Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect

Associations of luteal phase changes in vagally mediated heart rate variability with premenstrual emotional changes

BACKGROUND

A recent meta-analysis revealed that vagally mediated heart rate variability (vmHRV; a biomarker of emotion regulation capacity) significantly decreases in the luteal phase of the menstrual cycle. As two follow-up studies suggest, these vmHRV decreases are driven primarily by increased luteal progesterone (P4). However, analyses also revealed significant interindividual differences in vmHRV reactivity to the cycle, which is in line with longstanding evidence for interindividual differences in mood sensitivity to the cycle. The present study begins to investigate whether these interindividual differences in vmHRV cyclicity can explain who is at higher risk of showing premenstrual emotional changes. We expected a greater degree of midluteal vmHRV decrease to be predictive of a greater premenstrual increase in negative affect.

METHODS

We conducted an observational study with a naturally cycling community sample (N = 31, M = 26.03 years). Over a span of six weeks, participants completed (a) daily ratings of negative affect and (b) counterbalanced lab visits in their ovulatory, midluteal, and perimenstrual phases. Lab visits were scheduled based on positive ovulation tests and included assessments of baseline vmHRV and salivary ovarian steroid levels.

RESULTS

In line with previous research, multilevel models suggest that most of the sample shows ovulatory-to-midluteal vmHRV decreases which, however, were not associated with premenstrual emotional changes. Interestingly, it was only the subgroup with luteal increases in vmHRV whose negative affect markedly worsened premenstrually and improved postmenstrually.

CONCLUSION

The present study begins to investigate cyclical changes in vmHRV as a potential biomarker of mood sensitivity to the menstrual cycle. The results demonstrate a higher level of complexity in these associations than initially expected, given that only atypical midluteal increases in vmHRV are associated with greater premenstrual negative affect. Potential underlying mechanisms are discussed, among those the possibility that luteal vmHRV increases index compensatory efforts to regulate emotion in those with greater premenstrual negative affect. However, future studies with larger and clinical samples and more granular vmHRV assessments should build on these findings and further explore associations between vmHRV cyclicity and menstrually related mood changes.

The association between perceived social functioning and heart rate variability is mediated by subclinical depressive symptomatology and moderated by gender

Chronic loneliness and low perceived social support have been recognized as risk factors for both mental and cardiovascular disorders. It has been proposed that their link to psychophysiological problems may involve changes in parasympathetic activity. However, the exact underlying psychopathological mechanisms and the moderating effects of gender are still not thoroughly examined. Thus, the present study investigated associations between perceived social functioning and resting vagal tone in the context of potential cognitive and subclinical mediators and gender differences. Three hundred twenty-five young adults (aged 18-35, 180 women) underwent an electrocardiogram measurement of 6-minute resting heart rate variability (HRV). They also completed questionnaires assessing loneliness, perceived social support, social cognitive biases, depressive and social anxiety symptoms, and general mental health. In men, HRV was significantly and negatively associated with poorer perceived social functioning, depressive symptoms, and self-reported social cognitive biases, while in women, there was a quadratic link between HRV and depressive symptoms and HRV and general mental health. Moderated mediation analysis revealed that depressive symptoms fully mediated the relationship between perceived social functioning and HRV in men. The results suggest that decreased resting vagal tone in lonely individuals is linked to depressive symptomatology rather than to specific social cognitive biases and that this association is significant only in men.

A sex-specific pathway linking early life maltreatment, vagal activity, and depressive symptoms

Background: Experiences of early life maltreatment (ELM) are alarmingly common and represent a risk factor for the development of psychopathology, particularly depression. Research has focused on alterations in autonomic nervous system (ANS) functioning as a mediator of negative mental health outcomes associated with ELM. Early alterations in autonomic vagal activity (vmHRV) may moderate the relationship between ELM and depression, particularly when considering forms of emotional maltreatment. Recent evidence suggests that the relationships of both ELM and vmHRV with depression may be non-linear, particularly considering females.Objective: Building on and extending theoretical considerations and previous work, the present work aims to further the current understanding of the complex relationships between ELM exposure, vmHRV, and depression.Methods: This study uses an adaptive modelling approach, combining exploratory network-based analyses with linear and quadratic moderation analyses, drawing on a large sample of males and females across adolescence (total N = 213; outpatient at-risk sample and healthy controls) and adulthood (total N = 85; community-based convenience sample).Results: Exploratory network-based analyses reveal that exposure to emotional abuse is particularly central within a network of ELM subtypes, depressive symptoms, and concurrent vmHRV in both adolescents and adults. In adults, emotional neglect shows strong associations with both emotional abuse and vmHRV and is highly central as a network node, which is not observed in adolescents. Moderator analyses reveal significant interactions between emotional maltreatment and vmHRV predicting depressive symptoms in adult females. Significant quadratic relationships of emotional maltreatment and vmHRV with depression are observed in both adolescent and adult females.Conclusions: The present findings contribute to the understanding of the psychological and physiological mechanisms by which ELM acts as a risk factor for the development of depression. Ultimately, this will contribute to the development of targeted and effective intervention strategies to mitigate the detrimental effects of early adversity.

Resting heart rate variability and emotion regulation difficulties: Comparing Asian Americans and European Americans

Asian Americans and European Americans differ in emotion regulation (ER), particularly regarding strategies utilized to adaptively engage in ER. Resting heart rate variability (HRV), a biomarker of ER ability, is suggested to differ between Asian Americans and European Americans, but evidence for such differences has been inconsistent. Yet, research has not considered how Asian Americans and European Americans might differ in the well-established link between resting HRV and ER difficulties, which might lend a better understanding of such inconsistencies. In 374 college-aged individuals (66 Asian Americans; 311 European Americans; 190 women; mean age = 19.3 years [Min. 18, Max 38]), we examined if ethnicity moderated the link between resting HRV and self-reported ER difficulties. Resting HRV was obtained during a 5-min resting-baseline period, and ER difficulties were assessed using the Difficulties in ER Scale, which contained six facets of ER difficulties. Adjusting for gender and body mass index, moderation analyses showed a stronger association between resting HRV and ER difficulties in Asian Americans compared to European Americans. When examining facets of ER, ethnicity moderated only the link between resting HRV and difficulties in accessing ER strategies when facing negative emotions. At lower levels of HRV, Asian Americans reported greater difficulties in ER relative to European Americans. This effect diminished and trended in the opposite direction among those with higher HRV. In sum, these results provide novel evidence that higher resting HRV might be particularly important for adaptive ER among Asian Americans - a marginalized ethnic group - in the U.S.

Cardiac Autonomic Balance Is Altered during the Acute Stress Response in Adolescent Major Depression-Effect of Sex

Autonomic nervous system (ANS) abnormalities are associated with major depressive disorder (MDD) already at adolescent age. The majority of studies so far evaluated parasympathetic and sympathetic branches of ANS individually, although composite indices including cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) seem to measure ANS functioning more comprehensively and thus could provide better psychopathologies' predictors. We aimed to study CAB and CAR derived from high-frequency bands of heart rate variability and left ventricular ejection time during complex stress response (rest-Go/NoGo task-recovery) in MDD adolescents with respect to sex. We examined 85 MDD adolescents (52 girls, age: 15.7 ± 0.14 yrs.) and 80 age- and sex-matched controls. The MDD group showed significantly reduced CAB compared to controls at rest, in response to the Go/NoGo task, and in the recovery phase. Moreover, while depressed boys showed significantly lower CAB at rest and in response to the Go/NoGo task compared to control boys, depressed girls showed no significant differences in evaluated parameters compared to control girls. This study for the first time evaluated CAB and CAR indices in drug-naïve first-episode diagnosed MDD adolescents during complex stress responses, indicating an altered cardiac autonomic pattern (i.e., reciprocal sympathetic dominance associated with parasympathetic underactivity), which was predominant for depressed boys.

Vagally-mediated heart rate variability and depression in children and adolescents - A meta-analytic update

BACKGROUND

Depression is one of the most common mental disorders and a leading cause of disability worldwide. In adults, depression is characterized by decreased vagal activity (vagally-mediated heart rate variability; vmHRV), while vmHRV is inversely correlated with depressive symptoms. In children/adolescents, a 2016 synthesis (4 studies, 259 individuals) found similarly decreased vmHRV in clinical depression, but no significant association between depressive symptoms and vmHRV (6 studies, 2625 individuals). Given the small number of studies previously considered for synthesis and the rapidly growing evidence base in this area, a meta-analytic update was warranted.

METHOD

A previous review was updated by a systematic literature search to identify studies that (a) compared vmHRV in clinically depressed children/adolescents with non-depressed controls and (b) reported associations between vmHRV and depression severity.

RESULTS

The search update identified 5 additional studies for group comparison (k = 9 studies in total, n = 608 individuals in total) and 15 additional studies for correlational meta-analysis (k = 21 studies in total, n = 4224 individuals in total). Evidence was found for lower resting-state vmHRV in clinically depressed children/adolescents compared to healthy controls (SMD = -0.593, 95 % CI [-1.1760; -0.0101], I2 = 90.92 %) but not for a significant association between vmHRV and depressive symptoms (r = -0.053, 95 % CI [-0.118; 0.012], I2 = 65.77 %). Meta-regression revealed a significant association between depressive symptoms and vmHRV as a function of sex.

LIMITATIONS

The samples considered are highly heterogeneous. Data on the longitudinal association between vmHRV and depression are currently lacking.

CONCLUSION

The present findings support the use of vmHRV as a biomarker for clinical depression in children/adolescents.

Gender moderates the association between resting vagally mediated heart rate variability and attentional control

Background

Women typically exhibit weaker attentional control ability than men. Lower resting vagally mediated heart rate variability (vmHRV) is thought to reflect the poorer function of the neurophysiological pathways underlying attentional control and thus, poorer attentional control ability. However, existing findings are inconsistent regarding the relationship between vmHRV and attentional control. Gender may be an important moderator.

Objective

To examine whether gender moderates the relationship between resting vmHRV and attentional control, and to provide neurophysiological evidence for elucidating gender differences in attentional control ability.

Methods

Two hundred and twenty college students completed the Attentional Control Scale to evaluate their attentional control ability. Resting vmHRV was assessed during a 5 min baseline period using an electrocardiographic amplifier (ECG100C) of the Biopac MP150 physiological recorder.

Results

(1) There was no significant difference in the total scores of the Attentional Control Scale between men and women (t = 0.498, p > 0.05), but the scores of the attentional shifting dimension of women were significantly lower than those of men (t = 1.995, p < 0.05); (2) Resting vmHRV was significantly negatively correlated with attentional control in women(r = -0.233, p < 0.01), whereas the correlation was not significant in men; (3) Gender significantly moderated the relationship between resting vmHRV and attentional control (B = -3.088, 95% boot CI [-5.431, -0.745], t = -2.598, p < 0.05); (4) Among participants with lower resting vmHRV, there was no significant difference in attentional control between men and women (B = 2.284, 95% boot CI [-0.748, 5.310], p > 0.05), but among participants with higher resting vmHRV, men scored significantly higher than women in attentional control (B = -3.377, 95% boot CI [-6.406, -0.348], p < 0.05).

Conclusion

Gender moderates the relationship between resting vmHRV and attentional control, with higher resting vmHRV in women reflecting a compensatory response to deficits in attentional control.

Higher Resting Cardiovagal Activity Predicts Larger Decrease of Depressive Symptoms in Inpatients Treated for Stress-Related Depression

Abstract. Depression is one of the most prevalent mental disorders, with treatment outcomes generally being unsatisfactory. The identification of outcome predictors could contribute to improving diagnosis, treatment, and outcome. Heart rate variability (HRV), an index of cardiovagal activity, has been proposed as a potential correlate of depression as well as a predictor of treatment effectiveness. The aim of the present study was to examine if HRV at baseline could predict the outcome of inpatient treatment for stress-related depressive disorder (SRDD). Depressive symptoms of n = 57 inpatients with an SRDD, who were treated in a specialized burnout ward, were assessed using the Beck Depression Inventory (BDI) at the beginning, the end of treatment, and at 3-month follow-up. HRV (i.e., RMSSD, the root mean square of successive RR interval differences) was determined from a five-minute measurement in the supine position. RMSSD was not significantly associated with the BDI score at the beginning, end, and follow-up. Higher RMSSD was revealed to be a significant predictor of a stronger decrease in depressive severity from the beginning to the end of the treatment. Thereby, the regression model explained 7.6% of the total variance in the BDI decrease. The results revealed initial HRV to predict a larger decrease in depressive severity. Therefore, resting HRV represents a physiological resource and index of successful neurovisceral interaction, which supports inpatients in benefitting from specialized treatment.

Gender Differences in Cardiac Chronotropic Control: Implications for Heart Rate Variability Research

There is a continuing debate concerning “adjustments” to heart period variability [i.e., heart rate variability (HRV)] for the heart period [i.e., increases inter-beat-intervals (IBI)]. To date, such arguments have not seriously considered the impact a demographic variable, such as gender, can have on the association between HRV and the heart period. A prior meta-analysis showed women to have greater HRV compared to men despite having shorter IBI and higher heart rate (HR). Thus, it is plausible that men and women differ in the association between HRV and HR/IBI. Thus, the present study investigates the potential moderating effect of gender on the association between HRV and indices of cardiac chronotropy, including both HR and IBI. Data from 633 participants (339 women) were available for analysis. Cardiac measures were assessed during a 5-min baseline-resting period. HRV measures included the standard deviation of inter-beat-intervals, root mean square of successive differences, and autoregressive high frequency power. Moderation analyses showed gender significantly moderated the association between all HRV variables and both HR and IBI (each p < 0.05). However, results were not consistent when using recently recommended HRV variables “adjusted” for IBI. Overall, the current investigation provides data illustrating a differential association between HRV and the heart period based on gender. Substantial neurophysiological evidence support the current findings; women show greater sensitivity to acetylcholine compared to men. If women show greater sensitivity to acetylcholine, and acetylcholine increases HRV and the heart period, then the association between HRV and the heart period indeed should be stronger in women compared to men. Taken together, these data suggest that routine “adjustments” to HRV for the heart period are unjustified and problematic at best. As it relates to the application of future HRV research, it is imperative that researchers continue to consider the potential impact of gender.