Measures of Heart Rate Variability in Individuals With Somatic Symptom Disorder

Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies

OBJECTIVE

Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment.

METHODS

Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included.

RESULTS

Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning.

CONCLUSION

This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.

Stress Response Pattern of Heart Rate Variability in Patients with Functional Somatic Syndromes

Functional somatic syndromes (FSSs) represent a clinically important group of disorders that are often stress-related. Their autonomic pathophysiology, including reduced heart rate variability (HRV), has been reported. However, the response pattern to mental stress and recovery in FSSs remains unclear. Thus, we aimed to clarify the pattern of autonomic stress response and recovery to mental arithmetic stress in patients with FSS compared to that in healthy controls. This cross-sectional study included 79 patients with FSS who visited the Department of Psychosomatic Medicine at a university hospital in Japan and 39 healthy controls. Following a mood questionnaire and obtaining epidemiologic information, HRV was measured during three periods (5 min each): relaxation baseline resting, stress (mental arithmetic task), and post-stress recovery period. The HRV analysis included inter-beat interval, low frequency power, and high frequency power. Compared to healthy controls, patients with FSS exhibited significantly higher scores on the mood questionnaire, prolonged duration of illness, and decreased functionality in daily activities. While the healthy control group showed a pronounced stress response pattern with a significant decrease in vagal HRV and recovery, the FSS group showed a "flat" vagal stress response pattern, and the HRV in the FSS group was lower at relaxation baseline, remained low during the stress, and did not change post stress. Patients with severe FSS exhibit an altered stress response pattern. Our results could provide significant clues for the diagnosis and treatment of such patients, as well as useful insights into the relationship between stress and illness.

Subjective and physiological reactivity to emotional stressors in somatic symptom disorder

OBJECTIVE

We examined whether autonomic flexibility to experimentally presented stressors is reduced in somatic symptom disorder (SSD) as this would point to reduced vagal control as a proposed indicator of emotion regulation deficits.

METHOD

In this experimental study, the influence of health-related and social stressors on subjective and physiological reactivity was investigated in 29 subjects with SSD without any medical condition SSD(mc-), 33 subjects with SSD with medical condition SSD(mc+) and 32 healthy controls at the age from 18 to 70 years. Self-report and physiological variables were measured before and after/during stressor exposure, using state ratings of symptom intensity, disability, tension and mood, heart rate (HR), and heart rate variability (HRV).

RESULTS

Overall, the tension increased and the mood worsened after exposure to stressors compared to pre-exposure. Compared to HC, the two SSD groups showed higher symptom intensity, disability, tension and worse mood. The SSD(mc-) group revealed higher HR than HC (p = .012, d = -0.77). Compared to pre-exposure, symptom impairment increased after social stressor exposure in SSD(mc-) (p < .001, d = 1.36). HRV-root mean square of successive differences (RMSSD) only decreased in HC during exposure (p = .003, d = -1.09), not in the SSD groups. The two SSD groups did not differ in their reactivity to stressors.

CONCLUSION

HRV in SSD, seems to respond less flexibly to stressors, potentially reflecting overall physiological disturbance through reduced parasympathetic influence on HR. Stress reactivity in SSD(mc-) and SSD(mc+) do not seem to differ.

Clarifying the link between psychopathologies and heart rate variability, and the sex differences: Can neuropsychological features serve as mediators?

BACKGROUND

Patients with common mental disorders (depression, anxiety, and somatic symptoms) often exhibit lower heart rate variability (HRV) than healthy individuals. Under the hypothesis that disorder status affects cognitive function, we examined whether neuropsychological features can be mediators between psychopathologies and HRV and possible sex differences.

METHODS

We recruited 359 individuals (aged 42.47 ± 12.23) with and without common mental disorders. Questionnaires were used to measure their psychopathologies. Eight tests from the Cambridge Neuropsychological Test Automated Battery were selected to measure neuropsychological functions. Resting-state HRV measurements were obtained for 5 min. The associations among these constructs were analyzed using multiple linear regression analysis and structural equation modelling.

RESULTS

Among women, Reaction Time (RTI, a task of psychomotor speed) indicator mediated the relationship between depression and low-frequency power (LF); Emotion Recognition Task (ERT, a task of emotional regulation) indicator mediated the relationship between health anxiety and high-frequency power (HF). Among men, Intra-Extra Dimensional Set Shift (IED, a task of shifting) indicator mediated the relationship between depression and LF; Match to Sample Visual Search (MTS, a task of selective attention) indicator mediated the relationship between health cognition and HF. The depression-RTI-LF pathway in women tended to lower HRV; whereas health anxiety-ERT-HF in women, depression-IED-LF and health cognition-MTS-HF in men tended to increase HRV.

LIMITATIONS

Possible medication effects; not directly measuring brain activity; only gathering resting-state HRV.

CONCLUSION

Our findings support the notion that neuropsychological features mediate the relationship between psychopathologies and HRV, and that sex differences exist.

Heart Rate Variability, Autonomic Reactivity, and Emotion Regulation during Sadness Induction in Somatic Symptom Disorder

BACKGROUND

Preliminary evidence suggests altered heart rate variability (HRV) and impaired emotion regulation (ER) in somatic symptom disorder (SSD). Moreover, HRV can be considered an index of ER. Yet, to date, research on HRV and emotional reactivity in SSD is scarce and findings are inconsistent. Thus, this study aimed to examine ER differences, HRV at rest, and in response to emotion induction in persons with SSD compared to controls.

METHODS

The sample comprised 44 persons with SSD (DSM-5; 79.5% female, Mage = 45.7, SD = 14.7) and 41 persons without SSD (non-SSD; 78% female, Mage = 44.2, SD = 14.7). We assessed the participants' somatic symptom severity, ER, and control variables (e.g., depressive symptoms). Frequency and time domain HRV by ECG and subjective emotional states were measured at rest, under sadness induction, and during recovery periods. We evaluated baseline between-group differences with t-tests, and HRV and emotional reactivity and recovery with repeated measures ANOVAs.

RESULTS

We found no significant differences in resting state HRV between persons with and without SSD. Regarding reactivity and recovery, SSD group showed lower reactivity in SDNN (standard deviation of NN interval) than non-SSD group. Moreover, SSD group reported more maladaptive ER techniques (e.g. rumination) and a higher effort to regulate their emotions during the experiment than non-SSD group.

CONCLUSIONS

The study indicated impaired ER in persons with SSD. This finding showed more clearly in self-report than in HRV. Further research on HRV reactivity including tasks evoking other negative emotions in persons with SSD is required.

Mirror Therapy in Patients with Somatoform Pain Disorders-A Pilot Study

Patients with chronic pain report reduced quality of life and high symptom burden while often responding insufficiently to treatment options. Mirror therapy has been proven to be effective in treating phantom limb pain and other conditions such as CRPS. This study was designed to investigate the efficacy of mirror therapy in patients with somatoform pain disorders on symptom severity and associated physiological parameters. Fifteen patients with persistent somatoform pain disorder (F45.40) or chronic pain disorder with somatic and psychological factors (F45.41) participated and received four weeks of tablet-based mirror therapy. Symptom severity was measured with established questionnaires, and their thermal detection, pain thresholds, and heart rate variability (HRV) were also assessed. After mirror therapy, pain intensity was reduced (z = -2.878, p = 0.004), and pain thresholds for cold stimuli were also diminished, i.e., the subjects became more sensitive to cold stimuli (z = -2.040, p = 0.041). In addition, a reduction of absolute power in the low-frequency band of HRV (t(13) = 2.536, p = 0.025) was detected. These findings indicate that this intervention may reduce pain intensity and modulate associated physiological parameters. As these results are limited by several factors, e.g., a small sample size and no control group, they should be validated in further studies investigating this novel intervention in these patients.

Can Heart Rate Variability be Viewed as a Biomarker of Problematic Internet Use? A Systematic Review and Meta-Analysis

Heart rate variability (HRV) has been used to explore the parasympathetic activity of individuals with problematic Internet use (PIU), but the results are controversial. We conducted a systematic review and meta-analysis of studies comparing HRV in PIU individuals and healthy participants from several databases. HRV was analyzed according to the parasympathetic activity in hierarchical order (primary analysis), and the total variability (secondary analysis). The baseline HRV and HRV reactivity were both considered. Of the 106 studies screened, 12 were included in the quantitative analysis. Significant differences were observed for baseline HRV in PIU individuals compared to the controls. Regarding HRV reactivity, PIU individuals did not have a significantly lower HRV value during pleasant or unpleasant stimuli. In summary, PIU individuals and healthy subjects had significantly different resting state parasympathetic activity. The finding of HRV reactivity in PIU individuals awaits further investigation.

Population-based prevalence of somatic symptom disorder and comorbid depression and anxiety in Taiwan

OBJECTIVE

The nationwide prevalence of somatic symptom disorder (SSD) has not yet been investigated in Asia. SSD is often comorbid with depression and anxiety, and the effects of these conditions on medical utilization await clarification. We hence performed a study in Taiwan to explore these issues.

METHODS

Using telephone-based sampling and interview, we obtained data for 3161 participants whose age, gender and living area were compatible with the Taiwan population. We gathered scores of the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ) and Patient Health Questionnaire-4 (PHQ-4). Individuals with a PHQ-15 score of at least 4 and a HAQ score of at least 17 were considered to have SSD. Descriptive statistics were used to clarify the prevalence and normative data of the questionnaires. We used multiple logistic regression analyses to investigate the relation between diagnoses and medical utilization.

RESULTS

The prevalence of SSD was 5.00% and women had a higher SSD prevalence than men; participants aged 40-49 years had the highest SSD prevalence. In SSD patients, 33.58% had depression or anxiety. After correcting for demographics, SSD and anxiety (but not depression) were associated with a significantly high level of outpatient/emergency department attendance. Comorbid depression or anxiety did not significantly increase the medical utilization of SSD patients.

CONCLUSION

The nationwide SSD prevalence in Taiwan is compatible with the description in the DSM-5. The comorbidity of SSD and depression/anxiety is common, but depression or anxiety does not significantly increase the SSD patients' medical utilization.

Association of Depressive and Somatic Symptoms with Heart Rate Variability in Patients with Traumatic Brain Injury

Depressive and somatic symptoms are common after traumatic brain injury (TBI). Depression after TBI can relate to worsened cognitive functioning, functional impairment, higher rates of suicide attempts, and larger health care costs. Heart rate variability (HRV) represents the activity of the autonomic nervous system (ANS), which regulates almost all vascular, visceral, and metabolic functions. Several studies show a correlation between HRV, depression, and somatic symptoms in other diseases. However, studies on autonomic dysfunction, depression, and somatic symptoms in TBI patients are lacking. This study investigated the association between reduced ANS function, depression, and somatic symptoms in TBI patients. We retrospectively recruited 136 TBI patients who underwent 24 h ambulatory Holter electrocardiography to measure autonomic dysfunction within 1 month of onset. Patients who used BDI and PHQ-15 to evaluate depressive and somatic symptoms were included. Using Pearson's correlation analysis and multiple linear regression, the association between HRV parameters and BDI and PHQ-15 was determined. The HRV parameters and BDI and PHQ-15 showed statistical significance. In addition, HRV was shown to be a significantly associated factor of BDI and PHQ-15. HRV was associated with depressive and somatic symptom severity in TBI patients. Additionally, autonomic dysfunction may serve as an associated factor of depressive and somatic symptoms in patients with TBI.

Use of machine learning to diagnose somatic symptom disorder: Are the biomarkers beneficial for the diagnosis?

OBJECTIVES

We used machine learning to incorporate three types of biomarkers (respiratory sinus arrhythmia, RSA; skin conductance, SC; finger temperature, FT) for examining the performance of diagnosing somatic symptom disorder (SSD).

METHODS

We recruited 97 SSD subjects and 96 controls without psychiatric history or somatic distress. The values of RSA, SC and FT were recorded in three situations (resting state, under a cognitive task and under paced breathing) and compared for the two populations. We used machine learning to combine the biological signals and then applied receiver operating characteristic curve analysis to examine the performance of diagnosing SSD regarding the distinct indicators and situations. Subgroup analysis for subjects without depression/anxiety was also conducted.

RESULTS

FT was significantly different between SSD patients and controls, especially in the resting state and under paced breathing. However, the biomarkers (0.75-0.76) did not reveal an area under the curve (AUC) comparable with the psychological questionnaires (0.86). Combining the biological and psychological indicators gave a high AUC (0.86-0.92). When excluding individuals with depression/anxiety, combining three biomarkers (0.79-0.83) and adopting psychological questionnaires (0.78) revealed a similar AUC.

CONCLUSIONS

The performance of RSA/SC/FT was unsatisfactory for diagnosing SSD but became comparable when excluding comorbid depression/anxiety.

A simple version of resting-state heart rate variability interpretation for patients with affective disorders: A four-pattern perspective

Heart rate variability (HRV) is often considered as a biomarker reflecting well-being, but the clinical meaning of short-term resting-state HRV is not sufficiently defined. We assume that combining several common HRV indices as "HRV patterns" and using the patterns for screening purposes are meaningful approaches. Resting-state 5-min HRV data of 424 subjects were analyzed. Four of the most commonly used HRV indices were considered: standard deviation of normal-to-normal RR intervals, low-frequency power, high-frequency power and the ratio of low-frequency to high-frequency power. According to these indices, four HRV patterns were defined: normal pattern, low HRV pattern, relatively high sympathetic pattern, and relatively high vagal pattern. The associations between the demographics, lifestyles, personality traits, psychological states, and HRV patterns were explored: the low HRV pattern was positively associated with age, body mass index, and depression; the relatively high sympathetic pattern was positively associated with age and negatively associated with exercise habit; and the relatively high vagal pattern was negatively associated with having a steady job and novelty seeking. The pattern perspective may provide a convenient and evidence-based way to interpret resting-state HRV for patients with affective disorders.

The association between heart rate variability and skin conductance: a correlation analysis in healthy individuals and patients with somatic symptom disorder comorbid with depression and anxiety

Objective

To investigate the correlations between heart rate variability (HRV) and skin conductance (SC) in two populations under three different situations.

Methods

This cross-sectional study enrolled patients with somatic symptom disorder comorbid with depression and anxiety and healthy individuals without a psychiatric history. The biological signals were measured under three conditions: resting state, during a cognitive task and during paced breathing. Pearson’s correlation analysis and the generalized estimating equation were used to examine the correlations between SC and HRV in the two populations under the three situations.

Results

The study enrolled 97 patients with somatic symptom disorder comorbid with depression and anxiety and 96 healthy individuals. In healthy individuals, the ratio of low-frequency power to high frequency power (LF/HF) and normalized LF (LF%) were significantly correlated with SC in the resting state and during a cognitive task, but the correlation coefficients were low level. In patients with somatic symptom disorder comorbid with depression and anxiety, LF/HF and LF% did not show significant correlations with SC under any situation.

Conclusions

The two different populations and three situations might have affected the significance of the LF/HF-SC and LF%-SC correlations. The generally low correlations indicate that LF/HF and LF% cannot fully reflect the sympathetic cholinergic activity represented by SC.

Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis

BACKGROUND

In 2013, the diagnosis of somatic symptom disorder (SSD) was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This review aims to comprehensively synthesize contemporary evidence related to SSD.

METHODS

A scoping review was conducted using PubMed, PsycINFO, and Cochrane Library. The main inclusion criteria were SSD and publication in the English language between 01/2009 and 05/2020. Systematic search terms also included subheadings for the DSM-5 text sections; i.e., diagnostic features, prevalence, development and course, risk and prognostic factors, culture, gender, suicide risk, functional consequences, differential diagnosis, and comorbidity.

RESULTS

Eight hundred and eighty-two articles were identified, of which 59 full texts were included for analysis. Empirical evidence supports the reliability, validity, and clinical utility of SSD diagnostic criteria, but the further specification of the psychological SSD B-criteria criteria seems necessary. General population studies using self-report questionnaires reported mean frequencies for SSD of 12.9% [95% confidence interval (CI) 12.5-13.3%], while prevalence studies based on criterion standard interviews are lacking. SSD was associated with increased functional impairment, decreased quality of life, and high comorbidity with anxiety and depressive disorders. Relevant research gaps remain regarding developmental aspects, risk and prognostic factors, suicide risk as well as culture- and gender-associated issues.

CONCLUSIONS

Strengths of the SSD diagnosis are its good reliability, validity, and clinical utility, which substantially improved on its predecessors. SSD characterizes a specific patient population that is significantly impaired both physically and psychologically. However, substantial research gaps exist, e.g., regarding SSD prevalence assessed with criterion standard diagnostic interviews.

Ethnic discrimination and depressed mood: The role of autonomic regulation

Perceived ethnic discrimination (PED) is thought to underlie increased prevalence of depressed mood in ethnic minorities. Depression is associated with increased sympathetic and decreased parasympathetic activity. We investigated a biopsychosocial model linking PED, disrupted sympathovagal balance and depressed mood. Baseline data of HELIUS, a cohort study on health among a multi-ethnic population, was used. Heart rate variability (HRV), baroreflex sensitivity (BRS), PED (evaluated with the Everyday Discrimination Scale) and presence of depressed mood (evaluated with the Patient Health Questionnaire-9) were assessed. Associations of PED, HRV/BRS and depressed mood were analyzed with linear and logistic regression analyses. Mediation of the association of PED and depressed mood by HRV/BRS was assessed in a potential outcomes model and four steps mediation analysis. Of 9492 included participants, 14.7% fulfilled criteria for depressed mood. Higher PED was associated with depressed mood (P < .001). Lower autonomic regulation indexes were associated with depressed mood (deltaR² = 0.4-1.1%, P < .001) and at most weakly with PED (deltaR² = 0.2-0.3%, P < .001). A very modest mediating effect by HRV/BRS in the association between PED and depressed mood was attenuated after adjustment for socioeconomic status. To conclude, we found no support for the hypothesis that autonomic regulation relevantly mediates the association between PED and depression.

The interplay of self-critical rumination and resting heart rate variability on subjective well-being and somatic symptom distress: A prospective study

OBJECTIVE

The aim of this prospective study was to investigate the association of self-critical rumination, autonomic function (indexed by a time domain metric of resting heart rate variability-RMSSD), subjective well-being and somatic symptom distress.

METHOD

84 healthy participants (73 females; mean age = 23.56, SD = 3.35 years) completed the Somatic Symptom Severity Scale of the Patient Health Questionnaire and Mental Health Continuum Short Form at two timepoints (at baseline and six months later). Resting heart rate variability (HRV) was assessed at baseline, along with content specific rumination using the Self-Critical Rumination Scale. Four moderation analyses were performed to test these associations.

RESULTS

The interaction between resting HRV and self-critical rumination significantly explained somatic symptom distress at baseline. For those participants who had high resting HRV, somatic symptom distress was basically independent from the level of self-critical rumination. At the same time, lower resting HRV was associated with higher somatic symptom distress, especially in the presence of more ruminative thoughts. Prospectively, however, the interaction between rumination and resting HRV was not a significant predictor of somatic symptom distress. The association between resting HRV and self-critical rumination did not explain the variance on subjective well-being, but subjective well-being was negatively related to self-critical rumination.

CONCLUSION

Our findings potentially indicate that self-critical rumination could have a long-term negative impact on psychological functioning, even in a non-clinical sample, and highlight that a lower level of parasympathetic activation, assessed with RMSSD, might be an important factor in the relationship of self-critical rumination and somatic symptom distress.

Heart Rate Variability Reactivity to Food Image Stimuli is Associated with Body Mass Index

Appetitive control is driven by the hedonic response to food and affected by several factors. Heart rate variability (HRV) signals have been used to index autonomic activity and arousal levels towards visual stimuli. The current research aimed to examine the influence of body mass index (BMI), disordered eating behaviors, and sex on the HRV reactivity to food in a nonclinical sample. Thirty-eight healthy male and sixty-one healthy female participants completed questionnaires assessing disordered eating symptoms. HRV was recorded when the participants received visual stimuli of high-calorie food, neutral and negative emotional signals. Generalized estimating equation models were used to investigate the associations between HRV, BMI, disordered eating behaviors, and sex across the three stimulus types. Male participants demonstrated a higher ratio of low-frequency power to high-frequency power (LF/HF) than females across all the stimulus types. An increase in LF/HF reactivity to food signals was observed in all the study subjects. The moderation effect of BMI on LF/HF in response to food signals was also observed. Our study suggests that body weight may play a role in the interaction between sympathetic activity and food stimuli; however, how the interaction between sympathetic activity and food stimuli contributes to diet control warrants further investigation.

Association between Stroop tasks and heart rate variability features in patients with somatic symptom disorder

OBJECTIVE

Patients with somatic symptom disorder (SSD) may have declined parasympathetic activity and selective attention to negative information. We combined Stroop tasks and heart rate variability (HRV) measurements to explore the brain mechanism of SSD.

METHODS

104 SSD patients (64 women) and 100 healthy adults (76 women) received three Stroop tasks (the "cognitive" color-word Stroop, "emotional" emotion Stroop, and "cognitive and emotional" face-word Stroop) with low and high interference conditions. The key HRV indexes included high-frequency power (HF) and standard deviation of normal to normal RR intervals (SDNN). The generalized estimating equation model was used to examine the effects of SSD on three Stroop tasks performance (accuracy and reaction time) and HRV (HF and SDNN) controlling for sex, age, body mass index, and the levels of anxiety and depression.

RESULTS

For Stroop tasks, the significant group difference in emotion Stroop task with the high level of interference (SSD patients had lower accuracy than healthy ones) was only found in women. As for HRV, only men during color-word Stroop, women during emotion Stroop revealed significant between-group differences; SDNN in SSD men was higher than healthy men, and HF in SSD women was lower than healthy women controlling for the confounding factors. The significantly longer reaction time in SSD women than in healthy women diminished in the adjusted analysis.

CONCLUSION

Emotion Stroop task and HRV helps distinguish SSD patients from healthy adults, particularly in women. Sex-specific measures for early detection and intervention for SSD are suggested.

Application of heart rate variability during blood pressure measurement in patients with somatic symptom disorder

OBJECTIVE

This study wants to test whether the heart rate variability (HRV) analysis using sphygmomanometers can effectively reflect the physical and emotional distress of somatic symptom disorder (SSD) cases and assist in further health management.

METHODS

This study includes 66 female SSD cases and 32 male SSD cases. All cases received a 200-second blood pressure (BP) measurement, after which the numerical figure for the heart rate was obtained from the BP signal for HRV analysis. All cases also filled out Patient Health Questionnaire-15 (PHQ-15), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI) to understand the extent of their somatic distress, depression, and anxiety. The relationship between psychological conditions and HRV indicators are examined statistically. Receiver operating characteristic (ROC) curve analysis was used to understand whether HRV indicators can assist in the determination of psychosomatic problems.

RESULTS

Considering all and female SSD cases, low-frequency power (LF) and PHQ-15 in the HRV index have the most significant correlations. In male SSD cases, root mean square of successive NN interval differences (RMSSD) and BDI-II have the highest correlations. The results of ROC curve analysis indicate that LF is useful to judge the severity of female SSD cases, while RMSSD has reference value in determining whether male patients of SSD cases have depression or not. In addition, physical stress index (PSI) can also help determine the degree of depression in male SSD cases.

CONCLUSION

The use of BP in HRV analysis can help in the monitoring of somatic distress and depression issues in SSD cases. LF, RMSSD, PSI are potential physiological indicators.

Heart rate variability helps to distinguish the intensity of menopausal symptoms: A prospective, observational and transversal study

Heart Rate Variability (HRV) represents cardiac autonomic behavior and have been related to menopausal symptoms, mainly vasomotor symptoms and their imbalance to cardiovascular risk. It is not clear in the literature which index represents this imbalance and what is their involvement with the menopausal state. The aim of this study was to evaluate HRV in menopausal transition and post-menopausal symptoms with different intensities. This cross-sectional study was conducted in Rio Branco, State of Acre, Brazil from October 2016 to July 2017. We used Kupperman-Blatt Menopausal Index (KMI) to measure menopausal symptoms intensity. HRV analysis was performed based on the guidelines of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. HRV is lower in the group with moderate/intense menopausal symptoms compared to mild symptoms. (RMSSD: p = 0.005, Cohen’s d = 0.53, pNN50: p = 0.0004, Cohen’s d = 0.68; HF: p = 0.024, Cohen’s d = 0.44). There was association between HRV and KMI (RMSSD: r = -1.248, p = 0.004; and pNN50: r = -0.615, p: 0.029) in inverse relation to the intensity of vasomotor symptoms in women in TM. In conclusion, HRV was able to distinguish menopausal symptoms, indicating reduced vagal control in women with more intense symptoms.

Autonomic reactivity during reading of a somatic distress script in patients with somatic symptom disorder

OBJECTIVE

The relationship between resting-state heart rate variability (HRV) and somatic symptom disorder (SSD) has been explored in several studies. We planned to examine HRV during the performance of psychological tasks, and assumed that it could be applied for the diagnosis of SSD.

METHODS

Fifty-three patients with SSD and 52 healthy controls were recruited. Demographic and psychological data were collected. Subjects' HRV was measured over five 5-minute blocks during which they viewed different scripts (resting state; health anxiety; somatic distress; depression; neutral topic). After each block they completed a self-assessment manikin. Generalized estimated equation analysis was used to analyze the impact of mental scripts, SSD and sex on physiological and psychological indicators.

RESULTS

In men there was a script*SSD interaction concerning high-frequency power (HF) involving the neutral script; SSD men showed significantly higher HF than healthy men when viewing neutral script. In women there were script*SSD interactions with respect to low-frequency power (LF) and HF involving the somatic distress script and a script*SSD interaction with respect to LF and emotional valence involving the neutral script; SSD women revealed significantly lower LF and HF than healthy women when viewing somatic distress script, they also showed significantly lower LF and higher valence than healthy ones during neutral script. The somatic distress script*SSD interaction still influenced LF and HF in women after adjusting for potential confounders.

CONCLUSION

In women cue-specific HRV is a better method of differentiating people with SSD from healthy individuals than resting-state HRV.

TRIAL REGISTRATION INFORMATION

The Research Ethics Committee of National Taiwan University Hospital approved this study (approval number: 201410050RINB).

Functioning and quality of life in patients with somatic symptom disorder: The association with comorbid depression

OBJECTIVES

Patients with somatic symptoms often have impaired functioning and reduced quality of life (QOL), but the factors identified as responsible for these impairments vary between studies. We examined functioning and QOL in patients with somatic symptom disorder (SSD), exploring their associations with demographic factors, personality traits and psychological features.

METHODS

The sample comprised 107 SSD patients and 100 healthy controls. Several types of self-report instrument were administered. Group differences were assessed with independent t-tests. We used multiple linear regression to examine relationships between the independent variables and functioning and QOL. Finally, we used structural equation modeling (SEM) to perform path analysis and examine the fit of a model based on the earlier results.

RESULTS

Most function scores were lower in SSD patients than in healthy controls. In SSD patients overall WHO Quality of Life-BREF (WHOQOL-BREF) score was correlated with exercise level and Beck Depression Inventory-II (BDI-II) score. There were also associations between Sheehan Disability Scale (SDS) score and age, novelty seeking, Cognitions About Body and Health Questionnaire (CABAH) score and BDI-II score. Family APGAR score was only related to BDI-II score. Path analysis revealed that BDI-II score was related to all three indices of functioning.

CONCLUSIONS

Depression is associated with functioning and QOL in SSD patients.

TRIAL REGISTRATION INFORMATION

The Research Ethics Committee of National Taiwan University National Taiwan University Hospital approved this study (approval number: 201507007RINB).

Somatic symptom disorder in the general population: Associations with medical status and health care utilization using the SSD-12

OBJECTIVE

Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, feelings, and behaviors associated with physical symptoms. DSM-5 criteria for SSD focus on these psychological features (criterion B) rather than the presence or absence of an identifiable medical disorder. This study examines the role of medical disorder in the assessment of SSD and associations of SSD with health care utilization.

METHOD

Participants (N = 448, mean age 46.7 ± 16.9 years, 53.8% women) were recruited from the general community and completed the SSD-12 to quantify DSM-5 Criterion B for SSD. Participants also provided demographic and medical background information.

RESULTS

The SSD-12 total score was elevated in individuals with a major medical disorder (N = 97: cardiovascular disease, cancer, pulmonary disease or other: SSD-12 = 11.6 ± 8.8), and also among those with medical conditions commonly treated in primary care (N = 46: e.g., migraine, asthma: SSD-12 = 8.3 ± 7.1), compared to those free of these disorders (SSD-12 = 5.8 ± 7.0), which remained significant in age- and sex-adjusted models. Normative values are reported. High SSD-12 scores (≥15) were associated with more health care utilization (adjusted OR primary care visits = 3.35, 95%CI = 1.64-6.87).

CONCLUSIONS

The SSD-12 is a useful tool for the assessment of SSD. Medical comorbidity is associated with higher SSD-12 scores. Future studies are needed to determine whether SSD is more common in medical patients or whether correction of normative values is needed for screening purposes.