Electrocardiography-derived autonomic profiles in depression and suicide risk with insights from the UK Biobank

The role of the autonomic nervous system (ANS) in depression and suicidality is multifaceted. This study examined whether distinct electrocardiography based ANS profiles exist, associated with a lifetime/recent at-risk cohort or a resilient group. Using data from 15,768 participants from the UK Biobank, four unique ANS activity patterns related to heart rate variability (HRV) measures were identified. Two specific clusters, both with low HRV, showed different risks: one characterized by high relative sympathetic tonus and lower breathing rate, indicated higher resilience with less likely depressive symptoms and suicidal thoughts whereas another cluster with dominant relative parasympathetic activity and high breathing rate, aligned with greater depression and suicide attempt prevalence, potentially representing a high-risk cluster. Resilience to depression might be defined by different psychophysiological entities and coping strategies, where the resilient cluster might be characterized by cognitive coping strategies, and increased susceptibility might be linked to more rigid maladaptive coping strategies.