ReviewAnxiety and physiological responses to the Trier Social Stress Test for Children in adolescents with cyclic vomiting syndrome

- Anxiety is prevalent in pediatric CVS warranting screening.
- HRV may serve as a biomarker for evaluating stress as a trigger for CVS episodes.
- State anxiety may provide a link to the association between stress and CVS episodes.

This study compared anxiety and physiological responses during the Trier Social Stress Test for Children (TSST-C) in adolescents. 38 subjects (26 females) were enrolled: 11 cyclic vomiting syndrome (CVS), 11 anxiety, and 16 controls. Salivary cortisol, α-amylase and heart rate variability (HRV) were assessed during the TSST-C. Anxiety was measured by the Screen for Childhood Anxiety Related Emotional Disorders (SCARED), Anxiety Disorders Interview Schedule, and State-Trait Anxiety Inventory for Children (STAI-C). 11 anxiety and 7 CVS subjects had ≥ 1 anxiety disorder. 82% in the anxiety and CVS groups met criteria for an anxiety disorder on the SCARED. Combining groups, cortisol increased from baseline to recovery during the TSST-C (p = 0.0004) and the stressor to recovery (p = 0.005). α-amylase did not differ during the TSST-C for the total sample, but increased for anxiety compared to controls from baseline to recovery (p = 0.01). HRV decreased during the stressor (p = 0.0001) and increased at recovery (p = 0.004). No associations were found between biomarkers and trait anxiety. Associations were found between baseline HRV and pre-test state anxiety (r = − 0.406, p = 0.012) and between recovery HRV and post-test state anxiety (r = − 0.501, p = 0.002) for the total sample. Anxiety is prevalent in CVS warranting screening. HRV may serve as a biomarker for evaluating stress as a potential trigger for CVS episodes. State but not trait anxiety was associated with changes in HRV, suggesting acute anxiety may be more relevant in linking stress and CVS episodes.