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A complex interplay between autonomic symptoms and symptoms of depression, anxiety, and stress

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Abstract

Background

We evaluated the influence of symptoms of depression, anxiety, and stress on the results of COMPASS-31 in a large population of people referred to the head-up tilt test (HUTT) and healthy controls (HC).

Methods

Nine hundred fifty-nine consecutive patients referred to HUTT and 518 HC were enrolled. All participants completed Composite Autonomic Symptom Score-31 (COMPASS-31). Stress symptoms were evaluated by Depression, Anxiety, and Stress-21 (DASS-21) questionnaire. We corrected the result of the COMPASS-31 with the independent predictors in order to improve the specificity of the test.

Results

In both patients and HC, COMPASS-31 was higher in participants with depression, anxiety, and stress symptoms (all p < 0.001). In a multivariable linear regression analysis, HC was negative, while female sex and symptoms of depression, anxiety, and stress were independent positive predictors of COMPASS-31. In HC, COMPASS-31 had a median of 7.913, and this value differentiated between HC and patients with a high sensitivity of 87% and low specificity of 50%. In order to adjust the value of COMPASS-31 with the parameters that were significant in the multivariable linear regression model, we calculated the new corrected COMAPSS-31 (cCOMPASS-31), which had comparable sensitivity of 77%, but an increased specificity of 73%.

Conclusion

This study has shown that symptoms of depression, anxiety, and/or stress worsen the perceived severity of autonomic symptoms in people with symptoms of orthostatic intolerance and healthy population. cCOMPASS-31 is a valuable tool that can help clinicians in discerning the true autonomic background of patients’ complaints.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Referral Center for Autonomic Nervous System Disorders, Department of Neurology, University Hospital Center Zagreb, Kišpatićeva 12, HR-10000, Zagreb, Croatia

    Anamari Junaković, Ivan Adamec, Magdalena Krbot Skorić & Mario Habek

  2. Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia

    Milena Skočić Hanžek

  3. School of Medicine, University of Zagreb, Zagreb, Croatia

    Milena Skočić Hanžek, Ivan Adamec & Mario Habek

  4. Faculty of Electrical Engineering, University of Zagreb, Zagreb, Croatia

    Magdalena Krbot Skorić

Authors
  1. Anamari Junaković
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  2. Milena Skočić Hanžek
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  3. Ivan Adamec
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  4. Magdalena Krbot Skorić
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  5. Mario Habek
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Contributions

Study concept and design: Habek. Acquisition of data: Junaković, Skočić Hanžek, Adamec, Krbot Skorić, Habek. Analysis and interpretation of data: Junaković, Skočić Hanžek, Adamec, Krbot Skorić, Habek. Drafting of the manuscript: Habek. Critical revision of the manuscript for important intellectual content: Junaković, Skočić Hanžek, Adamec, Krbot Skorić, Habek. Administrative, technical, and material support: Junaković, Skočić Hanžek, Adamec, Krbot Skorić, Habek.

Corresponding author

Correspondence to Mario Habek.

Ethics declarations

Ethical approval

The study protocol was approved by the ethical committees of the University Hospital Center Zagreb and the University of Zagreb, School of Medicine (class: 8.1-19/74-2; number: 02/21 AG).

Conflict of interest

AJ: nothing to disclose.

MSH: nothing to disclose.

IA: participated as a clinical investigator and/or received consultation and/or speaker fees from Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, and TG Pharmaceuticals.

MKS: received consultation and/or speaker fees from Sanofi Genzyme and Roche.

MH: participated as a clinical investigator and/or received consultation and/or speaker fees from Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, and TG Pharmaceuticals.

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Junaković, A., Skočić Hanžek, M., Adamec, I. et al. A complex interplay between autonomic symptoms and symptoms of depression, anxiety, and stress. Neurol Sci 44, 3169–3179 (2023). https://doi.org/10.1007/s10072-023-06787-9

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  • DOI: https://doi.org/10.1007/s10072-023-06787-9

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