Association Between Mood Variability and Psychotic Symptoms in First-Episode Psychosis Patients: The Mediating Effects of Anxiety and Depression

Objectives: Mood variability has been linked to various psychopathologies, including schizophrenia spectrum disorders, yet its relationship with psychotic symptoms remains insufficiently understood. Given its close association with anxiety and depression, this study examined whether these emotional factors mediate the association between mood variability and psychotic symptoms in first-episode psychosis (FEP).Methods: A total of 143 patients with FEP and 118 healthy controls were included. Mood variability was assessed using the reactivity subscale of the Mood Survey. Combined anxiety–depression symptom scores were measured with the Symptom Checklist-90-Revised, and psychotic symptoms with the Positive and Negative Syndrome Scale. Mediation analyses were conducted using the PROCESS macro with 5,000 bootstrap samples.Results: Combined anxiety–depression symptom scores fully mediated the association between mood variability and positive symptoms. For negative symptoms, an inconsistent mediation pattern emerged: mood variability showed a negative direct effect, while indirect effects via combined anxiety–depression symptom scores were positive. Subdomain analyses showed a direct association with expressive deficits, whereas experiential deficits were associated with a significant positive indirect effect via combined anxiety–depression symptom scores.Conclusion: Mood variability was associated with psychotic symptoms in FEP through distinct pathways, with combined anxiety–depression symptom scores playing a central mediating role, particularly for positive symptoms and experiential aspects of negative symptoms. These findings highlight the importance of considering emotional processes in the assessment and understanding of early psychosis.