood

Refer to Mood (Psychology).

Mood, like emotion, is an affective state. However, an emotion tends to have a clear focus (i.e. its cause is self-evident), while mood tends to be more unfocused and diffuse. Mood, according to Batson, Shaw and Oleson (1992), involves tone and intensity and a structured set of beliefs about general expectations of a future experience of pleasure or pain, or of positive or negative affect in the future. Unlike instant reactions that produce affect or emotion, and that change with expectations of future pleasure or pain, moods, being diffuse and unfocused and thus harder to cope with, can last for days, weeks, months or even years (Schucman & Thetford, 1975). Moods are hypothetical constructs depicting an individual’s emotional state. Researchers typically infer the existence of moods from a variety of behavioural referents (Blechman, 1990). Habitual negative affect and negative mood is characteristic of high neuroticism.

Positive affect and negative affect (PANAS) represent independent domains of emotion in the general population, and positive affect is strongly linked to social interaction. Positive and negative daily events show independent relationships to subjective well-being, and positive affect is strongly linked to social activity. Recent research suggests that high functional support is related to higher levels of positive affect. In his work on negative affect arousal and white noise, Seidner (1991) found support for the existence of a negative affect arousal mechanism regarding the devaluation of speakers from other ethnic origins. The exact process through which social support is linked to positive affect remains unclear. The process could derive from predictable, regularised social interaction, from leisure activities where the focus is on relaxation and positive mood, or from the enjoyment of shared activities. The techniques used to shift a negative mood to a positive one are called mood repair strategies.

Social Interaction

Affect display is a critical facet of interpersonal communication. Evolutionary psychologists have advanced the hypothesis that hominids have evolved with sophisticated capability of reading affect displays.

Emotions are portrayed as dynamic processes that mediate the individual’s relation to a continually changing social environment. In other words, emotions are considered to be processes of establishing, maintaining, or disrupting the relation between the organism and the environment on matters of significance to the person.

Most social and psychological phenomena occur as the result of repeated interactions between multiple individuals over time. These interactions should be seen as a multi-agent system – a system that contains multiple agents interacting with each other and/or with their environments over time. The outcomes of individual agents’ behaviours are interdependent: Each agent’s ability to achieve its goals depends on not only what it does but also what other agents do.

Emotions are one of the main sources for the interaction. Emotions of an individual influence the emotions, thoughts and behaviours of others; others’ reactions can then influence their future interactions with the individual expressing the original emotion, as well as that individual’s future emotions and behaviours. Emotion operates in cycles that can involve multiple people in a process of reciprocal influence.

Affect, emotion, or feeling is displayed to others through facial expressions, hand gestures, posture, voice characteristics, and other physical manifestation. These affect displays vary between and within cultures and are displayed in various forms ranging from the most discrete of facial expressions to the most dramatic and prolific gestures.

Observers are sensitive to agents’ emotions, and are capable of recognising the messages these emotions convey. They react to and draw inferences from an agent’s emotions. The emotion an agent displays may not be an authentic reflection of his or her actual state (refer to Emotional Labour).

Agents’ emotions can have effects on four broad sets of factors:

  • Emotions of other persons.
  • Inferences of other persons.
  • Behaviours of other persons.
  • Interactions and relationships between the agent and other persons.

Emotion may affect not only the person at whom it was directed, but also third parties who observe an agent’s emotion. Moreover, emotions can affect larger social entities such as a group or a team. Emotions are a kind of message and therefore can influence the emotions, attributions and ensuing behaviours of others, potentially evoking a feedback process to the original agent.

Agents’ feelings evoke feelings in others by two suggested distinct mechanisms:

  • Emotion contagion:
    • People tend to automatically and unconsciously mimic non-verbal expressions.
    • Mimicking occurs also in interactions involving textual exchanges alone.
  • Emotion interpretation:
    • An individual may perceive an agent as feeling a particular emotion and react with complementary or situationally appropriate emotions of their own.
    • The feelings of the others diverge from and in some way complement the feelings of the original agent.

People may not only react emotionally, but may also draw inferences about emotive agents such as the social status or power of an emotive agent, his competence and his credibility. For example, an agent presumed to be angry may also be presumed to have high power.

References

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Batson, C.D., Shaw, L.L. & Oleson, K.C. (1992). Differentiating Affect, Mood and Emotion: Toward Functionally based Conceptual Distinctions. Emotion. Newbury Park, CA: Sage.

Blechman, E.A. (1990). Moods, Affect, and Emotions. Hillsdale, New Jersey: Lawrence Erlbaum Associates: Hillsdale.

Bradley, M.M., Codispoti, M., Cuthbert, B.N. & Lang, P.J. (2001) Emotion and motivation I: Defensive and appetitive reactions in picture processing. Emotion. 1(3), pp.276-298. doi:10.1037/1528-3542.1.3.276.

Brewin, C.R. (1989) Cognitive Change Processes in Psychotherapy. Psychological Review. 96(45), pp.379-394. doi:10.1037/0033-295x.96.3.379.

Damasio, A. (2006) Descartes’ Error: Emotion, Reason, and the Human Brain. London: Vintage (Part of the Random House Group).

Glimcher, P.W. & Fehr, E (Eds.) (2014) Chapter 27 – Understanding Others: Brain Mechanisms of Theory of Mind and Empathy. Neuroeconomics (Second Edition). Academic Press. pp.513-532. https://doi.org/10.1016/B978-0-12-416008-8.00027-9.

Green, A. (Author), Sheridan, A. (Trans) & Spillius, E.B. (General Editor) (1999) The Fabric of Affect in the Psychoanalytic Discourse. The New Library of Psychoanalysis 37. London: Routledge.

Griffiths, P.E. (1997) What Emotions Really Are: The Problem of Psychological Categories. Chicago: The University of Chicago Press.

Harmon-Jones, E. & Gable, P.A. (2009) Neural Activity Underlying the Effect of Approach-Motivated Positive Affect on Narrowed Attention. Psychological Science. 20(4), pp.406-409. doi:10.1111/j.1467-9280.2009.02302.x.

Lazarus, R.S. (1982) Thoughts on the Relations between Emotions and Cognition. American Physiologist. 37 (10), pp.1019-1024.

Lerner, J.S. & Keltner, D. (2000) Beyond valence: Toward a model of emotion-specific influences on judgement and choice. Cognition and Emotion. 14(4), pp.473-493. doi:10.1080/026999300402763.

Mroczek, D.K. & Kolarz, C.M. (1998) The effect of age on positive and negative affect: A developmental perspective on happiness. Journal of Personality and Social Psychology. 75(5), pp.1333-1349. doi:10.1037/0022-3514.75.5.1333.

Quirin, M., Kazén, M. & Kuhl, J. (2009) When nonsense sounds happy or helpless: The Implicit Positive and Negative Affect Test (IPANAT). Journal of Personality and Social Psychology. 97(3), pp.500-516. doi:10.1037/a001606

Samur, D., Tops, M., Schlinkert, C., Quirin, M., Cuijpers, P. & Koole, S.L. (2013) Four decades of research on alexithymia: moving toward clinical applications. Frontiers in Psychology. 4, pp.861. https://dx.doi.org/10.3389%2Ffpsyg.2013.00861.

Sashin, J.I. (1985) Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures. 8(2), pp.175-202.

Schucman, H. & Thetford, C. (1975). A Course in Miracle. New York: Viking Penguin.

Seidner, S.S. (1991). Negative Affect Arousal Reactions from Mexican and Puerto Rican Respondents. Washington, D.C.: ERIC.

Shepard, R.N. (1984) Ecological Constraints on Internal Representation. Psychological Review. 91(4), pp.417-447. doi:10.1037/0033-295x.91.4.417.

Shepard, R.N. (1994) Perceptual-cognitive Universals as Reflections of the World. Psychonomic Bulletin & Review. 1(1), pp.2-28. doi:10.3758/bf03200759

Watson, D., Clark, L.A. & Tellegen, A. (1988) Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology. 54(6), pp.1063-1070. doi:10.1037/0022-3514.54.6.1063.

Weaver, C.C., Martens, M.P., Cadigan, J.M., Takamatsu, S.K., Treloar, H.R. & Pedersen, E.R. (2013) Sport-related achievement motivation and alcohol outcomes: An athlete-specific risk factor among intercollegiate athletes. Addictive Behaviours. 38(12), pp.2930-2936. doi:10.1016/j.addbeh.2013.08.021.

Weiskrantz, L. (1997) Consciousness Lost and Found. Oxford: Oxford University Press.

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Linking Depression & Internet Gaming Disorder

Research Paper Title

Depressive symptoms and depression in individuals with internet gaming disorder: A systematic review and meta-analysis.

Background

Although depression has frequently been associated with Internet Gaming Disorder (IGD), its epidemiological impact on this emerging condition has not been systematically assessed. In this study, the researchers aimed to synthesize the available evidence focusing on depression and depressive symptoms in individuals with IGD.

Methods

The researchers searched PubMed, Embase, PsycINFO, GreyLit, OpenGrey, and ProQuest up to March 2020 for observational studies focusing on depression-related outcomes in IGD. They conducted random-effects meta-analyses on 1) rate of comorbid depression in IGD; 2) severity of depressive symptoms in IGD participants without depression.

Results

The researchers identified 92 studies from 25 different countries including 15,148 participants. 21 studies (n = 5025 participants) provided data for the first analysis, resulting in a pooled event rate of depression of 0.32 (95% Confidence Interval 0.21-0.43). The pooled Beck Depression Inventory scores in individuals without depression were suggestive of mild severity (13 studies, n = 508; 10.3, 95% Confidence Interval 8.3-12.4).

Conclusions

The considerable inconsistency of methods employed across studies limits the transferability of these findings to clinical practice.

The prevalence of depression in individuals with IGD varied considerably across studies, affecting approximately one out of three participants overall. Furthermore, a globally major severity of depressive symptoms was found in those without a clinical diagnosis of depression, compared to the general population.

These findings confirm a relevant impact of mood disturbances in IGD.

Reference

Ostinelli, E.G., Zangani, C., Giordano, B., Maestri, D., Gambini, O., D’Agostino, A., Furukawa, T.A. & Purgato, M. (2021) Depressive symptoms and depression in individuals with internet gaming disorder: A systematic review and meta-analysis. Journal of Affective Disorders. doi: 10.1016/j.jad.2021.02.014. Online ahead of print.

What is Mood Disorder?

Introduction

Mood disorder, also known as mood affective disorders, is a group of conditions where a disturbance in the person’s mood is the main underlying feature. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

Mood disorders fall into the basic groups of elevated mood, such as mania or hypomania; depressed mood, of which the best-known and most researched is major depressive disorder (MDD) (commonly called clinical depression, unipolar depression, or major depression); and moods which cycle between mania and depression, known as bipolar disorder (BD) (formerly known as manic depression). There are several sub-types of depressive disorders or psychiatric syndromes featuring less severe symptoms such as dysthymic disorder (similar to but milder than MDD) and cyclothymic disorder (similar to but milder than BD). Mood disorders may also be substance induced or occur in response to a medical condition.

English psychiatrist Henry Maudsley proposed an overarching category of affective disorder. The term was then replaced by mood-disorder, as the latter term refers to the underlying or longitudinal emotional state, whereas the former refers to the external expression observed by others.

Refer to Depression (Mood).

Epidemiology

According to a substantial amount of epidemiology studies conducted, women are twice as likely to develop certain mood disorders, such as major depression. Although there is an equal number of men and women diagnosed with bipolar II disorder, women have a slightly higher frequency of the disorder.

The prevalence of depressive symptoms has increased over the years with recent generations reporting a 6% increase in symptoms of depression compared to individuals from older generations.

In 2011, mood disorders were the most common reason for hospitalization among children aged 1-17 years in the United States, with approximately 112,000 stays. Mood disorders were top principal diagnosis for Medicaid super-utilisers in the United States in 2012. Further, a study of 18 States found that mood disorders accounted for the highest number of hospital readmissions among Medicaid patients and the uninsured, with 41,600 Medicaid patients and 12,200 uninsured patients being readmitted within 30 days of their index stay – a readmission rate of 19.8 per 100 admissions and 12.7 per 100 admissions, respectively. In 2012, mood and other behavioural health disorders were the most common diagnoses for Medicaid-covered and uninsured hospital stays in the United States (6.1% of Medicaid stays and 5.2% of uninsured stays).

A study conducted in 1988 to 1994 amongst young American adults involved a selection of demographic and health characteristics. A population-based sample of 8,602 men and women ages 17-39 years participated. Lifetime prevalence were estimated based on six mood measures:

  • Major depressive episode (MDE) 8.6%.
  • Major depressive disorder with severity (MDE-s) 7.7%.
  • Dysthymia 6.2%.
  • MDE-s with dysthymia 3.4%.
  • Any bipolar disorder 1.6%.
  • Any mood disorder 11.5%.

Classification

Depressive Disorders

  • Major depressive disorder (MDD):
    • Commonly called major depression, unipolar depression, or clinical depression, wherein a person has one or more major depressive episodes.
    • After a single episode, Major Depressive Disorder (single episode) would be diagnosed.
    • After more than one episode, the diagnosis becomes Major Depressive Disorder (Recurrent).
    • Depression without periods of mania is sometimes referred to as unipolar depression because the mood remains at the bottom “pole” and does not climb to the higher, manic “pole” as in bipolar disorder.
  • Individuals with a major depressive episode or major depressive disorder are at increased risk for suicide.
  • Seeking help and treatment from a health professional dramatically reduces the individual’s risk for suicide.
  • Studies have demonstrated that asking if a depressed friend or family member has thought of committing suicide is an effective way of identifying those at risk, and it does not “plant” the idea or increase an individual’s risk for suicide in any way.
  • Epidemiological studies carried out in Europe suggest that, at this moment, roughly 8.5% of the world’s population have a depressive disorder. No age group seems to be exempt from depression, and studies have found that depression appears in infants as young as 6 months old who have been separated from their mothers.
  • Depressive disorder is frequent in primary care and general hospital practice but is often undetected.
  • Unrecognised depressive disorder may slow recovery and worsen prognosis in physical illness, therefore it is important that all doctors be able to recognise the condition, treat the less severe cases, and identify those requiring specialist care.

Diagnosticians recognise several subtypes or course specifiers:

  • Atypical depression (AD):
    • This is characterised by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite (“comfort eating”), excessive sleep or somnolence (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.
    • Difficulties in measuring this subtype have led to questions of its validity and prevalence.
  • Melancholic depression:
    • This is characterised by a loss of pleasure (anhedonia) in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.
  • Psychotic major depression (PMD):
    • Or simply psychotic depression, is the term for a major depressive episode, in particular of melancholic nature, wherein the patient experiences psychotic symptoms such as delusions or, less commonly, hallucinations.
    • These are most commonly mood-congruent (content coincident with depressive themes).
  • Catatonic depression:
    • This is a rare and severe form of major depression involving disturbances of motor behaviour and other symptoms.
    • Here, the person is mute and almost stuporose, and either is immobile or exhibits purposeless or even bizarre movements.
    • Catatonic symptoms can also occur in schizophrenia or a manic episode, or can be due to neuroleptic malignant syndrome.
  • Postpartum depression (PPD)
    • This is listed as a course specifier in DSM-IV-TR; it refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth.
    • Postpartum depression, which affects 10-15% of women, typically sets in within three months of labour, and lasts as long as three months.
    • It is quite common for women to experience a short-term feeling of tiredness and sadness in the first few weeks after giving birth; however, postpartum depression is different because it can cause significant hardship and impaired functioning at home, work, or school as well as, possibly, difficulty in relationships with family members, spouses, or friends, or even problems bonding with the newborn.
    • In the treatment of postpartum major depressive disorders and other unipolar depressions in women who are breastfeeding, nortriptyline, paroxetine (Paxil), and sertraline (Zoloft) are in general considered to be the preferred medications.
    • Women with personal or family histories of mood disorders are at particularly high risk of developing postpartum depression.
  • Premenstrual dysphoric disorder (PMDD):
    • This is a severe and disabling form of premenstrual syndrome affecting 3-8% of menstruating women.
    • The disorder consists of a “cluster of affective, behavioural and somatic symptoms” that recur monthly during the luteal phase of the menstrual cycle.
    • PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013.
    • The exact pathogenesis of the disorder is still unclear and is an active research topic. Treatment of PMDD relies largely on antidepressants that modulate serotonin levels in the brain via serotonin reuptake inhibitors as well as ovulation suppression using contraception.
  • Seasonal affective disorder (SAD):
    • Also known as “winter depression” or “winter blues”, is a specifier.
    • Some people have a seasonal pattern, with depressive episodes coming on in the autumn or winter, and resolving in spring.
    • The diagnosis is made if at least two episodes have occurred in colder months with none at other times over a two-year period or longer.
    • It is commonly hypothesised that people who live at higher latitudes tend to have less sunlight exposure in the winter and therefore experience higher rates of SAD, but the epidemiological support for this proposition is not strong (and latitude is not the only determinant of the amount of sunlight reaching the eyes in winter).
    • It is said that this disorder can be treated by light therapy.
    • SAD is also more prevalent in people who are younger and typically affects more females than males.
  • Dysthymia:
    • This is a condition related to unipolar depression, where the same physical and cognitive problems are evident, but they are not as severe and tend to last longer (usually at least 2 years).
    • The treatment of dysthymia is largely the same as for major depression, including antidepressant medications and psychotherapy.
  • Double depression:
    • Can be defined as a fairly depressed mood (dysthymia) that lasts for at least two years and is punctuated by periods of major depression.
  • Depressive Disorder Not Otherwise Specified (DD-NOS):
    • This is designated by the code 311 for depressive disorders that are impairing but do not fit any of the officially specified diagnoses.
    • According to the DSM-IV, DD-NOS encompasses “any depressive disorder that does not meet the criteria for a specific disorder.”
    • It includes the research diagnoses of recurrent brief depression, and minor depressive disorder listed below.
  • Depressive personality disorder (DPD)
    • This is a controversial psychiatric diagnosis that denotes a personality disorder with depressive features.
    • Originally included in the DSM-II, depressive personality disorder was removed from the DSM-III and DSM-III-R.
    • Recently, it has been reconsidered for reinstatement as a diagnosis. Depressive personality disorder is currently described in Appendix B in the DSM-IV-TR as worthy of further study.
  • Recurrent brief depression (RBD):
    • Distinguished from major depressive disorder primarily by differences in duration.
    • Individuals with RBD have depressive episodes about once per month, with individual episodes lasting less than two weeks and typically less than 2-3 days.
    • Diagnosis of RBD requires that the episodes occur over the span of at least one year and, in female patients, independently of the menstrual cycle.
    • Individuals with clinical depression can develop RBD, and vice versa, and both illnesses have similar risks.
  • Minor depressive disorder:
    • Or simply minor depression, which refers to a depression that does not meet full criteria for major depression but in which at least two symptoms are present for two weeks.

Bipolar Disorders

Bipolar disorder (BD) (also called “manic depression” or “manic-depressive disorder”), an unstable emotional condition characterised by cycles of abnormal, persistent high mood (mania) and low mood (depression), which was formerly known as “manic depression” (and in some cases rapid cycling, mixed states, and psychotic symptoms). Subtypes include:

  • Bipolar I:
    • This is distinguished by the presence or history of one or more manic episodes or mixed episodes with or without major depressive episodes.
    • A depressive episode is not required for the diagnosis of Bipolar I Disorder, but depressive episodes are usually part of the course of the illness.
  • Bipolar II :
    • Consisting of recurrent intermittent hypomanic and depressive episodes or mixed episodes.
  • Cyclothymia:
    • This is a form of bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes, but no full manic episodes or full major depressive episodes.
  • Bipolar disorder not otherwise specified (BD-NOS):
    • Sometimes called “sub-threshold” bipolar, indicates that the patient has some symptoms in the bipolar spectrum (e.g. manic and depressive symptoms) but does not fully qualify for any of the three formal bipolar DSM-IV diagnoses mentioned above.

It is estimated that roughly 1% of the adult population has bipolar I, a further 1% has bipolar II or cyclothymia, and somewhere between 2% and 5% percent have “sub-threshold” forms of bipolar disorder. Furthermore, the possibility of getting bipolar disorder when one parent is diagnosed with it is 15-30%. Risk, when both parents have it, is 50-75%. Also, while with bipolar siblings the risk is 15-25%, with identical twins it is about 70%.

A minority of people with bipolar disorder have high creativity, artistry or a particular gifted talent. Before the mania phase becomes too extreme, its energy, ambition, enthusiasm and grandiosity often bring people with this type of mood disorder life’s masterpieces.[29]

Substance-induced

A mood disorder can be classified as substance-induced if its aetiology can be traced to the direct physiologic effects of a psychoactive drug or other chemical substance, or if the development of the mood disorder occurred contemporaneously with substance intoxication or withdrawal. Also, an individual may have a mood disorder coexisting with a substance abuse disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode. Most substances can induce a variety of mood disorders. For example, stimulants such as amphetamine, methamphetamine, and cocaine can cause manic, hypomanic, mixed, and depressive episodes.

Alcohol-Induced

High rates of major depressive disorder occur in heavy drinkers and those with alcoholism. Controversy has previously surrounded whether those who abused alcohol and developed depression were self-medicating their pre-existing depression. But recent research has concluded that, while this may be true in some cases, alcohol misuse directly causes the development of depression in a significant number of heavy drinkers. Participants studied were also assessed during stressful events in their lives and measured on a Feeling Bad Scale. Likewise, they were also assessed on their affiliation with deviant peers, unemployment, and their partner’s substance use and criminal offending. High rates of suicide also occur in those who have alcohol-related problems. It is usually possible to differentiate between alcohol-related depression and depression that is not related to alcohol intake by taking a careful history of the patient. Depression and other mental health problems associated with alcohol misuse may be due to distortion of brain chemistry, as they tend to improve on their own after a period of abstinence.

Benzodiazepine-induced

Benzodiazepines, such as alprazolam, clonazepam, lorazepam and diazepam, can cause both depression and mania.

Benzodiazepines are a class of medication commonly used to treat anxiety, panic attacks and insomnia, and are also commonly misused and abused. Those with anxiety, panic and sleep problems commonly have negative emotions and thoughts, depression, suicidal ideations, and often have comorbid depressive disorders. While the anxiolytic and hypnotic effects of benzodiazepines disappear as tolerance develops, depression and impulsivity with high suicidal risk commonly persist. These symptoms are “often interpreted as an exacerbation or as a natural evolution of previous disorders and the chronic use of sedatives is overlooked”. Benzodiazepines do not prevent the development of depression, can exacerbate pre-existing depression, can cause depression in those with no history of it, and can lead to suicide attempts. Risk factors for attempted and completed suicide while using benzodiazepines include high dose prescriptions (even in those not misusing the medications), benzodiazepine intoxication, and underlying depression.

The long-term use of benzodiazepines may have a similar effect on the brain as alcohol, and are also implicated in depression. As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of serotonin and norepinephrine, are believed to be responsible for the increased depression. Additionally, benzodiazepines can indirectly worsen mood by worsening sleep (i.e. benzodiazepine-induced sleep disorder). Like alcohol, benzodiazepines can put people to sleep but, while asleep, they disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep sleep (the most restorative part of sleep for both energy and mood). Just as some antidepressants can cause or worsen anxiety in some patients due to being activating, benzodiazepines can cause or worsen depression due to being a central nervous system depressant – worsening thinking, concentration and problem solving (i.e. benzodiazepine-induced neurocognitive disorder). However, unlike antidepressants, in which the activating effects usually improve with continued treatment, benzodiazepine-induced depression is unlikely to improve until after stopping the medication.

In a long-term follow-up study of patients dependent on benzodiazepines, it was found that 10 people (20%) had taken drug overdoses while on chronic benzodiazepine medication despite only two people ever having had any pre-existing depressive disorder. A year after a gradual withdrawal programme, no patients had taken any further overdoses.

Just as with intoxication and chronic use, benzodiazepine withdrawal can also cause depression. While benzodiazepine-induced depressive disorder may be exacerbated immediately after discontinuation of benzodiazepines, evidence suggests that mood significantly improves after the acute withdrawal period to levels better than during use. Depression resulting from withdrawal from benzodiazepines usually subsides after a few months but in some cases may persist for 6-12 months.

Due to Another Medical Condition

“Mood disorder due to a general medical condition” is used to describe manic or depressive episodes which occur secondary to a medical condition. There are many medical conditions that can trigger mood episodes, including neurological disorders (e.g. dementias), metabolic disorders (e.g. electrolyte disturbances), gastrointestinal diseases (e.g. cirrhosis), endocrine disease (e.g. thyroid abnormalities), cardiovascular disease (e.g. heart attack), pulmonary disease (e.g. chronic obstructive pulmonary disease), cancer, and autoimmune diseases (e.g. multiple sclerosis).

Not Otherwise Specified

Mood disorder not otherwise specified (MD-NOS) is a mood disorder that is impairing but does not fit in with any of the other officially specified diagnoses. In the DSM-IV MD-NOS is described as “any mood disorder that does not meet the criteria for a specific disorder.” MD-NOS is not used as a clinical description but as a statistical concept for filing purposes.

Most cases of MD-NOS represent hybrids between mood and anxiety disorders, such as mixed anxiety-depressive disorder or atypical depression. An example of an instance of MD-NOS is being in minor depression frequently during various intervals, such as once every month or once in three days. There is a risk for MD-NOS not to get noticed, and for that reason not to get treated.

Causes

Meta-analyses show that high scores on the personality domain neuroticism are a strong predictor for the development of mood disorders. A number of authors have also suggested that mood disorders are an evolutionary adaptation. A low or depressed mood can increase an individual’s ability to cope with situations in which the effort to pursue a major goal could result in danger, loss, or wasted effort. In such situations, low motivation may give an advantage by inhibiting certain actions. This theory helps to explain why negative life incidents precede depression in around 80% of cases, and why they so often strike people during their peak reproductive years. These characteristics would be difficult to understand if depression were a dysfunction.

A depressed mood is a predictable response to certain types of life occurrences, such as loss of status, divorce, or death of a child or spouse. These are events that signal a loss of reproductive ability or potential, or that did so in humans’ ancestral environment. A depressed mood can be seen as an adaptive response, in the sense that it causes an individual to turn away from the earlier (and reproductively unsuccessful) modes of behaviour.

A depressed mood is common during illnesses, such as influenza. It has been argued that this is an evolved mechanism that assists the individual in recovering by limiting his/her physical activity. The occurrence of low-level depression during the winter months, or seasonal affective disorder, may have been adaptive in the past, by limiting physical activity at times when food was scarce. It is argued that humans have retained the instinct to experience low mood during the winter months, even if the availability of food is no longer determined by the weather.

Much of what is known about the genetic influence of clinical depression is based upon research that has been done with identical twins. Identical twins have exactly the same genetic code. It has been found that when one identical twin becomes depressed the other will also develop clinical depression approximately 76% of the time. When identical twins are raised apart from each other, they will both become depressed about 67% of the time. Because both twins become depressed at such a high rate, the implication is that there is a strong genetic influence. If it happened that when one twin becomes clinically depressed the other always develops depression, then clinical depression would likely be entirely genetic.

Bipolar disorder is also considered a mood disorder and it is hypothesized that it might be caused by mitochondrial dysfunction.

Sex Differences

Mood disorders, specifically stress-related mood disorders such as anxiety and depression, have been shown to have differing rates of diagnosis based on sex. In the United States, women are two times more likely than men to be diagnosed with a stress-related mood disorder. Underlying these sex differences, studies have shown a dysregulation of stress-responsive neuroendocrine function causing an increase in the likelihood of developing these affective disorders. Overactivation of the hypothalamic-pituitary-adrenal (HPA) axis could provide potential insight into how these sex differences arise. Neuropeptide corticotropin-releasing factor (CRF) is released from the paraventricular nucleus (PVN) of the hypothalamus, stimulating adrenocorticotropic hormone (ACTH) release into the blood stream. From here ACTH triggers the release of glucocorticoids such as cortisol from the adrenal cortex. Cortisol, known as the main stress hormone, creates a negative feedback loop back to the hypothalamus to deactivate the stress response. When a constant stressor is present, the HPA axis remains overactivated and cortisol is constantly produced. This chronic stress is associated with sustained CRF release, resulting in the increased production of anxiety- and depressive-like behaviours and serving as a potential mechanism for differences in prevalence between men and women.

Diagnosis

DSM-5

The DSM-5, released in May 2013, separates the mood disorder chapter from the DSM-TR-IV into two sections: Depressive and related disorders and bipolar and related disorders. Bipolar disorders falls in between depressive disorders and schizophrenia spectrum and related disorders “in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history and genetics” (Ref. 1, p 123). Bipolar disorders underwent a few changes in the DSM-5, most notably the addition of more specific symptomology related to hypomanic and mixed manic states. Depressive disorders underwent the most changes, the addition of three new disorders: disruptive mood dysregulation disorder, persistent depressive disorder (previously dysthymia), and premenstrual dysphoric disorder (previously in appendix B, the section for disorders needing further research). Disruptive mood dysregulation disorder is meant as a diagnosis for children and adolescents who would normally be diagnosed with bipolar disorder as a way to limit the bipolar diagnosis in this age cohort. Major depressive disorder (MDD) also underwent a notable change, in that the bereavement clause has been removed. Those previously exempt from a diagnosis of MDD due to bereavement are now candidates for the MDD diagnosis.

Treatment

There are different types of treatments available for mood disorders, such as therapy and medications. Behaviour therapy, cognitive behaviour therapy and interpersonal therapy have all shown to be potentially beneficial in depression. Major depressive disorder medications usually include antidepressants; a combination of antidepressants and cognitive behavioural therapy has shown to be more effective than one treatment alone. Bipolar disorder medications can consist of antipsychotics, mood stabilisers, anticonvulsants and/or lithium. Lithium specifically has been proven to reduce suicide and all causes of mortality in people with mood disorders. If mitochondrial dysfunction or mitochondrial diseases are the cause of mood disorders like bipolar disorder, then it has been hypothesized that N-acetyl-cysteine (NAC), acetyl-L-carnitine (ALCAR), S-adenosylmethionine (SAMe), coenzyme Q10 (CoQ10), alpha-lipoic acid (ALA), creatine monohydrate (CM), and melatonin could be potential treatment options. In determining treatment, there are many types of depression scales that are used.

  • One of the depression scales is a self-report scale called Beck Depression Inventory (BDI).
  • Another scale is the Hamilton Depression Rating Scale (HAMD).
    • HAMD is a clinical rating scale in which the patient is rated based on clinician observation.
  • The Centre for Epidemiologic Studies Depression Scale (CES-D) is a scale for depression symptoms that applies to the general population.
    • This scale is typically used in research and not for self-reports.
  • The PHQ-9 which stands for Patient-Health Questionnaire-9 questions, is a self-report as well.
  • Finally, the Mood Disorder Questionnaire (MDQ) evaluates bipolar disorder.

Research

Kay Redfield Jamison and others have explored the possible links between mood disorders – especially bipolar disorder – and creativity. It has been proposed that a “ruminating personality type may contribute to both [mood disorders] and art.”

Jane Collingwood notes an Oregon State University study that:

“…looked at the occupational status of a large group of typical patients and found that ‘those with bipolar illness appear to be disproportionately concentrated in the most creative occupational category.’ They also found that the likelihood of ‘engaging in creative activities on the job’ is significantly higher for bipolar than nonbipolar workers”.

In Liz Paterek’s article “Bipolar Disorder and the Creative Mind” she wrote:

“Memory and creativity are related to mania. Clinical studies have shown that those in a manic state will rhyme, find synonyms, and use alliteration more than controls. This mental fluidity could contribute to an increase in creativity. Moreover, mania creates increases in productivity and energy. Those in a manic state are more emotionally sensitive and show less inhibition about attitudes, which could create greater expression. Studies performed at Harvard looked into the amount of original thinking in solving creative tasks. Bipolar individuals, whose disorder was not severe, tended to show greater degrees of creativity.”

The relationship between depression and creativity appears to be especially strong among poets.

What is Depression (Mood)?

Introduction

Depression is a state of low mood and aversion to activity. It can affect a person’s thoughts, behaviour, motivation, feelings, and sense of well-being.

The core symptom of depression is said to be anhedonia, which refers to loss of interest or a loss of feeling of pleasure in certain activities that usually bring joy to people. Depressed mood is a symptom of some mood disorders such as major depressive disorder or dysthymia; it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments.

It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection, hopelessness and, sometimes, suicidal thoughts. It can either be short term or long term.

Epidemiology

Depression is the leading cause of disability worldwide, the United Nations (UN) health agency reported, estimating that it affects more than 300 million people worldwide – the majority of them women, young people and the elderly. An estimated 4.4% of the global population suffers from depression, according to a report released by the UN World Health Organisation (WHO), which shows an 18 percent increase in the number of people living with depression between 2005 and 2015.

Global Health

Depression is a major mental-health cause of disease burden. Its consequences further lead to significant burden in public health, including a higher risk of dementia, premature mortality arising from physical disorders, and maternal depression impacts on child growth and development. Approximately 76% to 85% of depressed people in low- and middle-income countries do not receive treatment;[48] barriers to treatment include: inaccurate assessment, lack of trained health-care providers, social stigma and lack of resources.

The WHO has constructed guidelines – known as The Mental Health Gap Action Programme (mhGAP) – aiming to increase services for people with mental, neurological and substance-use disorders. Depression is listed as one of conditions prioritised by the programme. Trials conducted show possibilities for the implementation of the programme in low-resource primary-care settings dependent on primary-care practitioners and lay health-workers. Examples of mhGAP-endorsed therapies targeting depression include Group Interpersonal Therapy as group treatment for depression and “Thinking Health”, which utilises cognitive behavioural therapy to tackle perinatal depression. Furthermore, effective screening in primary care is crucial for the access of treatments. The mhGAP programme adopted its approach of improving detection rates of depression by training general practitioners. However, there is still weak evidence supporting this training.

History of the Concept

The Greco-Roman world used the tradition of the four humours to attempt to systematise sadness as “melancholia”.

The well-established idea of melancholy fell out of scientific favour in the 19th century.

Emil Kraepelin tried to give a scientific account of depression (German: das manisch-depressive Irresein) in 1896.

Factors

Life Events

Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, or unequal parental treatment of siblings can contribute to depression in adulthood. Childhood physical or sexual abuse in particular significantly correlates with the likelihood of experiencing depression over the victim’s lifetime.

Life events and changes that may influence depressed moods include (but are not limited to): childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, family, living conditions etc.), a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, or catastrophic injury. Adolescents may be especially prone to experiencing a depressed mood following social rejection, peer pressure, or bullying.

Personality

Changes in personality or in one’s social environment can affect levels of depression. High scores on the personality domain neuroticism make the development of depressive symptoms as well as all kinds of depression diagnoses more likely, and depression is associated with low extraversion. Other personality indicators could be: temporary but rapid mood changes, short term hopelessness, loss of interest in activities that used to be of a part of one’s life, sleep disruption, withdrawal from previous social life, appetite changes, and difficulty concentrating.

Medical Treatment

Depression may also be the result of healthcare, such as with medication induced depression. Therapies associated with depression include interferon therapy, beta-blockers, isotretinoin, contraceptives, cardiac agents, anticonvulsants, antimigraine drugs, antipsychotics, and hormonal agents such as gonadotropin-releasing hormone agonist.

Substance-Induced

Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcohol, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants.

Non-Psychiatric Illnesses

Refer to Differential Diagnoses of Depression.

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions, and physiological problems, including hypoandrogenism (in men), Addison’s disease, Cushing’s syndrome, hypothyroidism, hyperparathyroidism, Lyme disease, multiple sclerosis, Parkinson’s disease, chronic pain, stroke, diabetes, and cancer.

Psychiatric Syndromes

Refer to Depressive Mood Disorders.

A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD; commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode.

Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition, and energy levels, but may also involve one or more episodes of depression. When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder.

Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioural symptoms are significant but do not meet the criteria for a major depressive episode; and posttraumatic stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed mood.

Historical Legacy

Refer to Dispossession, Oppression and Depression.

Researchers have begun to conceptualise ways in which the historical legacies of racism and colonialism may create depressive conditions.

Measures of Depression

Measures of depression as an emotional disorder include (but are not limited to) the Beck Depression Inventory-11 and the 9-item depression scale in the Patient Health Questionnaire.

Both of these measures are psychological tests that ask personal questions of the participant, and have mostly been used to measure the severity of depression. The Beck Depression Inventory (BDI) is a self-report scale that helps a therapist identify the patterns of depression symptoms and monitor recovery. The responses on this scale can be discussed in therapy to devise interventions for the most distressing symptoms of depression. Several studies, however, have used these measures to also determine healthy individuals who are not suffering from depression as a mental disorder, but as an occasional mood disorder. This is substantiated by the fact that depression as an emotional disorder displays similar symptoms to minimal depression and low levels of mental disorders such as major depressive disorder; therefore, researchers were able to use the same measure interchangeably. In terms of the scale, participants scoring between 0-13 and 0-4 respectively were considered healthy individuals.

Another measure of depressed mood would be the IWP Multi-affect Indicator. It is a psychological test that indicates various emotions, such as enthusiasm and depression, and asks for the degree of the emotions that the participants have felt in the past week. There are studies that have used lesser items from the IWP Multi-affect Indicator which was then scaled down to daily levels to measure the daily levels of depression as an emotional disorder.

Connections

Alcoholism

Alcohol can be a depressant which slows down some regions of the brain, like the prefrontal and temporal cortex, negatively affecting rationality and memory. It also lowers the level of serotonin in the brain, which could potentially lead to higher chances of depressive mood.

The connection between the amount of alcohol intake, level of depressed mood, and how it affects the risks of experiencing consequences from alcoholism, were studied in a research done on college students. The study used 4 latent, distinct profiles of different alcohol intake and level of depression; Mild or Moderate Depression, and Heavy or Severe Drinkers. Other indicators consisting of social factors and individual behaviours were also taken into consideration in the research. Results showed that the level of depression as an emotion negatively affected the amount of risky behaviour and consequence from drinking, while having an inverse relationship with protective behavioural strategies, which are behavioural actions taken by oneself for protection from the relative harm of alcohol intake. Having an elevated level of depressed mood does therefore lead to greater consequences from drinking.

Bullying

Social abuse, such as bullying, are defined as actions of singling out and causing harm on vulnerable individuals. In order to capture a day-to-day observation of the relationship between the damaging effects of social abuse, the victim’s mental health and depressive mood, a study was conducted on whether individuals would have a higher level of depressed mood when exposed to daily acts of negative behaviour. The result concluded that being exposed daily to abusive behaviours such as bullying has a positive relationship to depressed mood on the same day.

The study has also gone beyond to compare the level of depressive mood between the victims and non-victims of the daily bullying. Although victims were predicted to have a higher level of depressive mood, the results have shown otherwise that exposure to negative acts has led to similar levels of depressive mood, regardless of the victim status. The results therefore have concluded that bystanders and non-victims feel as equally depressed as the victim when being exposed to acts such as social abuse.

Creative Thinking

Divergent thinking is defined as a thought process that generates creativity in ideas by exploring many possible solutions. Having a depressed mood will significantly reduce the possibility of divergent thinking, as it reduces the fluency, variety and the extent of originality of the possible ideas generated.

However, some depressive mood disorders might have a positive effect for creativity. Upon identifying several studies and analysing data involving individuals with high levels of creativity, Christa Taylor was able to conclude that there is a clear positive relationship between creativity and depressive mood. A possible reason is that having a low mood could lead to new ways of perceiving and learning from the world, but it is unable to account for certain depressive disorders. The direct relationship between creativity and depression remains unclear, but the research conducted on this correlation has shed light that individuals who are struggling with a depressive disorder may be having even higher levels of creativity than a control group, and would be a close topic to monitor depending on the future trends of how creativity will be perceived and demanded.

Stress Management Techniques

There are empirical evidences of a connection between the type of stress management techniques and the level of daily depressive mood.

Problem-focused coping leads to lower level of depression. Focusing on the problem allows for the subjects to view the situation in an objective way, evaluating the severity of the threat in an unbiased way, thus it lowers the probability of having depressive responses. On the other hand, emotion-focused coping promotes a depressed mood in stressful situations. The person has been contaminated with too much irrelevant information and loses focus on the options for resolving the problem. They fail to consider the potential consequences and choose the option that minimises stress and maximises well-being.

Management

Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition which may benefit from treatment. The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicated that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor. Physical activity can have a protective effect against the emergence of depression.

Physical activity can also decrease depressive symptoms due to the release of neurotrophic proteins in the brain that can help to rebuild the hippocampus that may be reduced due to depression. Also yoga could be considered an ancillary treatment option for patients with depressive disorders and individuals with elevated levels of depression.

Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly who have lived longer and have more experiences in life. It is a method that causes a person to recollect memories of their own life, leading to a process of self-recognition and identifying familiar stimuli. By maintaining one’s personal past and identity, it is a technique that stimulates people to view their lives in a more objective and balanced way, causing them to pay attention to positive information in their life stories, which would successfully reduce depressive mood levels.

Self-help books are a growing form of treatment for peoples physiological distress. There may be a possible connection between consumers of unguided self-help books and higher levels of stress and depressive symptoms. Researchers took many factors into consideration to find a difference in consumers and non-consumers of self-help books. The study recruited 32 people between the ages of 18 and 65; 18 consumers and 14 non-consumers, in both groups 75% of them were female. Then they broke the consumers into 11 who preferred problem-focused and 7 preferred growth-oriented. Those groups were tested for many things including cortisol levels, depressive symptomatology, and stress reactivity levels. There were no large differences between consumers of self-help books and non-consumers when it comes to diurnal cortisol level, there was a large difference in depressive symptomatology with consumers having a higher mean score. The growth-oriented group has higher stress reactivity levels than the problem-focused group. However, the problem-focused group shows higher depressive symptomatology.

Book: Feeling Good: The New Mood Therapy

Book Title:

Feeling Good: The New Mood Therapy.

Author(s): David D. Burns.

Year: 1998.

Edition: First (1st), New Edition.

Publisher: Avon Books.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

The good news is that anxiety, guilt, pessimism, procrastination, low self-esteem, and other ′black holes′ of depression can be cured without drugs. In Feeling Good, eminent psychiatrist David D. Burns, M.D. outlines the remarkable, scientifically proven techniques that will immediately lift your spirits and help you develop a positive outlook on life.

Now, in this updated edition, Dr Burns adds an all-new Consumer′s Guide To Antidepressant Drugs, as well as a new introduction to help answer your questions about the many options available for treating depression.

Book: Mental Health Journal: Anxiety and Depression Journal

Book Title:

Mental Health Journal: Anxiety and Depression Journal. Mental Health Journal & Mood Tracker – Thoughts and Feelings Tracker – PTSD and Depression … Goals, Promote Positive Thinking & Gratitude.

Author(s): R. Roslinda.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback.

Synopsis:

This Mental Health Journal & Mood Tracker is designed to help you keep track of your mental and emotional wellbeing. Ideal for anyone struggling with anxiety and mood disorders: depression, ADHD, Bipolar etc. The journal features a 12 monthly daily mood tracker, pages for you to write down your feelings and thoughts. Keep notes on things you are grateful for and your achievements. There are also spaces for you to jot down stuff like, things you did well at today, things that made you smile, things that you had fun doing and enjoyed, things you did that made you feel proud. You can also make notes on goals you want to accomplish.

Features:

  • Mood Tracker For 12 Months: Angry, Ashamed, Confused, Excited….
  • Anxiety Levels Chart-Mood Chart-Section with writing prompts: How do I feel?, Today I am grateful for…, Something I did well today, I felt proud when…
  • and many more!

Book: Learned Hopefulness – The Power of Positivity to Overcome Depression

Book Title:

Learned Hopefulness – The Power of Positivity to Overcome Depression.

Author(s): Dan Tomasulo, PhD.

Year: 2020.

Edition: First (1st).

Publisher: New Harbinger Publications.

Type(s): Paperback and Kindle.

Synopsis:

Cultivate hope with strengths-based practices grounded in positive psychology.

If you suffer from depression, sub-clinical depression, or low mood, you may have days where you feel like you have lost hope – hope that you will ever feel better, that the world will be a better place, or that you will someday find the happiness that always seems to elude you. You are not alone. Many people struggle with feelings of sadness and hopelessness – especially in our difficult, modern world. The good news is that you can change.

Learned Hopefulness offers powerful exercises grounded in evidence-based positive psychology to help you identify your strengths; ditch the self-limiting beliefs that diminish your capacity for positivity; and increase feelings of motivation, resiliency, and wellness. You will also learn to untangle yourself from rumination over past negative events, while shifting your perspective to the present moment and anticipating your future through a more positive lens.

With this unique, compassionate, and life-affirming guide, you will find the tools you need to break free from hopelessness and start living a life of happiness and vitality.

Book: When Someone You Know Has Depression

Book Title:

When Someone You Know Has Depression – Words to Say and Things to Do.

Author(s): Susan J Noonan M.D. MPH.

Year: 2016.

Edition: First (1ed).

Publisher: John Hopkins University Press (JHUP).

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Mood disorders such as depression and bipolar disorder can be devastating to the person who has the disorder and to his or her family. Depression and bipolar disorder affect every aspect of how a person functions, including their thoughts, feelings, actions, and relationships with other people. Family members and close friends are often the first to recognise the subtle changes and symptoms of depression. They are also the ones who provide daily support to their relative or friend, often at great personal cost. They need to know what to say or do to cope with the person’s impaired thinking and fluctuating moods.

In When Someone You Know Has Depression, Dr. Susan J. Noonan draws on first-hand experience of the illness and evidence-based medical information. As a physician she has treated, supported, and educated those living with – and those caring for – a person who has a mood disorder. She also has lived through the depths of her own mood disorder. Here, she has written a concise and practical guide to caring fevor someone who has depression or bipolar disorder. This compassionate book offers specific suggestions for what to say, how to encourage, and how to act around a loved one – as well as when to back off.

Dr Noonan describes effective communication strategies to use during episodes of depression and offers essential advice for finding appropriate professional help. She also explains how to reinforce progress made in therapy, how to model resilience skills, and how caregivers can and must care for themselves. Featuring tables and worksheets that convey information in an accessible way, as well as references, resources, and a glossary, this companion volume to Dr. Noonan’s patient-oriented Managing Your Depression is an invaluable handbook for readers navigating and working to improve the depression of someone close to them.

What is Sickness Behaviour?

Sickness Behaviour is a type of short-term depression:

“Remember the last time you had a stomach bug and just wanted to crawl into bed and pull up the covers? That is called “sickness behaviour” and it is a kind of short-term depression.

The bacteria infecting you aren’t just making you feel nauseous, they are controlling your mood too. It sounds absurd: they are in your gut and your feelings are generated in your brain.

In fact, this is just an inkling of the power that microbes have over our emotions. In recent years, such organisms in the gut have been implicated in a range of conditions that affect mood, especially depression and anxiety.

The good news is that bacteria don’t just make you feel low; the right ones can also improve your mood. That has an intriguing implication: one day we may be able to manipulate the microbes living within our gut to change our mood and feelings.” (Anderson, 2019, p.34).

Reference

Anderson, S. (2019) The Psychobiotic Revolution. New Scientist. 07 September 2019.

A Trip to the Park Can Boost Happiness

A new study has found that spending time in city parks can improve our mood just as much as Christmas.

Published in the People and Nature Journal, this research looked at the content of people’s tweets and found that those who visited urban parks used more upbeat words and expressed less negativity on Twitter than they did before their visit.

The results also showed that their increase in happiness lasted up to four hours after their green space fix.