The International Journal of Neuropsychopharmacology

Special Section

Enhanced stress reactivity in paediatric anxiety disorders: implications for future cardiovascular health

Catherine  Monk  c1 a1, Pavel  Kovelenko  a1, Lauren M.  Ellman  a1, Richard P.  Sloan  a1, Emilia  Bagiella  a1, Jack M.  Gorman  a1 and Daniel S.  Pine  a1
a1 Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, and the College of Physicians and Surgeons of Columbia University, USA


The aim was to clarify the developmental nature of associations between psychiatric illness and risk for cardiovascular disease by investigating differences in cardiac functioning between youth with anxiety disorders and healthy controls. Twenty-two children meeting DSM-IV criteria for either separation anxiety disorder, overanxious disorder, panic disorder/panic attacks, or social phobia and 12 healthy controls underwent continuous electrocardiogram and respiration rate monitoring during a 15 min baseline period and 15 min of exposure to 5% CO2. Heart rate (HR) and high frequency heart rate variability (HRV), a non-invasive measure of cardiac parasympathetic control, were calculated. Youth with anxiety disorders had higher and less fluctuating HR during baseline. Data also suggested that probands showed diminished overall changes in HRV during baseline and CO2 inhalation relative to controls. However, as respiration rate affects HRV, these findings were confounded by changes in respiration elicited by CO2 inhalation. The data suggest that youth with anxiety disorders experience an elevated and less fluctuating HR in the face of a novel situation, possibly due to a failure to appropriately modulate HRV. In adults, sustained elevations in HR in conjunction with deficient vagal modulation predicts risk for future cardiovascular disease. As such, the current data suggest that the presence of an anxiety disorder may identify youth who exhibit autonomic profiles that place them at risk for cardiac disease.

(Received September 11 2000)
(Reviewed December 13 2000)
(Revised February 19 2001)
(Accepted February 20 2001)

Key Words: Paediatric anxiety disorders; cardiovascular disease; stress; heart rate; heart rate variability.

c1 Address for correspondence: Dr C. Monk, NYSPI, Unit no. 40, New York, NY 10032, USA. Tel.: 212-305-4509 Fax: 212-342-2847 E-mail: