Abstract
Background: Schizophrenia (SCH), which reduces the average life expectancy by 10-25 years, is associated with an increased risk of diabetes and cardiovascular disease. Elevated resting HR has been associated with increased risk for the development of cardiometabolic disease, which is common in SCH patients. This association may be due in part to increased sympathovagal tone inducing elevated resting HR. However, the impact of cardioprotective positive emotions such as trait forgiveness (TF) on HR and cardiac autonomic modulation via HRV in patients with SCH is not well known. We hypothesized that TF would be a significant predictor of HR in SCH patients. Methods: A total of 250 subjects (SCH patients = 80; male = 68; healthy controls [CON] = 170; Male = 115) participated in this study. SCH patients stopped antipsychotic medications 24-hrs before the experiments and were body weight (M ± SEM) (82 ± 5 Kg), aged matched (42 ± 4 years) with CON. Standardized scales were used to measure affectivity including depression (CESD), positivity of relationships (PR), rumination, and TF. After a 10-min rest period, 5-min ECG tracings were collected for HRV analysis. The non-parametric Mann-Whitney U Tests were used to evaluate the differences in HRV parameters at rest between SCH and CON. Hierarchical multiple regression (HMR) analyses were conducted to test the association between HR and affectivity to demonstrate the incremental contribution of sets of predictors in accounting for HR variance. Results: There were significant (p<0.01) differences between the groups (CON vs. SCH) in HR (72 ± 1.0 vs. 87 ± 1.4) and HRV the parameters Total Power (1822 ± 134 vs. 1183 ± 148), RMSSD (32.0 ± 1.7 vs. 19.0 ± 1.6), LF (762.7 ± 80.1 vs. 337.4 ± 45.0; surrogate of baroreflex function), and PR (26.1 ± 0.4 vs. 23.5 ± 0.7), but not TF. The HMR models showed that among affective symptoms, TF had an inverse relationship with heart rates and was the only significant predictor (p<.05) in the full model accounting for 8.1% in HR variance in the SCH group. Conclusions: These findings suggest that TF positively influences cardiac autonomic modulation in patients with SCH. Prospective studies aimed at examining TF as a cardioprotective behavioral intervention in SCH patients at increased cardiovascular risk.
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