Tracking positive emotions in the course of adult depression: A systematic scoping review of longitudinal studies
Emotional symptoms are core elements to the lived experience of depression, with the absence of positive emotions being a key distinctive feature of depression. However, while negative emotions are repeatedly monitored by measures, positive emotions rarely are assessed in people with depression. Measuring positive emotions is a methodological challenge as their presence varies notably depending on the daily events encountered by a person. Assessing positive emotions at a single timepoint or outside of the context of daily life may only reflect a general overview of the positive emotions encountered. It remains unclear what kind of positive emotions are measured, at what frequency, and how they are measured. A better knowledge of the evolution of positive emotions in depression may be of particular interest for a range of clinical applications.
We aimed to describe the procedures and measurement instruments used in longitudinal observational studies to assess positive emotions in assess the course of depression in adults and assess their methodological quality and the content validity. We conducted a systematic scoping review of studies that investigated the course of positive emotions in adults (>18 years old) with depression. Then, we evaluated the development (e.g., design and cognitive interview study/pilot test) and content validity (e.g., relevance, comprehensiveness, comprehensibility) of the patient-reported outcome measures identified.
In total, we included 19 research articles published between 1977 and 2023. Majority (81%) measured positive emotions with the Ecological Momentary Assessment, which uses a variety of repeated data collection modes: smartphone apps, electronic diaries, physical research booklets. Three studies, published before 2013, used a collection of two or three measures. Positive emotions were identified by lists of adjectives from standardized measures (the State-Trait Depression Adjectives Checklist [ST-DACL] or the Positive and Negative Affect Schedule [PANAS]), derivatives of standardized measures, or ad hoc lists specifically developed for the study. In total, 37 unique adjectives were used to measure positive emotions. The most measured emotions were enthusiastic, happy, cheerful, and satisfied. Eight positive emotions were measured by only one study: close to others, contented, euphoric, full of life, hopeful, in good spirits, like you belong, and self-assured. We evaluated the quality of the ST-DACL, PANAS, PANAS-SF, and PANAS-X. The quality of the development studies for these measures was doubtful for all four measures, due to the absence of a dedicated content validity study, non-involvement of people with depression, and limited information on measurement properties.
This study shows that there is no consensus on the measurement of positive emotions in people with depression. Effective management of depression should aim to not only to reduce the suffering caused by negative emotions, but also to restore the presence of positive emotions. Agreement about what positive emotions are and how to measure them should be further developed to improve both research and the lives of those with lived experiences of depression.
This study was conducted with 6 members from CRESS: Clara Mebazaa, Chris Veal, Alexandre Ribeiro, Isabelle Boutron, Karolin Krause, and Astrid Chevance.
