Heart Rate Variability and Its Ability to Detect Worsening Suicidality in Adolescents: A Pilot Trial of Wearable Technology
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective Suicide is the 2nd leading cause of death in adolescence, and acute pediatric mental health emergency department (ED) visits have doubled in the past decade. The objective of this study was to evaluate physiologic parameters relationship to suicide severity.Methods This was a prospective, observational study from April 2018 thru November 2019 in a tertiary care pediatric emergency department (ED) and inpatient pediatric psychiatric unit enrolling acutely suicidal adolescent patients. Patients wore a wrist device that used photoplethysmography for 7 days during their acute hospitalization to measure heart rate variability (HRV). During that time, Columbia Suicide Severity Scores (CSSRS) were assessed at 3 time points.Results There was complete device data and follow-up for 51 patients. There was an increase in the high frequency (HF) component of HRV in patients that had a 25% or greater decrease in their CSSRS (mean difference 11.89 ms/ Hz ; p-value 0.005). Patients with a CSSRS≥15 on day of enrollment had a lower, although not statistically significant, HF component (mean difference -8.34 ms/ Hz; p-value 0.071).Conclusion We found an inverse correlation between parasympathetic activity measured through the HF component and suicidality in an acutely suicidal population of adolescents. Wearable technology may have the ability to improve outpatient monitoring for earlier detection and intervention.
Abstract
Objective Suicide is the 2nd leading cause of death in adolescence, and acute pediatric mental health emergency department (ED) visits have doubled in the past decade. The objective of this study was to evaluate physiologic parameters relationship to suicide severity.Methods This was a prospective, observational study from April 2018 thru November 2019 in a tertiary care pediatric emergency department (ED) and inpatient pediatric psychiatric unit enrolling acutely suicidal adolescent patients. Patients wore a wrist device that used photoplethysmography for 7 days during their acute hospitalization to measure heart rate variability (HRV). During that time, Columbia Suicide Severity Scores (CSSRS) were assessed at 3 time points.Results There was complete device data and follow-up for 51 patients. There was an increase in the high frequency (HF) component of HRV in patients that had a 25% or greater decrease in their CSSRS (mean difference 11.89 ms/ Hz ; p-value 0.005). Patients with a CSSRS≥15 on day of enrollment had a lower, although not statistically significant, HF component (mean difference -8.34 ms/ Hz; p-value 0.071).Conclusion We found an inverse correlation between parasympathetic activity measured through the HF component and suicidality in an acutely suicidal population of adolescents. Wearable technology may have the ability to improve outpatient monitoring for earlier detection and intervention.
참고문헌 (31)
- Web-Based Injury Statistics Query and Reporting System (WISQARS), "Center for Disease Control", National Center for Injury Prevention and Control, ~ (2019)
- Burstein B, "Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015", JAMA Pediatr, 173, pp.598~600 (2019)
- Sheridan DC, "Impact of an inpatient psychiatric unit on pediatric emergency mental health care", Pediatr Emerg Care, 33, pp.1~4 (2017)
- Mapelli E, "Trends in pediatric emergency department utilization for mental health-related visits", J Pediatr, 167, pp.905~910 (2015)
- Carroll R, "Hospital presenting self-harm and risk of fatal and non-fatal repetition : systematic review and meta-analysis", PLoS One, 9, pp.e89944~ (2014)
- Leon SL, "Child and adolescent mental health repeat visits to the emergency department : a systematic review", Hosp Pediatr, 7, pp.177~186 (2017)
- Rottenberg J, "Respiratory sinus arrhythmia as a predictor of outcome in major depressive disorder", J Affect Disord, 71, pp.265~272 (2002)
- Tsypes A, "Resting respiratory sinus arrhythmia in suicide attempters", Psychophysiology, 55, pp.10~ (2018)
- Chesin M, "Blunted arousal in response to psychological stress is associated with current suicide ideation", Arch Suicide Res, 24(sup2), pp.S381~S390 (2020)
- McGirr A, "Dysregulation of the sympathetic nervous system, hypothalamicpituitary-adrenal axis and executive function in individuals at risk for suicide", J Psychiatry Neurosci, 35, pp.399~408 (2010)
- Wilson ST, "Heart rate variability and suicidal behavior", Psychiatry Res, 240, pp.241~247 (2016)
- Forkmann T, "Resting vagal tone is negatively associated with suicide ideation", J Affect Disord, 194, pp.30~32 (2016)
- Schafer A, "How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram", Int J Cardiol, 166, pp.15~29 (2013)
- Scholkmann F, "An efficient algorithm for automatic peak detection in noisy periodic and quasi-periodic signals", Algorithms, 5, pp.588~603 (2012)
- Gipson PY, "Columbia-suicide severity rating scale : predictive validity with adolescent psychiatric emergency patients", Pediatr Emerg Care, 31, pp.88~94 (2015)
- Rogovoy NM, "Hemodialysis procedure-associated autonomic imbalance and cardiac arrhythmias : insights from continuous 14-day ECG monitoring", J Am Heart Assoc, 8, pp.e013748~ (2019)
- Andrews JA, "Suicidal attempts among older adolescents : prevalence and co-occurrence with psychiatric disorders", J Am Acad Child Adolesc Psychiatry, 31, pp.655~662 (1992)
- Campo JV, "Suicide prevention : time for ‘zero tolerance’", Curr Opin Pediatr, 21, pp.611~612 (2009)
- Chang HA, "Heart rate variability in patients with fully remitted major depressive disorder", Acta Neuropsychiatr, 25, pp.33~42 (2013)
- Koenig J, "Depression and resting state heart rate variability in children and adolescents-A systematic review and meta-analysis", Clin Psychol Rev, 46, pp.136~150 (2016)
- Schiweck C, "Heart rate and high frequency heart rate variability during stress as biomarker for clinical depression. A systematic review", Psychol Med, 49, pp.200~211 (2019)
- Adolph D, "High frequency heart rate variability : Evidence for a transdiagnostic association with suicide ideation", Biol Psychol, 138, pp.165~171 (2018)
- Jelinek HF, "Reducing suicidal ideation by biofeedbackguided respiration – heart rate coherence", Digit Psychiatry, 3, pp.1~11 (2020)
- Lewis GF, "Relaxation training assisted by heart rate variability biofeedback : Implication for a military predeployment stress inoculation protocol", Psychophysiology, 52, pp.1167~1174 (2015)
- Park SM, "Respiratory sinus arrhythmia biofeedback alters heart rate variability and default mode network connectivity in major depressive disorder : a preliminary study", Int J Psychophysiol, 158, pp.225~237 (2020)
- McAusland L, "Biofeedback to treat anxiety in young people at clinical high risk for developing psychosis", Early Interv Psychiatry, 12, pp.694~701 (2018)
- Goessl VC, "The effect of heart rate variability biofeedback training on stress and anxiety : a meta-analysis", Psychol Med, 47, pp.2578~2586 (2017)
- Hernando D, "Validation of the apple watch for heart rate variability measurements during relax and mental stress in healthy subjects", Sensors(Basel), 18, pp.2619~ (2018)
- Pestian JP, "A machine learning approach to identifying the thought markers of suicidal subjects : a prospective multicenter trial", Suicide Life Threat Behav, 47, pp.112~121 (2017)
- Shaffer F, "An overview of heart rate variability metrics and norms", Front Public Health, 5, pp.258~ (2017)
- Laborde S, "Heart rate variability and cardiac vagal tone in psychophysiological research-recommendations for experiment planning, data analysis, and data reporting", Front Psychol, 8, pp.213~ (2017)