Heart Rate Variability as a Biomarker for Transdiagnostic Depressive and Anxiety Symptom Trajectory in Adolescents and Young Adults (Literature Review)

Abstract

This study looked at how heart rate variability (HRV), which reflects the activity of the parasympathetic nervous system, is related to depression and anxiety symptoms over time in adolescents and young adults. HRV is an indicator of how well the autonomic nervous system, particularly the parasympathetic branch, controls heart function. Lower HRV has been linked to depressive and anxiety disorders, signaling reduced parasympathetic activity [2]. Previous research mainly used categorical methods, grouping people based on diagnoses rather than examining the symptoms on a scale. This approach does not account for the overlap and variety within mental health disorders. Instead, the study used a dimensional approach to assess symptoms across a broad spectrum. Researchers used the tri-level model, which breaks symptoms into three categories: General Distress (shared between depression and anxiety), Fear (related to anxiety), and anhedonia apprehension (related to depression) [5].

In a 3-year longitudinal study involving 362 adolescents and young adults, participants had their heart rate measured and reported their symptoms [1][4]. The analysis showed that higher HRV at the start was linked to a reduction in General Distress symptoms over time. However, HRV did not predict changes in more specific symptom factors like Fears or anhedonia apprehension. This suggests that higher parasympathetic activity might help reduce overall distress but not symptoms specific to depression or anxiety [6]. The findings imply that HRV could be a useful marker for understanding and predicting the shared features of internalizing disorders like depression and anxiety. It highlights the importance of looking at HRV as a transdiagnostic indicator rather than focusing solely on individual disorders [7][8].

Methods

Participants in the BrainMAPD study, a long-term research project carried out at UCLA and Northwestern University, were 18 to 19 years old when they joined. They were recruited through fliers and online ads. To ensure a wide range of participants, 2,461 people were initially screened based on their levels of neuroticism (a personality trait linked to emotional instability) and sensitivity to rewards. From this group, 362 individuals were selected, covering a broad spectrum of scores in these traits [1][4].

The study followed participants for three years, gathering data at four-time points: the start, then 10, 20, and 30 months later. In the beginning, the average age was around 18.65 years, with a majority of the sample being female (67.2%). The group was ethnically diverse, with participants identifying as White (33.1%), Asian (28.5%), Latinx (18.5%), and other races [3].

Participants had their heart rate recorded using electrodes attached to their chest and abdomen, while specialized software processed the heart data to measure HRV [2]. HRV was analyzed in relation to symptoms of depression and anxiety over time, using a model that categorized symptoms into General Distress, Fears, and Anhedonia-Apprehension. This approach allowed researchers to examine the broad impact of heart rate variability on mental health symptoms [5][6].

Discussion

This study was the first to look at how heart rate variability (HRV) relates to the long-term development of symptoms common in anxiety and depression in young people. HRV, specifically the high-frequency (HF) power related to the parasympathetic nervous system, was linked to changes in overall distress symptoms (General Distress) over 30 months. Higher HF HRV at the beginning predicted a greater decrease in General Distress over time, even when factors like neuroticism, age, gender, and race were considered. However, HRV did not affect more specific anxiety or depression symptoms, like Fear or anhedonia apprehension [13] [14].

This suggests that parasympathetic activity, as shown by HRV, could be a general marker for shared anxiety and depression symptoms rather than disorder-specific ones. The findings support previous ideas that HRV can serve as a broad indicator of mental health risks [7][8]. The study also found that higher HRV was linked to changes in distress symptoms over time but not to initial symptom levels. This means that good parasympathetic function might help reduce future anxiety or depression symptoms, which is important for young people at risk [9] [10].

Despite these insights, the study had some limitations. It only focused on young people, so the results might not apply to older adults. Also, HRV was only measured once at the start, making it hard to see how it changes over time. Future research should explore HRV over longer periods and in response to stress, especially in different age groups [11][12]

Conclusion

This study investigated how heart rate variability (HRV), which is regulated by the parasympathetic nervous system, relates to the long-term patterns of general internalizing symptoms in adolescents and young adults [15]. HRV measured at the start of the study was a significant predictor of the broad General Distress (GD) symptom factor over 30 months, even when accounting for more specific factors like Fears and Anhedonia-Apprehension (A-A) and the personality trait of neuroticism [15]. Higher HRV was linked to a greater reduction in GD symptoms over time [15]. These results indicate that higher vagally regulated HRV could serve as a general biomarker for tracking anxiety and depression symptom development [15]. Future research should explore HRV in different symptom dimensions and under stressful life circumstances to better understand its role in mental health outcomes [15].

References

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15. Wen, A., Zbozinek, T. D., Ruiz, J., Zinbarg, R. E., Nusslock, R., & Craske, M. G. (2024). Heart rate variability as a biomarker for transdiagnostic depressive and anxiety symptom trajectory in adolescents and young adults. Journal of Psychopathology and Clinical Science, 133(8), 638–646. https://doi.org/10.1037/abn0000946