The association of phasic irritability (aggressive outbursts) and tonic irritability (irritable mood) to depression occurrences, symptoms, and subtypes

Network structure of phasic and tonic irritability in adults: A Bayesian Gaussian graphical model

BACKGROUND

Tonic (i.e., irritable mood) and phasic (i.e., temper outbursts) irritability are distinct constructs in childhood, yet there has been little work investigating their relations in adulthood. In particular, no study has examined the relations between these symptoms in the daily lives of adults. The present study seeks to address these gaps by applying a Bayesian Gaussian graphical model to daily diary data of tonic and phasic irritability in adults.

METHOD

A total of 122 participants (Mage = 34.94 [SD = 12.3] years, 52 % female) completed up to 18 days of daily diary, with questions on both tonic and phasic irritability. Contemporaneous, temporal, and between-person networks were constructed using 5 items of tonic and 11 items of phasic irritability. Predictability, centrality, density, and network loadings were also calculated.

RESULTS

Five main findings emerged. First, phasic and tonic irritability were connected in our contemporaneous and temporal networks but distinct in our between-person network. Second, phasic irritability symptoms demonstrated the most importance and influence across networks. Third, tonic irritability symptoms best connected the two subnetworks. Fourth, phasic irritability symptoms appeared to have the potential to be more responsive to interventions. Fifth, tonic irritability demonstrated robust associations with daily functional impairment.

CONCLUSIONS

Tonic and phasic irritability symptoms demonstrate unique associations in the daily lives of adults. Future work should examine the differential potential of these symptoms to respond to targeted interventions.

Early Predictors and Concurrent Correlates of Tonic and Phasic Irritability in Adolescence

Irritability is a common presenting problem in youth mental health settings that is thought to include two components: tonic (e.g., irritable, touchy mood) and phasic (e.g., temper outbursts), each with unique correlates and outcomes, including later internalizing and externalizing problems, respectively. However, we are unaware of any studies of early predictors of tonic and phasic irritability. We utilized data from a longitudinal study of a community sample of 3-year-old children followed to age 15 (n = 444). We conducted confirmatory factor analysis (CFA) of items from several self-report irritability measures at age 15, including the Affective Reactivity Index, the International Personality Item Pool, the Schedule for Non-Adaptive and Adaptive Personality Youth Version, and the Child Depression Inventory, and examined their early childhood predictors. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability at age 15 was uniquely associated with concurrent internalizing disorders and suicidal behavior while phasic irritability was uniquely associated with concurrent externalizing disorders. When adolescent tonic and phasic irritability were examined together, female sex and parental depressive and substance use disorders at age 3 uniquely predicted adolescent tonic irritability. Additionally, male sex, less parental education, greater laboratory-observed anger and impulsivity, ODD symptoms, higher irritability, and no parental substance use history at age 3 uniquely predicted adolescent phasic irritability. Youth-reported tonic and phasic irritability at age 15 appear to be distinguishable constructs with distinct concurrent correlates and early antecedents. Findings have important implications for research on the etiology of irritability and developing effective treatments.

Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately1

Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.

Irritability: A concept analysis

Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.

Dissecting the depressed mood criterion in adult depression: The heterogeneity of mood disturbances in major depressive episodes

BACKGROUND

Mood disturbances have historically remained a core criterion in diagnosing major depressive episode. DSMs have illustrated this criterion with depressed, hopeless, discouraged, cheerless, and irritable mood, suggesting interchangeability. Extant research has examined individual forms of mood disturbance to depression severity. Less examined is the heterogeneity in mood disturbances and its implication to their association to depression presentations and outcomes.

METHOD

The current study used a nationally representative sample of U.S. adults with unipolar major depressive disorder to study the association between specific forms of mood disturbances to depression severity, chronicity, or symptoms, above and beyond other forms, as well as their relations to functional impairment, suicidal outcomes, and psychiatric comorbidity via generalized linear models.

RESULTS

Cheerless and hopeless mood were associated with depression severity. Hopeless and irritable mood were associated with depression chronicity. Different forms of mood disturbance showed differential relations to depressive symptoms. Cheerless, hopeless, and irritable mood were associated with depression-specific functional interference, incremental to depression severity. Cheerless, hopeless, and discouraged mood were associated with passive suicidal ideation. Hopeless mood was associated with active suicidal ideation. Hopeless and irritable mood were associated with both suicide plan and suicide attempt. Different forms of mood disturbance demonstrated differential associations to comorbid psychiatric conditions.

DISCUSSION

The relations between different forms of mood disturbances and various aspects of depression are nuanced. Theoretically, these relations highlight the potential utility in acknowledging the complexity and heterogeneity in mood disturbances. Clinically, our results suggest potential utility in routinely monitoring mood disturbances.

The Influence of Personality and Demographic Characteristics on Aggressive Driving Behaviors in Eastern Chinese Drivers

Purpose

Road safety research is important due to the large number of road traffic fatalities globally. This study investigated the influences of age, driving experience and other covariates on aggressive driving behavior.

Methods

A cross-sectional survey was conducted in Yixing City, Wuxi City, Jiangsu Province, China. Regression analysis was applied to explore the influences of age and driving experience and their interactions with other covariates on aggressive driving behavior. Two analyses methodologies were used to assess the simple effect of the interactions. Firstly, the Jamovi automatic analysis classification program was used to calculate the simple slope test. Second, the SPSS macro program was also used to calculate the simple slope test also.

Results

A total of 570 drivers (247 males, 282 females) participated in the survey. A negative correlation was found between age and aggressive driving behaviors, and a positive correlation was found between neuroticism and aggressive driving behaviors in the multiple regression analysis. Significant associations were also found between age, driving experience, and depression, as well as age, driving experience, and neuroticism. Simple slope tests showed that depressive symptoms could increase aggressive behaviors in the elderly and experienced drivers. When experiencing neuroticism, individuals with higher driving experience were more aggressive in driving than shorter experienced drivers.

Conclusion

Age and neuroticism influenced aggressive driving behaviors. Veteran drivers could be aggressive drivers when experiencing depressive symptoms or neuroticism. Mobile intervention could be sent to the potentially risky drivers, which would be safe and broadly feasible to prevent aggressive driving behavior in the background of COVID-19.