Reduced autonomic flexibility as a predictor for future anxiety in girls from the general population: The TRAILS study
Introduction
The onset of adolescence is characterised by high levels of anxiety, especially in girls (Verhulst et al., 1997). Since anxiety problems put forth an enormous burden in both human and economic terms, it is important to investigate putative indicators of future anxiety in early adolescence.
One factor that may indicate vulnerability towards anxiety is reduced autonomic flexibility (Friedman and Thayer, 1998a, Friedman and Thayer, 1998b, Friedman, 2007). An autonomic nervous system (ANS) that lacks flexibility may hinder an individual in adequately responding to a constantly changing environment. This may enhance feelings of anxiety and lack of control, and thus may increase the risk for anxiety problems.
Autonomic flexibility is reflected in cardiovascular measures, such as heart rate (HR) reactivity. Furthermore, indices such as respiratory sinus arrhythmia (RSA) provide more precise information on autonomic flexibility, since cardiovascular functions are influenced both by sympathetic and parasympathetic activity, and RSA more specifically reflects parasympathetic activity (Mezzacappa et al., 1997). It is important to investigate measures of parasympathetic activation such as RSA when investigating the relation between autonomic flexibility and anxiety, since Porges, 1995, Porges, 2001 proposed that some individuals may be at risk for developing various mental and physical health problems, among which anxiety, due to decreased parasympathetic activation.
RSA can be determined by performing power spectral analyses on the HR signal. This generates measures of HR variability (HRV). HRV in the high-frequency band (0.15–0.40 Hz) is often called RSA (e.g., Akselrod et al., 1981) since it is related to respiratory variations in HRV. HR and RSA are commonly assessed during rest (i.e., baseline), and in reaction to a physical or psychological/mental stressor, so that HR or RSA reactivity can be determined by calculating the difference between the two. HR and RSA reactivity can be used as indices of autonomic flexibility.
Previous studies on the relation between autonomic flexibility and anxiety are equivocal, showing evidence for either higher or lower autonomic flexibility in relation to anxiety. For instance, in cross-sectional studies of adults with anxiety problems, evidence was found for low HRV reactivity, reflecting lower autonomic flexibility (Friedman et al., 1993, Klein et al., 1995, Piccirillo et al., 1997, Tulen et al., 1996). However, the few findings in adolescents are less clear cut. Gerra et al. (2000) found that adolescent boys with an anxiety disorder showed a higher HR reactivity to a mixed-model stress task than controls. This suggests increased autonomic flexibility. Further, Mezzacappa et al. (1997) found a relation between anxiety and higher baseline HR when performing an orthostatic challenge test in adolescent males. This finding of a higher baseline HR could indicate reduced autonomic flexibility, when interpreting the already- high baseline HR values as ceiling effects. However, this explanation does not apply to the finding of higher HR reactivity in relation to anxiety (Gerra et al., 2000). To elucidate the relation between autonomic flexibility and anxiety in adolescence, it is therefore important to investigate measures of both baseline autonomic activity and reactivity.
In our earlier studies we investigated baseline and reactivity measures of HR and RSA in a general population sample aged 10–13 years old (Dietrich et al., 2007, Greaves-Lord et al., 2007). Since previous studies mainly concerned male adolescents, and did not consider the often co-occurring symptoms of depression, we also took into account these factors. We found that internalising problems (i.e., anxiety, depression and somatic complaints) were associated with higher baseline HR and lower baseline RSA (Dietrich et al., 2007), and more specifically, that anxiety was related to lower baseline RSA, especially in boys (Greaves-Lord et al., 2007).
Our previous work only concerned cross-sectional data. In a cross-sectional design it remains unclear whether autonomic flexibility indeed results in anxiety, or whether autonomic flexibility is in fact the result of long periods of anxiety. Therefore, a longitudinal design is needed to consider the predictive value of autonomic measures for future anxiety. To our knowledge, prospective studies on the relationship of autonomic flexibility with future anxiety levels in young adolescents are lacking. Therefore, the aim of the present study was to investigate whether measures of autonomic flexibility predict future anxiety levels, using data from a large, prospective cohort study of both boys and girls. We assessed HR and RSA in rest, and in reaction to an orthostatic challenge test. Possible gender differences and the role of co-occurring depressive problems were also examined.
Section snippets
Sample and procedure
The present study was part of the TRacking Adolescents' Individual Lives Survey (TRAILS). TRAILS is a prospective cohort study of Dutch young adolescents, who were 10–13 years old at the first assessment wave (wave 1; 2001–02; extensive study of a) psychopathology, including anxiety, and b) putative risk factors, including autonomic measures). They were re-assessed 2 years later in 2003–04 (wave 2; re-assessment of psychopathology, including anxiety). The target sample consisted of adolescents
Autonomic reactions
Both HR and RSA changed significantly in reaction to the orthostatic challenge test (change from supine rest to active standing; HR: t = − 57.5, df = 964, P < 0.01, RSA: t = 36.4, df = 964, P < 0.01). As expected, HR increased significantly, whereas RSA decreased significantly in reaction to standing up.
Descriptives
Mean scores, standard deviations and ranges of all independent and dependent variables are presented in Table 1.
Multiple regression analyses
Table 2 shows results of the two linear regression analyses performed with wave 2 anxiety
Discussion
In the present study, we investigated whether non-invasive cardiovascular measures indicating autonomic flexibility predicted future anxiety levels in young adolescent boys and girls. Measures of baseline autonomic activity (i.e., assessed during supine rest) did not predict anxiety levels two years later. However, low RSA reactivity predicted higher anxiety levels 2 years later in girls.
Acknowledgements
We are grateful to all adolescents, their parents and teachers who participated in this research and to everyone who worked on this project and made it possible. This research is part of the TRacking Adolescents' Individual Lives Survey (TRAILS). Participating centers of TRAILS include various departments of the University Medical Center and University of Groningen, the Erasmus University Medical Center Rotterdam, the University of Utrecht, the Radboud Medical Center Nijmegen and the Trimbos
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