Blunted cardiac reactions to acute psychological stress predict symptoms of depression five years later: Evidence from a large community study

Abstract

We recently reported a cross-sectional negative relationship between cardiovascular reactivity and depressive symptoms. The present analyses examined the prospective association between reactivity and symptoms of depression five years later. At the earlier time point depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS), and cardiovascular reactions to a standard mental stress were measured in 1608 adults comprising three distinct age cohorts: 24-, 44-, and 63-year olds. Depression was re-assessed using the HADS five years later. Heart rate reactions to acute psychological stress were negatively associated with subsequent depressive symptoms; the lower the reactivity the higher the depression scores. This association withstood adjustment for symptom scores at the earlier time point, and for socio-demographic factors and medication status. The mechanisms underlying this prospective relationship remain to be determined.Key words: Blood pressure; depression; heart rate; psychological stress; prospective study 3 4 Depression has been linked prospectively to mortality in general and death from cardiovascular disease in particular (for reviews, see Hemingway & Marmot, 1999;Wulsin, Vaillant, & Wells, 1999). However, the mechanisms underlying this association have yet to be established. Autonomic dysregulation remains a possibility, and depression has been associated with a variety of adaptations that suggest altered autonomic function. For example, enhancement of cardiac sympathetic activity relative to vagal tone has been reported in those with depression and subclinical depressive symptoms (Carney, et al., 1988;Light, Kothandapani, & Allen, 1998), as have increased plasma noradrenalin concentrations in patients with major depression (Rudorfer, Ross, Linnoila, Sherer, & Potter, 1985). Thus, the hypothesis that such autonomic dysregulation in depression may also be manifest as exaggerated cardiovascular reactivity (Kibler & Ma, 2004), which in turn increases the risk of cardiovascular pathology, is intuitively appealing.First, exaggerated cardiovascular (blood pressure and heart rate) reactions to acute psychological challenge have long been considered a risk factor for cardiovascular pathology ( Lovallo & Gerin, 2003;Schwartz, et al., 2003) and several prospective studies have now shown consistently that higher cardiovascular reactivity (most commonly blood pressure and heart rate, and additionally cardiac output, stroke volume, total peripheral resistance, and pre-ejection period when measured) confers a modest additional risk for a range of cardiovascular outcomes, such as high blood pressure, carotid atherosclerosis, carotid intima-thickness, and increased left ventricular mass (e.g. (Allen, Matthews, & Sherman, 1997;Barnett, Spence, Manuck, & Jennings, 1997;Carroll, Ring, Hunt, Ford, & Macintyre, 2003;Kamarck, et al., 1997;Lynch, Everson, Kaplan, Salonen, & Salonen, 1998;Markovitz, Raczynski, Wallace, Chettur, & Chesney, 1998;Treiber, et al., 2003). Second, a meta-analysis of 11 relev...

Heart rate reactivity is associated with future cognitive ability and cognitive change in a large community sample

“…Our observations are also consistent with a growing body of crosssectional and prospective evidence that low, not high, cardiovascular reactivity, including HR reactivity, is associated with a range of adverse health and behavioural outcomes, such as obesity (Carroll et al, 2008;de Rooij et al, in preparation), symptoms of depression (Carroll et al, 2007;deRooij et al, 2010;Phillips et al, 2011;York et al, 2007), tobacco and alcohol dependence, as well as risk of dependence (al'Absi,, 2006;al'Absi et al, 2005;Girdler et al, 1997;Lovallo et al, 2000;Panknin et al, 2002;Phillips et al, 2009aPhillips et al, , 2009bRoy et al, 1994), and exercise dependence (Heaney et al, 2011). Thus, it would appear that for health outcomes such as high blood pressure, hypertension, and atherosclerosis cardiovascular reactivity is a positive predictor, whereas other outcomes are negatively associated with cardiovascular reactivity.…”

“…The possible confounders selected were age cohort, sex, household occupational group, disability status, HADS depression, BMI, and baseline cardiovascular levels. All of these have been related to reactivity and/or cognitive ability in this cohort (Carroll et al, 2000(Carroll et al, , 2007(Carroll et al, , 2008Phillips et al, 2011). The main regression analyses were repeated separately for numerical reasoning and verbal reasoning at the two time points testing both unadjusted and fully adjusted models.…”

Gender differences and the relationships of perceived background stress and psychological distress with cardiovascular responses to laboratory stressors

“…Phillips (2011) nicely summarizes the relationships of higher depression scores with other blunted responses such as cardiovascular reactivity in coronary artery disease patients during public speaking (York et al, 2007), and emotional reactions to reward (Bylsma et al, 2008). A study by Phillips et al (2011) supports the possibility that lower reactivity could be a marker of risk for depression. They report that heart rate reactivity to psychological stress was negatively related to degree of depression in a 5-year longitudinal study.…”

Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks

“…Phillips et al examined cardiovascular reactivity and symptoms of depression and anxiety and reassessed HADS depression and anxiety scores after 5 years of follow-up. 41 They found HR reactions to the PASAT were negatively associated with subsequent depressive symptoms. The small effect sizes observed in this and other studies suggests that largescale investigations are needed to examine the contribution of possible mediating variables.…”