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Heart rate variability and depressive symptoms: a cross-lagged analysis over a 10-year period in the Whitehall II study

Published online by Cambridge University Press:  16 May 2016

V. K. Jandackova ,
A. Britton ,
M. Malik  and
A. Steptoe
V. K. Jandackova*
Affiliation:
Department of Epidemiology and Public Health, University of Ostrava, Ostrava, Czech Republic
A. Britton
Affiliation:
Research Department of Epidemiology and Public Health, University College London, London, UK
M. Malik
Affiliation:
National Heart and Lung Institute, Imperial College, London, UK
A. Steptoe
Affiliation:
Research Department of Epidemiology and Public Health, University College London, London, UK
*
*Address for correspondence: V. K. Jandackova, Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic. (Email: [email protected])
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Abstract

Background

People with depression tend to have lower heart rate variability (HRV), but the temporal sequence is poorly understood. In a sample of the general population, we prospectively examined whether HRV measures predict subsequent depressive symptoms or whether depressive symptoms predict subsequent levels of HRV.

Method

Data from the fifth (1997–1999) and ninth (2007–2009) phases of the UK Whitehall II longitudinal population-based cohort study were analysed with an average follow-up of 10.5 years. The sample size for the prospective analysis depended on the analysis and ranged from 2334 (644 women) to 2276 (602 women). HRV measures during 5 min of supine rest were obtained. Depressive symptoms were evaluated by four cognitive symptoms of depression from the General Health Questionnaire.

Results

At follow-up assessment, depressive symptoms were inversely associated with HRV measures independently of antidepressant medication use in men but not in women. Prospectively, lower baseline heart rate and higher HRV measures were associated with a lower likelihood of incident depressive symptoms at follow-up in men without depressive symptoms at baseline. Similar but statistically insignificant associations were found in women. Adjustments for known confounders including sociodemographic and lifestyle factors, cardiometabolic conditions or medication did not change the predictive effect of HRV on incident depressive symptoms at follow-up. Depressive symptoms at baseline were not associated with heart rate or HRV at follow-up in either sex.

Conclusions

These findings are consistent with an aetiological role of the autonomic nervous system in depression onset.

Keywords

Aetiological significanceautonomic nervous systemdepressive symptomsheart rate variabilitylongitudinal cohort studies
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 10 , July 2016 , pp. 2121 - 2131
Copyright
Copyright © Cambridge University Press 2016 

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References

Acar, B, Savelieva, I, Hemingway, H, Malik, M (2000). Automatic ectopic beat elimination in short-term heart rate variability measurement. Computer Methods and Programs in Biomedicine 63, 123–131.Google Scholar
Batty, GD, Shipley, M, Tabák, A, Singh-Manoux, A, Brunner, E, Britton, A, Kivimäki, M (2014). Generalizability of occupational cohort study findings. Epidemiology (Cambridge, Mass.) 25, 932–933.Google Scholar
Bernardi, L, Wdowczyk-Szulc, J, Valenti, C, Castoldi, S, Passino, C, Spadacini, G, Sleight, P (2000). Effects of controlled breathing, mental activity and mental stress with or without verbalization on heart rate variability. Journal of the American College of Cardiology 35, 1462–1469.CrossRefGoogle ScholarPubMed
Britton, A, Shipley, M, Malik, M, Hnatkova, K, Hemingway, H, Marmot, M (2007). Changes in heart rate and heart rate variability over time in middle-aged men and women in the general population (from the Whitehall II Cohort Study). American Journal of Cardiology 100, 524–527.CrossRefGoogle ScholarPubMed
Brunoni, AR, Kemp, AH, Dantas, EM, Goulart, AC, Nunes, MA, Boggio, PS, Mill, JG, Lotufo, PA, Fregni, F, Benseñor, IM (2013). Heart rate variability is a trait marker of major depressive disorder: evidence from the sertraline vs. electric current therapy to treat depression clinical study. International Journal of Neuropsychopharmacology/Official Scientific Journal of the Collegium Internationale Neuropsychopharmacologicum (CINP) 16, 1937–1949.CrossRefGoogle ScholarPubMed
Chambers, AS, Allen, JJB (2002). Vagal tone as an indicator of treatment response in major depression. Psychophysiology 39, 861–864.CrossRefGoogle ScholarPubMed
Cuijpers, P, Smit, F (2004). Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavica 109, 325–331.CrossRefGoogle ScholarPubMed
Dauphinot, V, Rouch, I, Kossovsky, MP, Pichot, V, Dorey, J-M, Krolak-Salmon, P, Laurent, B, Roche, F, Barthélémy, J-C (2012). Depressive symptoms and autonomic nervous system dysfunction in an elderly population-based study: the PROOF study. Journal of Affective Disorders 143, 153–159.CrossRefGoogle Scholar
De Guevara, MSL, Schauffele, SI, Nicola-Siri, LC, Fahrer, RD, Ortíz-Frágola, E, Martínez-Martínez, JA, Cardinali, DP, Guinjoan, SM (2004). Worsening of depressive symptoms 6 months after an acute coronary event in older adults is associated with impairment of cardiac autonomic function. Journal of Affective Disorders 80, 257–262.CrossRefGoogle ScholarPubMed
Gimeno, D, Kivimäki, M, Brunner, EJ, Elovainio, M, De Vogli, R, Steptoe, A, Kumari, M, Lowe, GDO, Rumley, A, Marmot, MG, Ferrie, JE (2009). Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study. Psychological Medicine 39, 413–423.Google Scholar
Goldberg, DP (1972). The Detection of Psychiatric Illness by Questionnaire; a Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness. Oxford University Press: London, New York.Google Scholar
Goldberg, DP, Hillier, VF (1979). A scaled version of the General Health Questionnaire. Psychological Medicine 9, 139–145.Google Scholar
Goldstein, DS, Bentho, O, Park, M-Y, Sharabi, Y (2011). Low-frequency power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Experimental Physiology 96, 1255–1261.Google Scholar
Grippo, AJ, Johnson, AK (2009). Stress, depression and cardiovascular dysregulation: a review of neurobiological mechanisms and the integration of research from preclinical disease models. Stress (Amsterdam, Netherlands) 12, 1–21.Google Scholar
Hare, DL, Toukhsati, SR, Johansson, P, Jaarsma, T (2014). Depression and cardiovascular disease: a clinical review. European Heart Journal 35, 1365–1372.Google Scholar
Hassan, M, Li, Q, Brumback, B, Lucey, DG, Bestland, M, Eubanks, G, Fillingim, RB, Sheps, DS (2008). Comparison of peripheral arterial response to mental stress in men versus women with coronary artery disease. American Journal of Cardiology 102, 970–974.Google Scholar
Hemingway, H, Shipley, M, Brunner, E, Britton, A, Malik, M, Marmot, M (2005). Does autonomic function link social position to coronary risk? The Whitehall II study. Circulation 111, 3071–3077.Google Scholar
Huikuri, HV, Ma, TH, Airaksinen, KEJ, Seppa, T, Puukka, P, Ra, IJ (1998). Power-law relationship of heart rate variability as a predictor of mortality in the elderly. Circulation 97, 2031–2036.Google Scholar
Jarczok, MN, Koenig, J, Mauss, D, Fischer, JE, Thayer, JF (2014). Lower heart rate variability predicts increased level of C-reactive protein 4 years later in healthy, nonsmoking adults. Journal of Internal Medicine 276, 667–671.Google Scholar
Kemp, AH, Brunoni, AR, Santos, IS, Nunes, MA, Dantas, EM, Carvalho de Figueiredo, R, Pereira, AC, Ribeiro, ALP, Mill, JG, Andreão, RV, Thayer, JF, Benseñor, IM, Lotufo, PA (2014). Effects of depression, anxiety, comorbidity, and antidepressants on resting-state heart rate and its variability: an ELSA-Brasil cohort baseline study. American Journal of Psychiatry 171, 1328–1334.Google Scholar
Kemp, AH, Quintana, DS, Gray, MA, Felmingham, KL, Brown, K, Gatt, JM (2010). Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis. Biological Psychiatry 67, 1067–1074.CrossRefGoogle ScholarPubMed
Klarer, M, Arnold, M, Günther, L, Winter, C, Langhans, W, Meyer, U (2014). Gut vagal afferents differentially modulate innate anxiety and learned fear. Journal of Neuroscience: the Official Journal of the Society for Neuroscience 34, 7067–7076.CrossRefGoogle ScholarPubMed
Lahiri, MK, Kannankeril, PJ, Goldberger, JJ (2008). Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. Journal of the American College of Cardiology 51, 1725–1733.Google Scholar
Licht, C, de Geus, EJC, Zitman, FG, Hoogendijk, WJG, van Dyck, R, Penninx, BWJH (2008). Association between major depressive disorder and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). Archives of General Psychiatry 65, 1358–1367.Google Scholar
Licht, CMM, de Geus, EJC, van Dyck, R, Penninx, BWJH (2010). Longitudinal evidence for unfavorable effects of antidepressants on heart rate variability. Biological Psychiatry 68, 861–868.CrossRefGoogle ScholarPubMed
Marmot, M, Brunner, E (2005). Cohort profile: the Whitehall II study. International Journal of Epidemiology 34, 251–256.Google Scholar
Nemeroff, CB, Goldschmidt-Clermont, PJ (2012). Heartache and heartbreak – the link between depression and cardiovascular disease. Nature Reviews. Cardiology 9, 526–539.CrossRefGoogle ScholarPubMed
Nicholson, A, Kuper, H, Hemingway, H (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 27, 2763–2774.Google Scholar
O'Regan, C, Kenny, RA, Cronin, H, Finucane, C, Kearney, PM (2015). Antidepressants strongly influence the relationship between depression and heart rate variability: findings from The Irish Longitudinal Study on Ageing (TILDA). Psychological Medicine 45, 623–636.Google Scholar
Porges, SW (1995). Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology 32, 301–318.Google Scholar
Rennie, KL, Hemingway, H, Kumari, M, Brunner, E, Malik, M, Marmot, M (2003). Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants. American Journal of Epidemiology 158, 135–143.CrossRefGoogle Scholar
Reyes del Paso, GA, Langewitz, W, Mulder, LJM, van Roon, A, Duschek, S (2013). The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology 50, 477–487.Google Scholar
Rothman, KJ (1990). No adjustments are needed for multiple comparisons. Epidemiology (Cambridge, Mass.) 1, 43–46.Google Scholar
Rothman, KJ (2014). Six persistent research misconceptions. Journal of General Internal Medicine 29, 1060–1064.Google Scholar
Rottenberg, J (2007). Cardiac vagal control in depression: a critical analysis. Biological Psychology 74, 200–211.Google Scholar
Sabia, S, Nabi, H, Kivimaki, M, Shipley, MJ, Marmot, MG, Singh-Manoux, A (2009). Health behaviors from early to late midlife as predictors of cognitive function: the Whitehall II study. American Journal of Epidemiology 170, 428–437.CrossRefGoogle ScholarPubMed
Saville, D (1990). Multiple comparison procedures: the practical solution. American Statistician 44, 174–180.Google Scholar
Schroeder, EB, Chambless, LE, Liao, D, Prineas, RJ, Evans, GW, Rosamond, WD, Heiss, G (2005). Diabetes, glucose, insulin, and heart rate variability. Diabetes Care 28, 668–674.Google Scholar
Silverstein, B, Edwards, T, Gamma, A, Ajdacic-Gross, V, Rossler, W, Angst, J (2013). The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression. Social Psychiatry and Psychiatric Epidemiology 48, 257–263.Google Scholar
Smetana, P, Malik, M (2013). Sex differences in cardiac autonomic regulation and in repolarisation electrocardiography. Pflügers Archiv: European Journal of Physiology 465, 699–717.CrossRefGoogle ScholarPubMed
Soares-Miranda, L, Sattelmair, J, Chaves, P, Duncan, GE, Siscovick, DS, Stein, PK, Mozaffarian, D (2014). Physical activity and heart rate variability in older adults: the Cardiovascular Health Study. Circulation 129, 2100–2110.CrossRefGoogle ScholarPubMed
Stansfeld, SA, Head, J, Fuhrer, R, Wardle, J, Cattell, V (2003). Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: exploring a common cause explanation. Journal of Epidemiology and Community Health 57, 361–367.Google Scholar
Stansfeld, SA, Head, J, Marmot, MG (1998). Explaining social class differences in depression and well-being. Social Psychiatry and Psychiatric Epidemiology 33, 1–9.Google Scholar
Stansfeld, SA, North, FM, White, I, Marmot, MG (1995). Work characteristics and psychiatric disorder in civil servants in London. Journal of Epidemiology and Community Health 49, 48–53.Google Scholar
Stapelberg, NJ, Hamilton-Craig, I, Neumann, DL, Shum, DHK, McConnell, H (2012). Mind and heart: heart rate variability in major depressive disorder and coronary heart disease – a review and recommendations. Australian and New Zealand Journal of Psychiatry 46, 946–957.CrossRefGoogle ScholarPubMed
Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. European Heart Journal 17, 354–381.CrossRefGoogle Scholar
Thayer, JF, Ahs, F, Fredrikson, M, Sollers, JJ, Wager, TD (2012). A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neuroscience and Biobehavioral Reviews 36, 747–756.CrossRefGoogle ScholarPubMed
Thayer, JF, Lane, RD (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders 61, 201–216.CrossRefGoogle Scholar
Thayer, JF, Sternberg, E (2006). Beyond heart rate variability: vagal regulation of allostatic systems. Annals of the New York Academy of Sciences 1088, 361–372.Google Scholar
Tracey, KJ (2002). The inflammatory reflex. Nature 420, 853–859.Google Scholar
Vonck, K, Raedt, R, Naulaerts, J, De Vogelaere, F, Thiery, E, Van Roost, D, Aldenkamp, B, Miatton, M, Boon, P (2014). Vagus nerve stimulation…25 years later! What do we know about the effects on cognition? Neuroscience and Biobehavioral Reviews 45, 63–71.Google Scholar
Zhang, Y, Popovic, ZB, Bibevski, S, Fakhry, I, Sica, DA, Van Wagoner, DR, Mazgalev, TN (2009). Chronic vagus nerve stimulation improves autonomic control and attenuates systemic inflammation and heart failure progression in a canine high-rate pacing model. Circulation. Heart Failure 2, 692–699.Google Scholar