Somatic, but not cognitive–affective, symptoms are associated with reduced heart rate variability in individuals with dysphoria

Abstract

Background: Somatic, but not cognitive–affective, symptoms of depression have been associated with reduced heart rate variability (HRV), and with poor prognosis in cardiovascular patients. However, factors concomitant with cardiovascular diseases may confound the relationship between somatic symptoms of depression and reduced HRV. Therefore, this study examined whether reduced HRV was differentially associated with cognitive–affective and somatic symptoms of depression in medically healthy individuals with and without dysphoria.Methods: Self-reported cognitive–affective and somatic symptoms as measured with the Beck Depression Inventory-II questionnaire and time and frequency domain parameters of HRV were collected in 62 medically healthy individuals, of whom 25 with and 37 without dysphoria.Results: Somatic, but not cognitive–affective, symptoms of depression were inversely associated with SD of NN intervals (β = -0.476, p < 0.05), number of interval differences of successive NN intervals greater than 50 ms (NN50; β = -0.498, p < 0.03), and HRV total power (β = -0.494, p < 0.04) in the group with dysphoria, after controlling for sex, anxiety, and lifestyle factors. Cognitive–affective and somatic symptoms were not related to any of the HRV parameters in the group without dysphoria (all ps > 0.24).Conclusion: By showing that the relationship between somatic depressive symptoms and reduced HRV extends to medically healthy individuals with dysphoria, the present findings suggest that this association is independent of factors concomitant with cardiovascular diseases. The present study also suggests that individuals with somatic rather than cognitive–affective subsets of depressive symptoms may be at greater risk for developing cardiovascular diseases.

DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

“…However, research on depression and HRV has been typically conducted in patients with cardiovascular disease ( 46 – 50 ). Our findings are in agreement with the recent report by Benvenuti et al ( 51 ) who showed that somatic depressive symptoms are related to reduced HRV in medically healthy individuals with dysphoria. Here we demonstrated that moderately and severely depressed patients may express symptoms of low mood or distress through two distinct clusters of DSM-5 criteria.…”

“…The somatic symptoms may be related to autonomic disturbances in depressed patients without known cardiovascular disease ( 52 , 53 ). Likewise, the Mental Stress-Induced Myocardial Ischemia has already been described in a patient with normal coronary arteries and generalized anxiety disorder ( 51 ). In this case, anxiety might be considered a somatic component of depression ( 54 – 57 ).…”

“…Conversely, increased sympathetic tone increases the risk of malignant arrhythmias and sudden cardiac death ( 60 ). Thus, a high degree of HRV provides cardioprotective effect whereas the reduction in HRV is associated with higher cardiovascular risk in depressed patients ( 43 , 51 , 52 ).…”

Self-care and health-related quality of life in chronic heart failure: A longitudinal analysis

“…Research increasingly shows that somatic rather than cognitive depressive symptoms are related to poorer cardiovascular health (e.g. reduced heart rate variability 32 ), as well as increased mortality risk in HF. 16 We hypothesise that somatic–affective symptoms may be of indirect influence on physical HRQOL, preventing patients from performing daily self-care behaviours.…”

Direction of Dependence Between Specific Symptoms of Depression: A Non-Gaussian Approach

“…There is ample evidence of these associations at both the dimensional (i.e., symptom sum or “syndrome”) and symptom levels. Somatic but not cognitive-affective symptoms independently relate to physical conditions such as diabetes, metabolic syndrome, cardiac disease, or inflammation (de Jonge, Mangano, & Whooley, 2007; Hawkins, Callahan, Stump, & Stewart, 2014; Hwang, Moser, Pelter, Nesbitt, & Dracup, 2015; Jokela, Virtanen, Batty, & Kivimäki, 2016; Lamers, Milaneschi, de Jonge, Giltay, & Penninx, 2018; Messerotti Benvenuti, Buodo, Mennella, & Palomba, 2015; Michal et al, 2013; Roest et al, 2013; Wiltink et al, 2014; Wiltink et al, 2018). Thus, it seems difficult to draw the boundary between somatic presentations of depression and other bodily symptoms.…”