A complex interplay between autonomic symptoms and symptoms of depression, anxiety, and stress

• Published in: Neurological sciences 2023-09, Vol.44 (9), p.3169-3179
• Main Authors: Junaković, Anamari, Skočić Hanžek, Milena, Adamec, Ivan, Krbot Skorić, Magdalena, Habek, Mario
• Format: Article
• Language: English
• Subjects: Anxiety; Autonomic Nervous System in Clinical Practice; Intolerance; Medicine; Medicine & Public Health; Mental depression; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Psychiatry; Regression analysis
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-023-06787-9

Background We evaluated the influence of symptoms of depression, anxiety, and stress on the results of COMPASS-31 in a large population of people referred to the head-up tilt test (HUTT) and healthy controls (HC). Methods Nine hundred fifty-nine consecutive patients referred to HUTT and 518 HC were enrolled. All participants completed Composite Autonomic Symptom Score-31 (COMPASS-31). Stress symptoms were evaluated by Depression, Anxiety, and Stress-21 (DASS-21) questionnaire. We corrected the result of the COMPASS-31 with the independent predictors in order to improve the specificity of the test. Results In both patients and HC, COMPASS-31 was higher in participants with depression, anxiety, and stress symptoms (all p < 0.001). In a multivariable linear regression analysis, HC was negative, while female sex and symptoms of depression, anxiety, and stress were independent positive predictors of COMPASS-31. In HC, COMPASS-31 had a median of 7.913, and this value differentiated between HC and patients with a high sensitivity of 87% and low specificity of 50%. In order to adjust the value of COMPASS-31 with the parameters that were significant in the multivariable linear regression model, we calculated the new corrected COMAPSS-31 (cCOMPASS-31), which had comparable sensitivity of 77%, but an increased specificity of 73%. Conclusion This study has shown that symptoms of depression, anxiety, and/or stress worsen the perceived severity of autonomic symptoms in people with symptoms of orthostatic intolerance and healthy population. cCOMPASS-31 is a valuable tool that can help clinicians in discerning the true autonomic background of patients’ complaints.