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Troubled Hearts: Association Between Heart Rate Variability and Depressive Symptoms in Healthy Children

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Abstract

Heart rate variability (HRV) captures the change in timing of consecutive heart beats and is reduced in individuals with depression and anxiety. The present study investigated whether typically-developing children without clinically recognized signs of depression or anxiety showed a relationship between HRV and depressive or anxiety symptoms. Children aged 9–14 years (N = 104) provided three minutes of cardiac signal during eyes closed rest and eyes open rest. The association between high frequency HRV, low frequency HRV, root mean square of the successive differences (RMSSD), and pNN20 versus depressive symptoms (NIH Toolbox and Child Behavior Checklist) was investigated. Results partially confirm our hypothesis, with pNN20 positively correlated with the self-reported depression measure of loneliness while controlling for age, sex, social status, and physical activity. The association was stronger in male participants. However, there is no consensus in the literature about which HRV measures are associated with depressive symptoms in healthy children. Additional studies are needed which reliably account for variables that influence HRV to establish whether certain HRV measures can be used as an early marker for depression risk in children.

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References

  • Achenbach, T. M. (1991). Manual for The Child Behavior Checklist/4-18 and 1991 Profile. University of Vermont, Department of Psychiatry.

  • Ahrnsbrak, R. B., Jonaki; Hedden, Sara L.; Lipari, Rachel N.; Park-Lee, Eunice. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration Retrieved from https://www.samhsa.gov/data/report/key-substance-use-and-mental-health-indicators-united-states-results-2016-national-survey.

  • Allen, J. J., Chambers, A. S., & Towers, D. N. (2007). The many metrics of cardiac chronotropy: A pragmatic primer and a brief comparison of metrics. Biological Psychology, 74(2), 243–262. https://doi.org/10.1016/j.biopsycho.2006.08.005.

    Article  Google Scholar 

  • Altemus, M., Sarvaiya, N., & Neill Epperson, C. (2014). Sex differences in anxiety and depression clinical perspectives. Frontiers in Neuroendocrinology, 35(3), 320–330. https://doi.org/10.1016/j.yfrne.2014.05.004.

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Depressive Disorders. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA: Washington, DC.

    Book  Google Scholar 

  • Barratt. (2006). The Barratt Simplified Measure of Social Status. available online at https://wbarratt.indstate.edu/socialclass/Barratt_Simplifed_Measure_of_Social_Status.pdf.

  • Bizik, G., Bob, P., Raboch, J., Pavlat, J., Uhrova, J., Benakova, H., et al. (2014). Dissociative symptoms reflect levels of tumor necrosis factor alpha in patients with unipolar depression. Neuropsychiatr Dis Treat, 10, 675–679. https://doi.org/10.2147/NDT.S50197.

    Article  Google Scholar 

  • Blood, J. D., Wu, J., Chaplin, T. M., Hommer, R., Vazquez, L., Rutherford, H. J., et al. (2015). The variable heart: High frequency and very low frequency correlates of depressive symptoms in children and adolescents. Journal of Affective Disorders, 186, 119–126. https://doi.org/10.1016/j.jad.2015.06.057.

    Article  Google Scholar 

  • Bosch, N. M., Riese, H., Dietrich, A., Ormel, J., Verhulst, F. C., & Oldehinkel, A. J. (2009). Preadolescents' somatic and cognitive-affective depressive symptoms are differentially related to cardiac autonomic function and cortisol: The TRAILS study. Psychosomatic Medicine, 71(9), 944–950. https://doi.org/10.1097/PSY.0b013e3181bc756b.

    Article  Google Scholar 

  • Breslau, J., Gilman, S. E., Stein, B. D., Ruder, T., Gmelin, T., & Miller, E. (2017). Sex differences in recent first-onset depression in an epidemiological sample of adolescents. Transl Psychiatry, 7(5), e1139. https://doi.org/10.1038/tp.2017.105.

    Article  Google Scholar 

  • Brown, E. G., Creaven, A. M., & Gallagher, S. (2019). Loneliness and cardiovascular reactivity to acute stress in younger adults. International Journal of Psychophysiology, 135, 121–125. https://doi.org/10.1016/j.ijpsycho.2018.07.471.

    Article  Google Scholar 

  • Chien, H. C., Chung, Y. C., Yeh, M. L., & Lee, J. F. (2015). Breathing exercise combined with cognitive behavioural intervention improves sleep quality and heart rate variability in major depression. Journal of Clinical Nursing, 24(21–22), 3206–3214. https://doi.org/10.1111/jocn.12972.

    Article  Google Scholar 

  • Claudel, S. E., Adu-Brimpong, J., Banks, A., Ayers, C., Albert, M. A., Das, S. R., et al. (2018). Association between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study. American Heart Journal, 204, 109–118. https://doi.org/10.1016/j.ahj.2018.07.005.

    Article  Google Scholar 

  • Clifford, G. D. B. (2002). Signal Processing Methods for Heart Rate Variability (Doctor of Philosophy), St. Cross College, England. Retrieved from https://web.mit.edu/~gari/www/papers/GDCliffordThesis.pdf

  • Elfassy, T., Swift, S. L., Glymour, M. M., Calonico, S., Jacobs, D. R., Jr., Mayeda, E. R., et al. (2019). Associations of income volatility with incident cardiovascular disease and all-cause mortality in a US Cohort. Circulation, 139(7), 850–859. https://doi.org/10.1161/CIRCULATIONAHA.118.035521.

    Article  Google Scholar 

  • Erzen, E., & Cikrikci, O. (2018). The effect of loneliness on depression: A meta-analysis. International Journal of Social Psychiatry, 64(5), 427–435. https://doi.org/10.1177/0020764018776349.

    Article  Google Scholar 

  • Fatisson, J., Oswald, V., & Lalonde, F. (2016). Influence diagram of physiological and environmental factors affecting heart rate variability: An extended literature overview. Heart International, 11(1), e32–e40. https://doi.org/10.5301/heartint.5000232.

    Article  Google Scholar 

  • Gershon, R. C., Wagster, M. V., Hendrie, H. C., Fox, N. A., Cook, K. F., & Nowinski, C. J. (2013). NIH toolbox for assessment of neurological and behavioral function. Neurology, 80(11 Suppl 3), S2–6. https://doi.org/10.1212/WNL.0b013e3182872e5f.

    Article  Google Scholar 

  • Gouin, J. P., Zhou, B., & Fitzpatrick, S. (2015). Social integration prospectively predicts changes in heart rate variability among individuals undergoing migration stress. Annals of Behavioral Medicine, 49(2), 230–238. https://doi.org/10.1007/s12160-014-9650-7.

    Article  Google Scholar 

  • Greaves-Lord, K., Ferdinand, R. F., Sondeijker, F. E., Dietrich, A., Oldehinkel, A. J., Rosmalen, J. G., et al. (2007). Testing the tripartite model in young adolescents: Is hyperarousal specific for anxiety and not depression? Journal of Affective Disorders, 102(1–3), 55–63. https://doi.org/10.1016/j.jad.2006.12.009.

    Article  Google Scholar 

  • Gross, A. C., Kaizer, A. M., Ryder, J. R., Fox, C. K., Rudser, K. D., Dengel, D. R., et al. (2018). Relationships of anxiety and depression with cardiovascular health in youth with normal weight to severe obesity. Journal of Pediatrics, 199, 85–91. https://doi.org/10.1016/j.jpeds.2018.03.059.

    Article  Google Scholar 

  • Hartmann, R., Schmidt, F. M., Sander, C., & Hegerl, U. (2018). Heart rate variability as indicator of clinical state in depression. Frontiers in Psychiatry, 9, 735. https://doi.org/10.3389/fpsyt.2018.00735.

    Article  Google Scholar 

  • Henje Blom, E., Olsson, E. M., Serlachius, E., Ericson, M., & Ingvar, M. (2010). Heart rate variability (HRV) in adolescent females with anxiety disorders and major depressive disorder. Acta Paediatrica, 99(4), 604–611. https://doi.org/10.1111/j.1651-2227.2009.01657.x.

    Article  Google Scholar 

  • Heron, M. (2018). Death: Leading Causes for 2016 National Vital Statistics Report (Vol. 67). Hyattsville, MD: National Center for Health Statistics.

  • Huang, H. T., & Wan, K. S. (2013). Heart rate variability in junior high school students with depression and anxiety in Taiwan. Acta Neuropsychiatrics, 25(3), 175–178. https://doi.org/10.1111/acn.12010.

    Article  Google Scholar 

  • Javorka, K., Lehotska, Z., Kozar, M., Uhrikova, Z., Kolarovszki, B., Javorka, M., & Zibolen, M. (2017). Heart rate variability in newborns. Physiological Research, 66(Supplementum 2), S203–S214.

  • Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., et al. (2018). Youth risk behavior surveillance—United States, 2017. MMWR Surveillance Summary, 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1.

    Article  Google Scholar 

  • Kemp, A. H., & Quintana, D. S. (2013). The relationship between mental and physical health: Insights from the study of heart rate variability. International Journal of Psychophysiology, 89(3), 288–296. https://doi.org/10.1016/j.ijpsycho.2013.06.018.

    Article  Google Scholar 

  • Kemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010). Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biological Psychiatry, 67(11), 1067–1074. https://doi.org/10.1016/j.biopsych.2009.12.012.

    Article  Google Scholar 

  • Kowalski, K. C., Crocker, P. R. E., & Kowalski, N. P. (1997). Convergent validity of the physical activity questionnaire for adolescents. Pediatric Exercise Science, 9(4), 342–352. https://doi.org/10.1123/Pes.9.4.342.

    Article  Google Scholar 

  • Kowalski, K. C., Crocker, P. R., & Donen, R. M. (2004). The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. College of Kinesiology, University of Saskatchewan, 87(1), 1–38.

    Google Scholar 

  • McLaughlin, K. A., Alves, S., & Sheridan, M. A. (2014). Vagal regulation and internalizing psychopathology among adolescents exposed to childhood adversity. Developmental Psychobiology, 56(5), 1036–1051. https://doi.org/10.1002/dev.21187.

    Article  Google Scholar 

  • Mezzacappa, E., Tremblay, R. E., Kindlon, D., Saul, J. P., Arseneault, L., Seguin, J., et al. (1997). Anxiety, antisocial behavior, and heart rate regulation in adolescent males. Journal of Child Psychology and Psychiatry, 38(4), 457–469.

    Article  Google Scholar 

  • Michels, N., Sioen, I., Clays, E., De Buyzere, M., Ahrens, W., Huybrechts, I., et al. (2013). Children's heart rate variability as stress indicator: Association with reported stress and cortisol. Biological Psychology, 94(2), 433–440. https://doi.org/10.1016/j.biopsycho.2013.08.005.

    Article  Google Scholar 

  • Mietus, J. E., Peng, C. K., Henry, I., Goldsmith, R. L., & Goldberger, A. L. (2002). The pNNx files: Re-examining a widely used heart rate variability measure. Heart, 88(4), 378–380.

    Article  Google Scholar 

  • Monk, C., Kovelenko, P., Ellman, L. M., Sloan, R. P., Bagiella, E., Gorman, J. M., et al. (2001). Enhanced stress reactivity in paediatric anxiety disorders: implications for future cardiovascular health. International Journal of Neuropsychopharmacology, 4(2), 199–206. https://doi.org/10.1017/S146114570100236X.

    Article  Google Scholar 

  • Oberlander, T. F., Jacobson, S. W., Weinberg, J., Grunau, R. E., Molteno, C. D., & Jacobson, J. L. (2010). Prenatal alcohol exposure alters biobehavioral reactivity to pain in newborns. Alcoholism, Clinical and Experimental Research, 34(4), 681–692. https://doi.org/10.1111/j.1530-0277.2009.01137.x.

    Article  Google Scholar 

  • Paniccia, M., Paniccia, D., Thomas, S., Taha, T., & Reed, N. (2017). Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability. Autonomic Neuroscience, 208, 1–14. https://doi.org/10.1016/j.autneu.2017.08.008.

    Article  Google Scholar 

  • Pine, D. S., Wasserman, G. A., Miller, L., Coplan, J. D., Bagiella, E., Kovelenku, P., et al. (1998). Heart period variability and psychopathology in urban boys at risk for delinquency. Psychophysiology, 35(5), 521–529.

    Article  Google Scholar 

  • Porges, S. W. (1995). Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology, 32(4), 301–318.

    Article  Google Scholar 

  • Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116–143. https://doi.org/10.1016/j.biopsycho.2006.06.009.

    Article  Google Scholar 

  • Qualter, P., Brown, S. L., Munn, P., & Rotenberg, K. J. (2010). Childhood loneliness as a predictor of adolescent depressive symptoms: An 8-year longitudinal study. European Child and Adolescent Psychiatry, 19(6), 493–501. https://doi.org/10.1007/s00787-009-0059-y.

    Article  Google Scholar 

  • Roddick, C. (2019). Loneliness and the heart: Examining the associations between trait loneliness, state loneliness and high-frequency heart rate variability. (Masters of Arts), The University of British Columbia. Retrieved from https://hdl.handle.net/2429/71353

  • Salsman, J. M., Butt, Z., Pilkonis, P. A., Cyranowski, J. M., Zill, N., Hendrie, H. C., et al. (2013). Emotion assessment using the NIH Toolbox. Neurology, 80(11 Suppl 3), S76–86. https://doi.org/10.1212/WNL.0b013e3182872e11.

    Article  Google Scholar 

  • Seppala, S., Laitinen, T., Tarvainen, M. P., Tompuri, T., Veijalainen, A., Savonen, K., et al. (2014). Normal values for heart rate variability parameters in children 6–8 years of age: The PANIC Study. Clinical Physiology and Functional Imaging, 34(4), 290–296. https://doi.org/10.1111/cpf.12096.

    Article  Google Scholar 

  • Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., et al. (2018). Vital signs: Trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 States, 2015. MMWR. Morbidity and Mortality Weekly Report, 67(22), 617–624. https://doi.org/10.15585/mmwr.mm6722a1.

    Article  Google Scholar 

  • Tarvainen, M. P., Niskanen, J. P., Lipponen, J. A., Ranta-Aho, P. O., & Karjalainen, P. A. (2014). Kubios HRV–heart rate variability analysis software. Computer Methods and Programs in Biomedicine, 113(1), 210–220. https://doi.org/10.1016/j.cmpb.2013.07.024.

    Article  Google Scholar 

  • Task Force. (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(3), 354–381.

    Article  Google Scholar 

  • Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61(3), 201–216.

    Article  Google Scholar 

  • Tonhajzerova, I., Ondrejka, I., Javorka, K., Turianikova, Z., Farsky, I., & Javorka, M. (2010). Cardiac autonomic regulation is impaired in girls with major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 34(4), 613–618. https://doi.org/10.1016/j.pnpbp.2010.02.023.

    Article  Google Scholar 

  • Tonhajzerova, I., Ondrejka, I., Javorka, M., Adamik, P., Turianikova, Z., Kerna, V., et al. (2009). Respiratory sinus arrhythmia is reduced in adolescent major depressive disorder. European Journal of Medical Research, 14(Suppl 4), 280–283.

    Article  Google Scholar 

  • Trivedi, M. H. (2004). The link between depression and physical symptoms. Prim Care Companion J Clin Psychiatry, 6(Suppl 1), 12–16.

    Google Scholar 

  • Vazquez, L., Blood, J. D., Wu, J., Chaplin, T. M., Hommer, R. E., Rutherford, H. J., et al. (2016). High frequency heart-rate variability predicts adolescent depressive symptoms, particularly anhedonia, across one year. Journal of Affective Disorders, 196, 243–247. https://doi.org/10.1016/j.jad.2016.02.040.

    Article  Google Scholar 

  • Xhyheri, B., Manfrini, O., Mazzolini, M., Pizzi, C., & Bugiardini, R. (2012). Heart rate variability today. Progress in Cardiovascular Diseases, 55(3), 321–331. https://doi.org/10.1016/j.pcad.2012.09.001.

    Article  Google Scholar 

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This work was supported by the National Science Foundation [Grant Number 1539067].

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Gleichmann, D.C., Solis, I., Janowich, J.R. et al. Troubled Hearts: Association Between Heart Rate Variability and Depressive Symptoms in Healthy Children. Appl Psychophysiol Biofeedback 45, 283–292 (2020). https://doi.org/10.1007/s10484-020-09488-7

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