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Researchers looked for a biomarker of PTSD with heart rate variability

5/19/2025

 
Like all previous attempts to find biomarkers for PTSD, failure was predestined.
CATEGORY: CONTROL OF LANGUAGE AND IDEAS
Picture
Lauriane Guichard, MD
Source: Psychiatry Research
Read time: 2.0 minutes

 
This Happened
Researchers measured heart rate variability repeatedly in individuals for six months after they experienced traumatic incidents, hoping to identify those with more severe PTSD symptoms at a single time point or to predict those whose symptoms would worsen in the future.
This was an attempt to discover a biomarker, which is a measure of biology that indicates a disease state or tracks with the worsening or improvement of symptoms. An example in medicine is the HbA1c blood test which can predict diabetes.
 
Who Did This?
Lauriane Guichard, MD, is Assistant Professor of Anesthesiology at UNC-Chapel Hill. She first- or co-authored approximately thirty publications on anesthesia and surgery. This is her only publication on trauma. This publication had 41 co-authors, many of whom have extensively published on trauma and PTSD.
 
The Claim
The motivation for this study was that the researchers believed the post-trauma psychiatric problems of too many people are not being diagnosed and these people are not receiving treatment that could help them. If successful, this would discover biomarkers of psychological problems that would not require self-disclosure.
They recruited 2,032 adults from 27 emergency departments who suffered traumatic events. These were mostly motor vehicle accidents (76%). For six months, subjects wore wrist devices that measured heart rate. They also answered surveys about their symptoms (nightmares, anxiety, sleep difficulty, etc.) on their smartphones at 10 or 11 time points.
 
Researchers conducted a comprehensive and complicated set of statistical tests that involved 10 psychological outcomes, 50 possible biomarker variables, and both cross-sectionally and longitudinally.
Results were less than exciting. When associations were found between heart rate variables and psychological outcomes, they were small, plagued by both many false positives and false negatives, and results often differed between sexes for inexplicable reasons.
Of the 50 possible biomarkers, not one achieved both sensitivity and precision.
The authors concluded, somewhat wistfully, that “these biomarkers might be most useful as a tool to supplement other existing measures such as self-reported symptoms.”
 
Analysis
This study raises two important concerns. First, this study illustrated that efforts to identify biomarkers for PTSD, and probably for any psychiatric syndrome, are of limited utility.
No biomarker has been identified for any psychiatric disorder. This is not for lack of trying.
​Thousands of studies have been published on potential biomarkers, including heart rate, hypothalamic-pituitary axis, cortisol, inflammatory factors, and brain imaging [1, 2, 3]. This body of literature empirically demonstrates that this research topic is not fruitful. 
The manifestation of symptoms in psychiatric syndromes are too heterogenous. The underlying neurobiology of symptoms is much more complicated than people know or pretend to know.
 
Second, even if biomarkers could be identified, no one has presented a strong case for how they might be useful. One weak argument has been that identification of a biomarker could lead to prevention before symptoms develop, but there are no known preventable psychiatric syndromes. Another weak argument is that biomarkers could help clinicians track the course of waxing and waning of syndromes, but this is already easily accomplished simply by asking individuals about their symptoms. A final weak argument is that biomarkers could lead to targeted treatment interventions, but there is no known menu of treatment interventions that can narrowly target specific systems.
 
These are well-known and obvious concerns, but you would not know it by reading this study, or by reading almost any study or review of biomarkers. Like much of trauma research, authors in this field are prone to over-interpret their findings and try to deceive themselves and others that we know more than we do.
 
​
References
[1] Schmidt, U., Willmund, G.-D., Holsboer, F., Wotjak, C. T., Gallinat, J., Kowalski, J. T., & Zimmermann, P. (2015). Searching for non-genetic molecular and imaging PTSD risk and resilience markers: Systematic review of literature and design of the German Armed Forces PTSD biomarker study. Psychoneuroendocrinology, 51, 444–458. https://doi.org/10.1016/j.psyneuen.2014.08.020
 
[2] Yang, J.-J., & Jiang, W. (2020). Immune biomarkers alterations in post-traumatic stress disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 268, 39–46. https://doi.org/10.1016/j.jad.2020.02.044
 
[3] Sbisa, A. M., Madden, K., Toben, C., McFarlane, A. C., Dell, L., & Lawrence-Wood, E. (2023). Potential peripheral biomarkers associated with the emergence and presence of posttraumatic stress disorder symptomatology: A systematic review. Psychoneuroendocrinology, 147, 1–17. https://doi.org/10.1016/j.psyneuen.2022.105954


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