Emotional Stress and Heart Rate Variability Measures Associated With Cardiovascular Risk in Relocated Katrina Survivors

Objective To explore the effects of hurricane exposure and forced relocation on the mind and body, we compared psychiatric diagnoses and symptoms with heart rate variability (HRV) for 34 relocated Katrina survivors and 34 demographically matched controls. Methods All participants were healthy and free of psychiatric and cardiovascular medications. We measured symptoms of posttraumatic stress disorder (PTSD) (Clinician-Administered PTSD Scale 1) and depression (Beck Depression Inventory), Axis I psychiatric diagnoses (Structured Clinical Interview for DSM-IV), psychosocial disability (Sheehan Disability Scale), and power spectral analysis HRV reactivity to trauma reminders. Results Katrina-related PTSD occurred in 38% of survivors and 12% of controls. Survivors reported higher levels of PTSD and depression symptoms, within diagnostic ranges, and greater psychosocial disability than controls. Survivors had higher resting heart rate (80.82 [standard deviation = 13.60] versus 74.85 [10.67], p = .05), lower parasympathetic (high-frequency [HF] normalized unit) baseline HRV activity (40.14 [23.81] versus 50.67 [19.93], p = .04) and less reactivity with trauma cues (−2.63 [20.70] versus −11.96 [15.84], p = .04), and higher baseline sympathovagal activity (low frequency/HF ratio) (2.84 [3.08] versus 1.35 [1.08], p = .04) than controls. Survivors with depression (n = 12) and with depression and PTSD combined (n = 7), but not those with PTSD (n = 13), had flattened parasympathetic responsiveness to trauma cues. HRV indices correlated with depressive (low frequency/HF, p = .01; HF normalized unit, p = .046) but not PTSD symptoms (p values > .05). Conclusions Results showed this multilayer trauma’s impact on emotional health and HRV-based measures of autonomic nervous system dysregulation. Specifically, dysregulation of depressed survivors’ HRV in response to trauma reminders supports more autonomic involvement in traumatic loss/depression than in PTSD. Diagnostic criteria for PTSD include physiologic reactivity, and the present findings suggest that, in this setting, altered physiologic reactivity observed when PTSD coexists with depression.

[1]  N. Schneiderman,et al.  Posttraumatic Stress Symptoms, Intrusive Thoughts, Loss, and Immune Function after Hurricane Andrew , 1997, Psychosomatic medicine.

[2]  S. Orr,et al.  Psychometric profile of posttraumatic stress disorder, anxious, and healthy Vietnam veterans: correlations with psychophysiologic responses. , 1990, Journal of consulting and clinical psychology.

[3]  M. Rateau.  Differences in emotional well-being of hurricane survivors: a secondary analysis of the ABC News Hurricane Katrina Anniversary Poll. , 2009, Archives of psychiatric nursing.

[4]  Chau-Chung Wu,et al.  Derangement of Heart Rate Variability During a Catastrophic Earthquake: A Possible Mechanism for Increased Heart Attacks , 2001, Pacing and clinical electrophysiology : PACE.

[5]  K. Bradley,et al.  Rapid Needs Assessment of Hurricane Katrina Evacuees—Oklahoma, September 2005 , 2006, Prehospital and Disaster Medicine.

[6]  S. Galea,et al.  The serotonin transporter genotype and social support and moderation of posttraumatic stress disorder and depression in hurricane-exposed adults. , 2007, The American journal of psychiatry.

[7]  P. Delafontaine,et al.  Effect of Hurricane Katrina on the Incidence of Acute Coronary Syndrome at a Primary Angioplasty Center in New Orleans , 2009, Disaster Medicine and Public Health Preparedness.

[8]  T. Shinba,et al.  Decrease in heart rate variability response to task is related to anxiety and depressiveness in normal subjects , 2008, Psychiatry and clinical neurosciences.

[9]  H. Meltzer,et al.  Immunoendocrine aspects of major depression , 1995, European Archives of Psychiatry and Clinical Neuroscience.

[10]  B. Druss,et al.  Swept away: use of general medical and mental health services among veterans displaced by Hurricane Katrina. , 2007, The American journal of psychiatry.

[11]  R. Carney,et al.  Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease. , 2000, Journal of psychosomatic research.

[12]  H. Meltzer,et al.  Immunoendocrine aspects of major depression. Relationships between plasma interleukin-6 and soluble interleukin-2 receptor, prolactin and cortisol. , 1995, European archives of psychiatry and clinical neuroscience.

[13]  Amir B. Geva,et al.  Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks , 2000, Psychiatry Research.

[14]  Hagit Cohen,et al.  Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder , 1998, Biological Psychiatry.

[15]  E. Blanchard.  Elevated basal levels of cardiovascular responses in Vietnam veterans with PTSD: A health problem in the making? , 1990 .

[16]  S. Orr,et al.  Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. , 1987, Archives of general psychiatry.

[17]  Betty Pfefferbaum,et al.  Exploring community resilience in workforce communities of first responders serving Katrina survivors. , 2011, The American journal of orthopsychiatry.

[18]  A. Malliani,et al.  Cardiovascular Neural Regulation Explored in the Frequency Domain , 1991, Circulation.

[19]  C. Glenn,et al.  Psychosocial Risk and Protective Factors , 2008 .

[20]  R. Bluhm,et al.  A review of neuroimaging studies in PTSD: heterogeneity of response to symptom provocation. , 2006, Journal of psychiatric research.

[21]  Betty Pfefferbaum,et al.  Physiologic reactivity despite emotional resilience several years after direct exposure to terrorism. , 2007, The American journal of psychiatry.

[22]  D. Sheehan,et al.  The Anxiety Disease , 1984 .

[23]  D. Janowsky,et al.  Cellular immunity and the hypothalamic-pituitary axis in major affective disorder: A preliminary study , 1988, Psychiatry Research.

[24]  N. Lakušić,et al.  Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction. , 2007, Military medicine.

[25]  B. Pfefferbaum,et al.  Katrina Survivors Relocated to Oklahoma: A Tale of Two Cities , 2008 .

[26]  M. First,et al.  Structured clinical interview for DSM-IV axis I disorders : SCID-I: clinical version : administration booklet , 1996 .

[27]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[28]  M. Fujita,et al.  Effect of autogenic training on cardiac autonomic nervous activity in high-risk fire service workers for posttraumatic stress disorder. , 2006, Journal of psychosomatic research.

[29]  C. North,et al.  Post-traumatic stress disorder in disaster survivors. , 1990, Comprehensive therapy.

[30]  B. A. van der Kolk,et al.  Preliminary evidence of parasympathetic influence on basal heart rate in posttraumatic stress disorder. , 2006, Journal of psychosomatic research.

[31]  Daniel J. Whitaker,et al.  Posttraumatic Stress Disorder in Rape Victims: Autonomic Habituation to Auditory Stimuli , 2001, Journal of traumatic stress.

[32]  S. Orr,et al.  Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder. , 1993, The American journal of psychiatry.

[33]  E. Suarez.  Joint Effect of Hostility and Severity of Depressive Symptoms on Plasma Interleukin‐6 Concentration , 2003, Psychosomatic medicine.

[34]  Heart Rate Variability Standards of Measurement , Physiological Interpretation , and Clinical Use Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology , 2022 .

[35]  A. Preston,et al.  Hurricane Georges: A Cross-National Study Examining Preparedness, Resource Loss, and Psychological Distress in the U.S. Virgin Islands, Puerto Rico, Dominican Republic, and the United States , 2002, Journal of traumatic stress.

[36]  D. Stirling,et al.  Interleukin 6 and Haemostasis , 2001, British journal of haematology.

[37]  K. Erikson.  Disaster at Buffalo Creek. Loss of communality at Buffalo Creek. , 1976, The American journal of psychiatry.

[38]  Ronald C Kessler,et al.  Mental illness and suicidality after Hurricane Katrina. , 2006, Bulletin of the World Health Organization.

[39]  G. Turecki,et al.  Alcohol and Cigarette Use and Misuse Among Hurricane Katrina Survivors: Psychosocial Risk and Protective Factors , 2009, Substance use & misuse.

[40]  D. Charney,et al.  The development of a Clinician-Administered PTSD Scale , 1995, Journal of traumatic stress.

[41]  M. A. Mills,et al.  Trauma and stress response among Hurricane Katrina evacuees. , 2007, American journal of public health.

[42]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[43]  M. Reite,et al.  Elevated Cytotoxicity in Combat Veterans with Long-Term Post-traumatic Stress Disorder: Preliminary Observations , 1998, Brain, Behavior, and Immunity.

[44]  Marylene Cloitre,et al.  Enhanced cellular immune response in women with PTSD related to childhood abuse. , 2003, The American journal of psychiatry.

[45]  R. Kessler,et al.  Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. , 2008, The American journal of psychiatry.

[46]  N. Schneiderman,et al.  Psychiatric morbidity following Hurricane Andrew. , 1996, Journal of traumatic stress.

[47]  Luis Baumela Molina,et al.  Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch. , 2001, The American journal of psychiatry.

[48]  B. Pfefferbaum,et al.  Emotional and biological stress measures in Katrina survivors relocated to Oklahoma. , 2010, American journal of disaster medicine.

[49]  J. Davidson,et al.  Clinician‐administered PTSD scale: A review of the first ten years of research , 2001, Depression and anxiety.

[50]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[51]  S. Orr,et al.  Psychophysiological investigations of posttraumatic stress disorder imagery. , 1989, Psychopharmacology bulletin.

[52]  C. Plata-salamán.  Immunoregulators in the nervous system , 1991, Neuroscience & Biobehavioral Reviews.

[53]  E. Bosmans,et al.  Elevated serum interleukin-6 (IL-6) and IL-6 receptor concentrations in posttraumatic stress disorder following accidental man-made traumatic events , 1999, Biological Psychiatry.