Abstract
North Korean Defectors (NKDs) are known to experience multiple psychological symptoms such depression and anxiety. Heart rate variability (HRV) has been implicated in various psychiatric disorders, including posttraumatic stress disorder (PTSD) and depression. No studies have prospectively evaluated HRV parameters in NKDs. We recruited 34 NKDs (2 men, 32 women; age range 25–58 years) who were diagnosed with major depressive disorder. We evaluated psychiatric symptoms using the Korean version of the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale, and PTSD checklist civilian version. We also performed HRV measurements before and after 12 weeks of antidepressant treatment. In the baseline, HDRS item 14 and 15 showed statistically significant positive correlation with LF/HF ratio. At the endpoint, HDRS item 5 and 8 were found to have positive correlations with some HRV parameters. We found that the sum of fatigue-related HDRS symptoms scores (number 7 and 13) showed significant positive correlation with LF. HDRS total scores also showed significant positive correlations with LF and HF. When the severity of depression was decreased and only the PTSD symptoms persisted at the endpoint, the relationships between HRV and clinical measures were more clearly revealed. This study shows the possibility of using HRV as an objective neurobiological index of autonomic nervous system disorder and reaction to stress in NKDs.
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References
Ahn, Y. M., Lee, K. Y., Yi, J. S., Kang, M. H., Kim, D. H., Kim, J. L., et al. (2005). A validation study of the Korean-version of the montgomery-asberg depression rating scale. Journal of Korean Neuropsychiatric Association, 44(4), 466–476.
An, J. H., Lee, K. E., Lee, H. C., Kim, H. S., Hong, J. P., Jun, J. Y., et al. (2018). Prevalence and correlates of suicidal thoughts and behaviors among North Korean defectors. Psychiatry Investigation, 15(5), 445–451.
APA. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5(TM)) (Diagnostic and Statistical Manual of Mental Disorders). Washington, D.C., USA: American Psychiatric Association.
Austen, M. L., & Wilson, G. V. (2001). Increased vagal tone during winter in subsyndromal seasonal affective disorder. Biological Psychiatry, 50(1), 28–34. https://doi.org/10.1016/s0006-3223(00)01102-1
Bech, P. (2006). Rating scales in depression: Limitations and pitfalls. Dialogues in Clinical Neuroscience, 8(2), 207–215.
Borrione, L., Brunoni, A. R., Sampaio, B., Aparicio, L. M., Kemp, A. H., Bensenor, I., et al. (2018). Associations between symptoms of depression and heart rate variability: An exploratory study. Psychiatry Research, 262, 482–487. https://doi.org/10.1016/j.psychres.2017.09.028
Brown, L., Karmakar, C., Gray, R., Jindal, R., Lim, T., & Bryant, C. (2018). Heart rate variability alterations in late life depression: A meta-analysis. Journal of Affective Disorders, 235, 456–466. https://doi.org/10.1016/j.jad.2018.04.071
Buyukdura, J. S., McClintock, S. M., & Croarkin, P. E. (2011). Psychomotor retardation in depression: Biological underpinnings, measurement, and treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(2), 395–409. https://doi.org/10.1016/j.pnpbp.2010.10.019
Carney, R. M., Blumenthal, J. A., Stein, P. K., Watkins, L., Catellier, D., Berkman, L. F., et al. (2001). Depression, heart rate variability, and acute myocardial infarction. Circulation, 104(17), 2024–2028.
Choi, S. K., Min, S. J., Cho, M. S., Joung, H., & Park, S. M. (2011). Anxiety and depression among North Korean young defectors in South Korea and their association with health-related quality of life. Yonsei Medical Journal, 52(3), 502–509. https://doi.org/10.3349/ymj.2011.52.3.502
Cohen, H., Kotler, M., Matar, M. A., Kaplan, Z., Miodownik, H., & Cassuto, Y. (1997). Power spectral analysis of heart rate variability in posttraumatic stress disorder patients. Biological Psychiatry, 41(5), 627–629.
Ernst, G. (2017). Heart-rate variability-more than heart beats? Frontiers in Public Health, 5, 240. https://doi.org/10.3389/fpubh.2017.00240
Hjortskov, N., Rissen, D., Blangsted, A. K., Fallentin, N., Lundberg, U., & Sogaard, K. (2004). The effect of mental stress on heart rate variability and blood pressure during computer work. European Journal of Applied Physiology, 92(1–2), 84–89. https://doi.org/10.1007/s00421-004-1055-z
Jeon, W., Hong, C., Lee, C., Kim, D. K., Han, M., & Min, S. (2005). Correlation between traumatic events and posttraumatic stress disorder among North Korean defectors in South Korea. Journal of Traumatic Stress, 18(2), 147–154. https://doi.org/10.1002/jts.20017
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
Kim, H. H., Lee, Y. J., Kim, H. K., Kim, J. E., Kim, S. J., Bae, S. M., et al. (2011). Prevalence and correlates of psychiatric symptoms in North Korean defectors. Psychiatry Investigation, 8(3), 179–185. https://doi.org/10.4306/pi.2011.8.3.179
Koch, C., Wilhelm, M., Salzmann, S., Rief, W., & Euteneuer, F. (2019). A meta-analysis of heart rate variability in major depression. Psychological Medicine, 49(12), 1948–1957. https://doi.org/10.1017/S0033291719001351
Kristal-Boneh, E., Raifel, M., Froom, P., & Ribak, J. (1995). Heart rate variability in health and disease. Scandinavian Journal of Work, Environment & Health, 21(2), 85–95.
Lee, J. Y., Dong Woo, L., Cho, S. J., Na, D. L., Hong Jin, J., Kim, S. K., et al. (2008). Brief screening for mild cognitive impairment in elderly outpatient clinic: Validation of the Korean version of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology, 21(2), 104–110. https://doi.org/10.1177/0891988708316855
Lee, Y., Lee, M. K., Chun, K. H., Lee, Y. K., & Yoon, S. J. (2001). Trauma experience of North Korean refugees in China. American Journal of Preventive Medicine, 20(3), 225–229.
Lee, Y., Lee, M., & Park, S. (2017). Mental health status of North Korean refugees in South Korea and risk and protective factors: A 10-year review of the literature. European Journal of Psychotraumatology, 8(sup2), 1369833. https://doi.org/10.1080/20008198.2017.1369833
Malliani, A., Lombardi, F., & Pagani, M. (1994). Power spectrum analysis of heart rate variability: A tool to explore neural regulatory mechanisms. British Heart Journal, 71(1), 1–2.
Ministry of Unification (2018). Number of North Korean refugees entered the south. Retrieved from https://www.unikorea.go.kr/unikorea/business/NKDefectorsPolicy/status/lately/.
Oh, S.-I., Won, S.-D., Lee, S. H., Yoo, S.-Y., Kim, H.-C., & Kim, H. J. (2014). Reliability and validity of the Korean version of the PTSD checklist civilian version in North Korean defectors. Journal of Korean Neuropsychiatric Association, 53(6), 410–417.
Reyes del Paso, G. A., Langewitz, W., Mulder, L. J., 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(5), 477–487. https://doi.org/10.1111/psyp.12027
Rohan, K. J., Rough, J. N., Evans, M., Ho, S. Y., Meyerhoff, J., Roberts, L. M., et al. (2016). A protocol for the Hamilton Rating Scale for Depression: Item scoring rules, Rater training, and outcome accuracy with data on its application in a clinical trial. Journal of Affective Disorders, 200, 111–118. https://doi.org/10.1016/j.jad.2016.01.051
Segerstrom, S. C., & Nes, L. S. (2007). Heart rate variability reflects self-regulatory strength, effort, and fatigue. Psychological Science, 18(3), 275–281. https://doi.org/10.1111/j.1467-9280.2007.01888.x
Shaffer, F., McCraty, R., & Zerr, C. L. (2014). A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology, 5, 1040. https://doi.org/10.3389/fpsyg.2014.01040
Silverman, M. N., Heim, C. M., Nater, U. M., Marques, A. H., & Sternberg, E. M. (2010). Neuroendocrine and immune contributors to fatigue. PM R, 2(5), 338–346. https://doi.org/10.1016/j.pmrj.2010.04.008
Song, B. A., Yoo, S. Y., Kang, H. Y., Byeon, S. H., Shin, S. H., Hwang, E. J., et al. (2011). Post-traumatic stress disorder, depression, and heart-rate variability among North Korean defectors. Psychiatry Investigation, 8(4), 297–304. https://doi.org/10.4306/pi.2011.8.4.297
Sowmya, S., Thomas, T., Bharathi, A. V., & Sucharita, S. (2014). A body shape index and heart rate variability in healthy Indians with low body mass index. Journal of Nutrition and Metabolism, 2014, 865313. https://doi.org/10.1155/2014/865313
Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. (1996). Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation, 93(5), 1043–1065. https://doi.org/10.1161/circ.93.5.1043
Thayer, J. F., Ahs, F., Fredrikson, M., Sollers, J. J., 3rd., & Wager, T. D. (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(2), 747–756. https://doi.org/10.1016/j.neubiorev.2011.11.009
Udupa, K., Sathyaprabha, T. N., Thirthalli, J., Kishore, K. R., Lavekar, G. S., Raju, T. R., et al. (2007). Alteration of cardiac autonomic functions in patients with major depression: A study using heart rate variability measures. Journal of Affective Disorders, 100(1–3), 137–141. https://doi.org/10.1016/j.jad.2006.10.007
Yi, J. S., Bae, S. O., Ahn, Y. M., Park, D. B., Noh, K. S., & Shin, S. K. (2005). Validity and reliability of the Korean version of the Hamilton Depression Rating Scale (K-HDRS). Journal of Korean Neuropsychiatric Association, 44(4), 456–465.
Yoo, C. S., Lee, K., Yi, S. H., Kim, J. S., & Kim, H. C. (2011). Association of heart rate variability with the framingham risk score in healthy adults. Korean Journal of Family Medicine, 32(6), 334–340. https://doi.org/10.4082/kjfm.2011.32.6.334
Yoon, S. Y., Lim, J. H., & Han, C. (2012). Rating scales for measurement-based clinical practice of depression. Korean Journal of Psychopharmacology, 23, 136–146.
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Lee, MS., Seo, Y.E., Mok, Y.E. et al. Heart Rate Variability after Treatment for Depression in North Korean Defectors. Appl Psychophysiol Biofeedback 46, 11–18 (2021). https://doi.org/10.1007/s10484-020-09491-y
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DOI: https://doi.org/10.1007/s10484-020-09491-y