Heart Rate Variability after Treatment for Depression in North Korean Defectors
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Heart Rate Variability after Treatment for Depression in North Korean Defectors Moon‑Soo Lee1 · Yae Eun Seo2 · Young Eun Mok1 · So Hee Lee2 Accepted: 13 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract North Korean Defectors (NKDs) are known to experience multiple psychological symptoms such depression and anxiety. Heart rate variability (HRV) has been implicated in various psychiatric disorders, including posttraumatic stress disorder (PTSD) and depression. No studies have prospectively evaluated HRV parameters in NKDs. We recruited 34 NKDs (2 men, 32 women; age range 25–58 years) who were diagnosed with major depressive disorder. We evaluated psychiatric symptoms using the Korean version of the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale, and PTSD checklist civilian version. We also performed HRV measurements before and after 12 weeks of antidepressant treatment. In the baseline, HDRS item 14 and 15 showed statistically significant positive correlation with LF/HF ratio. At the endpoint, HDRS item 5 and 8 were found to have positive correlations with some HRV parameters. We found that the sum of fatigue-related HDRS symptoms scores (number 7 and 13) showed significant positive correlation with LF. HDRS total scores also showed significant positive correlations with LF and HF. When the severity of depression was decreased and only the PTSD symptoms persisted at the endpoint, the relationships between HRV and clinical measures were more clearly revealed. This study shows the possibility of using HRV as an objective neurobiological index of autonomic nervous system disorder and reaction to stress in NKDs. Keywords Depression · Post-traumatic stress disorder · Heart rave variability · North Korean defector
Introduction North Korea has maintained its political system since 1945. The number of North Korean defectors (NKDs) has increased until recently because of poor living conditions including food shortages and economic difficulties (Lee et al. 2001). As of the beginning of 2018, an estimated 31,000 NKDs resided in South Korea (Ministry of Unification 2018). NKDs suffer from various traumatic experiences during their stay in, and the process of escape from, North Korea. Even after settlement in South Korea, defectors are also vulnerable to stressors including political and cultural differences, identity problems, and financial difficulties (An * So Hee Lee [email protected] 1
Department of Psychiatry, Korea University Guro Hospital, College of medicine, Guro‑gu, Seoul 08308, Republic of Korea
Department of Psychiatry, National Medical Center, 245 Eulji‑ro, Jung‑gu, Seoul 04564, Republic of Korea
2
et al. 2018). Accordingly, NKDs are known to experience multiple psychological symptoms such as depression, anxiety (Choi et al. 2011), and somatization (Kim et al. 2011). They are also formally diagnosed with psychiatric disorders such as depression and PTSD (Jeon et al. 2005). Heart rate variability (HRV) is a measure of auto
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