Cited by 215Heart Rate Variability and Autonomic ControlCardiac Health and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA)

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Licht, Carmilla M. M., de Geus, Eco J. C., van Dyck, Richard, Penninx, Brenda W. J. H.·2009·Psychosomatic Medicine

Abstract

Objective: To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants. Methods: The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and subjects with current anxiety diagnosis (n = 1059). Results: Current anxious subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, a selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20–0.80 for SDNN and 0.42–0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA. Conclusion: This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants. ANOVA = analysis of variance; ANS = autonomic nervous system; ATC = anatomical therapeutic chemical; BAI = Beck Anxiety Inventory; BMI = body mass index; CIDI = Composite International Diagnostic Interview; CVD = cardiovascular disease; dZ = changes in thorax impedance; ECG = electrocardiogram; GAD = generalized anxiety disorder; HR = heart rate; HRV = heart rate variability; IBI = inter-beat-interval; MDD = major depressive disorder; MET = multiple of one's resting metabolic rate times minutes of physical activity; NESDA = The Netherlands Study of Depression and Anxiety; PD = panic disorder; pv = peak-valley; PNS = parasympathetic nervous system; RR = respiratory rate; RSA = respiratory sinus arrhythmia; SDNN = standard deviation of the normal-to-normal interval; SNS = sympathetic nervous system; SP = social phobia; VU-AMS = Vrije Universiteit Ambulatory Monitoring System; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

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  1. Friedman BH. An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone. Biol Psychol 2007;74:185-99.

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Authors
Licht, C. M. M., de Geus, E. J. C., van Dyck, R., & Penninx, B. W. J. H.
Affiliations
  • Amsterdam Public Health (NL)
  • University Medical Center Groningen (NL)
Corresponding author
Licht, Carmilla M. M.
Venue
Psychosomatic Medicine
Published
2009-06
Volume
71
Issue
5
Pages
508-518
ISSN
0033-3174 (ISSN-L)
OpenAlex
W2111743880
Cited by
215
References
69
Citations by year
2026: 5 · 2025: 7 · 2024: 14 · 2023: 10 · 2022: 7 · 2021: 19 · 2020: 11 · 2019: 12 · 2018: 14 · 2017: 10 · 2016: 21 · 2015: 12 · 2014: 14 · 2013: 20 · 2012: 18
FWCI
8.44
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
  • VU Research Portal (submittedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • Vrije Universiteit Amsterdam
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (10-000-1002, Grant 10-000-1002)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
anxiety disorders, heart rate variability, respiratory sinus arrhythmia, panic disorder, social anxiety disorder, generalized anxiety disorder, tricyclic antidepressants, selective serotonin reuptake inhibitors, autonomic nervous system, heart rate, lifestyle confounding, NESDA, cardiovascular risk, comorbid depression
MeSH terms
Adolescent, Adult, Aged, Antidepressive Agents, Anxiety Disorders, Arrhythmias, Cardiac, Arrhythmia, Sinus, Cross-Sectional Studies, Depressive Disorder, Major, Major Depressive Disorder, Electrocardiography, Female, Health Status, Heart Rate, Humans, Male, Middle Aged, Netherlands, Phobic Disorders, Psychiatric Status Rating Scales, Surveys and Questionnaires, Respiration, Risk Factors, Severity of Illness Index, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders

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