Autonomic cardiac control in depressed adolescents

The relationship between depression severity and heart rate variability in children and adolescents: A meta-analysis

OBJECTIVE

Depression in children and adolescents has gradually attracted social attention. Heart rate variability (HRV) has been found to be influenced by depression severity, but results have not been uniformed in children and adolescents. This study investigated the relationship between depression severity and heart rate variability in children and adolescents, aiming to provide additional evidence for an objective, effective, and convenient depression screening tool in this population.

METHODS

Literature searching was conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, PubMed, ScienceDirect, and EBSCO. Relevant studies investigating the relationship between depression severity and HRV in children and adolescents were selected for meta-analysis.

RESULTS

31 articles were included in this meta-analysis, involving 4534 participants. Depression severity in children and adolescents was significantly negatively correlated with high frequency (HF) and root mean square of successive differences (RMSSD) in HRV (HF: r = -0.10, 95% CI: -0.17 to -0.04, p = 0.001; RMSSD: r = -0.18, 95% CI: -0.30 to -0.05, p = 0.01). The relationship between HF and depression severity was moderated by age, higher among those aged >12 than among those aged <12 (r = -0.17, -0.02, Q = 7.32, p = 0.007).

CONCLUSION

Heart rate variability is associated with depression severity in children and adolescents.

Increased cardiovascular events in young patients with mental disorders: a nationwide cohort study

AIMS

It remains unclear whether young patients with mental disorders have a higher risk of cardiovascular diseases than does the general population. Using a nationwide database, we investigated the prognostic association between the risks of myocardial infarction (MI), ischaemic stroke (IS), and mental disorders in young patients.

METHODS AND RESULTS

Young patients aged between 20 and 39 years old who underwent nationwide health examinations between 2009 and 2012 were screened. A total of 6 557 727 individuals were identified and subsequently classified according to mental disorders including depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. Patients were then followed up for MI and IS until December 2018. Patients with mental disorders did not show unfavourable lifestyle behaviours or worse metabolic profiles than their counterparts. During the follow-up period (median, 7.6 years; interquartile range, 6.5-8.3), 16 133 cases of MI and 10 509 cases of IS occurred. Patients with mental disorders had higher risks of MI (log-rank P = 0.033 in eating disorder and log-rank P < 0.001 in all other mental disorders). Patients with mental disorders had higher risks of IS except post-traumatic stress disorder (log-rank P = 0.119) and eating disorder (log-rank P = 0.828). After adjusting for covariates, the overall diagnosis and each mental disorder were independently associated with increased cardiovascular endpoints.

CONCLUSION

Mental disorders in young patients may have deleterious effects which increase the incidence of MI and IS. Prevention efforts are needed to prevent MI and IS in young patients with mental disorders.

Heart rate variability in children and adolescents with major depressive disorder: A systematic review and meta-analysis

Although reduced heart rate variability (HRV) has been observed in adults with major depressive disorder (MDD), the correlation between HRV and MDD in children and adolescents remains uncertain and requires to be systematically reviewed. Our meta-analysis included ten articles comprising 410 MDD patients and 409 healthy controls. Adolescents with MDD showed significant reductions in most HRV measures, such as HF-HRV, RMSSD, and PNN50, and depressive symptom severity was statistically associated with RMSSD, HF-HRV, and LF/HF ratio. A large heterogeneity across studies was detected. Sensitivity analysis revealed that removal of a specific study would significantly decline the heterogeneity for measures of HF-HRV, LF-HRV, and SDNN, and meta-regression analysis found that sample size and year of publication substantially moderated the differences between depressed samples and controls in RMSSD. Compared with adults, depression-induced autonomic dysfunction was more detectable in children and adolescents with substantial effects. Moreover, excluded studies which reported both HRV and MDD or depression symptoms were summarized based on objectives. Findings indicate that it is promising for HRV to be an appropriate and objective candidate biomarker for clinically depressed children and adolescents.

Associations between autonomic nervous system activity and risk-taking and internalizing behavior in young adolescents

Dysregulated autonomic nervous system (ANS) activity has been associated with adolescent risk‐taking and internalizing behavior, but previous results in community samples have been mixed. We investigated whether ANS activity was associated with higher risk‐taking and internalizing behavior in young adolescents (age 11/12; n = 875), and whether adolescents' gender, parents' parenting style or a combination of both moderated these associations. Adolescents and their parents were recruited as part of the population‐based, longitudinal Amsterdam Born Children and their Development (ABCD) study. Risk‐taking behavior was assessed with the Balloon Analogue Risk Task and the personality characteristics sensation seeking and impulsivity, measured with the Substance Use Risk Profile Scale (SURPS). Internalizing behavior was assessed via the SURPS subscales anxiety sensitivity and hopelessness. Authoritative (AUTH‐SW) and authoritarian (AUTH‐S) parenting styles were measured with the Parenting Styles and Dimensions Questionnaire. Resting ANS activity was assessed via heart rate and respiratory sinus arrhythmia (RSA). Hierarchical, multivariable regression analyses showed higher RSA, but not heart rate, being associated with higher risk‐taking behavior and sensation seeking. The associations between ANS activity and risk‐taking variables were not significantly moderated by gender, parenting, or interactions between gender and parenting. Our findings suggest that RSA activity may be a relevant factor in mild to moderate risk‐taking behavior in adolescents from the general population, regardless of their gender or the type of parenting they experience.

Dysregulated autonomic nervous system activity has been associated with adolescent risk‐taking and internalizing behavior, but previous results in community samples have been mixed. Our findings suggest that in adolescents from the general population, respiratory sinus arrhythmia activity may be a relevant factor in mild to moderate risk‐taking behavior but not in internalizing behavior, regardless of adolescents' gender or the type of parenting they experience.

The Heart-Brain Connection in Depression: Can it inform a personalised approach for repetitive transcranial magnetic stimulation (rTMS) treatment?

There is growing enthusiasm into the frontal-vagal network theory of major depressive disorder (MDD) and the potential role of a frontal-vagal network in the therapeutic mechanism of repetitive transcranial magnetic stimulation (rTMS) treatment for MDD. A review of the autonomic nervous system (ANS) in MDD and its role in antidepressant treatment for MDD is timely. The literature supports the well-established notion of ANS dysfunction in MDD and the benign effect of selective serotonin reuptake inhibitors, but not tricyclic antidepressants, on perturbed ANS function in MDD. Notwithstanding, there is some evidence that ANS measures have the capacity to inform response to antidepressant medication treatment. While there is a paucity of studies on the effects of rTMS on the ANS, critically, there is preliminary support that rTMS may alleviate ANS dysfunction in MDD and that ANS measures are associated with rTMS treatment response. These observations are consistent with the frontal-vagal theory of depression and the emerging literature on the use of ANS measures for personalising and optimising rTMS treatment of MDD.

Psychobiological markers of allostatic load in depressed and nondepressed mothers and their adolescent offspring

BACKGROUND

A substantial body of research has emerged suggesting that depression is strongly linked to poor physical health outcomes, which may be partly due to increased allostatic load across stress response systems. Interestingly, health risks associated with depression are also borne by the offspring of depressed persons. Our aim was to simultaneously investigate whether maternal depression is associated not only with increased allostatic load across cardiac control, inflammation, cellular aging, but also if this is transmitted to adolescent children, possibly increasing the risk for early onset of psychiatric conditions and disease in these offspring.

METHODS

A preregistered, case-control study of 180 low-income mothers (50% mothers depressed, 50% mothers nondepressed) and their adolescent offspring was conducted to determine how depressed mothers and their adolescent offspring systematically differ in terms of autonomic, sympathetic, and parasympathetic cardiac control; inflammation; cellular aging; and behavioral health in offspring, which are indicators suggestive of higher allostatic load.

RESULTS

Findings indicate that depressed mothers and their adolescent offspring differ in terms of comorbid mental and physical health risk profiles that are suggestive of higher allostatic load. Findings indicate that depressed mothers exhibit elevated resting heart rate and decreased heart rate variability, and adolescent offspring of depressed mothers exhibit greater mental health symptoms, elevated heart rate, and accelerated biological aging (shorter telomeres). These effects persisted after controlling for a range of potential covariates, including medication use, sex, age, and adolescents' own mental health symptoms.

CONCLUSIONS

Findings indicate that maternal depression is associated with increased allostatic load in depressed women and their adolescent children, possibly increasing risk for early onset of psychiatric conditions and disease in these offspring. Future research is needed to delineate why some biological systems are more impacted than others and to explore how findings might inform preventative programs targeted at adolescent offspring of depressed mothers.

Depressive symptoms among stress-exposed youth: Relations with tonic and phasic indices of autonomic functioning

Theoretical models of adolescent depression postulate that one possible individual vulnerability factor for the development of depressive symptoms is autonomic dysregulation. However, there is limited and mixed support for these models among ethnically diverse and higher risk stress-exposed youth. Therefore, this study investigated the relations between both tonic and phasic indices of parasympathetic autonomic functioning (i.e., resting high-frequency heart rate variability [HF-HRV] and root mean square of successive differences [RMSSD]; HF-HRV and RMSSD reactivity to a mental arithmetic stressor) and depressive symptoms among 80 severely stress-exposed youth (51% female; 11-17 years of age) from diverse backgrounds (61.3% ethnic minority; caregiver-reported median family income = $20,000-$49,999 per year). Results demonstrated that lower resting HF-HRV and RMSSD, but not HF-HRV and RMSSD reactivity, was associated with greater youth depressive symptoms. Our findings suggest that lower resting parasympathetic autonomic functioning may be a potential vulnerability factor of depressive symptoms among stress-exposed youth, instead of specific emotional responses to stressors. These findings will need to be replicated in larger samples of stress-exposed youth and youth at higher risk for or exhibiting clinical levels of depressive symptoms to better elucidate relations with autonomic functioning and depressive symptoms among adolescents.

Lower activity of salivary alpha-amylase in youths with depression

Measurement of basal and stress-induced salivary alpha-amylase activity may help to understand autonomic nervous system disturbance in mental disorders. The potential sympathetic nervous system dysregulation in children and adolescent psychopathologies is mostly unknown. The present study was aimed to test the hypothesis that salivary alpha-amylase activity is higher in youths diagnosed with depression than in healthy subjects considering a part of the daily rhythm of enzyme activity and its morning to midday slope. A total of 30 children aged 15 ± 0.46 years (15 patients with depression, 4 boys, 11 girls, and 15 sex- and age-matched healthy controls) participated in the study. Two saliva samples were collected from each subject to measure activity of alpha-amylase in the morning and midday. The results of the present study revealed that the midday but not morning alpha-amylase activity was lower in patients with depression than in healthy controls. The diurnal increase in enzyme activity present in healthy subjects was absent in patients. The children and adolescents with depression exhibited flatter morning to midday slopes of alpha-amylase activity. In conclusion, the present results indicate a disturbance of alpha-amylase daily rhythm in youths with depression and motivate further studies on the relationship between sympathetic activation and mood disorders.

Exploring Key Physiological System Profiles at Rest and the Association with Depressive Symptoms in Autism Spectrum Disorder

Depression is often associated with dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). Individuals with autism spectrum disorder (ASD) may experience physiological dysregulation and psychological comorbidities; however, the extent to which the interactions between these systems predict internalizing symptoms in ASD has not been investigated. The study examined interactions with the HPA axis and ANS in 10-13-year-old children with ASD (n = 41) and typical development (TD; n = 46). The interrelated systems uniquely contributed to depressive symptoms in ASD above and beyond any system in isolation. A reciprocal, parasympathetic-dominant ANS was related to fewer affective symptoms in ASD. Findings highlight the importance of examining arousal across multiple systems to more precisely identify profiles associated with maladaptive psychiatric outcomes in ASD.

Internalizing Problems and Attentional Control

Abstract. Individuals with internalizing problems differ in levels of attentional control (AC), and this heterogeneity could be associated with differences in autonomic arousal. The present study investigated whether AC moderated the effect of internalizing problems on self-reported experience and autonomic nervous system (ANS) responses after the induction of negative affect. Children aged 9–13 years were recruited into a patient group (29) and a healthy control group (25). AC was measured by the Early Adolescent Temperament Questionnaire. Heart rate, heart rate variability (HRV) and pre-ejection period (PEP) were recorded during baseline, a sad film clip and recovery, and analyzed using a marginal linear model. Children reported their experienced emotion, valence, and arousal in response to the film. A significant interaction effect showed increased HRV and longer PEP from baseline to recovery for patients with higher AC. Patients with lower AC showed increased HRV followed by a return to baseline values after the film clip and no significant changes in PEP. Healthy controls showed no significant changes in HRV or PEP independent of level of AC. There were no differences between groups in self-reported experience. The results indicate that AC moderated the effect of internalizing problems on ANS regulation. Increased HRV and longer PEP from baseline to recovery were uniquely associated with higher AC and internalizing problems. This physiological response might indicate a cognitive avoidance strategy. AC could be an important factor explaining heterogeneity in ANS activity among individuals with internalizing problems. Clinical implications of the present findings are discussed.

Mean Heart Rate and Parameters of Heart Rate Variability in Depressive Children and the Effects of Antidepressant Medication

Introduction: Researchers have repeatedly discovered an association between depression and autonomic cardiac dysregulation in adults. However, corresponding data concerning minors are still rare. Method: For this exploratory, cross-sectional study, we included N = 43 minors (age range 9-17 years). The subjects were depressive subjects with or without antidepressant medication (N = 23) or healthy control children (HC) (N = 20). We assessed several indices of cardiac functioning using long-term electrocardiogram data (mean heart rate, HR, and several parameters of heart rate variability, HRV). We hypothesized that increased HR and reduced HRV are associated with depressive disorders. Furthermore, we assessed the impact of age, sex, and antidepressant medication on HR and HRV. Results: When sex and age were controlled for, HR was significantly increased in depressive minors compared to HC. However, our preliminary data suggest that this might not be the case in medicated patients, and there were no differences between groups regarding HRV parameters. There was no significant correlation in the whole sample between severity of depression and both HR and HRV. In the subsample of patients with depression, antidepressant medication was associated with lower HR and higher indices of HRV. Conclusion: The data indicate an association between depression and altered autonomic cardiac regulation, which can already manifests in minors.

Gut permeability and depressive symptom severity in unmedicated adolescents

OBJECTIVE

This study examined gut permeability in unmedicated adolescents with and without major depressive disorder.

METHOD

Medically healthy, non-medicated, 12-17 year-old females in a major depressive episode (MDE) or healthy controls, without any psychiatric condition, were enrolled. They completed the Children's Depression Rating Scale-Revised (CDRS-R) and underwent a clinical interview. Preejection period (PEP) and respiratory sinus arrhythmia (RSA) data were collected to measure autonomic nervous system activity. Following an overnight fast, participants ingested lactulose and mannitol and collected urine for 4 hours while still fasting, to examine gut permeability. Plasma cytokines (interleukin 1β, interleukin 6, and tumor necrosis factor α) were measured. Correlational analyses were used to examine the associations between relevant variables.

RESULTS

41 female participants (age: 14.8 ± 1.6 years, n = 25 with MDE) were enrolled. PEP, but not RSA, was inversely associated with neurovegetative symptom severity on the CDRS-R (r = -0.31, p < 0.06). In the 30 participants with gut permeability data, the lactulose to mannitol ratio (LMR) was significantly positively associated with depression severity, particularly neurovegetative symptom severity (r = 0.37, p < 0.05). Notably, the association between neurovegetative symptom severity and PEP was substantially reduced after adjusting for LMR. Additionally, depression severity was significantly associated with circulating cytokines.

CONCLUSIONS

This is the first study to examine gut permeability in unmedicated adolescents, offering preliminary support for a mechanistic pathway linking sympathetic nervous system activation to increased gut permeability and activation of the innate immune system, likely contributing to the emergence of neurovegetative symptoms of depression.

Changes in heart rate variability in first-episode drug-naïve adolescents with major depressive disorder: A 12-week prospective study

BACKGROUND

Major depressive disorder (MDD) is a common mental disorder, the onset of which frequently occurs during adolescence. While differences in heart rate variability (HRV) between depressed and healthy participants have previously been observed, results have been inconsistent. This study thus investigated the features of HRV in adolescents with MDD.

METHODS

We recruited first-episode drug-naïve adolescents aged 13-18 years who had been diagnosed with MDD, and healthy age-matched controls. HRV was measured before and after a 12-week antidepressant treatment. We compared HRV measures between patient group and control group. We also tried to find correlation between HRV measures and depression rating scales.

RESULTS

Fifty-seven participants were included (patient group: n = 31; control group: n = 26). The patient group showed a lower normalized high frequency (HF norm), a higher normalized low frequency (LF norm), and a higher LF/HF ratio than did the control group. After treatment, LF was significantly decreased within the patient group compared to baseline. Hamilton Depression Rating Scales and Children's Depression Inventory scores were positively correlated with LF norm and LF/HF ratio, and negatively correlated with HF norm, when included all participants in analysis LIMITATIONS: Sample size of this study was small to assess influences of confounding factors on HRV. And follow up period was relatively short to see impact of pharmacotherapy.

CONCLUSION

An imbalance of the autonomic nervous system might be a meaningful feature of adolescent MDD, and HRV might represent a potential biological marker for pathophysiological changes in MDD.

Relationships of Anxiety and Depression with Cardiovascular Health in Youth with Normal Weight to Severe Obesity

OBJECTIVE

To evaluate the relationships of depression and anxiety symptoms with cardiovascular disease (CVD) risk factors and measures of vascular health in youth.

STUDY DESIGN

Participants (n = 202) were 8- to 18-year-olds from a cross-sectional study evaluating cardiovascular health across a wide range of body mass index values (normal weight to severe obesity). CVD risk measurement included blood pressure, fasting lipids, glucose, insulin, carotid artery intima-media thickness, compliance and distensibility, brachial artery flow-mediated dilation, carotid-radial artery pulse wave velocity, body fat percentage, and a metabolic syndrome cluster score. Anxiety and depression symptoms were self-reported on the Screen for Child Anxiety Related Disorders and Center for Epidemiological Studies Depression Scale for Children. Two sets of adjustment variables were used in evaluation of differences between those with and without anxiety or depression symptomatology for the CVD risk factor and vascular outcomes. The first set included adjustment for Tanner stage, sex, and race; the second was additionally adjusted for percent body fat.

RESULTS

Anxiety was not significantly associated with CVD risk factors or vascular health in either model. Depression was associated with high-density lipoprotein cholesterol, triglycerides, and metabolic syndrome cluster score; these relationships were attenuated when accounting for percent body fat.

CONCLUSIONS

When accounting for body fat, we found no clear relationship of self-reported depression or anxiety symptoms with CVD risk factors or vascular health in youth.

Inflexibility as a Vulnerability to Depression: A Systematic Qualitative Review

The study of vulnerabilities to depression typically identifies factors that are thought to be universally maladaptive or adaptive. In contrast, researchers recently have theorized that the ability to flexibly engage in different thoughts and behaviors that fit situational demands may be most indicative of psychological health. We review empirical evidence from 147 studies reporting associations between five components of flexibility (set-shifting, affective set-shifting, cardiac vagal control, explanatory flexibility, and coping flexibility) and depression and classify studies according to strength of study design. Evidence from correlational and case-controlled studies suggests cross-sectional relationships, but few prospective studies have been conducted. We discuss limitations of existing studies, identify new directions for programmatic research, and discuss implications that flexibility has for the prevention and treatment of depression.

Emotion dysregulation and autonomic responses to film, rumination, and body awareness: Extending psychophysiological research to a naturalistic clinical setting and a chemically dependent female sample

Substance use is a complex clinical problem characterized by emotion dysregulation and daily challenges that can interfere with laboratory research. Thus, few psychophysiological studies examine autonomic and self-report measures of emotion dysregulation with multidiagnostic, chemically dependent samples or extend this work into naturalistic settings. In this study, we used a within-subject design to examine changes in respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), and self-reported affect across three tasks designed to elicit distinct psychophysiological and emotional response patterns. We also examined emotion dysregulation as a moderator of psychophysiological responses. Participants include 116 women with multiple comorbid mental health conditions enrolled in substance use treatment, many of whom also reported high emotion dysregulation. Participants were assessed in the treatment setting and completed three tasks: watching a sad movie clip, rumination on a stressful event, and a mindful interoceptive awareness meditation. Multilevel models were used to examine changes from resting baselines to the tasks. During the film, results indicate a significant decrease in RSA and an increase in EDA. For the rumination task, participants showed a decrease in RSA but no EDA response. For the body awareness task, there was an increase in RSA and a decrease in EDA. Emotion dysregulation was associated with differences in baseline RSA but not with EDA or with the slope of response patterns across tasks. Self-reported affect was largely consistent with autonomic patterns. Findings add to the literature on emotion dysregulation, substance use, and the translation of psychophysiological measurements into clinical settings with complex samples.

Does Context Matter? A Multi-Method Assessment of Affect in Adolescent Depression Across Multiple Affective Interaction Contexts

This study utilized a multi-method approach (self-reported affect, observed behavior, and psychophysiology) to investigate differences between clinically depressed and non-depressed adolescents across three different affective interaction contexts with their parents. 152 adolescents (52 males, 14-18 y.o.), and their parents, participated in a laboratory session in which they discussed positive and negative aspects of their relationship, and reminisced on positive and negative memories. We found that across contexts depressed adolescents exhibited higher negative affect and behaviors, lower positive behaviors, and greater autonomic and sympathetic activity. Context specific findings indicated that depressed adolescents 1) exhibited greater persistence of negative affect and dysphoric behavior across the sequence of tasks, whereas these phenomena declined amongst their non-depressed peers, 2) depressed adolescents had greater increases in aggressive behaviors during negative interactions, and 3) depressed adolescents had greater parasympathetic withdrawal during negative interactions, while this response characterized the non-depressed group during positive interactions.

Maladaptive mood repair, atypical respiratory sinus arrhythmia, and risk of a recurrent major depressive episode among adolescents with prior major depression

BACKGROUND

Because depressive illness is recurrent, recurrence prevention should be a mainstay for reducing its burden on society. One way to reach this goal is to identify malleable risk factors. The ability to attenuate sadness/dysphoria (mood repair) and parasympathetic nervous system functioning, indexed as respiratory sinus arrhythmia (RSA), are impaired during depression and after it has remitted. The present study therefore tested the hypothesis that these two constructs also may mirror risk factors for a recurrent major depressive episode (MDE).

METHOD

At time 1 (T1), 178 adolescents, whose last MDE had remitted, and their parents, reported on depression and mood repair; youths' RSA at rest and in response to sad mood induction also were assessed. MDE recurrence was monitored until time 2 (T2) up to 2 years later. Mood repair at T1 (modeled as a latent construct), and resting RSA and RSA response to sadness induction (RSA profile), served to predict onset of first recurrent MDE by T2.

RESULTS

Consistent with expectations, maladaptive mood repair predicted recurrent MDE, above and beyond T1 depression symptoms. Further, atypical RSA profiles at T1 were associated with high levels of maladaptive mood repair, which, in turn, predicted increased risk of recurrent MDE. Thus, maladaptive mood repair mediated the effects of atypical RSA on risk of MDE recurrence.

CONCLUSIONS

This study documented that a combination of behavioral and physiological risk factors predicted MDE recurrence in a previously clinically referred sample of adolescents with depression histories. Because mood repair and RSA are malleable, both could be targeted for modification to reduce the risk of recurrent depression in youths.

Parasympathetic nervous system activity predicts mood repair use and its effectiveness among adolescents with and without histories of major depression

Depressive disorders that onset in the juvenile years have been linked to far-reaching adverse consequences, making it imperative to elucidate key mechanisms and contributory factors. Excessive use of regulatory responses that exacerbate sadness (maladaptive mood repair) or insufficient use of regulatory responses that reduce it (adaptive mood repair) may reflect behavioral mechanisms of depression risk. Cardiac vagal control, indexed by patterns of respiratory sinus arrhythmia (RSA), has received attention as a putative physiological risk factor for depression. Although mood repair and RSA are related, the nature of this relationship is not well characterized in the context of depression risk. Therefore, we tested alternative models of the relationships between RSA patterns (at rest and in response to a sad film), trait mood repair, and the effectiveness of a mood repair response in the laboratory (state mood repair) among adolescents with depression histories (n = 210) and emotionally healthy peers (n = 161). In our data, a mediation model best explained the association between the key constructs: Adolescents with normative RSA patterns exhibited lower levels of depression and trait maladaptive mood repair, and benefited more from instructed (state) mood repair in the laboratory. By contrast, adolescents with atypical RSA patterns exhibited higher levels of depression and dispositional maladaptive mood repair, which, in turn, mediated the relations of RSA patterns and depression symptoms. Atypical RSA patterns also predicted reduced benefits from laboratory mood repair.

Interaction of Biological Stress Recovery and Cognitive Vulnerability for Depression in Adolescence

Major Depressive Disorder is a common mental illness with rates increasing during adolescence. This has led researchers to examine developmental antecedents of depression. This study examined the association between depressive symptoms and the interaction between two empirically supported risk factors for depression: poor recovery of the biological stress system as measured through heart rate and cortisol, and cognitive vulnerabilities as indexed by rumination and a negative cognitive style. Adolescents (n = 127; 49 % female) completed questionnaires and a social stress task to elicit a stress response measured with neuroendocrine (cortisol) and autonomic nervous system (heart rate) endpoints. The findings indicated that higher depressive symptoms were associated with the combination of higher cognitive vulnerabilities and lower cortisol and heart rate recovery. These findings can enhance our understanding of stress responses, lead to personalized treatment, and provide a nuanced understanding of depression in adolescence.

The SENSE Study (Sleep and Education: learning New Skills Early): a community cognitive-behavioural therapy and mindfulness-based sleep intervention to prevent depression and improve cardiac health in adolescence

Background

Sleep problems are a major risk factor for the emergence of depression in adolescence. The aim of this study was to test whether an intervention for improving sleep habits could prevent the emergence of depression, and improve well-being and cardiovascular indices amongst at-risk adolescents.

Methods/Design

A longitudinal randomised controlled trial (RCT) is being conducted across Victorian Secondary Schools in Melbourne, Australia. Adolescents (aged 12–17 years) were defined as at-risk for depression if they reported high levels of anxiety and sleep problems on in-school screening questionnaires and had no prior history of depression (assessed by clinical diagnostic interview). Eligible participants were randomised into either a sleep improvement intervention (based on cognitive behavioral and mindfulness principles) or an active control condition teaching study skills. Both programs consisted of seven 90 minute-long sessions over seven weeks. All participants were required to complete a battery of mood and sleep questionnaires, seven-days of actigraphy, and sleep diary entry at pre- and post-intervention. Participants also completed a cardiovascular assessment and two days of saliva collection at pre-intervention. Participants will repeat all assessments at two-year follow up (ongoing).

Discussion

This will be the first efficacy trial of a selective group-based sleep intervention for the prevention of depression in an adolescent community sample. If effective, the program could be disseminated in schools and greatly improve health outcomes for anxious adolescents.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12612001177842. Date of Registration: 06-Nov-2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-015-0096-x) contains supplementary material, which is available to authorized users.

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association

In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.

A blunted sympathetic and accentuated parasympathetic response to postural change in subjects with depressive disorders

BACKGROUND

In recent years, the bi-directional relationship between depression and ANS dysfunction has received considerable attention, but findings remain inconclusive. In this study, we aimed to examine the spectral HRV response to postural change in subjects with depressive disorders and in healthy controls, in order to gain insight into the characteristics of autonomic nervous system (ANS) response to postural change in subjects with depressive disorders.

METHODS

We compared HRV response to postural change between subjects with depressive disorders and healthy controls aged 20-37 years. Depression severity was assessed by the self-reported Beck Depression Inventory-II (BDI-II). Spectral HRV was analyzed at two moments: 10 min seated rest and 10 min at standing position, with spontaneous breathing.

RESULTS

No significant differences existed in the resting spectral HRV indices between subjects with depressive disorders and controls, however, following postural change, the increasing level of LF and LF/HF was lower and the decreasing level of HF power was higher, in the individuals with depression than that in healthy subjects. The differences in the LF power, HF power and the LF/HF ratio between seated rest before standing up and after postural change were found negatively correlated with depression severity.

CONCLUSION

We found a blunted sympathetic and accentuated parasympathetic response to postural change in subjects with depressive disorder, suggesting that the autonomic impairment and early ANS dysfunction may exist among depressed individuals. These findings indicated that spectral analysis of HRV associated with postural change may be a more sensitive method than resting HRV analysis for detecting ANS dysfunction in depressive disorders.

LIMITATIONS

Further studies are needed to expand the sample size and to clarify the mechanisms responsible for the autonomic dysfunction observed in individuals with depressive disorders.

Early physiological markers of cardiovascular risk in community based adolescents with a depressive disorder

BACKGROUND

Depression is recognised as an independent cardiovascular risk factor in adults. Identifying this relationship early on in life is potentially important for the prevention of cardiovascular disease (CVD). This study investigated whether clinical depression is associated with multiple physiological markers of CVD risk in adolescents from the general community.

METHODS

Participants aged 12-18 years were recruited from the general community and screened for depressive symptoms. Individuals with high and low depressive symptoms were administered a diagnostic interview. Fifty participants, 25 with a current depressive episode and 25 matched healthy controls, subsequently completed cardiovascular assessments. Variables assessed were automatic brachial and continuous beat-to-beat finger arterial blood pressure, heart rate, vascular functioning by pulse amplitude tonometry following reactive hyperaemia and pulse transit time (PTT) at rest. Blood samples were collected to measure cholesterol, glucose and glycohaemoglobin levels and an index of cumulative risk of traditional cardiovascular risk factors was calculated.

RESULTS

Depressed adolescents had a significantly lower reactive hyperaemia index and shorter PTT, suggesting deterioration in vascular integrity and structure. Higher fasting glucose and triglyceride levels were also observed in the depressed group, who also had higher cumulative risk scores indicative of increased engagement in unhealthy behaviours and higher probability of advanced atherosclerotic lesions.

LIMITATIONS

The sample size and number of males who completed all cardiovascular measures was small.

CONCLUSIONS

Clinically depressed adolescents had poorer vascular functioning and increased CVD risk compared to controls, highlighting the need for early identification and intervention for the prevention of CVD in depressed youth.

Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes

In this study, the authors analyzed whether chronotypes, sleep duration, and sleep sufficiency are associated with cardiovascular diseases and type 2 diabetes by using the National FINRISK Study 2007 data (N = 6258), being a representative sample of the population aged 25 to 74 living in five areas of Finland. Health status assessments and laboratory measurements from the participants (N = 4589) of the DILGOM substudy were used for the detailed analysis of chronotype. Evening types had a 2.5-fold odds ratio for type 2 diabetes (p < .01) as compared with morning types, the association being independent of sleep duration and sleep sufficiency. Evening types had a 1.3-fold odds ratio for arterial hypertension (p < .05 after controlling for sleep duration or sleep sufficiency), a faster resting heart rate and a lower systolic blood pressure (both p < .01), and lower levels of serum total cholesterol and low-density lipoprotein cholesterol (both p < .0001) than morning types. There were significant 1.2- to 1.4-fold odds ratios for arterial hypertension among those with long or short sleep durations or reduced sleep sufficiency. To conclude, the behavioral trait towards eveningness is suggested to predispose individuals to type 2 diabetes in particular, whereas compromised sleep is robustly associated with arterial hypertension.

Heart rate time irreversibility is impaired in adolescent major depression

We aimed to study heart rate time irreversibility--a nonlinear qualitative characteristics of heart rate variability indicating complexity of cardiac autonomic control at rest and in response to physiological stress (orthostasis) in never-treated major depressive disorder (MDD) adolescent female patients.

METHODS

We studied 20 MDD girls and 20 healthy age-matched girls at the age of 15 to 18 years. The ECG was recorded in supine position and in response to position change from lying to standing (orthostasis). Time irreversibility analysis was performed using Porta's (P%), Guzik's (G%) and Ehlers' (E) index. The depressive disorder severity was evaluated using Montgomery-Asberg Depression Rating Scale (MADRS) and Children's Depression Inventory (CDI).

RESULTS

Resting heart rate time irreversibility indices (logG%, logP%, Ehlers' index) were significantly reduced in MDD female patients without significant differences in response to orthostasis in MDD girls compared to controls. No significant correlations between time irreversibility and MDD severity were observed.

CONCLUSION

This study revealed the impaired heart rate asymmetry pattern indicating an altered complexity of cardiac autonomic regulation in adolescent female patients suffering from MDD.

Heart rate responses to parental behavior in depressed adolescents

In order to more fully understand the abnormalities in emotional responding associated with adolescent depression we examined clinically depressed and non-depressed adolescents' physiological responses to their parents' negative emotional behavior, as indexed by their heart rate responses to parental angry and dysphoric behavior during laboratory-based interactions. Maternal angry and dysphoric behavior predicted heart rate deceleration amongst non-depressed adolescents, a response that was not observed in depressed adolescents. Fathers' angry behavior predicted significant heart rate acceleration in depressed (but not non-depressed) adolescents, whereas fathers' dysphoric behavior predicted heart rate deceleration amongst depressed but not amongst non-depressed adolescents. These findings are interpreted within the framework of orienting and defense cardiac responses, and suggest that reactivity in adolescent depression is characterized by the absence of a normative orienting response toward aversive maternal behaviors, and a defensive physiological response to aggressive paternal behavior.

Expression of anger in depressed adolescents: the role of the family environment

The expression of anger is considered to be abnormal in depression, yet its role is only poorly understood. In the present study we sought to clarify this role by examining the moderating influence of the family environment on overall levels of anger expression and anger reactivity in depressed and non-depressed adolescents during conflictual interactions with their parents. One hundred and forty one depressed and non-depressed adolescent participants engaged in a problem-solving task with their parents during which their behavioral expression of anger and heart rate were recorded. The results demonstrate that general levels of parental anger in the family environment (as indicated by the overall level of expressed anger by the parents during the interactions) strongly moderates how depressed differ from non-depressed adolescents in terms of their anger, heart rate and reactivity. Overall, the findings suggest that in depressed adolescents anger is much less adaptively attuned to the environment, consistent with models that predict dysfunction in the regulation of anger that prevents depressed individuals responding adaptively to their social environment.