The temporal course and clinical correlates of subjective impulsivity in bipolar disorder as revealed through ecological momentary assessment

J Affect Disord. 2016 Mar 15;193:145-50. doi: 10.1016/j.jad.2015.12.016. Epub 2015 Dec 15.


Background: Impulsivity is frequently linked with bipolar disorder and is associated with mania and negative outcomes. The temporal dynamics of subjective impulsivity are unclear, in particular whether impulsivity precedes or follows changes in positive or negative affect.

Methods: A total of 41 outpatients with bipolar disorder (I or II) were provided with mobile devices for 11 weeks and completed twice-daily surveys about affective states and subjective impulsivity. We examined the association between aggregate subjective impulsivity with baseline global cognitive function, suicide risk ratings, and medication adherence, as well as concurrent and lagged associations with momentary positive and negative affect ratings.

Results: A total of 2902 ratings were available across study subjects. Higher aggregate mean ratings of impulsivity were associated with worse baseline global cognitive function, prior suicide attempts, and self-reported problems with medication adherence, as well as more severe manic (but not depressive) symptoms. Time-lagged models indicated that greater negative affect, but not positive affect, predicted subsequent increases in subjective impulsivity, which, in turn, predicted diminished positive affect.

Limitations: Other measures of impulsivity with which to validate subjective ratings were unavailable and the sample was restricted to generally clinically stable outpatients.

Conclusions: Subjective impulsivity as measured by daily monitoring was associated with worse cognitive function and self-rated medication adherence, and higher suicide risk ratings. Impulsivity may be a maladaptive strategy to regulate negative affect in bipolar disorder.

Keywords: Assessment; Bipolar disorder; Emotion; Mobile health; Technology; Time series analysis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / psychology*
  • Cognition
  • Female
  • Humans
  • Impulsive Behavior*
  • Male
  • Medication Adherence / psychology
  • Middle Aged
  • Risk Factors
  • Self Report
  • Suicide, Attempted / psychology
  • Symptom Assessment / methods*
  • Time Factors