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Mental health
Blunted stress reactivity is a distinctive feature in clinically depressed patients
  1. Lolita Alfred,
  2. Vickie Howard
  1. School of Health and Social Work, Faculty of Health Sciences, University of Hull, Hull, UK
  1. Correspondence to Vickie Howard, School of Health and Social Work, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, UK; V.Howard{at}

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Commentary on: Schiweck C, Piette D, Berckmans D et al. Heart rate and high frequency heart rate variability during stress as biomarker for clinical depression. A systematic review. Psychol Med 2018 23:1–12. doi: 10.1017/S0033291718001988.

Implications for practice and research

  • Nurses must be aware that clinically depressed patients may exhibit reduced heart rate variability in response to stress.

  • Future research in this area needs to use larger sample sizes, and consider other factors such as childhood trauma history, subjective stress ratings, sleep quality and co-morbidity with anxiety disorders.


Depression is the leading cause of disability and morbidity worldwide.1 A complex mix of biopsychosocial risk factors is thought to contribute to the development and maintenance of depression.2 One of these factors is chronic mental stress.3 The review by Schiweck et al indicates that despite an increasing volume of research, there remains obscurity around the effects of depression on stress reactivity.4 An increased understanding of this may have important …

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  • LA and VH contributed equally.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.