Depression and resting state heart rate variability in children and adolescents — A systematic review and meta-analysis

•In adults, depression is associated with reduced resting state high-frequency heart rate variability (HF-HRV).•We reviewed the evidence on such association in children and adolescents.•We found lower resting state HF-HRV in clinically depressed adolescents.•Unlike in adults, depressive symptom severity is not associated with HF-HRV.•Clinical implications and suggestions for future research are provided.

Among adults, depression is associated with reduced vagal activity, as indexed by high frequency heart rate variability [HF-HRV]), which correlates inversely with depression severity. Available evidence in depressed children and adolescents remains to be reviewed systematically. A search of the literature was performed to identify studies reporting (i) HF-HRV in clinically depressed children/adolescents relative to controls (k = 4, n = 259) and (ii) the association between HF-HRV and depressive symptoms as measured by standardized psychometric instruments in children and adolescents (k = 6, n = 2625). Random-effects meta-analysis on group differences revealed significant effects that were associated with a moderate effect size (Hedges' g = − 0.59; 95% CI [− 1.05; − 0.13]), indicating lower resting state HF-HRV among clinically depressed children/adolescents (n = 99) compared to healthy controls (n = 160), consistent with findings among adults. While no correlation between HF-HRV and depressive symptom severity was observed (r = −.041 [− 0.143; 0.062]), these additional correlational findings are limited to non-clinical samples. Findings have important clinical implications including a potentially increased risk for future physical ill health and also the identification of potential new treatment targets in child and adolescent depression.