Abstract
Introduction: In research and treatment of mood disorders, “euthymia” traditionally denotes the absence of clinically significant mood disturbance. A newer, expanded definition of euthymia also includes positive affect and psychological well-being. Objective: We aimed to test this comprehensive model of euthymia and estimate the coherence and predictive power of each factor in the model. Methods: Community-dwelling adults (N = 601), including both mental health outpatients and non-patients at high risk for personality pathology, completed a battery of interviews and questionnaires at time 1. Most (n = 497) were reassessed on average 8 months later (time 2). We modeled euthymia using standard mood, personality, and psychosocial functioning assessments rather than measures designed specifically for euthymia. Results: The hypothesized model of euthymia was supported by confirmatory factor analysis: specific measures loaded on three lower order factors (mood disturbance, positive affect, and psychological well-being) that reflected general euthymia at time 1. Each factor (general euthymia plus lower order factors) demonstrated moderately strong concurrent (time 1) and predictive (time 1–2) correlations with outcomes, including employment status, income, mental health treatment consumption, and disability. Compared to positive affect and psychological well-being, mood disturbance had stronger incremental (i.e., nonoverlapping) relations with these outcomes. Conclusions: Support for a comprehensive model of euthymia reinforces efforts to improve assessment and treatment of mood and other disorders. Beyond dampening of psychological distress, euthymia-informed treatment goals encompass full recovery, including enjoyment and meaning in life.
References
1.
Fava
GA
, Bech
P
. The concept of euthymia
. Psychother Psychosom
. 2016
;85
(1
):1
–5
.2.
Fava
GA
, Guidi
J
. The pursuit of euthymia
. World Psychiatry
. 2020 Feb
19
1
40
50
.3.
Guidi
J
, Fava
GA
. The clinical science of euthymia: a conceptual map
. Psychother Psychosom
. 2022
;91
(3
):156
–67
.4.
Demyttenaere
K
, Donneau
AF
, Albert
A
, Ansseau
M
, Constant
E
, van Heeringen
K
. What is important in being cured from depression? Discordance between physicians and patients (1)
. J Affect Disord
. 2015 Mar 15
174
390
6
.5.
Frank
E
, Prien
RF
, Jarrett
RB
, Keller
MB
, Kupfer
DJ
, Lavori
PW
. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence
. Arch Gen Psychiatry
. 1991 Sep
48
9
851
5
.6.
American Psychiatric Association
. Diagnostic and statistical manual of mental disorders. 5th edWashington, DC
American Psychiatric Association
2013
.7.
Watson
D
, Wiese
D
, Vaidya
J
, Tellegen
A
. The two general activation systems of affect: structural findings, evolutionary considerations, and psychobiological evidence
. J Personal Soc Psychol
. 1999 May
76
5
820
38
.8.
Ryff
CD
. Psychological well-being revisited: advances in the science and practice of eudaimonia
. Psychother Psychosom
. 2014
;83
(1
):10
–28
.9.
Ryff
CD
, Keyes
CL
. The structure of psychological well-being revisited
. J Pers Soc Psychol
. 1995 Oct
69
4
719
27
.10.
Sharp
C
, Wall
K
. DSM-5 level of personality functioning: refocusing personality disorder on what it means to be human
. Annu Rev Clin Psychol
. 2021 May 7
17
313
37
.11.
Clark
LA
, Ro
E
. Three-pronged assessment and diagnosis of personality disorder and its consequences: personality functioning, pathological traits, and psychosocial disability
. Personal Disord
. 2014 Jan
5
1
55
69
.12.
Clark
LA
, Nuzum
H
, Shapiro
JL
, Vanderbleek
EN
, Daly
EJ
, Simons
AD
. Personality profiles as potential targets for intervention: identification and replication
. Personal Ment Health
. 2020 Feb
14
1
142
63
.13.
Langbehn
DR
, Pfohl
BM
, Reynolds
S
, Clark
LA
, Battaglia
M
, Bellodi
L
. The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview
. J Pers Disord
. 1999
;13
(1
):75
–89
.14.
Sheehan
DV
, Lecrubier
Y
, Harnett Sheehan
K
, Janavs
J
, Weiller
E
, Keskiner
A
. The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability
. Eur Psychiatry
. 1997
;12
(5
):232
–41
.15.
Watson
D
, O’Hara
MW
, Naragon-Gainey
K
, Koffel
E
, Chmielewski
M
, Kotov
R
. Development and validation of new anxiety and bipolar symptom scales for an expanded version of the IDAS (the IDAS-II)
. Assessment
. 2012 Dec
19
4
399
420
.16.
Diener
E
, Emmons
RA
, Larsen
RJ
, Griffin
S
. The satisfaction with life scale
. J Pers Assess
. 1985 Feb
49
1
71
5
.17.
Development of the world health organization WHOQOL-BREF quality of life assessment. The WHOQOL Group
. Psychol Med
. 1998 May
28
3
551
8
.18.
Parker
G
, Hadzi-Pavlovic
D
, Both
L
, Kumar
S
, Wilhelm
K
, Olley
A
. Measuring disordered personality functioning: to love and to work reprised
. Acta Psychiatr Scand
. 2004 Sep
110
3
230
9
.19.
Ro
E
, Clark
LA
. Psychosocial functioning in the context of diagnosis: assessment and theoretical issues
. Psychol Assess
. 2009 Sep
21
3
313
24
.20.
Ryff
CD
, Singer
B
. Psychological well-being: meaning, measurement, and implications for psychotherapy research
. Psychother Psychosom
. 1996
;65
(1
):14
–23
.21.
World Health Organization
. Measuring health and disability: manual for WHO disability assessment Schedule (WHO-DAS 2.0). Geneva, Switzerland
World Health Organization
2010
.22.
Rosseel
Y
. Lavaan: an R package for structural equation modeling
. J Stat Softw
. 2012 May
48
2
1
36
.23.
R Core Team. R
. A language and environment for statistical computing. Vienna, Austria
R Foundation for Statistical Computing
2021
. Available from: https://www.R-project.org/.24.
Vittengl
JR
, Jha
MK
, Minhajuddin
A
, Thase
ME
, Jarrett
RB
. Quality of life after response to acute-phase cognitive therapy for recurrent depression
. J Affect Disord
. 2021 Jan 1
278
218
25
.25.
World Health Organization
. The WHO special initiative for mental health (2019-2023): universal health coverage for mental health. Geneva, Switzerland
World Health Organization
2019
.26.
Dunn
BD
, German
RE
, Khazanov
G
, Xu
C
, Hollon
SD
, DeRubeis
RJ
. Changes in positive and negative affect during pharmacological treatment and cognitive therapy for major depressive disorder: a secondary analysis of two randomized controlled trials
. Clin Psychol Sci
. 2020 Jan
8
1
36
51
.27.
Vittengl
JR
, Clark
LA
, Thase
ME
, Jarrett
RB
. Levels of depressed mood and low interest for two years after response to cognitive therapy for recurrent depression
. Behav Res Ther
. 2022 Jan
148
103996
.28.
Craske
MG
, Meuret
AE
, Ritz
T
, Treanor
M
, Dour
H
, Rosenfield
D
. Positive affect treatment for depression and anxiety: a randomized clinical trial for a core feature of anhedonia
. J Consult Clin Psychol
. 2019 May
87
5
457
71
.29.
Dunn
BD
, Widnall
E
, Reed
N
, Owens
C
, Campbell
J
, Kuyken
W
. Bringing light into darkness: a multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT)
. Behav Res Ther
. 2019 Sep
120
103418
.30.
Geschwind
N
, Arntz
A
, Bannink
F
, Peeters
F
. Positive cognitive behavior therapy in the treatment of depression: a randomized order within-subject comparison with traditional cognitive behavior therapy
. Behav Res Ther
. 2019 May
116
119
30
.31.
Fava
GA
, Tomba
E
, Grandi
S
. The road to recovery from depression-don’t drive today with yesterday’s map
. Psychother Psychosom
. 2007
;76
(5
):260
–5
.32.
Fava
GA
. Well-being therapy: conceptual and technical issues
. Psychother Psychosom
. 1999
;68
(4
):171
–9
.33.
Fava
GA
. Well-being therapy: Treatment manual and clinical applications
Basel
Karger
2016
.34.
Guidi
J
, Fava
GA
. The emerging role of euthymia in psychotherapy research and practice
. Clin Psychol Rev
. 2020
;82
:101941
.35.
Carrozzino
D
, Christensen
KS
, Mansueto
G
, Brailovskaia
J
, Margraf
J
, Cosci
F
. A clinimetric analysis of the euthymia, resilience, and positive mental health scales
. J Affect Disord
. 2021
;294
:71
–6
.36.
Lukat
J
, Margraf
J
, Lutz
R
, van der Veld
WM
, Becker
ES
. Psychometric properties of the positive mental health scale (PMH-scale)
. BMC Psychol
. 2016 Feb 10
4
8
.37.
Bartova
L
, Dold
M
, Fugger
G
, Kautzky
A
, Mitschek
MMM
, Weidenauer
A
. The role of relationship status in major depressive disorder: results of the European group for the study of resistant depression
. J Affect Disord
. 2021
;286
:149
–57
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