Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

RADAR-CNS Consortium

doi:10.1016/j.jad.2025.02.010

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

RADAR-CNS Consortium

Research output: Contribution to journal › Review article › peer-review

Abstract

Background: Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity. Methods: This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions. Results: Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR. Conclusions: Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

Original language	English
Pages (from-to)	139-148
Number of pages	10
Journal	Journal of Affective Disorders
Volume	376
DOIs	https://doi.org/10.1016/j.jad.2025.02.010
Publication status	Published - 1 May 2025

Keywords

Anxiety
Depression
Mobile health (mHealth)
Night resting heart rate
Real-world monitoring
Sleep disturbance

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10.1016/j.jad.2025.02.010

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@article{b8c580a5dce1447da000ddb417fce9eb,

title = "Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder",

abstract = "Background: Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity. Methods: This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions. Results: Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR. Conclusions: Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.",

keywords = "Anxiety, Depression, Mobile health (mHealth), Night resting heart rate, Real-world monitoring, Sleep disturbance",

author = "{RADAR-CNS Consortium} and Elena Condominas and Albert Sanchez-Niubo and Joan Dom{\`e}nech-Abella and Haro, {Josep Maria} and Raquel Bailon and Iago Gin{\'e}-V{\'a}zquez and Gemma Riquelme and Faith Matcham and Femke Lamers and Spyridon Kontaxis and Estela Laporta and Esther Garcia and {Pe{\~n}arrubia Maria}, {Maria Teresa} and White, {Katie M.} and Carolin Oetzmann and Peter Annas and Matthew Hotopf and Penninx, {Brenda W.J.H.} and Narayan, {Vaibhav A.} and Amos Folarin and Daniel Leightley and Nicholas Cummins and Yathart Ranjan and {de Girolamo}, Giovanni and Antonio Preti and Sara Simblett and Til Wykes and Inez Myin-Germeys and Richard Dobson and Sara Siddi",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier B.V.",

year = "2025",

month = may,

day = "1",

doi = "10.1016/j.jad.2025.02.010",

language = "English",

volume = "376",

pages = "139--148",

journal = "Journal of Affective Disorders",

issn = "0165-0327",

publisher = "Elsevier",

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TY - JOUR

T1 - Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

AU - RADAR-CNS Consortium

AU - Condominas, Elena

AU - Sanchez-Niubo, Albert

AU - Domènech-Abella, Joan

AU - Haro, Josep Maria

AU - Bailon, Raquel

AU - Giné-Vázquez, Iago

AU - Riquelme, Gemma

AU - Matcham, Faith

AU - Lamers, Femke

AU - Kontaxis, Spyridon

AU - Laporta, Estela

AU - Garcia, Esther

AU - Peñarrubia Maria, Maria Teresa

AU - White, Katie M.

AU - Oetzmann, Carolin

AU - Annas, Peter

AU - Hotopf, Matthew

AU - Penninx, Brenda W.J.H.

AU - Narayan, Vaibhav A.

AU - Folarin, Amos

AU - Leightley, Daniel

AU - Cummins, Nicholas

AU - Ranjan, Yathart

AU - de Girolamo, Giovanni

AU - Preti, Antonio

AU - Simblett, Sara

AU - Wykes, Til

AU - Myin-Germeys, Inez

AU - Dobson, Richard

AU - Siddi, Sara

PY - 2025/5/1

Y1 - 2025/5/1

N2 - Background: Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity. Methods: This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions. Results: Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR. Conclusions: Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

AB - Background: Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity. Methods: This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions. Results: Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR. Conclusions: Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

KW - Anxiety

KW - Depression

KW - Mobile health (mHealth)

KW - Night resting heart rate

KW - Real-world monitoring

KW - Sleep disturbance

UR - http://www.scopus.com/inward/record.url?scp=85216979373&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2025.02.010

DO - 10.1016/j.jad.2025.02.010

M3 - Review article

C2 - 39922289

AN - SCOPUS:85216979373

SN - 0165-0327

VL - 376

SP - 139

EP - 148

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

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Keywords

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