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Attenuated vagally-mediated heart rate variability at rest and in response to postural maneuvers in patients with generalized anxiety disorder

Published online by Cambridge University Press:  07 June 2019

Hsin-An Chang
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Wen-Hui Fang
Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Fang-Jung Wan
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Nian-Sheng Tzeng
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Yia-Ping Liu
Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan Departments of Physiology and Psychiatry, Laboratory of Cognitive Neuroscience, National Defense Medical Center, Taipei, Taiwan
Jia-Fwu Shyu
Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
Tieh-Ching Chang
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
San-Yuan Huang
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Chuan-Chia Chang*
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Author for correspondence: Chuan-Chia Chang, E-mail:



Altered heart rate variability (HRV), an index of autonomic nervous system function, has been reported in generalized anxiety disorder (GAD), but the results have been mixed. Thus, the present study, using a large sample size and better methodology, aims to examine whether GAD is associated with impaired HRV, both at rest and in response to posture challenges.


In total, 1832 participants were recruited in this study, consisting of 682 patients with GAD (including 326 drug- and comorbidity-free GAD patients) and 1150 healthy controls. Short-term HRV was measured during the supine-standing-supine test (5-min per position). Propensity score matching (PSM), a relatively novel method, was used to control for potential confounders.


After PSM algorithm, drug- and comorbidity-free GAD patients had reductions in resting (baseline) high-frequency power (HF), an index for parasympathetic modulation, and increases in the low-frequency/HF ratio (LF/HF), an index for sympathovagal balance as compared to matched controls. Furthermore, the responses of HF and LF/HF to posture changes were all attenuated when compared with matched controls. Effect sizes, given by Cohen's d, for resting HF and HF reactivity were 0.42 and 0.36–0.42, respectively.


GAD is associated with altered sympathovagal balance, characterized by attenuation in both resting vagal modulation and vagal reactivity, with an almost medium effect size (Cohen's d ≈ 0.4), regardless of medication use or comorbidity status.

Original Articles
Copyright © Cambridge University Press 2019

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Equal contributors.


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