Short communicationNonverbal behaviors are associated with increased vagal activity in major depressive disorder: Implications for the polyvagal theory

•The polyvagal theory sustains that vagal activity regulates heart rate and facial expression.•We explored the association of non-verbal behaviors (NVBs) with HRV in 50 depressed patients.•Positive NVBs were associated with increased vagal activity in depression.•Negative NVBs were not associated with HRV in depression.•NVBs and vagal activity are depression endophenotypes that are related.

BackgroundMajor depressive disorder (MDD) is associated with impairments in nonverbal behaviors (NVBs) and vagal activity. The polyvagal theory proposes that vagal activity regulates heart rate and NVBs by modulating a common anatomically and neurophysiologically discrete social engagement system. However, the association between these putative endophenotypes has not yet been explored. We hypothesize that in MDD, NVBs indicating positive affects and social interest and those indicating negative feelings and social disinterest could be associated with different patterns of vagal activity.MethodsFor this cross-sectional study we recruited 50 antidepressant-free participants with moderate-to-severe MDD. Vagal activity was indexed by heart rate variability (HRV) measures, and positive and negative nonverbal behaviors (NVBs) by a validated ethogram. Associations between NVBs and HRV were explored by bivariate analyses and multivariable models were adjusted by age, gender, depression severity, and self-reported positive and negative affects.ResultsHRV measures indicative of higher vagal activity were positively correlated with positive NVBs exhibited during the clinical interview. Conversely, NVBs related to negative affects, low energy and social disinterest were not associated with HRV.LimitationsAbsence of a control group.ConclusionsThe findings highlight that the examined depression endophenotypes (nonverbal behaviors and vagal activity) are related, shedding light on MDD pathophysiology in the context of the polyvagal theory.