Summary: Exposure to everyday stressors may result in impairments in endothelial function for patients with major depressive disorder. The findings reveal a possible reason for the association between stress, depression and an increased risk of cardiovascular disease.
Source: Penn State
Long-term stress has been linked with cardiovascular disease, but for people with depression, researchers say small, everyday stressors may be enough to diminish blood vessel function in otherwise healthy adults.
A team of researchers led by Penn State found that among adults with depression, those who had experienced stress in the previous 24 hours had worse endothelial function — a process that helps regulate blood flow — than those with depression alone.
Lacy Alexander, associate professor of kinesiology, said the results help explain the links between stress, depression and cardiovascular disease and may help design future intervention and prevention strategies.
“This study could be a jumping-off point for looking into whether if people are taught more behavioral strategies in dealing with everyday stressors, maybe that could be protective for their cardiovascular health,” Alexander said. “For example, maybe mindfulness or cognitive behavioral therapy could be beneficial not just for young, healthy adults, but also for those who are at risk for cardiovascular disease.”
Previous research has linked chronic exposure to stress with the development of cardiovascular disease. But the researchers said the exact processes of how stress affects the body and can contribute to cardiovascular disease are not known.
Jody Greaney, now an assistant professor at the University of Texas at Arlington, who led this study as a postdoctoral research fellow at Penn State, said that because depression is also linked with cardiovascular disease, she and the other researchers wanted to better understand how stress, depression and vascular function are connected.
“When I started studying how vascular function differs in adults with depression, it became clear that we had to consider the role of stress, as well,” Greaney said.
“If you’re chronically stressed, you’re more likely to develop depression. It’s just impossible to tease those two apart. We wanted to look at the three-way interaction between stress, depression and vascular function.”
For the study, the researchers recruited 43 healthy adults who did not have cardiovascular disease, did not use tobacco products and were recreationally active. The researchers also evaluated the participants for symptoms of depression.
On the day of the experiment, the participants reported any stressors they had experienced in the previous 24 hours, including arguments with a friend or family member or a stressful event at work or school.
The researchers also measured endothelial function by inserting a tiny fiber under the skin of the participants’ arms. The fiber allowed them to apply a small amount of the drug acetylcholine, which then affected the blood vessels in an area about the size of a dime. The researchers then looked at how the drug affected the endothelial function in those vessels.
In addition to stress being linked with worse endothelial function in people with depression, the researchers found other symptoms associated with depression.
“Adults with depression also experienced more stress and rated it as being more severe than healthy nondepressed adults, which confirms the link between stress and depression,” Greaney said. “Additionally, adults with depression may have worse vascular function in general, although endothelial function was worse when depression and stress were combined.”
Greaney said that in addition to being helpful for designing future prevention and intervention efforts, the results — recently published in the Journal of the American Heart Association — have helped underline the importance of the psychological aspects of certain conditions.
“As a physiologist, I’m used to drilling down into the specific mechanisms of vascular function without ever considering a psychological profile of that person,” Greaney said. “But this study would tell you that’s critically important to consider — the interplay because of physiology and psychology.”
In the future, Greaney said she hopes to continue researching a more comprehensive assessment of stress and additional measures of vascular function.
Funding: The National Institutes of Health, the National Center for Advancing Translational Sciences, and the American Heart Association helped support this work.
Erika F. H. Saunders, Shively-Tan Professor and Chair of the Department of Psychiatry; David M. Almeida, professor of human development and family studies; and Rachel E. Koffer, predoctoral training fellow, also worked on this research.
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Self‐Reported Everyday Psychosocial Stressors Are Associated With Greater Impairments in Endothelial Function in Young Adults With Major Depressive Disorder
Background Despite the epidemiological associations between psychological stress, depression, and increased cardiovascular disease risk, no studies have examined the relation between naturally occurring psychosocial stressors and directly measured microvascular function in adults with major depressive disorder (MDD). We tested the hypothesis that young adults with MDD exposed to everyday psychosocial stressors would exhibit more severe impairments in endothelium‐dependent dilation (EDD) compared with: (1) healthy nondepressed adults (HCs); and (2) adults with MDD without acute psychosocial stress exposure.
Methods and Results Twenty HCs (22±1 years) and 23 otherwise healthy adults with MDD (20±0.3 years) participated in the study. Participants completed a psychosocial experiences survey to document their exposure to any of 6 stressors over the preceding 24 hours (eg, arguments, work stressors). Red cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of acetylcholine (10−10 to 10−1mol/L). EDD was expressed as a percentage of maximum vascular conductance (flux/mm Hg). Multiple linear regression was used to determine the associations between stress, EDD, and MDD. Adults with MDD reported a greater number and severity of psychosocial stressors compared with HCs (all P<0.05). EDD was blunted in adults with MDD (HCs: 91±2 versus MDD: 74±3%; P<0.001). Exposure to any stressor was related to more severe impairments in EDD in patients with MDD (no stressor: 81±3 versus 1+ stressors: 69±5%; P=0.04) but not in HCs (P=0.48).
Conclusions These data indicate that exposure to everyday psychosocial stressors is associated with greater impairments in endothelial function in patients with MDD, suggesting a potential mechanistic link between daily stress and depression in increased cardiovascular risk.