Hostility, gender, and cardiac autonomic control

Association between affective temperaments and the severity and the extent of coronary artery disease as obtained by coronary CT angiography

BACKGROUND

Affective temperaments are documented predictors of psychopathology, but cumulating data suggest their relationship with coronary artery disease (CAD). We aimed to evaluate their role in relation to surrogate semiquantitative markers of coronary plaque burden, as assessed by coronary CT angiography (CCTA).

METHODS

We included 351 patients who were referred for CCTA due to suspected CAD. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). The severity and extent of CAD was evaluated by CCTA, applying semiquantitative plaque burden scores, notably Segment Involvement Score (SIS) and Segment Stenosis Score (SSS). Logistic regression analyses were performed to define the predictors of CAD severity and extent.

RESULTS

Regarding the scores evaluated by TEMPS-A that consists of 110 questions, in men, significant inverse association was found between hyperthymic temperament score and SSS (β = -0.143, (95%CI: -0.091 to -0.004), p = 0.034). Compared to the TEMPS-A form, applying the abbreviated version - containing 40 questions - significant relationship between affective temperaments and SSS or SIS was found in case of both sexes. Concerning men, hyperthymic temperament was demonstrated to be independent predictor of both SSS (β = -0.193, (95%CI: -0.224 to -0.048), p = 0.004) and SIS (β = -0.194, (95%CI: -0.202 to -0.038), p = 0.004). Additionally, we proved, that significant positive association between irritable temperament and SSS (β = 0.152, (95%CI: 0.002 to 0.269), p = 0.047) and SIS (β = 0.155, (95%CI: 0.004 to 0.221), p = 0.042) exists among women.

LIMITATIONS

Cross-sectional analysis of a single center study with self-reported questionnaires.

CONCLUSIONS

Assessment of affective temperaments could offer added value in stratifying cardiovascular risk for patients beyond traditional risk factors.

The Utility of Physiological Measures in Assessing the Empathic Skills of Incarcerated Violent Offenders

Since lack of empathy is an important indicator of violent behaviors, researchers need consistent and valid measures. This study evaluated the practical significance of a potential physiological correlate of empathy compared to a traditional self-report questionnaire in 18 male violent offenders and 21 general population controls. Empathy skills were assessed with the Interpersonal Reactivity Index (IRI) questionnaire. Heart-Rate Variability (HRV) was assessed with an electrocardiogram. The RMSSD (Root Mean Square of the Successive beat-to-beat Differences), an HRV index implicated in social cognition, was calculated. There were no group differences in IRI scores. However, RMSSD was lower in the offender group. Positive correlations between RMSSD and IRI subscales were found for controls only. We conclude that psychometric measures of empathy do not discriminate incarcerated violent offenders, and that the incorporation of psychophysiological measures, such as HRV, could be an avenue for forensic research on empathy to establish translatable evidence-based information.

Association between affective temperaments and severe coronary artery disease

BACKGROUND

Affective temperaments are regarded as subclinical manifestations of major mood disorders and cumulating evidence suggest their role in cardiovascular (CV) pathology. We wished to analyze associations between affective temperaments and severe coronary artery disease (CAD), as assessed by coronary computed tomography angiography (CCTA).

METHODS

225 consecutive patients referred to CCTA due to suspected CAD were included. Medical history and demographic parameters were recorded and all patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). The severity and extent of CAD was evaluated by CCTA. Logistic regression analysis was used to identify predictors of severe CAD (≥70% luminal stenosis in ≥1 major coronary artery).

RESULTS

According to multivariate logistic regression analysis, elevated hyperthymic affective temperament scores significantly decreased the odds of severe CAD (OR=0.92 CI: 0.84-1.00, p = 0.04), while independent positive associations were observed in case of dyslipidemia (OR=4.23 CI: 1.81-9.88, p = 0.001) and cyclothymic affective temperament scores (OR=1.12 CI: 1.02-1.23, p = 0.02). Furthermore, receiver operating curve (ROC) analysis was used to define ideal cutoff values. Hyperthymic temperament scores >11 (OR=0.41 CI: 0.19-0.90, p = 0.03), cyclothymic scores >7 (OR=3.23 CI: 1.35-7.76, p = 0.01) and irritable scores >6 (OR=2.79 CI: 1.17-6.69, p = 0.02) were also independently associated with severe CAD.

LIMITATIONS

Our study was limited by the cross-sectional design and the self-report nature of the questionnaires.

CONCLUSIONS

Evaluation of affective temperaments might help to identify patients with elevated risk for severe CAD and subsequent need for coronary intervention.

The association between accelerated vascular aging and cyclothymic affective temperament in women

OBJECTIVE

Affective temperaments (depressive, anxious, irritable, hyperthymic, cyclothymic) are regarded as the biologically stable core of personality. Accumulating data suggest their relationship with cardiovascular diseases. However, there are currently limited data on the association of affective temperaments and accelerated vascular aging. The aim of our study was to evaluate the relationship between affective temperaments and vascular age, as assessed by coronary artery calcium scoring (CACS).

METHODS

In our cross-sectional study, 209 consecutive patients referred to coronary computed tomography angiography (CCTA) due to suspected coronary artery disease (CAD) were included. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and the Beck Depression Inventory (BDI). Vascular age was estimated using CACS and its difference from chronological age for each patient was calculated. Linear regression analysis was used to identify predictors of accelerated vascular aging in the entire cohort and in male and female sub-populations.

RESULTS

Besides traditional risk factors, cyclothymic temperament score proved to be an independent predictor of accelerated vascular aging in women (β = 0.89 [95%CI: 0.04-1.75]), while this association was absent in men.

CONCLUSIONS

Our results suggest that cyclothymic affective temperament is associated with accelerated vascular aging in women. Assessment of affective temperaments may potentiate more precise cardiovascular risk stratification of patients.

Media Exposure to Terrorism and Perception of Immigrants as a Threat: The Role of Emotional Intelligence and Psychophysiological Self-Regulation

To better understand how media exposure to terrorism-related images can lead to perceiving immigrants as more threatening, in the present study we manipulated participants' exposure to media coverage of terrorist attacks and investigated how this may influence people's perception of Arab immigrants. Considering the important role of regulatory abilities when facing stressful events like terrorist attacks, we measured individual differences in both trait emotional intelligence and resting heart rate variability (HRV). Results showed that participants perceived Arab immigrants as more threatening in the media exposure condition than in the control condition. Importantly, there were moderating effects of both trait emotional intelligence and HRV. People with lower trait emotional intelligence or lower HRV at rest felt more threatened in the media exposure condition compared to the control condition, whereas this effect was not observed among participants with higher trait emotional intelligence or higher resting HRV. The present study highlights some of the complexities related to how media exposure to terrorism-related images influences people's reactions to, and evaluations of, an outgroup that is related to the perpetrators of the attacks.

Association between Cyclothymic Affective Temperament and Age of Onset of Hypertension

Affective temperaments represent a biologically stable core of emotional reactivity and have previously been associated with hypertension and arterial stiffening. The age, when hypertension is initiated, is influenced by different factors, but the role of personality traits in this regard is not clarified yet. Our aim was to study the association between affective temperaments and the age at onset of hypertension. In this cross-sectional study, 353 patients were included. After the evaluation of history, patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire. We used linear regression analysis to identify predictors of the age of onset of hypertension in the whole cohort and in male and female subpopulations. The independent predictors of the age at onset of hypertension were male sex (B = −4.57 (95% CI = −1.40 to −7.74)), smoking (B = −4.31 (−7.41 to −1.22)), and positive family history (B = −6.84 (−10.22 to −3.45)). In women, cyclothymic temperament score was an independent predictor of the initiation of hypertension (B = −0.83 (−1.54 to −0.12)), while this association was absent in men. Besides traditional factors, cyclothymic affective temperament might contribute to the earlier initiation of hypertension in women.

Tantra and Modern Neurosciences: Is there any Correlation?

BACKGROUND AND AIMS

Many studies have conclusively proven that meditative techniques derived from the Indian systems of philosophy, meditation and ritual classified as "Tantra" can bring about sustained changes in the structure and function of the nervous system of practitioners. The aim of this study is to provide neuroscientists a framework through which to interpret Tantra, and thereby provide a foundation upon which future interdisciplinary study can be built.

METHODS

We juxtapose Tantric concepts such as the subtle body, nadis and mantras with relevant neuroscientific findings. Our premise is that through sustained internalization of attention, Tantric practitioners were able to identify and document subtle changes in their field of awareness, which usually do not cross the threshold to come into our perception.

RESULTS

The descriptions left by Tantric philosophers are often detailed and empirical, but they are about subjective phenomena, rather than external objects. They also focus on individual experiences, rather than the group-level analyses favored by modern medical science.

CONCLUSION

Systematic exploration of Tantric texts can be of tremendous value in expanding our understanding of human beings' experiential reality, by enabling us to build bridges between first-person and third-person approaches to the nervous system. This may open up new avenues for cognitive enhancement and treating neurological diseases.

Common pathways and communication between the brain and heart: connecting post-traumatic stress disorder and heart failure

Psychiatric illnesses and cardiovascular disease (CVD) contribute to significant overall morbidity, mortality, and health care costs, and are predicted to reach epidemic proportions with the aging population. Within the Veterans Administration (VA) health care system, psychiatric illnesses such as post-traumatic stress disorder (PTSD) and CVD such as heart failure (HF), are leading causes of hospital admissions, prolonged hospital stays, and resource utilization. Numerous studies have demonstrated associations between PTSD symptoms and CVD endpoints, particularly in the Veteran population. Not only does PTSD increase the risk of HF, but this relationship is bi-directional. Accordingly, a VA-sponsored conference entitled "Cardiovascular Comorbidities in PTSD: The Brain-Heart Consortium" was convened to explore potential relationships and common biological pathways between PTSD and HF. The conference was framed around the hypothesis that specific common systems are dysregulated in both PTSD and HF, resulting in a synergistic acceleration and amplification of both disease processes. The conference was not intended to identify all independent pathways that give rise to PTSD and HF, but rather identify shared systems, pathways, and biological mediators that would be modifiable in both disease processes. The results from this conference identified specific endocrine, autonomic, immune, structural, genetic, and physiological changes that may contribute to shared PTSD-CVD pathophysiology and could represent unique opportunities to develop therapies for both PTSD and HF. Some recommendations from the group for future research opportunities are provided.

Differential effects of vestibular processing on orienting exogenous and endogenous covert visual attention

Recent research highlights the overwhelming role of vestibular information for higher order cognition. Central to body perception, vestibular cues provide information about self-location in space, self-motion versus object motion, and modulate the perception of space. Surprisingly, however, little research has dealt with how vestibular information combines with other senses to orient one's attention in space. Here we used passive whole body rotations as exogenous (Experiment 1) or endogenous (Experiment 2) attentional cues and studied their effects on orienting visual attention in a classical Posner paradigm. We show that-when employed as an exogenous stimulus-rotation impacts attention orienting only immediately after vestibular stimulation onset. However, when acting as an endogenous stimulus, vestibular stimulation provides a robust benefit to target detection throughout the rotation profile. Our data also demonstrate that vestibular stimulation boosts attentional processing more generally, independent of rotation direction, associated with a general improvement in performance. These data provide evidence for distinct effects of vestibular processing on endogenous and exogenous attention as well as alertness that differ with respect to the temporal dynamics of the motion profile. These data reveal that attentional spatial processing and spatial body perception as manipulated through vestibular stimulation share important brain mechanisms.

Dyadic Coping, Respiratory Sinus Arrhythmia, and Depressive Symptoms Among Parents of Preschool Children

Respiratory sinus arrhythmia (RSA) is a biomarker of cardiac vagal tone that has been linked to social functioning. Recent studies suggest that RSA moderates the impact of interpersonal processes on psychosocial adjustment. The goal of this study was to assess whether RSA would moderate the association between dyadic coping (DC) and depressive symptoms. Eighty cohabiting couples raising preschool children completed the Dyadic Coping Inventory, the Center for Epidemiological Study-Depression scale and had their RSA assessed during a laboratory session. Couples completed follow-up assessments of depressive symptoms 6 and 12 months later. Data were analyzed using an Actor-Partner Interdependence Model. Results indicated that RSA moderated the actor effect of negative DC on depression in men, such that men with lower RSA had a stronger association between their own ratings of negative DC within the couple relationship and their own depressive symptoms, compared to their counterparts with higher RSA. RSA also moderated the partner effect of delegated DC on depressive symptoms. Among men with higher RSA, there was a significant negative association between their partner’s ratings of delegated DC within the couple relationship and the men’s depressive symptoms, whereas partner-rated delegated DC was unrelated to depressive symptoms among men with lower RSA. These results suggest that men with higher RSA may possess social skills and abilities that attenuate the association between stressful marital interactions and negative mood.

Cardiac vagal control as a marker of emotion regulation in healthy adults: A review

In the last two decades, a growing body of theory and research has targeted the role of cardiac vagal control (CVC) in emotional responding. This research has either focused on resting CVC (also denoted as cardiac vagal tone) or phasic changes in CVC (also denoted as vagal reactivity) in response to affective stimuli. The present paper is aimed at reporting a review of the papers published between 1996 and 2016, and focused on the results of 135 papers examining cardiac vagal control as a physiological marker of emotion regulation in healthy adults. The review shows that studies have employed a wide array of methodologies and measures, often leading to conflicting results. High resting CVC has been associated with better down-regulation of negative affect, use of adaptive regulatory strategies, and more flexible emotional responding. Concerning phasic changes, research has consistently found decreased CVC in response to stress, while CVC increases have been shown to reflect either self-regulatory efforts or recovery from stress. Despite conflicting results, we conclude that existing literature supports the use of CVC as a noninvasive, objective marker of emotion regulation.

Changes in Heart Rate Variability Recorded in Natural Situation with T-Shirt Integrated Sensors and Level of Observed Behavioral Excitation: A Pilot Study of Patients with Intellectual Disabilities and Psychiatric Disorders

BACKGROUND

The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research.

METHOD

Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient's level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states.

RESULTS

Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4).

CONCLUSION

The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.

Vagally-mediated heart rate variability and indices of well-being: Results of a nationally representative study

OBJECTIVE

High frequency (HF) heart rate variability (HRV) has long been accepted as an index of cardiac vagal control. Recent studies report relationships between HF-HRV and indices of positive and negative affect, personality traits and well-being but these studies generally are based on small and selective samples.

METHOD

These relationships were examined using data from 967 participants in the second Midlife in the U.S. (MIDUS II) study. Participants completed survey questionnaires on well-being and affect. HF-HRV was measured at rest. A hierarchical series of regression analyses examined relationships between these various indices and HF-HRV before and after adjustment for relevant demographic and biomedical factors.

RESULTS

Significant inverse relationships were found only between indices of negative affect and HF-HRV. Relationships between indices of psychological and hedonic well-being and positive affect failed to reach significance.

CONCLUSIONS

These findings raise questions about relationships between cardiac parasympathetic modulation, emotion regulation, and indices of well-being. (PsycINFO Database Record

Vagal Recovery From Cognitive Challenge Moderates Age-Related Deficits in Executive Functioning

Decline in executive functioning (EF) is a hallmark of cognitive aging. We have previously reported that faster vagal recovery from cognitive challenge is associated with better EF. This study examined the association between vagal recovery from cognitive challenge and age-related differences in EF among 817 participants in the Midlife in the U.S. study (aged 35-86). Cardiac vagal control was measured as high-frequency heart rate variability. Vagal recovery moderated the association between age and EF (β = .811, p = .004). Secondary analyses revealed that older participants (aged 65-86) with faster vagal recovery had superior EF compared to their peers who had slower vagal recovery. In contrast, among younger (aged 35-54) and middle-aged (aged 55-64) participants, vagal recovery was not associated with EF. We conclude that faster vagal recovery from cognitive challenge is associated with reduced deficits in EF among older, but not younger individuals.

The Effect of Hostility Reduction on Autonomic Control of the Heart and Vasculature: A Randomized Controlled Trial

OBJECTIVE

Hostility is associated with coronary artery disease. One candidate mechanism may be autonomic nervous system (ANS) dysregulation. In this study, we report the effect of cognitive behavioral treatment on ANS regulation.

METHODS

Participants were 158 healthy young adults, high in hostility measured by the Cook-Medley Hostility and Spielberger Trait Anger scales. Participants were also interviewed using the Interpersonal Hostility Assessment Technique. They were randomized to a 12-week cognitive behavioral treatment program for reducing hostility or a wait-list control group. The outcome measures were preejection period, low-frequency blood pressure variability, and high-frequency heart rate variability measured at rest and in response to and recovery from cognitive and orthostatic challenge. Linear-mixed models were used to examine group by session and group by session by period interactions while controlling for sex and age. Contrasts of differential group and session effects were used to examine reactivity and recovery from challenge.

RESULTS

After Bonferroni correction, two-way and three-way interactions failed to achieve significance for preejection period, low-frequency blood pressure variability, or high-frequency heart rate variability (p > .002), indicating that hostility reduction treatment failed to influence ANS indices.

CONCLUSIONS

Reduction in anger and hostility failed to alter ANS activity at rest or in response to or recovery from challenge. These findings raise questions about whether autonomic dysregulation represents a pathophysiological link between hostility and heart disease.

The Relationship between Expressive/Suppressive Hostility Behavior and Cardiac Autonomic Activations in Patients with Coronary Artery Disease

BACKGROUND

Hostility is an important psychosocial risk factor in coronary artery disease (CAD). Expressive and suppressive hostility behaviors are related to cardiovascular response in healthy adults. However, the relationships of these behavioral dimensions to cardiac autonomic activations in CAD remain unclear.

METHOD

This study involved 76 patients with CAD to whom a hostility inventory was administered, who were instructed to recall a neutral event and an anger-related event. Heart rate and blood pressure were obtained for each patient as the indices of cardiovascular response; heart rate variability was transformed from electrocardiograph and as the indices of cardiac autonomic activation.

RESULTS

The results showed that CAD patients with expressive hostility behavior experienced higher cardiovascular autonomic activations during the neutral and anger recall tasks, and lower parasympathetic activations during the recovery after an anger episode. On the other hand, CAD patients with suppressive hostility behavior experienced both sympathetic and parasympathetic activations during the baseline and recovery stages, as well as simultaneously activated higher parasympathetic response.

CONCLUSIONS

The results of this study suggested that it is appropriate to extend the cardiac autonomic activation model for expressive and suppressive hostility behaviors in patients with CAD.

KEY WORDS

Cardiac autonomic; Coronary artery disease; Expressive hostility; Suppressive hostility behaviors.

Sex differences in healthy human heart rate variability: A meta-analysis

The present meta-analysis aimed to quantify current evidence on sex differences in the autonomic control of the heart, indexed by measures of heart rate variability (HRV) in healthy human subjects. An extensive search of the literature yielded 2020 titles and abstracts, of which 172 provided sufficient reporting of sex difference in HRV. Data from 63,612 participants (31,970 females) were available for analysis. Meta-analysis yielded a total of 1154 effect size estimates (k) across 50 different measures of HRV in a cumulated total of 296,247 participants. Females showed a significantly lower mean RR interval and standard deviation of RR intervals (SDNN). The power spectral density of HRV in females is characterized by significantly less total power that contains significantly greater high- (HF) and less low-frequency (LF) power. This is further reflected by a lower LF/HF ratio. Meta-regression revealed significant effects of age, respiration control and the length of recording available for analysis. Although women showed greater mean heart rate, they showed greater vagal activity indexed by HF power of HRV. Underlying mechanisms of these findings are discussed.

Randomized controlled trial of heart rate variability biofeedback in cardiac autonomic and hostility among patients with coronary artery disease

Hostility is a psychosocial risk factor that may decrease heart rate variability (HRV) in coronary artery disease (CAD) through cardiac autonomic imbalance. Heart rate variability biofeedback (HRV-BF) increases HRV indices and baroreflex gain. This study examines the effectiveness of HRV-BF in restoring cardiac autonomic balance and decreasing hostility among patients with CAD. One hundred and fifty-four patients with CAD were assigned randomly to receive 6 weeks of HRV-BF, in addition to the standard medical care received by the wait-list control (WLC) group. A 5-min electrocardiogram, blood pressure, and hostility were assessed pre-intervention, post-intervention, and at 1-month follow-up. The standard deviation of normal-to-normal intervals (SDNN), low frequency (LF), and log LF at post-intervention was significantly higher than that at pre-intervention in the HRV-BF group. Baseline log LF was significantly higher post-intervention and at follow-up after HRV-BF training than at pre-intervention. The treatment curve of log LF pre-session increased significantly after session 2, which was maintained to post-intervention. Expressive hostility, suppressive hostility, and hostility total score at post-intervention and one-month follow-up after HRV-BF were significantly lower than at pre-intervention. This study showed increased HRV and decreased expressive and suppressive hostility behavior in patients with CAD following HRV-BF.

Maladaptive autonomic regulation in PTSD accelerates physiological aging

A core manifestation of post-traumatic stress disorder (PTSD) is a disconnection between physiological state and psychological or behavioral processes necessary to adequately respond to environmental demands. Patients with PTSD experience abnormal oscillations in autonomic states supporting either fight and flight behaviors or withdrawal, immobilization, and dissociation without an intervening “calm” state that would provide opportunities for positive social interactions. This defensive autonomic disposition is adaptive in dangerous and life threatening situations, but in the context of every-day life may lead to significant psychosocial distress and deteriorating social relationships. The perpetuation of these maladaptive autonomic responses may contribute to the development of comorbid mental health issues such as depression, loneliness, and hostility that further modify the nature of cardiovascular behavior in the context of internal and external stressors. Over time, changes in autonomic, endocrine, and immune function contribute to deteriorating health, which is potently expressed in brain dysfunction and cardiovascular disease. In this theoretical review paper, we present an overview of the literature on the chronic health effects of PTSD. We discuss the brain networks underlying PTSD in the context of autonomic efferent and afferent contributions and how disruption of these networks leads to poor health outcomes. Finally, we discuss treatment approaches based on our theoretical model of PTSD.

Hostility, health behaviors, and risk of recurrent events in patients with stable coronary heart disease: findings from the Heart and Soul Study

BACKGROUND

Hostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease (CHD), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes.

METHODS AND RESULTS

We prospectively examined the association between self-reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8-item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow-up time of 7.4 ± 2.7 years, the age-adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age-adjusted hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.30 to 2.17; P < 0.0001). After adjustment for cardiovascular risk factors, participants with hostility scores in the highest quartile had a 58% greater risk of secondary events than those in the lowest quartile (HR: 1.58, 95% CI: 1.19 to 2.09; P = 0.001). This association was mildly attenuated after adjustment for C-reactive protein (HR: 1.41, 95% CI, 1.06 to 1.87; P = 0.02) and no longer significant after further adjustment for smoking and physical inactivity (HR: 1.25, 95% CI: 0.94 to 1.67; P = 0.13).

CONCLUSIONS

Hostility was a significant predictor of secondary events in this sample of outpatients with baseline stable CHD. Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.

The association of cardiac vagal control and executive functioning--findings from the MIDUS study

Cardiac vagal control (CVC), an index of parasympathetic contribution to cardiac regulation, has been linked to enhanced executive functioning (EF). However, findings to date have been based on small or unique samples. Additionally, previous studies assessed the CVC-EF link only during rest or recovery period from a cognitive challenge, but not during both states. In the present study, data on 817 socioeconomically diverse participants were obtained from the Midlife Development in the United States (MIDUS) study. As part of this study, participants completed cognitive tests, including EF, along with laboratory-based measures of CVC during rest and following recovery from a cognitive challenge. Regression analyses adjusting for respiratory rate revealed no effect of CVC at rest or during recovery on a global index of EF. However, exploratory post-hoc analyses of the components of the global EF index revealed a significant association between faster vagal recovery and better attention-switching and response inhibition abilities, as indexed by faster reaction time to the mixed SGST. This association remained significant after controlling for demographic, clinical (BMI, diseases and medications altering cardiac autonomic functioning, etc.), and health behavior covariates (Beta = .148, p = .010). Our findings suggest that future studies may need to investigate the links of CVC to specific EF abilities, rather than global measures of EF. Additionally, our results highlight the importance of assessing CVC during both rest and recovery from a cognitive challenge. The authors discuss the putative neurobiological underpinning of this link, as well as suggestions for future basic and clinical research.

Cardiac vagal tone is associated with social engagement and self-regulation

The polyvagal theory (Porges, 2007) represents a biobehavioral model that relates autonomic functioning to self-regulation and social engagement. The aim of the two presented studies was to test the proposed association of cardiac vagal tone (CVT), assessed via resting high-frequency heart rate variability (respiratory sinus arrhythmia, RSA), with coping, emotion-regulation, and social engagement in young adults. In Study 1 (retrospective self-report), RSA was positively associated with engagement coping (situation control, response control, positive self-instructions, social-support seeking) and aspects of social well-being. In Study 2 (ecological momentary assessment), for 28 days following the initial assessment, RSA predicted less use of disengagement strategies (acceptance and avoidance) for regulating negative emotions and more use of socially adaptive emotion-regulation strategies (i.e., social-support seeking as a reaction to sadness and making a concession as a reaction to anger caused by others). Furthermore, RSA was higher in participants who reported no anger episodes compared to those who reported at least one anger episode and was positively associated with reported episodes of negative emotions. Results support the association proposed by the PVT between CVT and self-regulatory behavior, which promotes social bonds.

Links between adolescent sympathetic and parasympathetic nervous system functioning and interpersonal behavior over time

Extensive research has investigated links between individual differences in youths' autonomic nervous system (ANS) functioning and psychological outcomes related to emotion regulation, yet little of this research has examined developmental change. The study tested whether individual differences in youths' tonic and stress-induced ANS functioning, assessed at age 14, and changes in ANS functioning from age 14 to 16 predicted corresponding changes in youths' behavioral warmth, as displayed during videotaped mother-child conflict interactions conducted at age 14 and 16. Increased behavioral warmth was predicted by increased baseline respiratory sinus arrhythmia (RSA), increased SCL stress reactivity, decreased RSA stress reactivity (i.e., greater vagal suppression), and decreased baseline SCL. There was also an interaction between RSA stress reactivity at age 14 and changes in maternal warmth from age 14 to 16, such that increased maternal warmth was only associated with increased adolescent warmth for adolescents with lower RSA stress reactivity at age 14.

Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age

BACKGROUND

Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population.

METHODS

Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity.

RESULTS

Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk.

CONCLUSIONS

In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.

Like parent, like child: parent and child emotion dysregulation

PURPOSE

This study examined the association between children's emotion regulatory processes and parents' emotional problems.

DESIGN

A 5-year longitudinal study of families from Northwestern United States with data collected over 3 time points. Families were recruited in an effort to oversample for multiracial and African American families because these families have historically not been well represented in research studies.

METHOD

Parental hostility characteristics and subclinical levels of depression were assessed in combination with teachers' reports of children's externalizing and internalizing behaviors. Ninety-one families with married parents and an elementary school-aged child participated in the study.

FINDINGS

There was a significant main effect for the association between fathers' self-reports of hostility and teacher reports of children's externalizing behaviors. Neither parental hostility nor depressive symptoms were significantly associated with the children's internalizing behaviors.

CONCLUSION

The results suggest that children's externalizing behaviors are associated with their fathers' dysregulated expression of hostility.

CLINICAL RELEVANCE

Parent-child interactions are a key component of children's emotion regulation development. Our findings may guide health care professionals in identifying and intervening in parental behaviors, particularly fathers' behaviors, that may adversely affect the healthy emotional development of their children.

Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: the multi-ethnic study of atherosclerosis

OBJECTIVE

Carotid arterial wall thickness, measured as intima-media thickness (IMT), is an early subclinical indicator of cardiovascular disease. Few studies have investigated the association of psychological factors with IMT across multiple ethnic groups and by sex.

METHODS

We included 6561 men and women (2541 whites, 1790 African Americans, 1436 Hispanics, and 794 Chinese) aged 45 to 84 years who took part in the first examination of the Multi-Ethnic Study of Atherosclerosis. Associations of trait anger, trait anxiety, and depressive symptoms with mean values of common carotid artery (CCA) and internal carotid artery (ICA) IMTs were investigated using multivariable regression and logistic models.

RESULTS

In age-, sex-, and race/ethnicity-adjusted analyses, the trait anger score was positively associated with CCA and ICA IMTs (mean differences per 1-standard deviation increment of trait anger score were 0.014 [95% confidence interval {CI} = 0.003-0.025, p = .01] and 0.054 [95% CI = 0.017-0.090, p = .004] for CCA and ICA IMTs, respectively). Anger was also associated with the presence of carotid plaque (age-, sex-, and race/ethnicity-adjusted odds ratio per 1-standard deviation increase in trait anger = 1.27 [95% CI = 1.06-1.52]). The associations of the anger score with thicker IMT were attenuated after adjustment for covariates but remained statistically significant. Associations were stronger in men than in women and in whites than in other race/ethnic groups, but heterogeneity was only marginally statistically significant by race/ethnicity. There was no association of depressive symptoms or trait anxiety with IMT.

CONCLUSIONS

Only one of the three measures examined was associated with IMT, and the patterns seemed to be heterogeneous across race/ethnic groups.

Dipping status and hostility in newly diagnosed essential hypertension

AIM

Personality traits, including hostility, play an important role in the development of cardiovascular disease. Moreover, abnormalities in blood pressure circadian pattern, such as a lack of nocturnal BP fall, are related with target organ damage and increased cardiovascular risk. The aim of this study was to investigate the impact of hostility and its dimensions on dipping status, in newly diagnosed hypertensive patients.

METHODS

The study population consisted of 114 newly diagnosed untreated essential hypertensives. All participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) in order to assess dipping status. Hostility was assessed by Hostility and Direction of Hostility Questionnaire (HDHQ). The study population was divided in terms of dipping status in two groups, "dippers" and "non-dippers."

RESULTS

The statistical analysis revealed that dippers presented significantly higher score of extrapunitiveness (13.2 +/- 4.9 vs 11.4 +/- 3.9, p = 0.032), as well as significantly higher score of the dimension "urge to act out hostility (AH)" (4 +/- 3 vs 3 +/- 2, p = 0.025) compared to non-dippers. Multivariate regression analysis revealed extrapunitiveness as the only independent predictor of dipping status. The odds ratio (OR) for dipping status associated with each point increase in extrapunitiveness was 0.912 (95% CI: 0.832-0.992; p = 0.048).

CONCLUSION

The present findings may suggest that hostility and its features affect the circadian variation of blood pressure in hypertensive patients, providing a promising objective for future investigations linking psychological factors and dipping status in essential hypertension.

The interactive effect of change in perceived stress and trait anxiety on vagal recovery from cognitive challenge

The present study tested the hypothesis that the change in state negative affect (measured as perceived stress) after cognitive challenge moderates the relationship of trait anxiety and anger to vagal recovery from that challenge. Cardiac vagal control (assessed using heart rate variability) and respiratory rate were measured in a sample of 905 participants from the Midlife in the United States Study. Cognitive challenges consisted of computerized mental arithmetic and Stroop color-word matching tasks. Multiple regression analyses controlling for the effects of the demographic, lifestyle, and medical factors influencing cardiac vagal control showed a significant moderating effect of change in perceived stress on the relationship of trait anxiety to vagal recovery from cognitive challenges (Beta=.253, p=.013). After adjustment for respiratory rate, this effect became marginally significant (Beta=.177, p=.037). In contrast, for the relationship of trait anger to vagal recovery, this effect was not significant either before (Beta=.141, p=.257) or after (Beta=.186, p=.072) adjusting for respiratory rate. Secondary analyses revealed that among the individuals with higher levels of trait anxiety, greater reductions in perceived stress were associated with greater increases in cardiac vagal control after the challenge. In contrast, among the individuals with lower levels of trait anxiety, changes in perceived stress had no impact on vagal recovery. Therefore, change in perceived stress moderates the relationship of trait anxiety, but not trait anger, to vagal recovery from cognitive challenge.

Daily interpersonal conflict predicts masked hypertension in an urban sample

BACKGROUND

Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH.

METHODS

Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examine whether daily interpersonal conflict is an independent predictor of MMH.

RESULTS

This form of MMH (i.e., optimal office BP plus elevated ABP) was present in 21% of participants (n = 50). Those with MMH (vs. without) were significantly more likely to be men (P < 0.001). Daily harassment and unfair treatment scores were significant predictors of MMH group status (P < 0.05). Participants with harassment scores >30 were significantly more likely to be in the MMH group.

CONCLUSION

MH may be a concern, even for patients with optimal office BP. Evaluating exposure to psychosocial stressors, including routine levels of interpersonal conflict may help to identify those patients who might benefit from further clinical follow-up.

Associations of depressive symptoms, trait hostility, and gender with C-reactive protein and interleukin-6 response after emotion recall

OBJECTIVE

To examine the effects of depressive symptoms and hostility on changes in C-reactive protein (CRP) and interleukin (IL)-6 in response to an acute laboratory stressor. Depressive symptoms moderate the effect of trait hostility on circulating levels of CRP and IL-6.

METHODS

The study included 307 men and 218 women, affording the opportunity to examine moderation by gender. Regression analyses were performed to examine depressive symptoms, hostility ratings, gender, and their interactions as predictors of CRP and IL-6 response to an emotion recall task. Analyses were adjusted for age, race, body mass index, and prerecall task levels of either CRP or IL-6.

RESULTS

The product term for Depressive Symptoms x Hostility x Gender was not significantly related to CRP nor IL-6 response. However, Depressive Symptoms x Hostility did interact to predict CRP response (p = .002); those with the combination of high symptoms of depression and hostility had the largest CRP response. The Depressive Symptoms x Gender interaction was also a predictor of both CRP (p = .001) and IL-6 (p = .04) response; for each inflammatory marker, depressive symptoms were significantly associated with higher CRP response in women, as compared with men. Hostility did not moderate depressive symptoms, nor gender for IL-6.

CONCLUSIONS

Our findings extend prior research by suggesting that, broadly speaking, depression is related to inflammatory markers; however, this relationship seems complex. Depression seems to be related to inflammation more strongly among hostile individuals and more strongly among women than among men.

A urinary marker of oxidative stress covaries positively with hostility among midlife community volunteers

OBJECTIVE

Although not all findings are consistent, growing evidence suggests that individuals high in dispositional hostility are at elevated risk for cardiovascular disease and all-cause mortality; however, the mechanisms of these associations remain unclear. One possibility is that hostility is associated with oxidative stress. Here, we explore relationships between hostility and a measure of systemic oxidative stress among a mid-life sample.

METHODS

In a community sample of 223 adults aged 30 to 54 years (86% white, 50% female), oxidative stress was measured as the 24-hour urinary excretion of 8-hydroxy-2'-deoxyguanosine (8-OHdG). An abbreviated Cook Medley Hostility Scale was used to measure dimensions of hostility.

RESULTS

Regression analyses controlling for demographic characteristics and cardiovascular risk factors showed a positive relationship of 8-OHdG with total hostility (beta = 0.003, p = .03) and hostile affect (beta = 0.018, p < .001).

CONCLUSIONS

These findings provide evidence that dispositional hostility, and in particular, hostile affect, covary positively with systemic oxidative stress, raising the possibility that oxidative stress contributes to the pathogenicity of hostile attributes.

Effects of auricular electrical stimulation on vagal activity in healthy men: evidence from a three-armed randomized trial

The activity of the VN (vagus nerve) is negatively associated with risk factors such as stress and smoking, morbidity and mortality. In contrast, it is also a target of therapeutic intervention. VN stimulation is used in depression and epilepsy. Because of its high invasivity and exclusive application to therapy-resistant patients, there is interest in less invasive methods affecting the VN. Several studies examining acupuncture report beneficial effects on vagal activity. However, findings are inconsistent, and applied methods are heterogeneous resulting in difficulties in interpretation. The purpose of the present study was evaluation of the effects of acupuncture on vagal activity in a three-armed randomized trial while controlling several disturbing factors. Fourteen healthy men participated in random order in four examinations: a control condition without intervention, a condition with placebo, manual acupuncture and electroacupuncture. Acupuncture was conducted on the concha of the ear, as there is neuroanatomical evidence for vagal afferents. Each examination took place once, with a week's time between examinations. RSATR (respiratory sinus arrhythmia adjusted for tidal volume) indicating vagal activity was measured continuously. The study was conducted partially blind in accordance with recommendations. After controlling for respiration, condition-specific pain sensation, individual differences in belief of acupuncture effectiveness and time effects not attributable to the interventions, electroacupuncture but not manual acupuncture was found to have a positive effect on RSATR. The results underline the potential role of auricular electrical stimulation to induce an increase in vagal activity, and it therefore might be used as preventive or adjuvant therapeutic intervention promoting health.

Cardiac autonomic control and treatment of hostility: a randomized controlled trial

OBJECTIVE

To test whether reduction in hostility increases autonomic regulation of the heart.

METHODS

In this randomized controlled trial, participants were 158 healthy adults, aged 20 years to 45 years, who were 1 standard deviation (SD) above national norms on the Cook-Medley Hostility and the Spielberger Trait Anger Indices. Participants also were interviewed, using the Interpersonal Hostility Assessment Technique (IHAT). They were randomly assigned to a 12-week cognitive behavior therapy program for hostility reduction or a wait-list control condition. The main outcome measure was cardiac autonomic modulation, measured as RR interval variability (RRV) derived from 24-electrocardiographic recordings.

RESULTS

In a multivariate analysis of variance assessing psychological outcomes of hostility, anger, and IHAT scores, there was a significant treatment effect with an average reduction across the three outcomes that was approximately 0.7 SD (ES = 0.685, SE = 0.184, p < .001) greater for the intervention group than for the control group. In contrast, the change in heart rate was -0.14 beat/min (95% Confidence Interval [CI] = -2.43, 2.14) in treatment participants and -1.36 beat/min (95% CI = -3.28, 0.61) in wait-list participants. High-frequency RRV, an index of cardiac parasympathetic modulation, increased by 0.07 ln ms(2) (95% CI = -0.10, 0.24) for participants in the treatment condition and decreased by 0.04 ln ms(2) (95% CI = -0.18, 0.10) for participants in the wait-list condition. These differences were not significant. The findings for other indices of RRV were similar.

CONCLUSIONS

Reduction of hostility and anger was not accompanied by increases in cardiac autonomic modulation. These findings raise questions about the status of disordered autonomic nervous system regulation of the heart as a pathophysiological mechanism underlying the hostility-heart disease relationship and about whether hostility itself is a mechanism or merely a marker of elevated risk of heart disease.

Impact of maternal stress, depression and anxiety on fetal neurobehavioral development

Although postnatal psychologic distress has been widely studied for many years, particularly with a focus on postpartum depression, symptoms of maternal depression, stress, and anxiety are not more common or severe after childbirth than during pregnancy. This paper reviews the newer body of research aimed at identifying the effects of women's antenatal psychologic distress on fetal behavior and child development, and the biologic pathways for this influence. These studies are in line with the growing body of literature supporting the "fetal origins hypothesis" that prenatal environmental exposures--including maternal psychologic state-based alterations in in utero physiology--can have sustained effects across the lifespan.

Hostility is associated with visceral, but not subcutaneous, fat in middle-aged African American and white women

OBJECTIVE

To examine the cross-sectional association between hostility and measures of abdominal fat (visceral, subcutaneous) in middle-aged African American and white women. Because fat-patterning characteristics are known to differ by race, we were particularly interested in examining whether these associations were similar for women of both racial/ethnic groups.

METHODS

Participants were 418 (45% African American, 55% white) middle-aged women from the Chicago site of the Study of Women's Health Across the Nation. Visceral and subcutaneous fat were measured by computed tomographic scans and hostility was assessed via questionnaire. Multivariate linear regression models were conducted to test associations among race/ethnicity, hostility, and measures of abdominal fat.

RESULTS

In models adjusted for race/ethnicity and total percent fat, higher levels of hostility were associated with a greater amount of visceral fat (B = 1.8, standard error = 0.69, p = .01). This association remained significant after further adjustments for education, and multiple coronary heart disease (CHD) risk factors. Hostility was not associated with subcutaneous fat (p = .8). Although there were significant racial/ethnic differences in hostility (p < .001) and the amount of total body (p < .001), subcutaneous (p < .001) and visceral fat (p < .001), the associations between hostility and measures of abdominal fat did not differ for African American compared with white women (race/ethnicity x hostility interaction, p = .67 for visceral, p = .85 for subcutaneous).

CONCLUSIONS

Hostility may affect CHD risk in women via the accumulation of visceral fat. Despite significant black-white differences in fat patterning and overall CHD risk, the association between hostility and visceral fat seems to be similar for both African American and white women.

Sympathetic arousal to a vestibular stressor in high and low hostile men

The aim of the present experiment was to extend the literature on hostility and a cerebral systems based model of sympathetic arousal to a vestibular-based stress. Several authors have concluded that autonomic stress reactivity in high hostile individuals must be interpersonally based, whereas healthy vestibular system functioning does not depend on interpersonal features. Utilizing a vestibular activation paradigm, skin conductance levels of 15 high hostile and 15 low hostile men were recorded after brief passive rotation about the vertical neuroaxis. It was expected that hostile individuals would exhibit higher skin conductance levels after rotation compared with low hostile individuals. The results confirmed expectations of heightened sympathetic tone among high hostiles subsequent to vestibular stress. Overall, the findings are interpreted to support a cerebral model of frontal region capacity limitation for regulation of vestibular stress that is independent of psychosocial mechanisms.

How attributional ambiguity shapes physiological and emotional responses to social rejection and acceptance

The authors examined White and Black participants' emotional, physiological, and behavioral responses to same-race or different-race evaluators, following rejecting social feedback or accepting social feedback. As expected, in ingroup interactions, the authors observed deleterious responses to social rejection and benign responses to social acceptance. Deleterious responses included cardiovascular (CV) reactivity consistent with threat states and poorer performance, whereas benign responses included CV reactivity consistent with challenge states and better performance. In intergroup interactions, however, a more complex pattern of responses emerged. Social rejection from different-race evaluators engendered more anger and activational responses, regardless of participants' race. In contrast, social acceptance produced an asymmetrical race pattern--White participants responded more positively than did Black participants. The latter appeared vigilant and exhibited threat responses. Discussion centers on implications for attributional ambiguity theory and potential pathways from discrimination to health outcomes.

Heart-rate and blood-pressure variability during psychophysiological tasks involving speech: influence of respiration

Changes in heart-rate and systolic arterial pressure variability (HRV and SAPV) indexes have been used in psychophysiology to assess autonomic activation, including during tasks involving speech. The current article clearly demonstrates in a sample of 25 adult subjects that the erratic and broadband respiratory patterns during such tasks violate the usual assumption that respiration is limited to the high-frequency band (0.15-0.4 Hz). For these tasks, interindividual differences and rest-task changes in HRV and SAPV in the low-frequency band (0.04-0.15 Hz) can be explained, to a large extent, by variations in the respiratory volume signal. This makes the use of HRV and SAPV as markers of autonomic function during these tasks highly questionable. Furthermore, a number of subjects with long respiratory period at rest were identified, whose presence in the sample can bias the estimation of baseline rest values.

Autonomic characteristics of defensive hostility: reactivity and recovery to active and passive stressors

The autonomic characteristics of hostility and defensiveness were assessed in 55 male undergraduates based on composite Cook Medley Hostility (Chost) and Marlowe Crowne Social Desirability (MC) scores to create 4 groups: Defensive Hostile (DH; high MC, high Chost), High Hostile (HH; low MC, high Chost), Defensive (Def; high MC, low Chost) and Low Hostile (LH; low MC, low Chost). All subjects engaged in a video game (VG) and hand cold pressor (CP) task. Cardiovascular responses in DH subjects were predicted to show enhanced sympathetic alpha and beta-adrenergic activity and the least vagal control compared to others across tasks. DH and LH men showed significant heart rate reactivity to the CP task compared to HH men. LH men showed significant reductions in high frequency power (vagal assessment) to the tasks compared to HH men. Future studies may employ harassment techniques and include the factors of gender and ethnicity in their assessments.

Tryptophan depletion affects heart rate variability and impulsivity in remitted depressed patients with a history of suicidal ideation

BACKGROUND

Depression is a major risk factor for cardiovascular disease. An important risk factor for cardiovascular disease, low heart rate variability, often has been found in depressed patients and has been associated with impulsivity. The present study investigated whether experimental lowering of serotonin would decrease heart rate variability and increase impulsivity in remitted depressed patients, in particular in those patients with disturbed impulse control.

METHODS

Nineteen patients in remission from depression received high-dose and low-dose acute tryptophan depletion in a randomized, counterbalanced, double-blind crossover design. Heart rate variability and impulsivity were assessed during each acute tryptophan depletion session and during a baseline session. Suicidal ideation during past depression was used as an index for individual differences in impulse control.

RESULTS

High-dose acute tryptophan depletion led to a larger increase in depressive symptoms than did low-dose acute tryptophan depletion. High-dose acute tryptophan depletion decreased heart rate variability and increased impulsivity and anxiety, but only in patients with a history of suicidal ideation. Symptom effects of high-dose acute tryptophan depletion correlated with low heart rate variability at baseline.

CONCLUSIONS

Depressed patients who have problems with controlling impulsivity might be more at risk for developing cardiovascular disease, possibly related to increased vulnerability to impaired 5-hydroxytryptamine function.

Implementation and interpretation of respiratory sinus arrhythmia measures in psychosomatic medicine: practice against better evidence?

Respiratory sinus arrhythmia (RSA) or high-frequency heart rate variability has been widely used as a noninvasive measure of cardiac vagal tone. However, their dependency on both respiration rate and tidal volume is largely ignored. Only a minority of studies published in Psychosomatic Medicine in recent years has implemented precautions for controlling respiration rate in RSA measures, and tidal volume effects were only rarely addressed. We discuss methodologic issues related to respiratory control methods and present data that demonstrate that both respiration rate and tidal volume contribute substantially to the within-individual RSA variance under conditions of variable breathing, with tidal volume contributing up to one third beyond respiration rate. Finally, we outline a respiratory control method for the time-domain index of RSA and review research pertaining to its reliability, validity, and experimental application.

Hostility and sex differences in the magnitude, duration, and determinants of heart rate response to forehead cold pressor: Parasympathetic aspects of risk

Recent models hypothesize that hostility confers increased risk of CHD through weaker parasympathetic dampening of cardiovascular reactivity (CVR). We tested this possibility using the forehead cold pressor task, a common maneuver which elicits the "dive reflex" characterized by a reflexive decrease in HR presumably through cardiac-parasympathetic stimulation. Participants were initially chosen from the outer quartiles of a sample of 670 undergraduates screened using the hostility subscale of the Aggression Questionnaire ([Buss, A.H., Perry, M., 1992. The Aggression Questionnaire. Journal of Personality and Social Psychology, 63, 452-459.]). The final sample of 80 participants was evenly divided between men and women and high and low hostility. Following a 10-min baseline, participants underwent a 3-min forehead cold pressor task. The task evoked a significant HR deceleration that was mediated by PNS activation, as assessed by respiratory sinus arrhythmia (RSA). Replicating prior research, men displayed greater decrease in HR. More important, low hostiles maintained larger HR deceleration over time compared to high hostiles although the autonomic basis for this effect was unclear. The findings broaden understanding of hostility and sex-related cardiovascular functioning and support the task as a method for evoking PNS-cardiac stimulation.