Usefulness of heart rate variability indices in assessing the risk of an unsuccessful return to work after sick leave in depressed patients

Abstract

Aim The present study aimed to examine whether heart rate variability (HRV) indices in depressed patients measured at return to work after sick leave are related to the outcome of reinstatement. Methods This study included 30 workers who took a leave of absence due to major depressive disorder. HRV was measured twice, once when participants left work and another when they returned to work. One month after returning to work, 19 participants continued their original work (successful return group), while 11 failed to perform their original work (unsuccessful return group). HRV indices including high‐ and low‐frequency components (HF and LF) were calculated in three conditions within a session lasting for about 5 minutes, initial rest (Rest), mental task (Task), and rest after task (After), and were compared between the two participant groups. Psychological states were evaluated using Self‐rating Depression Scale and State‐Trait Anxiety Inventory. Results No significant differences were observed in the HRV indices on leaving work between groups. On returning to work, the “unsuccessful return group” exhibited lower HF Rest score, higher HF Task/Rest ratio, and higher LF/HF Rest score than the “successful return group.” Psychological scores improved in both groups. Conclusion These results indicate that autonomic dysregulations revealed by HRV measurement at return to work after a leave of absence in MDD patients were related to the outcome of reinstatement and can serve as useful information for the assessment of the risk of unsuccessful return.

Reduced heart rate variability is associated with vulnerability to depression

“…Moreover, the evidence that HRV might embody a vulnerability factor for the development of psychopathology raises the issue of whether in addition to be a trait-dependent feature, it may also be a state-dependent feature, associated with situational demands. Indeed, a series of studies have demonstrated that, not only baseline, but even task-related HRV could represent an index of clinical outcome in individuals with depression (Shinba et al, 2014; Shinba et al, 2020). Although resting-state HRV is a well-validated and feasible tool for the clinical practice, state-dependent HRV-fluctuations may increase the accuracy of HRV as a candidate endophenotype of depression.…”

Return-to-Work Screening by Linear Discriminant Analysis of Heart Rate Variability Indices in Depressed Subjects

“…In the search for more objective prognostic factors for adequate returns to work, biological parameters have been evaluated [ 6 ]. Our previous study [ 7 ] examined the usefulness of autonomic measurement in predicting the outcome of a return to work. In that study, heart rate variability (HRV) was used to evaluate autonomic activity at the time of reinstatement, and significant differences were observed between the HRV data of the depressed patients who returned to work successfully and those who did not.…”

“…Our study reported that these abnormal HRV profiles continue to be present at the time of return in patients whose return is unsuccessful despite their depressive symptoms having lessened [ 7 ]. The results suggest that abnormal HRV is related to a residual depressive state and can be linked to a patient’s lack of ability to perform work, as autonomic controllability is important in occupational activities and in the ability to face stressful events at work.…”

“…The present study first analyzed our previously published data [ 7 ] and made a linear discriminant using the HRV indices to effectively differentiate MDD patients who successfully returned from those did not. Then, the same discriminant was tested in new MDD patients who tried reinstatement after sick leave, and sensitivity and specificity were assessed.…”

“…We also used a small wearable electrocardiogram (ECG) device for HRV measurement [ 7 , 11 , 12 ]; this allowed stable recording in various places, including the hospital and the workplace. Measurement during behavioral tasks is also possible, enabling the assessment of HRV changes in experimental settings that simulate work [ 15 , 16 ].…”