Depression and anxiety: Associations with biological and perceived stress reactivity to a psychological stress protocol in a middle-aged population

Background: Depression and anxiety have been linked to higher as well as lower reactivity to stressful circumstances. Large, population-based studies investigating the association between depression and anxiety, perceived and physiological stress responses are lacking. Methods: We studied 725 men and women, aged 55-60 years, from a population-based cohort, who filled out the Hospital Anxiety and Depression Scale (HADS). We performed a standardized interview on medical history and lifestyle. We measured continuous blood pressure (BP) and heart rate (HR) reactivity, saliva cortisol reactivity and perceived stress during a psychological stress protocol. Results: Albeit not statistically significant in all groups, systolic BP (SBP), diastolic BP (DBP), HR and cortisol reactivity to the psychological stress protocol were lower in those with mild-to-severe depression or anxiety symptoms and those ever clinically diagnosed with depression or anxiety, while perceived levels of stress were higher compared to those without depression or anxiety symptomatology. Maximum SBP, HR and cortisol stress responses significantly decreased and perceived stress scores significantly increased with increasing scores on the HADS depression subscale (HADS-D) and HADS anxiety subscale (HADS-A) (all P < 0.05). The same held for stress responses in relation to the total HADS score (all P < 0.05) and, in this case, the maximum DBP stress response was also significantly lower with an increasing HADS score (P = 0.05). In addition, the maximum DBP stress response was significantly lower for those ever clinically diagnosed with depression (P = 0.04). Adjusting for sex, use of anti-hypertensive medication, anti-depressant and anxiolytic medication, smoking, alcohol consumption, socio-economic status (SES) and body mass index (BMI) did not attenuate the results. Conclusion: The present study results suggest that the biological stress response of middle-aged men and women who experienced depressed and anxious feelings does not completely correspond with how stressed they feel at that moment. Although differences were not substantial in all cases, response to a psychological stress protocol seemed to be decreased in the groups with experience of depressed and anxious feelings, while the perception of stress seemed to be increased. (C) 2009 Elsevier Ltd. All rights reserved.