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From the Department of Public Health Sciences (M.H., A.P., S.P.W., K.O.-G.), Division of Preventive Medicine, Karolinska Institute, Stockholm, Sweden; Department of Industrial Economics and Management (M.E.), Royal Institute of Technology, Stockholm, Sweden; Department of Cardiology (K.S.-G.), Karolinska Hospital, Stockholm, Sweden.
Address reprint requests to: Myriam Horsten, MA, Department of Public Health Sciences, Division of Preventive Medicine, Karolinska Institutet, Novum, Plan 7, S-141 57 Huddinge, Sweden. E:mail: Myriam.Horsten{at}phs.ki.se
OBJECTIVE: This study was conducted to investigate associations between psychosocial risk factors, including social isolation, anger and depressive symptoms, and heart rate variability in healthy women.
METHODS: The study group consisted of 300 healthy women (median age 57.5 years) who were representative of women living in the greater Stockholm area. For the measurement of social isolation, a condensed version of the Interpersonal Support Evaluation List was used and household size assessed. Anger was measured by the anger scales previously used in the Framingham study and depressive symptoms by a questionnaire derived from Pearlin. Health behaviors were measured by means of standard questionnaires. From 24-hour ambulatory electrocardiographic monitoring, both time and frequency domain measures were obtained: SDNN index (mean of the SDs of all normal to normal intervals for all 5-minute segments of the entire recording), VLF power (very low frequency power), LF power (low frequency power), HF power (high frequency power), and the LF/HF ratio (low frequency by high frequency ratio) were computed.
RESULTS: Social isolation and inability to relieve anger by talking to others were associated with decreased heart rate variability. Depressive symptoms were related only to the LF/HF ratio. Adjusting for age, menopausal status, exercise and smoking habits, history of hypertension, and BMI did not substantially change the results.
CONCLUSIONS: These findings suggest heart rate variability to be a mediating mechanism that could explain at least part of the reported associations between social isolation, suppressed anger, and health outcomes.
Key Words: psychosocial factors, • social support, • heart rate variability, • women.
Abbreviations: BMI = body mass index (kg/m2);; SBP = systolic blood pressure (mm Hg);; DBP = diastolic blood pressure (mm Hg);; HRT = hormone replacement therapy;; CHD = coronary heart disease;; JMP = John’s Macintosh program;; HRV = heart rate variability;; SDNN = SD of the normal to normal intervals (ms);; SDNN index = average of the SDs of all normal to normal intervals for each 5-minute interval of the entire recording (ms);; LF power = low frequency power (ms2);; HF power = high frequency power (ms2);; VLF power = very low frequency power (ms2);; LF/HF ratio = ratio of low-frequency to high-frequency power (none).
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