Skip to main content

Advertisement

SpringerLink
Log in

Mood instability, mental illness and suicidal ideas: results from a household survey

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

There is weak and inconsistent evidence that mood instability (MI) is associated with depression, post traumatic stress disorder (PTSD) and suicidality although the basis of this is unclear. Our objectives were first to test whether there is an association between depression and PTSD, and MI and secondly whether MI exerts an independent effect on suicidal thinking over and above that explained by common mental disorders.

Methods

We used data from the Adult Psychiatric Morbidity Survey 2007 (N = 7,131). Chi-square tests were used to examine associations between depression and PTSD, and MI, followed by regression modelling to examine associations between MI and depression, and with PTSD. Multiple logistic regression analyses were used to assess the independent effect of MI on suicidal thinking, after adjustment for demographic factors and the effects of common mental disorder diagnoses.

Results

There are high rates of MI in depression and PTSD and the presence of MI increases the odds of depression by 10.66 [95 % confidence interval (CI) 7.51–15.13] and PTSD by 8.69 (95 % CI 5.90–12.79), respectively, after adjusting for other factors. Mood instability independently explained suicidal thinking, multiplying the odds by nearly five (odds ratio 4.82; 95 % CI 3.39–6.85), and was individually by some way the most important single factor in explaining suicidal thoughts.

Conclusions

MI is strongly associated with depression and PTSD. In people with common mental disorders MI is clinically significant as it acts as an additional factor exacerbating the risk of suicidal thinking. It is important to enquire about MI as part of clinical assessment and treatment studies are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Westen D, Muderrisoglu S, Fowler C, Shedler J, Koren D (1997) Affect regulation and affective experience: individual differences, group differences, and measurement using a Q-sort procedure. J Consult Clin Psychol 65(3):429–439

    Article  PubMed  CAS  Google Scholar 

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Publishing, Arlington, p 707

  3. Trull TJ, Solhan MB, Tragesser SL, Jahng S, Wood PK, Piasecki TM, Watson D (2008) Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment. J Abnorm Psychol 117(3):647–661

    Article  PubMed  Google Scholar 

  4. Eysenck HJ (1983) Psychophysiology and personality: extraversion, neuroticism and psychoticism. Academic Press, London

    Google Scholar 

  5. Williams DG (1990) Effects of psychoticism, extraversion, and neuroticism in current mood: a statistical review of six studies. Pers Individ Differ 11(6):615–630

    Article  Google Scholar 

  6. McConville C, Cooper C (1999) Personality correlates of variable moods. Pers Individ Differ 26(1):65–78

    Article  Google Scholar 

  7. McConville C, Cooper C (1997) The temporal stability of mood variability. Pers Individ Differ 23(1):161–164

    Article  Google Scholar 

  8. Miller JD, Pilkonis PA (2006) Neuroticism and affective instability: the same or different? Am J Psychiatry 163(5):839–845

    Article  PubMed  Google Scholar 

  9. Pacini M, Maremmani I, Vitali M, Santini P, Romeo M, Ceccanti M (2009) Affective temperaments in alcoholic patients. Alcohol 43(5):397–404

    Article  PubMed  Google Scholar 

  10. Cassano GB, Dell’Osso L, Frank E, Miniati M, Fagiolini A, Shear K, Pini S, Maser J (1999) The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord 54(3):319–328

    Article  PubMed  CAS  Google Scholar 

  11. Paris J (2004) Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harv Rev Psychiatry 12(3):140–145

    Article  PubMed  Google Scholar 

  12. Koenigsberg H (2010) Affective instability: toward an integration of neuroscience and psychological perspectives. J Pers Disord 24:60–82

    Article  PubMed  Google Scholar 

  13. Thompson RJ, Berenbaum H, Bredemeier K (2011) Cross-sectional and longitudinal relations between affective instability and depression. J Affect Disord 130(1–2):53–59

    Article  PubMed  Google Scholar 

  14. Golier JA, Yehuda R, Schmeidler J, Siever LJ (2001) Variability and severity of depression and anxiety in post traumatic stress disorder and major depressive disorder. Depression Anxiety 13(2):97–100

    Article  PubMed  CAS  Google Scholar 

  15. Cowdry RW, Gardner DL, O’Leary KM, Leibenluft E, Rubinow DR (1991) Mood variability: a study of four groups. Am J Psychiatry 148(11):1505–1511

    PubMed  CAS  Google Scholar 

  16. Kashdan TB, Uswatte G, Steger MF, Julian T (2006) Fragile self-esteem and affective instability in posttraumatic stress disorder. Behav Res Ther 44(11):1609–1619

    Article  PubMed  Google Scholar 

  17. Black DW, Blum N, Letuchy E, Carney Doebbeling C, Forman-Hoffman VL, Doebbeling BN (2006) Borderline personality disorder and traits in veterans: psychiatric comorbidity, healthcare utilization, and quality of life along a continuum of severity. CNS Spectr 11(9):680–689 (quiz 719)

    PubMed  Google Scholar 

  18. Bagge C, Nickell A, Stepp S, Durrett C, Jackson K, Trull TJ (2004) Borderline personality disorder features predict negative outcomes 2 years later. J Abnorm Psychol 113(2):279–288

    Article  PubMed  Google Scholar 

  19. Rihmer Z (2007) Suicide risk in mood disorders. Curr Opin Psychiatry 20(1):17–22

    Article  PubMed  Google Scholar 

  20. Murray G, Allen NB, Trinder J (2002) Longitudinal investigation of mood variability and the ffm: neuroticism predicts variability in extended states of positive and negative affect. Pers Individ Differ 33(8):1217–1228

    Article  Google Scholar 

  21. McManus SaM H, Brugha TS, Bebbington PE, Jenkins R (2009) Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for Health and Social Care, London

    Google Scholar 

  22. Leicester NCfSraUo (2011) Adult psychiatric morbidity survey 2007 (computer file), 3rd edn. UK Data Archive, Colchester

    Google Scholar 

  23. First M, Gibbon M, Spitzer RL, William JBW, Benjamin L (1997) Structured clinical interview for DSM-IV axis II personality disorders. American Psychiatric Press, Washington

    Google Scholar 

  24. Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22(2):465–486

    Article  PubMed  CAS  Google Scholar 

  25. Saunders JB, Aasland OG, Babor TF, Delafuente JR, Grant M (1993) Development of the alcohol-use disorders identification test (audit)—WHO collaborative project on early detection of persons with harmful alcohol-consumption 2. Addiction 88(6):791–804

    Article  PubMed  CAS  Google Scholar 

  26. Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner S, Foa EB (2002) Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry 181:158–162

    PubMed  Google Scholar 

  27. Foa EB, Riggs DS, Dancu CV, Rothbaum BO (1993) Reliability and validity of a brief instrument for assessing posttraumatic-stress-disorder. J Trauma Stress 6(4):459–473

    Article  Google Scholar 

  28. Brewin CR (2005) Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress 18(1):53–62

    Article  PubMed  Google Scholar 

  29. Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA, McNally RJ, Ursano RJ, Petukhova M, Kessler RC (2007) Exposure to hurricane-related stressors and mental illness after hurricane Katrina. Arch Gen Psychiatry 64(12):1427–1434

    Article  PubMed  Google Scholar 

  30. Marwaha S, Parsons N, Flanagan S, Broome M (2012) The prevalence and clinical associations of mood instability in adults living in England: results from the adult psychiatric morbidity survey 2007. Psychiatry Res. doi:10.1016/j.psychres.2012.09.036

  31. Bowen RC, Mahmood J, Milani A, Baetz M (2011) Treatment for depression and change in mood instability. J Affect Disord 128(1–2):171–174

    Article  PubMed  Google Scholar 

  32. Clark LA, Watson D, Mineka S (1994) Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol 103(1):103–116

    Article  PubMed  CAS  Google Scholar 

  33. Korten NCM, Comijs HC, Lamers F, Penninx BWJH (2012) Early and late onset depression in young and middle aged adults: differential symptomatology, characteristics and risk factors? J Affect Disord 138(3):259–267

    Article  PubMed  Google Scholar 

  34. Craske MG, Brown TA, Meadows EA, Barlow DH (1995) Uncued and cued emotions and associated distress in a college sample. J Anxiety Disord 9(2):125–137

    Article  Google Scholar 

  35. Correll CU, Penzner JB, Lencz T, Auther A, Smith CW, Malhotra AK, Kane JM, Cornblatt BA (2007) Early identification and high-risk strategies for bipolar disorder. Bipolar Disord 9(4):324–338

    Article  PubMed  Google Scholar 

  36. Goossens PJJ, Kupka RW, Beentjes TAA, van Achterberg T (2010) Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: a cross-sectional study. Int J Nurs Stud 47(10):1201–1207

    Article  PubMed  CAS  Google Scholar 

  37. Chanen AM, Jackson HJ, McCutcheon LK, Jovev M, Dudgeon P, Yuen HP, Germano D, Nistico H, McDougall E, Weinstein C, Clarkson V, McGorry PD (2008) Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. (erratum appears in Br J Psychiatry 2009 Feb 194(2):191). Br J Psychiatry 193(6):477–484

    Article  PubMed  Google Scholar 

  38. Bernal M, Haro JM, Bernert S, Brugha T, de Graaf R, Bruffaerts R, Lépine JP, de Girolamo G, Vilagut G, Gasquet I, Torres JV, Kovess V, Heider D, Neeleman J, Kessler R, Alonso J (2007) Risk factors for suicidality in Europe: results from the ESEMED study. J Affect Disord 101(1–3):27–34

    Article  PubMed  CAS  Google Scholar 

  39. Tarrier N, Picken A (2011) Co-morbid PTSD and suicidality in individuals with schizophrenia and substance and alcohol abuse. Soc Psychiatry Psychiatr Epidemiol 46(11):1079–1086

    Article  PubMed  Google Scholar 

  40. Steiger H, Koerner N, Engelberg MJ, Israel M, Ng Ying Kin NM, Young SN (2001) Self-destructiveness and serotonin function in bulimia nervosa. Psychiatry Res 103(1):15–26

    Article  PubMed  CAS  Google Scholar 

  41. Palmier-Claus JE, Taylor PJ, Gooding P, Dunn G, Lewis SW (2012) Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: an experience sampling study. Br J Clin Psychol 51(1):72–83

    Article  PubMed  CAS  Google Scholar 

  42. Henry C, Mitropoulou V, New AS, Koenigsberg HW, Silverman J, Siever LJ (2001) Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res 35(6):307–312

    Article  PubMed  CAS  Google Scholar 

  43. Thompson RJ, Dizén M, Berenbaum H (2009) The unique relations between emotional awareness and facets of affective instability. J Res Pers 43(5):875–879

    Article  PubMed  Google Scholar 

  44. Yen S, Shea MT, Sanislow CA, Grilo CM, Skodol AE, Gunderson JG, McGlashan TH, Zanarini MC, Morey LC (2004) Borderline personality disorder criteria associated with prospectively observed suicidal behavior. Am J psychiatry 161(7):1296–1298

    Article  PubMed  Google Scholar 

  45. Angst J, Gamma A, Endrass J (2003) Risk factors for the bipolar and depression spectra. Acta Psychiatr Scand 108:15–19

    Article  Google Scholar 

  46. Berger W, Coutinho ES, Figueira I, Marques-Portella C, Luz MP, Neylan TC, Marmar CR, Mendlowicz MV (2012) Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol 47(6):1001–1011

    Article  PubMed  Google Scholar 

  47. Shea MT, Stout R, Gunderson J, Morey LC, Grilo CM, McGlashan T, Skodol AE, Dolan-Sewell R, Dyck I, Zanarini MC, Keller MB (2002) Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. Am J Psychiatry 159(12):2036–2041

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the UK Data Archive and the National Centre for Social Research as the data collectors and depositors of the study. The National Centre for Social Research and the University of Leicester were the principle investigators of the Adult Psychiatric Morbidity Survey. They bear no responsibility for this further analysis or interpretation of this public dataset.

Conflict of interest

We declare there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Gibbet Hill Campus, Coventry, CV47AL, UK

    Steven Marwaha & Matthew Broome

  2. Coventry and Warwickshire Partnership Trust, Wayside House, Coventry, CV66NY, UK

    Steven Marwaha & Matthew Broome

  3. Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, Warwick University, Gibbet Hill Campus, Coventry, CV47AL, UK

    Nick Parsons

  4. Department of Psychosis Studies, Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF, UK

    Matthew Broome

Authors
  1. Steven Marwaha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nick Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Broome
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven Marwaha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marwaha, S., Parsons, N. & Broome, M. Mood instability, mental illness and suicidal ideas: results from a household survey. Soc Psychiatry Psychiatr Epidemiol 48, 1431–1437 (2013). https://doi.org/10.1007/s00127-013-0653-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0653-7

Keywords

Search

Navigation