Abstract

Objectives: The onset or progression of mental ill-health may be understood as transitions in a

complex system. We investigated whether EWS anticipate sudden drops in mental health.

Methods: Young adults at risk for psychopathology (N=122, 23.6 ±0.7 years old, 57% males)

completed daily questionnaires on mental states for six consecutive months. Change point analyses

identified a drop in mental health in 17 individuals (14%). EWS, operationalized as rising trends in the

autoregressive coefficient of 36 negative mental states, were identified using generalized additive

models.

Results: EWS preceded drops in mental health in ten individuals (59%), but were also present in a

matched subsample of individuals without such drops (N=17, 47% of whom showed EWS). In the

presence of EWS, the probability of a drop in mental health increased from 14 to 25%. In absence of

EWS, this probability remained 14%.

Conclusions: The presence of EWS suggests that a drop in mental health is relatively likely, but their

absence does not signal resilience. Future research should investigate the prerequisites for detecting

EWS in the context of mental health, particularly with respect to the stability of pre- and post-

transition phases, the magnitude of transitions, and the timescale at which EWS manifest.