Association of depressive symptoms and heart rate variability in Vietnam war-era twins: A longitudinal twin difference study

Minxuan Huang, Amit Shah, Shaoyong Su, Jack Goldberg, Rachel J. Lampert, Oleksiy M. Levantsevych, Lucy Shallenberger, Pratik Pimple, J. Douglas Bremner, Viola Vaccarino

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

IMPORTANCE: Depressive symptoms are associated with lower heart rate variability (HRV), an index of autonomic dysregulation, but the direction of the association remains unclear. OBJECTIVE :To investigate the temporal association between depression and HRV. DESIGN, SETTINGS, AND PARTICIPANTS: A longitudinal, cross-lagged twin difference study, with baseline assessments from March 2002 to March 2006 (visit 1) and a 7-year follow-up (visit 2) at an academic research center with participants recruited from a national twin registry. Twins (n = 166) from the Vietnam Era Twin Registry, who served in the US military during the VietnamWar, and were discordant for depression at baseline were recruited. MAIN OUTCOMES AND MEASURES: At both visits, depressive symptomswere measured using the Beck Depression Inventory-II (BDI-II), and HRV was measured through 24-hour electrocardiogram monitoring. To assess the direction of the association, within-pair differences in multivariable mixed-effects regression models were examined, and standardized β coefficients for both pathways were calculated. The associations were evaluated separately in monozygotic and dizygotic twins. RESULTS: In the final analytic sample (N = 146), all participants were men, 138 (95%) were white, and the mean (SD) age was 54 (3) years at baseline. Results showed consistent associations between visit 1 HRV and visit 2 BDI score across all HRV domains and models (β coefficients ranging from -0.14 to -0.29), which were not explained by antidepressants or other participant characteristics. Themagnitude of the association was similar in the opposite pathway linking visit 1 BDI score to visit 2 HRV, with β coefficients ranging from 0.05 to -0.30, but it was largely explained by antidepressant use. In stratified analysis by zygosity, significant associations were observed in monozygotic and dizygotic twins for the path linking visit 1 HRV to visit 2 BDI score, although the associations were slightly stronger in dizygotic twins. CONCLUSIONS AND RELEVANCE: The association between depression and autonomic dysregulation, indexed by HRV, is bidirectional, with stronger evidence suggesting that autonomic function affects depression risk rather than vice versa. The opposite causal pathway from depression to lower HRV is mostly driven by antidepressant use. These findings highlight an important role of autonomic nervous system in the risk of depression and contribute new understanding of the mechanisms underlying the comorbidity of depression and cardiovascular disease.

Original languageEnglish (US)
Pages (from-to)705-712
Number of pages8
JournalJAMA Psychiatry
Volume75
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Twin Studies
Vietnam
Heart Rate
Depression
Dizygotic Twins
Antidepressive Agents
Monozygotic Twins
Registries
Warfare
Autonomic Nervous System
Comorbidity
Electrocardiography
Cardiovascular Diseases
Equipment and Supplies

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Association of depressive symptoms and heart rate variability in Vietnam war-era twins : A longitudinal twin difference study. / Huang, Minxuan; Shah, Amit; Su, Shaoyong; Goldberg, Jack; Lampert, Rachel J.; Levantsevych, Oleksiy M.; Shallenberger, Lucy; Pimple, Pratik; Bremner, J. Douglas; Vaccarino, Viola.

In: JAMA Psychiatry, Vol. 75, No. 7, 01.07.2018, p. 705-712.

Research output: Contribution to journalArticle

Huang, M, Shah, A, Su, S, Goldberg, J, Lampert, RJ, Levantsevych, OM, Shallenberger, L, Pimple, P, Bremner, JD & Vaccarino, V 2018, 'Association of depressive symptoms and heart rate variability in Vietnam war-era twins: A longitudinal twin difference study', JAMA Psychiatry, vol. 75, no. 7, pp. 705-712. https://doi.org/10.1001/jamapsychiatry.2018.0747
Huang, Minxuan ; Shah, Amit ; Su, Shaoyong ; Goldberg, Jack ; Lampert, Rachel J. ; Levantsevych, Oleksiy M. ; Shallenberger, Lucy ; Pimple, Pratik ; Bremner, J. Douglas ; Vaccarino, Viola. / Association of depressive symptoms and heart rate variability in Vietnam war-era twins : A longitudinal twin difference study. In: JAMA Psychiatry. 2018 ; Vol. 75, No. 7. pp. 705-712.
@article{5d51f4e88ff24cefaf7386ac585940e1,
title = "Association of depressive symptoms and heart rate variability in Vietnam war-era twins: A longitudinal twin difference study",
abstract = "IMPORTANCE: Depressive symptoms are associated with lower heart rate variability (HRV), an index of autonomic dysregulation, but the direction of the association remains unclear. OBJECTIVE :To investigate the temporal association between depression and HRV. DESIGN, SETTINGS, AND PARTICIPANTS: A longitudinal, cross-lagged twin difference study, with baseline assessments from March 2002 to March 2006 (visit 1) and a 7-year follow-up (visit 2) at an academic research center with participants recruited from a national twin registry. Twins (n = 166) from the Vietnam Era Twin Registry, who served in the US military during the VietnamWar, and were discordant for depression at baseline were recruited. MAIN OUTCOMES AND MEASURES: At both visits, depressive symptomswere measured using the Beck Depression Inventory-II (BDI-II), and HRV was measured through 24-hour electrocardiogram monitoring. To assess the direction of the association, within-pair differences in multivariable mixed-effects regression models were examined, and standardized β coefficients for both pathways were calculated. The associations were evaluated separately in monozygotic and dizygotic twins. RESULTS: In the final analytic sample (N = 146), all participants were men, 138 (95{\%}) were white, and the mean (SD) age was 54 (3) years at baseline. Results showed consistent associations between visit 1 HRV and visit 2 BDI score across all HRV domains and models (β coefficients ranging from -0.14 to -0.29), which were not explained by antidepressants or other participant characteristics. Themagnitude of the association was similar in the opposite pathway linking visit 1 BDI score to visit 2 HRV, with β coefficients ranging from 0.05 to -0.30, but it was largely explained by antidepressant use. In stratified analysis by zygosity, significant associations were observed in monozygotic and dizygotic twins for the path linking visit 1 HRV to visit 2 BDI score, although the associations were slightly stronger in dizygotic twins. CONCLUSIONS AND RELEVANCE: The association between depression and autonomic dysregulation, indexed by HRV, is bidirectional, with stronger evidence suggesting that autonomic function affects depression risk rather than vice versa. The opposite causal pathway from depression to lower HRV is mostly driven by antidepressant use. These findings highlight an important role of autonomic nervous system in the risk of depression and contribute new understanding of the mechanisms underlying the comorbidity of depression and cardiovascular disease.",
author = "Minxuan Huang and Amit Shah and Shaoyong Su and Jack Goldberg and Lampert, {Rachel J.} and Levantsevych, {Oleksiy M.} and Lucy Shallenberger and Pratik Pimple and Bremner, {J. Douglas} and Viola Vaccarino",
year = "2018",
month = "7",
day = "1",
doi = "10.1001/jamapsychiatry.2018.0747",
language = "English (US)",
volume = "75",
pages = "705--712",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "7",

}

TY - JOUR

T1 - Association of depressive symptoms and heart rate variability in Vietnam war-era twins

T2 - A longitudinal twin difference study

AU - Huang, Minxuan

AU - Shah, Amit

AU - Su, Shaoyong

AU - Goldberg, Jack

AU - Lampert, Rachel J.

AU - Levantsevych, Oleksiy M.

AU - Shallenberger, Lucy

AU - Pimple, Pratik

AU - Bremner, J. Douglas

AU - Vaccarino, Viola

PY - 2018/7/1

Y1 - 2018/7/1

N2 - IMPORTANCE: Depressive symptoms are associated with lower heart rate variability (HRV), an index of autonomic dysregulation, but the direction of the association remains unclear. OBJECTIVE :To investigate the temporal association between depression and HRV. DESIGN, SETTINGS, AND PARTICIPANTS: A longitudinal, cross-lagged twin difference study, with baseline assessments from March 2002 to March 2006 (visit 1) and a 7-year follow-up (visit 2) at an academic research center with participants recruited from a national twin registry. Twins (n = 166) from the Vietnam Era Twin Registry, who served in the US military during the VietnamWar, and were discordant for depression at baseline were recruited. MAIN OUTCOMES AND MEASURES: At both visits, depressive symptomswere measured using the Beck Depression Inventory-II (BDI-II), and HRV was measured through 24-hour electrocardiogram monitoring. To assess the direction of the association, within-pair differences in multivariable mixed-effects regression models were examined, and standardized β coefficients for both pathways were calculated. The associations were evaluated separately in monozygotic and dizygotic twins. RESULTS: In the final analytic sample (N = 146), all participants were men, 138 (95%) were white, and the mean (SD) age was 54 (3) years at baseline. Results showed consistent associations between visit 1 HRV and visit 2 BDI score across all HRV domains and models (β coefficients ranging from -0.14 to -0.29), which were not explained by antidepressants or other participant characteristics. Themagnitude of the association was similar in the opposite pathway linking visit 1 BDI score to visit 2 HRV, with β coefficients ranging from 0.05 to -0.30, but it was largely explained by antidepressant use. In stratified analysis by zygosity, significant associations were observed in monozygotic and dizygotic twins for the path linking visit 1 HRV to visit 2 BDI score, although the associations were slightly stronger in dizygotic twins. CONCLUSIONS AND RELEVANCE: The association between depression and autonomic dysregulation, indexed by HRV, is bidirectional, with stronger evidence suggesting that autonomic function affects depression risk rather than vice versa. The opposite causal pathway from depression to lower HRV is mostly driven by antidepressant use. These findings highlight an important role of autonomic nervous system in the risk of depression and contribute new understanding of the mechanisms underlying the comorbidity of depression and cardiovascular disease.

AB - IMPORTANCE: Depressive symptoms are associated with lower heart rate variability (HRV), an index of autonomic dysregulation, but the direction of the association remains unclear. OBJECTIVE :To investigate the temporal association between depression and HRV. DESIGN, SETTINGS, AND PARTICIPANTS: A longitudinal, cross-lagged twin difference study, with baseline assessments from March 2002 to March 2006 (visit 1) and a 7-year follow-up (visit 2) at an academic research center with participants recruited from a national twin registry. Twins (n = 166) from the Vietnam Era Twin Registry, who served in the US military during the VietnamWar, and were discordant for depression at baseline were recruited. MAIN OUTCOMES AND MEASURES: At both visits, depressive symptomswere measured using the Beck Depression Inventory-II (BDI-II), and HRV was measured through 24-hour electrocardiogram monitoring. To assess the direction of the association, within-pair differences in multivariable mixed-effects regression models were examined, and standardized β coefficients for both pathways were calculated. The associations were evaluated separately in monozygotic and dizygotic twins. RESULTS: In the final analytic sample (N = 146), all participants were men, 138 (95%) were white, and the mean (SD) age was 54 (3) years at baseline. Results showed consistent associations between visit 1 HRV and visit 2 BDI score across all HRV domains and models (β coefficients ranging from -0.14 to -0.29), which were not explained by antidepressants or other participant characteristics. Themagnitude of the association was similar in the opposite pathway linking visit 1 BDI score to visit 2 HRV, with β coefficients ranging from 0.05 to -0.30, but it was largely explained by antidepressant use. In stratified analysis by zygosity, significant associations were observed in monozygotic and dizygotic twins for the path linking visit 1 HRV to visit 2 BDI score, although the associations were slightly stronger in dizygotic twins. CONCLUSIONS AND RELEVANCE: The association between depression and autonomic dysregulation, indexed by HRV, is bidirectional, with stronger evidence suggesting that autonomic function affects depression risk rather than vice versa. The opposite causal pathway from depression to lower HRV is mostly driven by antidepressant use. These findings highlight an important role of autonomic nervous system in the risk of depression and contribute new understanding of the mechanisms underlying the comorbidity of depression and cardiovascular disease.

UR - http://www.scopus.com/inward/record.url?scp=85049571569&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049571569&partnerID=8YFLogxK

U2 - 10.1001/jamapsychiatry.2018.0747

DO - 10.1001/jamapsychiatry.2018.0747

M3 - Article

C2 - 29799951

AN - SCOPUS:85049571569

VL - 75

SP - 705

EP - 712

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 7

ER -