Naturalistically observed sighing and depression in rheumatoid arthritis patients: A preliminary study.

Abstract

Objective-This study tested the degree to which naturalistically observed sighing in daily life is a behavioral indicator of depression and reported physical symptoms (i.e. experienced pain and flare days) in rheumatoid arthritis (RA) patients.Design-Thirteen RA patients wore the Electronically Activated Recorder (EAR), an observational ambulatory assessment tool, for two weekends (Friday through Sunday) approximately one month apart. The EAR periodically recorded snippets of ambient sounds from participants' momentary environments (50 sec every 18 min). Sighs were coded from the sampled ambient sounds. Main Outcome Measures-Depression was assessed with the Center for EpidemiologicalStudies Depression Scale, and the Beck Depression Inventory. Pain during the past month was assessed with a 10-cm visual-analog scale, and number of flare days during the prior 6 months was reported.Results-Sighing was significantly and strongly related to patients' levels of depression and non-significantly and less strongly to their reported pain and number of flare days. Conclusion-The findings suggest that sighing can serve as an observable marker of depression in RA patients. Because of the small sample size, the findings should be considered preliminary. KeywordsAmbulatory Assessment; Ecological Momentary Assessment; Electronically Activated Recorder; Emotion Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder characterized by pain and destruction of peripheral joints. As with physical health, RA exacts a heavy toll on mental health. About forty percent of RA patients develop comorbid depression (Covic, Tyson, Spencer, & Howe, 2006), which tends to exacerbate disease activity and undermine health-related quality of life (Zautra et al., 2004). Because depression most immediately affects people's inner mood and cognitive landscape, it is often "invisible" to outsiders. Thus, depression's privacy can impede its early detection and thereby adequate treatment. These issues are compounded when the social stigma surrounding depression leads to patients intentionally hiding symptoms (NIMH, 2001 Sighing is a behavior that has been phenomenologically defined as "an obvious exaggerated exhalation of breath" (p. 366; Keefe & Block, 1982), and physiologically as a breath that is "at least 500 mL larger than the mean of the prior three breaths and at least 400 mL larger than the following breath" (Abelson et al., 2001; p. 589). As such, sighing is a subtle expression that is potentially detectable by the EAR. Despite its intuitive tie to constructs such as psychological distress and depression, it has so far received very little scientific attention. The scarce research that exists on sighing suggests that it is conceptually and empirically linked to negative affect (Roth, 2005;Wilhelm, Trabert, & Roth, 2001). Empirically, in-lab studies have found that panic disorder patients sigh significantly more often than control participants (e.g. Abelson, Weg, Nesse, & Curtis, 2001;Wilhelm et al., 2001), suggesting that sigh...

How Taking a Word for a Word Can Be Problematic: Context-Dependent Linguistic Markers of Extraversion and Neuroticism

“…The EAR is a handheld computer with software that unobtrusively records snippets of ambient sounds in participants' immediate environment, alleviating problems with reliance on in-lab observation or self-reports of behavioral frequencies (Mehl, 2007). The EAR has been reliably used in numerous studies across a variety of topics, including behavioral manifestation of personality (Mehl, Gosling, & Pennebaker, 2006), conversational correlates of well-being (Mehl, Vazire, Holleran, & Clark, 2010), the validity of gender stereotypes (Mehl, Vazire, Ramirez-Esparza, Slatcher, & Pennebaker, 2007), diurnal rhythms underlying affect-associated behavior (Hasler, Mehl, Bootzin, & Vazire, 2008), the role of expressive behaviors in the coping process Robbins, Mehl, Holleran, & Kasle, 2011), and manifestations of family conflict (Slatcher & Trentacosta, 2011). For a thorough review of the validity of the EAR method, see Mehl, Robbins, and große Deters (2012).…”

The Electronically Activated Recorder (EAR)

“…For example, in one study, arthritis patients wore the EAR and completed depression and physical symptom measures (Robbins et al, 2011a). Incidents of sighing were coded from the recorded sounds.…”

“…Consistent with the idea that sighing can be more indicative of depression than of pain, sighing was more strongly related to patients’ depressive symptoms than to their experienced pain and flare days. In another study, arthritis and breast cancer patients wore the EAR to track their natural language use (Robbins et al, 2011b). Information on how much participants were swearing was derived from automatic text analysis.…”

Social Context of Anger in Borderline Personality Disorder and Depressive Disorders: Findings From a Naturalistic Observation Study

“…The EAR has been used in studies of time allocation (Mehl et al, 2001;Mehl & Pennebaker, 2003), personality traits (Holtzman, Vazire, & Mehl, 2010;Mehl, Gosling, & Pennebaker, 2006), sub-clinical depression (Mehl, 2006) and coping with rheumatoid arthritis (Robbins, Mehl, Holleran, & Kasle, 2011) and breast cancer (Robbins, Focella, Kasle, Weihs, Lopez, & Mehl, 2011). Previous studies using the EAR methodology have assessed the prevalence and pattern of affective behaviors such as laughing, crying, arguing, and sighing (Hasler, Mehl, Bootzin, & Vazire, 2008;Mehl, Gosling, & Pennebaker, 2006;, and the stability and personality implications of language use conveying positive or negative emotion (Augustine, Mehl, & Larsen, 2011;Mehl & Pennebaker, 2003;Mehl et al, 2006).…”