AUTONOMIC DYSREGULATION AND LOW HEART RATE VARIABILITY IN SPINAL CORD INJURY (SCI): A MARKER FOR DEPRESSION
DOI:
https://doi.org/10.15621/ijphy/2020/v7i3/700Keywords:
Autonomic nervous system, HRV, depression, spinal cord injury, PHQ-9, Neurovisceral TheoryAbstract
Background: Spinal cord injury (SCI) results in physical, autonomic, and psychological consequences. Depression is among one the most common psychological effects of SCI, with an incidence of 22%. Depression is associated with reduced heart rate variability (HRV), but it remains unclear if autonomic dysregulation possesses depression risk in SCI. Thus, this study aims to explore the association between HRV and depression in SCI.
Methodology: Ninety-one spinal cord injured patients (eighty-eight males and three female) representing three levels of severity of injury (cervical, high thoracic, and low thoracic) were recruited. Basal/resting HRV was assessed using 1000Hz Polar Heart rate monitor RS800 CX and Kubios HRV software. PHQ-9 assessed the depression; a cut of 10 was used to divide the sample into patients with probable Major Depressive Disorder (MDD) and non-MDD.
Results: Non-parametric tests for between-group comparisons showed a significant difference in HRV variables (p<0.05) between the probable MDD and non-MDD SCI. Significant differences in HRV were observed between the low and high thoracic (p<0.05) and low thoracic and cervical group (p<0.05), suggesting that the functioning of the autonomic nervous system might differ with level of SCI.
Conclusion: Depression in SCI has been associated with injury-related factors; we use the neurovisceral theory to explain the role of the autonomic nervous system in depression in SCI.
References
Penninx BWJH, Milaneschi Y, Lamers F, Vogelzangs N. Understanding the somatic consequences of depression: Biological mechanisms and the role of depression symptom profile. BMC Med [Internet]. 2013 May 15 [cited 2020 Feb 18];11(1):129.
Williams R, Murray A. Prevalence of depression after spinal cord injury: A meta-analysis. Arch Phys Med Rehabil [Internet]. 2015;96(1):133–40.
Elliott TR, Frank RG. Depression following spinal cord injury. Arch Phys Med Rehabil. 1996;77(8):816–23.
Arango-Lasprilla JC, Ketchum JM, Starkweather A, Nicholls E, Wilk AR. Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury. NeuroRehabilitation. 2011;29(1):9–21.
Bombardier CH, Fann JR, Tate DG, Richards JS, Wilson CS, Warren AM, et al. An exploration of modifiable risk factors for depression after spinal cord injury: Which factors should we target? Arch Phys Med Rehabil [Internet]. 2012;93(5):775–81.
Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW, et al. depression following traumatic spinal cord injury. Neuroepidemiology. 2005;25(2):55–61.
Carney RM, Freedland KE, Veith RC. Depression, the Autonomic Nervous System, and Coronary Heart Disease. Psychosom Med [Internet]. 2005;67(August):S29–33. Available from:
Vaccarino V, Badimon L, Bremner JD, Cenko E, Cubedo J, Dorobantu M, et al. Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. Eur Heart J. 2019;0:1–15.
Kemp AH, Quintana DS, Gray MA, Felmingham KL, Brown K, Gatt JM. Impact of Depression and Antidepressant Treatment on Heart Rate Variability: A Review and Meta-Analysis. Biol Psychiatry [Internet]. 2010;67(11):1067–74.
Koch C, Wilhelm M, Salzmann S, Rief W, Euteneuer F. A meta-analysis of heart rate variability in major depression. Psychol Med. 2019; 49(12): 1948-57.
Biering-sørensen F, Biering-sørensen T, Liu N, Malmqvist L, Maria J, Krassioukov A. Autonomic Neuroscience : Basic and Clinical Alterations in cardiac autonomic control in spinal cord injury. Auton Neurosci Basic Clin. 2018; 209: 4-18.
Serra-Añó P, Montesinos LL, Morales J, López-Bueno L, Gomis M, García-Massó X, et al. Heart rate variability in individuals with thoracic spinal cord injury. Spinal Cord. 2015;53(1):59–63.
El-Kotob R, Craven BC, Mathur S, Ditor DS, Oh P, Miyatani M, et al. Assessing Heart Rate Variability As a Surrogate Measure of Cardiac Autonomic Function in Chronic Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2017;24(1):28–36.
Malmqvist L, Bartholdy K, Krassioukov A, Welling K, Svendsen JH, Kruse A, et al. Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses. Spinal Cord. 2015;53(November 2014):54–8.
Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, et al. Identification and management of cardiometabolic risk after spinal cord injury: Clinical practice guideline for health care providers. Top Spinal Cord Inj Rehabil. 2018 Sep 1;24(4):379–423.
Lim S-W, Shiue Y-L, Ho C-H, Yu S-C, Kao P-H, Wang J-J, et al. Anxiety and Depression in Patients with Traumatic Spinal Cord Injury: A Nationwide Population-Based Cohort Study. PLoS One [Internet]. 2017;12(1):e0169623.
Varas-Díaz G, Brunetti EP, Rivera-Lillo G, Maldonado PE. Patients with chronic spinal cord injury exhibit reduced autonomic modulation during an emotion recognition task. Front Hum Neurosci. 2017;11(February):1–9.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 Validity of a Brief Depression Severity Measure. J Gen Intern Med. 2001 Sep;16(9):606-13.
Bombardier CH, Kalpakjian CZ, Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the patient health questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil [Internet]. 2012;93(10):1838–45.
Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG. Symptoms of major depression in people with spinal cord injury: Implications for screening. Arch Phys Med Rehabil. 2004;85(11):1749–56.
Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-aho PO, Karjalainen PA. Kubios HRV - Heart rate variability analysis software. Comput Methods Programs Biomed [Internet]. 2014;113(1):210–20.
Task Force of The European Society of Cardiology and The North American Electrophysiology Society of Pacing and Electrophysiology. Guidelines Heart rate variability. Eur Heart J. 1996;354–81.
Serra-Añó P, Montesinos LL, Morales J, López-Bueno L, Gomis M, García-Massó X, et al. Heart rate variability in individuals with thoracic spinal cord injury. Spinal Cord. 2015;53(1):59–63.
Kemp AH, Quintana DS. The relationship between mental and physical health: Insights from the study of heart rate variability. Int J Psychophysiol [Internet]. 2013;89(3):288–96.
Koenig J, Kemp AH, Beauchaine TP, Thayer JF, Kaess M. Depression and resting state heart rate variability in children and adolescents — A systematic review and meta-analysis. Clin Psychol Rev [Internet]. 2016;46:136–50.
Beauchaine TP, Thayer JF. Heart rate variability as a transdiagnostic biomarker of psychopathology. Int J Psychophysiol [Internet]. 2015;98(2):338–50.
Thayer JF, Lane RD. A model of neurovisceral integration in emotion regulation and dysregulation. J Affect Disord. 2000;61(3):201–16.
Thayer JF, Hansen AL, Saus-Rose E, Johnsen BH. Heart rate variability, prefrontal neural function, and cognitive performance: The neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med. 2009;37(2):141–53.
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