Early dysautonomia detected by heart rate variability predicts late depression in female patients following mild traumatic brain injury.

Depression is one of the frequent complications following a mild traumatic brain injury (mTBI). Recent research indicated that abnormalities in the autonomic nervous system (ANS) can be evaluated by a noninvasive power spectral analysis of the heart rate variability (HRV). In this study, we investigated whether a frequency-domain analysis of HRV was correlated with late depression in mTBI patients. In total, 181 patients diagnosed with mTBI and 83 volunteers as healthy controls were recruited in 2010-2014. Beck Depression Inventory (BDI) scores were used to evaluate depression in the 1st week of assessment and at 1.5-, 3-, 6-, 12-, and 18-month follow-ups. Correlation and logistic regression analyses of the 1st week HRV parameters with BDI scores at 18 months were performed in individual female mTBI patients. Female mTBI patients were more vulnerable to depression accompanied by reduced HRV compared to healthy controls. Over time, depression was aggravated in female mTBI patients but was alleviated in male mTBI patients. A significantly lower parasympathetic proportion of the ANS was noted at 18 months with respect to the 1st week in female mTBI patients. In addition, depression in female mTBI patients at 18 months after injury was significantly correlated with a decrease in the parasympathetic proportion of the ANS in the 1st week (ρ = -0.411; p < .05). Dysautonomia resulted in higher risks of depression in female mTBI patients. We concluded that early dysautonomia following an mTBI contributes to late depression in female mTBI patients.

[1]  Jean A. Orman,et al.  The Epidemiology of Traumatic Brain Injury , 2010, The Journal of head trauma rehabilitation.

[2]  H. Nordahl,et al.  Psychological factors and weight problems in adolescents. The role of eating problems, emotional problems, and personality traits: the Young-HUNT study , 2011, Social Psychiatry and Psychiatric Epidemiology.

[3]  G. Wilkinson,et al.  Gender differences in depression. Critical review. , 2000, The British journal of psychiatry : the journal of mental science.

[4]  D. Arciniegas,et al.  Regarding the search for a unified definition of mild traumatic brain injury. , 2001, Brain injury.

[5]  Lingjiang Li,et al.  CSF serotonin, 5-hydroxyindolacetic acid and neuropeptide Y levels in severe major depressive disorder , 2006, Brain Research.

[6]  A. V. Zomeren,et al.  Residual complaints of patients two years after severe head injury. , 1985 .

[7]  R. Carney,et al.  Depression as a risk factor for cardiac events in established coronary heart disease: A review of possible mechanisms , 1995, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[8]  P. Mitchell,et al.  Gender differences in depression risk and coping factors in a clinical sample , 2002, Acta psychiatrica Scandinavica.

[9]  Epigenetic mechanisms of depression. , 2014, JAMA psychiatry.

[10]  R. Robinson,et al.  Reduction of CSF monoamine metabolites in poststroke depression: a preliminary report. , 1992, The Journal of neuropsychiatry and clinical neurosciences.

[11]  P. Rabins,et al.  High fatality rates of late-life depression associated with cardiovascular disease. , 1985, Journal of affective disorders.

[12]  Charles W Hoge,et al.  Mild traumatic brain injury in U.S. Soldiers returning from Iraq. , 2008, The New England journal of medicine.

[13]  A. Beck,et al.  Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. , 1996, Journal of personality assessment.

[14]  T B Kuo,et al.  Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit. , 1997, Critical care medicine.

[15]  I. Baguley,et al.  Dysautonomia and heart rate variability following severe traumatic brain injury , 2006, Brain injury.

[16]  R. Hanks,et al.  Etiology of traumatic brain injury: characterization of differential outcomes up to 1 year postinjury. , 2003, Archives of physical medicine and rehabilitation.

[17]  P. Schwartz,et al.  Cardiac Arrhythmias Elicited by Interaction Between Acute Myocardial Ischemia and Sympathetic Hyperactivity: A New Experimental Model for the Study of Antiarrhythmic Drugs , 1981, Journal of cardiovascular pharmacology.

[18]  Patrick R. Norris,et al.  Heart rate variability predicts trauma patient outcome as early as 12 h: implications for military and civilian triage. , 2005, The Journal of surgical research.

[19]  W. Scott,et al.  Heart rate variability after acute traumatic brain injury in children , 2000, Critical care medicine.

[20]  M. Faust,et al.  Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al.'s (2000, 2005) systematic reviews. , 2009, Neuropsychology.

[21]  D. Streiner,et al.  The clinical significance of major depression following mild traumatic brain injury. , 2003, Psychosomatics.

[22]  J. Barth,et al.  The relationship between behavioral and cognitive deficits, demographics and depression in patients with minor head injuries , 1986 .

[23]  T. Ownsworth,et al.  Depression after traumatic brain injury: conceptualization and treatment considerations. , 1998, Brain injury.

[24]  M. Türkçapar,et al.  Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. , 2001, Comprehensive psychiatry.

[25]  Benedicto Crespo-Facorro,et al.  Major depression following traumatic brain injury. , 2004, Archives of general psychiatry.

[26]  P. Shapiro,et al.  Depression and the course of coronary artery disease. , 1998, The American journal of psychiatry.

[27]  L. Mulder,et al.  The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. , 2013, Psychophysiology.

[28]  R A Steer,et al.  Further Evidence for the Construct Validity of the Beck Depression Inventory-II with Psychiatric Outpatients , 1997, Psychological reports.

[29]  Stephen W Marshall,et al.  Recurrent concussion and risk of depression in retired professional football players. , 2007, Medicine and science in sports and exercise.

[30]  R. Carney,et al.  Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. , 2002, Journal of psychosomatic research.

[31]  K. Light,et al.  Heart rate variability at rest and during mental stress in patients with coronary artery disease: Differences in patients with high and low depression scores , 1998, International journal of behavioral medicine.

[32]  M. Alexander,et al.  Outcomes for traumatically brain-injured patients following post-acute rehabilitation programmes. , 1992, Brain injury.

[33]  W. Katon,et al.  Sertraline in the treatment of major depression following mild traumatic brain injury. , 2000, The Journal of neuropsychiatry and clinical neurosciences.

[34]  M. Klauber,et al.  Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. , 1988, Journal of Neurosurgery.

[35]  J. .. Abildskov,et al.  Influence of sympathetic tone on ventricular fibrillation threshold during experimental coronary occlusion. , 1975, The American journal of cardiology.

[36]  S. Nolen-Hoeksema,et al.  Explaining the gender difference in depressive symptoms. , 1999, Journal of personality and social psychology.

[37]  H. Rhee.  Prevalence and Predictors of Headaches in US Adolescents , 2000, Headache.

[38]  T. Kuo,et al.  Sympathetic and parasympathetic activities evaluated by heart-rate variability in head injury of various severities , 2005, Clinical Neurophysiology.

[39]  M Diksic,et al.  Differences between males and females in rates of serotonin synthesis in human brain. , 1997, Proceedings of the National Academy of Sciences of the United States of America.

[40]  R. Schoenhuber,et al.  Anxiety and depression after mild head injury: a case control study. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[41]  J. Silver,et al.  Axis I Psychopathology in Individuals with Traumatic Brain Injury , 1998, The Journal of head trauma rehabilitation.

[42]  P V Bayly,et al.  Deformation of the human brain induced by mild acceleration. , 2005, Journal of neurotrauma.

[43]  N. Bohnen,et al.  Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. , 1992, Brain injury.

[44]  V. Coronado,et al.  Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. , 2004, Journal of rehabilitation medicine.

[45]  S. Dikmen,et al.  Rates of major depressive disorder and clinical outcomes following traumatic brain injury. , 2010, JAMA.

[46]  J. M. Mancilla-Díaz,et al.  Effect of gender and school level on disordered eating behaviours and attitudes in Mexican adolescents , 2009, Eating and weight disorders : EWD.

[47]  J. Langlois,et al.  The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview , 2006, The Journal of head trauma rehabilitation.

[48]  L. Wichstrøm,et al.  Role of physical and sedentary activities in the development of depressive symptoms in early adolescence , 2011, Social Psychiatry and Psychiatric Epidemiology.

[49]  Catherine M. Stoney,et al.  Depressed Mood Is Related to High-Frequency Heart Rate Variability During Stressors , 2000, Psychosomatic medicine.

[50]  W. Rutherford,et al.  SEQUELÆ OF CONCUSSION CAUSED BY MINOR HEAD INJURIES , 1977, The Lancet.

[51]  W. Chiu,et al.  Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury , 2016, Clinical Neurophysiology.

[52]  S. Marshall,et al.  Reliability of concussion history in former professional football players. , 2012, Medicine and science in sports and exercise.

[53]  M. Rapoport,et al.  The impact of major depression on outcome following mild-to-moderate traumatic brain injury in older adults. , 2006, Journal of affective disorders.

[54]  J. Cummings,et al.  Frontal-subcortical circuits and human behavior. , 1993, Journal of psychosomatic research.

[55]  Glen Wiesner,et al.  Elevated brain serotonin turnover in patients with depression: effect of genotype and therapy. , 2008, Archives of general psychiatry.

[56]  R. Linn,et al.  Affective symptoms in the chronic stage of traumatic brain injury: a study of married couples. , 1994, Brain injury.

[57]  K. Kendler,et al.  Genetic risk factors for major depression in men and women: similar or different heritabilities and same or partly distinct genes? , 2001, Psychological Medicine.

[58]  S. Marshall,et al.  Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players , 2005, Neurosurgery.

[59]  J. Davidson,et al.  Diagnostic Significance of Vegetative Symptoms in Depression , 1986, British Journal of Psychiatry.

[60]  B. Jennett,et al.  Assessment of coma and impaired consciousness. A practical scale. , 1974, Lancet.

[61]  J E Sniezek,et al.  Incidence of mild and moderate brain injury in the United States, 1991. , 1996, Brain injury.

[62]  E. Nestler,et al.  Sustained hippocampal chromatin regulation in a mouse model of depression and antidepressant action , 2006, Nature Neuroscience.

[63]  Depression in patients with acute traumatic brain injury. , 1992 .

[64]  W. Chiu,et al.  The impact of time, legislation, and geography on the epidemiology of traumatic brain injury , 2007, Journal of Clinical Neuroscience.

[65]  O. Cameron.  Depression increases post-Mi mortality: how? , 1996, Psychosomatic medicine.

[66]  T. Moritani,et al.  Effect of the combination of ginseng, oriental bezoar and glycyrrhiza on autonomic nervous activity as evaluated by power spectral analysis of HRV and cardiac depolarization-repolarization process. , 2008, Journal of nutritional science and vitaminology.

[67]  N. Williams,et al.  Chipping away at the old block , 2003, Current Biology.

[68]  Kenneth E Freedland,et al.  Depression, the Autonomic Nervous System, and Coronary Heart Disease , 2005, Psychosomatic medicine.