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Trait Negative Affect: Toward an Integrated Model of Understanding Psychological Risk for Impairment in Cardiac Autonomic Function

From the Department of Psychiatry (M.E.B.), University of California San Francisco, San Francisco, California; Department of Psychiatry (P.J.G., J.R.J.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology (J.D.F.), Queens College, City University of New York, Flushing, New York; and the Department of Psychology (S.B.M.), University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Maria E. Bleil, Department of Psychiatry, University of California San Francisco, 3333 California Street, Suite 465, San Francisco, CA 94143-0848. E-mail: maria.bleil{at}ucsf.edu

Objective: To assess depression, anxiety, and anger as well as the variance that these emotions share (conceptualized as negative affect) in relationship to high-frequency heart rate variability (HF-HRV), a specific indicator of parasympathetic cardiac autonomic function related to premature cardiovascular morbidity and mortality. Although individual trait negative emotions have been studied in relation to risk for coronary heart disease (CHD) as well as biological mechanisms leading to CHD end points (e.g., autonomic nervous system [ANS] dysfunction), the degree to which a general tendency to experience negative emotions may account for these relations is not known.

Methods: The sample included 653 community volunteers (51.0% female; 15.8% Black) aged 30 to 54 years (mean ± standard deviation = 43.8 ± 7.1 years). Latent constructs of depression, anxiety, and anger were each measured by three scales from well-validated self-report questionnaires. Resting HF-HRV was derived from 5-minute segments of continuous electrocadiographs recorded during both unpaced and paced respiration conditions.

Results: Structural equation models (SEM) of the individual trait emotions showed depression and anxiety related inversely to HF-HRV and anger unrelated to HF-HRV. SEM also showed negative affect related inversely to HF-HRV. All associations were present after covariate adjustment for traditional cardiovascular risk factors, including age, sex, race, education, body mass index, smoking status, and blood pressure.

Conclusions: Negative affect as a common pathway between depression, anxiety, and anger and impairments in cardiac autonomic function was supported, suggesting negative affect may be the unifying and potentially toxic element linking individual trait negative emotions to ANS dysregulation.

Key Words: anger • anxiety • cardiac autonomic function • depression • heart rate variability • negative affect

Abbreviations: ANS = autonomic nervous system; CHD = coronary heart disease; HR = heart rate; HRV = heart rate variability; HF-HRV = high-frequency heart rate variability; ECG = electrocardiograph; SEM = structural equation modeling; RMSEA = root mean square error of approximation; CFI = comparative fit index; BMI = body mass index; BP = blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure; BDI = Beck Depression Inventory; CES-D = Center for Epidemiologic Studies Depression Scale; NEO-DEP = Depression facet scale of the NEO Personality Inventory-Revised (NEO PI-R); STAI-T = Trait Anxiety scale of the State-Trait Anxiety Inventory; NEO-ANX = Anxiety facet scale of the NEO PI-R; TCI-HA = Harm Avoidance scale of the Temperament and Character Inventory; STAXI-T = Trait Anger scale of the State-Trait Anger Expression Inventory (STAXI); STAXI-OUT = Anger-Out scale of the STAXI; NEO-ANG = Anger facet scale of the NEO PI-R.