The relationship between mental and physical health: Insights from the study of heart rate variability

doi:10.1016/J.IJPSYCHO.2013.06.018

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The relationship between mental and physical health: Insights from the study of heart rate variability

Journal Article•DOI•

The relationship between mental and physical health: Insights from the study of heart rate variability

Andrew H. Kemp¹, Andrew H. Kemp², Daniel Quintana²•Institutions (2)

University of São Paulo¹, University of Sydney²

01 Sep 2013-International Journal of Psychophysiology (Int J Psychophysiol)-Vol. 89, Iss: 3, pp 288-296

TL;DR: This work shows that otherwise healthy, unmedicated patients with these disorders display reduced resting-state HRV, and that pharmacological treatments do not ameliorate these reductions, and proposes a working model for the effects of mood disorders, comorbid conditions, and their treatments to help guide future research activities.

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About: This article is published in International Journal of Psychophysiology.The article was published on 2013-09-01. It has received 412 citations till now. The article focuses on the topics: Mood disorders & Psychological intervention.

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Coronary heart disease

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Magno R

01 Oct 1955

898 citations

Journal Article•DOI•

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

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John A. Chalmers¹, Daniel Quintana², Maree J. Abbott¹, Andrew H. Kemp³•Institutions (3)

University of Sydney¹, Oslo University Hospital², University of São Paulo³

01 Jan 2014-Frontiers in Psychiatry

TL;DR: Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size, highlighting a need for comprehensive cardiovascular risk reduction.

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Abstract: Background: Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis. Method: Studies comparing resting-state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis. Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterized by lower HRV [high frequency (HF): Hedges’ gD 0.29. 95% CI: 0.41 to 0.17, p < 0.001; time domain: Hedges’ gD 0.45, 95% CI: 0.57 to 0.33, p < 0.001] than controls. Panic disorder (nD 447), post-traumatic stress disorder (nD 192), generalized anxiety disorder (nD 68), and social anxiety disorder (nD 90), but not obsessive‐compulsive disorder (nD 40), displayed reductions in HF HRV relative to controls (all ps< 0.001). Conclusion: Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.

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652 citations

Journal Article•DOI•

Pathophysiologic relationship between Alzheimer's disease, cerebrovascular disease, and cardiovascular risk: A review and synthesis

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Cláudia Y. Santos¹, Peter J. Snyder², Wen-Chih Wu², Mia Zhang³, Ana Echeverria⁴, Jessica Alber² - Show less +2 more•Institutions (4)

University of Rhode Island¹, Brown University², Griffith University³, University of Puerto Rico⁴

01 Jan 2017-Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring

TL;DR: This review discusses the current understanding of the epidemiology, genetics, and pathophysiology of AD, the intersection between AD and vascular causes of dementia, and proposes future directions for research and prevention.

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316 citations

Journal Article•DOI•

The hierarchical basis of neurovisceral integration.

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Ryan Smith¹, Julian F. Thayer², Sahib S. Khalsa³, Richard D. Lane¹•Institutions (3)

University of Arizona¹, Ohio State University², McGovern Institute for Brain Research³

01 Apr 2017-Neuroscience & Biobehavioral Reviews

TL;DR: An updated/expanded version of the NVI model is presented that incorporates recent advances in functional neuroanatomy, and a class of computational models of brain function known as "predictive coding" models are illustrated to increase understanding of the relationship between vagal control and both cognitive performance and emotional/physical health.

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295 citations

Journal Article•DOI•

The physiological effects of slow breathing in the healthy human

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Marc Russo, Danielle M. Santarelli, Dean O’Rourke

01 Dec 2017-Breathe

TL;DR: There appears to be potential for use of controlled slow breathing techniques as a means of optimising physiological parameters that appear to be associated with health and longevity, and that may extend to disease states; however, there is a dire need for further research into the area.

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Abstract: Slow breathing practices have been adopted in the modern world across the globe due to their claimed health benefits. This has piqued the interest of researchers and clinicians who have initiated investigations into the physiological (and psychological) effects of slow breathing techniques and attempted to uncover the underlying mechanisms. The aim of this article is to provide a comprehensive overview of normal respiratory physiology and the documented physiological effects of slow breathing techniques according to research in healthy humans. The review focuses on the physiological implications to the respiratory, cardiovascular, cardiorespiratory and autonomic nervous systems, with particular focus on diaphragm activity, ventilation efficiency, haemodynamics, heart rate variability, cardiorespiratory coupling, respiratory sinus arrhythmia and sympathovagal balance. The review ends with a brief discussion of the potential clinical implications of slow breathing techniques. This is a topic that warrants further research, understanding and discussion. Key points Slow breathing practices have gained popularity in the western world due to their claimed health benefits, yet remain relatively untouched by the medical community. Investigations into the physiological effects of slow breathing have uncovered significant effects on the respiratory, cardiovascular, cardiorespiratory and autonomic nervous systems. Key findings include effects on respiratory muscle activity, ventilation efficiency, chemoreflex and baroreflex sensitivity, heart rate variability, blood flow dynamics, respiratory sinus arrhythmia, cardiorespiratory coupling, and sympathovagal balance. There appears to be potential for use of controlled slow breathing techniques as a means of optimising physiological parameters that appear to be associated with health and longevity, and that may extend to disease states; however, there is a dire need for further research into the area. Educational aims To provide a comprehensive overview of normal human respiratory physiology and the documented effects of slow breathing in healthy humans. To review and discuss the evidence and hypotheses regarding the mechanisms underlying slow breathing physiological effects in humans. To provide a definition of slow breathing and what may constitute “autonomically optimised respiration”. To open discussion on the potential clinical implications of slow breathing techniques and the need for further research. Slow breathing techniques have been used in asthma but are there effects in healthy individuals? http://ow.ly/gCPO30eQOPZ

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272 citations

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Journal Article•DOI•

Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication

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Ronald C. Kessler¹, Wai Tat Chiu¹, Olga Demler¹, Ellen E. Walters¹•Institutions (1)

Harvard University¹

01 Jun 2005-Archives of General Psychiatry

TL;DR: Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity, as shown in the recently completed US National Comorbidities Survey Replication.

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Abstract: Background Little is known about the general population prevalence or severity of DSM-IV mental disorders. Objective To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. Main Outcome Measures Twelve-month DSM-IV disorders. Results Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. Conclusion Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.

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10,951 citations

"The relationship between mental and..." refers background in this paper

...When we examined the literature in regards to this question, the research was characterised by generally small samples and inconsistent AC C EP TE D M AN U SC R IP T findings leading us to conduct and publish our meta-analysis on the impact of major depressive disorder (MDD) on HRV (Kemp et al., 2010)....
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...We concluded that MDD patients with comorbid GAD would benefit from comprehensive cardiovascular risk reduction strategies....
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...While our meta-analysis was based on a relatively large sample size (patient n = 673), an earlier study (Licht et al., 2008) on 1075 MDD patients concluded that although depression is associated with reduced HRV, these reductions were driven by antidepressant medication....
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...These SSRI findings are consistent with those from our own meta-analysis on depression (Kemp et al., 2010), which indicated that antidepressant medication did not increase (or decrease) HRV in MDD patients....
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...Our new study also indicated that MDD patients with comorbid GAD (n=24) in particular, display the greatest reductions in HRV relative to MDD patients without comorbidity as well as those with comorbid panic and posttraumatic stress disorder....
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Journal Article•DOI•

Projections of Global Mortality and Burden of Disease from 2002 to 2030

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Colin Mathers¹, Dejan Loncar¹•Institutions (1)

World Health Organization¹

28 Nov 2006-PLOS Medicine

TL;DR: These projections represent a set of three visions of the future for population health, based on certain explicit assumptions, which enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends.

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Abstract: Background Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results. Methods and Findings Relatively simple models were used to project future health trends under three scenarios—baseline, optimistic, and pessimistic—based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015. Conclusions These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.

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10,090 citations

"The relationship between mental and..." refers background in this paper

...…than a germ” (John Steinbeck, Travels with Charley: In Search of America, 1962) Unipolar depressive disorders and cardiovascular disease (CVD) (including heart disease and stroke) are already leading burdens of disease and this burden is projected to worsen up to 2030 (Mathers and Loncar, 2006)....
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Journal Article•DOI•

From inflammation to sickness and depression: when the immune system subjugates the brain

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Robert Dantzer¹, Jason C. O'Connor¹, Gregory G. Freund¹, Rodney W. Johnson¹, Keith W. Kelley¹ - Show less +1 more•Institutions (1)

University of Illinois at Urbana–Champaign¹

01 Jan 2008-Nature Reviews Neuroscience

TL;DR: In response to a peripheral infection, innate immune cells produce pro-inflammatory cytokines that act on the brain to cause sickness behaviour, which can lead to an exacerbation of sickness and the development of symptoms of depression in vulnerable individuals.

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Abstract: In response to a peripheral infection, innate immune cells produce pro-inflammatory cytokines that act on the brain to cause sickness behaviour. When activation of the peripheral immune system continues unabated, such as during systemic infections, cancer or autoimmune diseases, the ensuing immune signalling to the brain can lead to an exacerbation of sickness and the development of symptoms of depression in vulnerable individuals. These phenomena might account for the increased prevalence of clinical depression in physically ill people. Inflammation is therefore an important biological event that might increase the risk of major depressive episodes, much like the more traditional psychosocial factors.

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5,665 citations

"The relationship between mental and..." refers background in this paper

...The established link (Dantzer et al., 2008) between inflammation, sickness and depression is acknowledged, indicated by a bi-directional arrow connecting the mood disorders and comorbid conditions with downstream risk markers associated with inflammatory processes....
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Journal Article•DOI•

The inflammatory reflex

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Kevin J. Tracey

19 Dec 2002-Nature

TL;DR: The discovery that cholinergic neurons inhibit acute inflammation has qualitatively expanded understanding of how the nervous system modulates immune responses, and the opportunity now exists to apply this insight to the treatment of inflammation through selective and reversible 'hard-wired' neural systems.

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Abstract: Inflammation is a local, protective response to microbial invasion or injury. It must be fine-tuned and regulated precisely, because deficiencies or excesses of the inflammatory response cause morbidity and shorten lifespan. The discovery that cholinergic neurons inhibit acute inflammation has qualitatively expanded our understanding of how the nervous system modulates immune responses. The nervous system reflexively regulates the inflammatory response in real time, just as it controls heart rate and other vital functions. The opportunity now exists to apply this insight to the treatment of inflammation through selective and reversible 'hard-wired' neural systems.

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3,146 citations

"The relationship between mental and..." refers background or methods in this paper

...…dysregulation may be the final common pathway for a host of conditions and diseases, including cardiovascular disease and mortality (Thayer et al., 2010b), which may be attributable to impairment in the cholinergic anti-inflammatory pathway (Pavlov and Tracey, 2012; Tracey, 2002b, 2007)....
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...…process by which vagal activity regulates these allostatic systems may relate to the actions of the vagus nerve labelled as the “inflammatory reflex” (Tracey, 2002a; Tracey, 2002b, 2007): the afferent (sensory) vagus nerve is responsible for detecting cytokines and pathogen-derived products, while…...
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...Third, our review draws heavily on models (Pavlov and Tracey, 2012; Thayer and Brosschot, 2005; Thayer and Lane, 2007; Thayer et al., 2010b; Tracey, 2002b, 2007) that propose a link between HRV and longer-term changes in health and wellbeing....
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...It highlights that change in HRV will be observed prior to changes in inflammatory markers and oxidative stress; while a typical, diffusible inflammatory response may take hours to days to develop, neural signalling contributing to changes in HRV occur within milliseconds (Tracey, 2002b)....
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...…antidepressants and serotonin and noradrenaline reuptake inhibitors (SNRIs) – are a consequence of chronic autonomic dysregulation (Thayer et al., 2010b), and impairment in the cholinergic inflammatory reflex (Pavlov and Tracey, 2012; Tracey, 2002b, 2007) as operationalized by reductions in HRV....
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Journal Article•DOI•

Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.

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Jürgen Rehm, Colin Mathers, Svetlana Popova¹, Svetlana Popova², Montarat Thavorncharoensap³, Montarat Thavorncharoensap⁴, Yot Teerawattananon⁴, Jayadeep Patra² - Show less +4 more•Institutions (4)

University of Toronto¹, Centre for Addiction and Mental Health², Mahidol University³, Health Intervention and Technology Assessment Program⁴

27 Jun 2009-The Lancet

TL;DR: The burden of mortality and disease attributable to alcohol, both globally and for ten large countries, is quantified and concludes that alcohol consumption is one of the major avoidable risk factors, and actions to reduce burden and costs associated with alcohol should be urgently increased.

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3,123 citations

"The relationship between mental and..." refers background in this paper

...Another body of evidence indicates that alcohol dependence – a disorder associated with a variety of psychological problems including depression and anxiety – also leads to CVD and mortality (Rehm et al., 2009)....
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