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.

Context

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 …