Pathways to Mania Risk in Young Adults: Investigating Concurrent and Prospective Associations with Affective Lability and Emotion Regulation

Increasing evidence suggests that both negative and positive emotion regulation influence mental health and well-being (Aldao et al., 2010; Carl et al., 2013). Hypomanic personality, a proxy measure of mania risk (Kwapil et al., 2000), is related to strategies for both upregulating and downregulating emotion, and all are related to mood symptoms. Mania risk is associated with affective lability (Sperry & Kwapil, 2017), but their shared and unique relationships with emotion regulation and mood symptoms have not been investigated. This study was a longitudinal investigation of associations between mania risk, affective lability, emotion regulation, and mood and anxiety symptoms. Specifically, this study aimed to test similarities and differences between hypomanic personality and affective lability in terms of their associations with mood, and the moderating role of emotion regulation in these relationships.
UK university students (aged 18-25 years) completed two surveys at the beginning of Semester Two. The first (T1) provided baseline data on hypomanic personality (mania risk), affective lability, manic, depressive and anxious symptoms, wellbeing, and outcomes that are meaningful to students: financial worries and university-related wellbeing. The second (T2) provided data on psychological mechanisms that are putatively related to mania risk, mood, wellbeing and academic outcome in students: positive and negative emotion regulation strategies, and mood-based impulsivity (positive and negative urgency). Mood and anxiety measures were completed again. A follow-up survey (T3) at the end of the academic year measured mood, wellbeing, and university-related wellbeing. From an initial sample of n = 1117, n = 221 completed T1 and T3, and the final sample who completed all phases was n = 113 (mean age = 20.5 years, 74% female).
Mania risk was positively associated with affective lability. Both were positively correlated with depression and anxiety, as well as tendencies to amplify and dampen positive affect, ruminate as a response to low mood, and positive and negative urgency. Mania risk was additionally related to higher mania and amplifying positive emotion. In linear regression analyses, mania risk and affective lability were not predictors of anxiety or depression over and above positive and negative emotion regulation strategies and urgency. Dampening positive affect was the strongest predictor of depression and anxiety, which was also predicted by negative urgency. Only mania risk and emotion-focused rumination were uniquely associated with manic symptoms.
Longitudinal analyses will investigate whether mania risk and affective lability predict outcomes at the end of Semester 2. Further analyses will explore whether emotion regulation strategies moderate these associations.
This study provides evidence that mania risk and affective lability are strongly related, and have a similar pattern of relationships with emotion regulation strategies and depression and anxiety in students (relatively common mental health difficulties in this population). However, mania risk related to manic symptoms whereas affective lability did not. Dampening, negative urgency and emotion-focused rumination appear particularly problematic for student mental health. Future work must reduce drop-out to improve power at follow-up.