Heart rate variability in bipolar disorder: A systematic review and meta-analysis

Neurosci Biobehav Rev. 2017 Feb;73:68-80. doi: 10.1016/j.neubiorev.2016.12.007. Epub 2016 Dec 13.


Background: Heart rate variability (HRV) has been suggested reduced in bipolar disorder (BD) compared with healthy individuals (HC). This meta-analysis investigated: HRV differences in BD compared with HC, major depressive disorder or schizophrenia; HRV differences between affective states; HRV changes from mania/depression to euthymia; and HRV changes following interventions.

Methods: A systematic review and meta-analysis reported according to the PRISMA guidelines was conducted. MEDLINE, Embase, PsycINFO, The Cochrane Library and Scopus were searched. A total of 15 articles comprising 2534 individuals were included.

Results: HRV was reduced in BD compared to HC (g=-1.77, 95% CI: -2.46; -1.09, P<0.001, 10 comparisons, n=1581). More recent publication year, larger study and higher study quality were associated with a smaller difference in HRV. Large between-study heterogeneity, low study quality, and lack of consideration of confounding factors in individual studies were observed.

Conclusions: This first meta-analysis of HRV in BD suggests that HRV is reduced in BD compared to HC. Heterogeneity and methodological issues limit the evidence. Future studies employing strict methodology are warranted.

Keywords: Bipolar disorder; HRV; Heart rate variability; Meta-analysis; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Bipolar Disorder*
  • Depressive Disorder, Major
  • Heart Rate*
  • Humans
  • Schizophrenia