The relationships between impulsivity and mood in bipolar disorder: An ecological momentary assessment study

ABSTRACT Background Impulsivity is a key feature of bipolar disorder (BD) associated with various negative outcomes. Recent use of ecological momentary assessment (EMA) has allowed for nuanced examination of the mechanisms of mood and impulsivity dysregulation. However, few existing studies have used an ecological momentary assessment of impulsivity in multiplex families with BD and examined its associations with mood. Objective Using EMA, this study investigated the concurrent and predictive relationships between impulsivity and mood. Methods Multiplex family members with BD (n=8), unaffected family members (n=6), individuals with BD not from families (n=8) and healthy controls (n=8), completed daily EMA surveys about mood and impulsivity for 6-12 weeks. Mixed-effects regression concurrent and lagged models were employed to analyze the relationship between impulsivity and mood. Results The diagnosis of BD was associated with lower mood and higher impulsivity levels. Belonging to a multiplex family (i.e. high genetic load for BD) was associated with lower mood but not with higher impulsivity. BD participants showed a negative association between impulsivity and concurrent mood measured with EMA. Time-lagged analyses revealed a significant negative association between prior impulsivity and mood at the next assessment independent of diagnosis. Conclusions These results contribute to the understanding of the complex interactions between BD, the genetic load of the disorder, impulsivity and mood. Furthermore, these findings indicate the potential benefits of addressing impulsivity as a means to improve mood outcomes at an early stage.