Reactive Heart Rate Variability and Cardiac Entropy in Children with Internalizing Disorder and Healthy Controls

  • Charlotte FiskumEmail author
  • Tonje G. Andersen
  • Magne A. Flaten
  • Per M. Aslaksen
  • Xavier Bornas
  • Karl Jacobsen


Atypical vagal reactivity has been linked to internalizing psychopathology and less adaptive emotion regulation, but reactive cardiac entropy is largely unexplored. Therefore, this study investigated reactive vagally-mediated heart-rate variability (vmHRV) and cardiac entropy in relation to emotion regulation. Electrocardiograms of 32 children (9–13 years) with internalizing difficulties and 25 healthy controls were recorded during a baseline and a sad film. Reactivity-measures were calculated from the root mean square of successive differences (RMSSD) and sample entropy (SampEn). Emotion regulation was assessed using the emotion regulation checklist (ERC). Determinants of reactive SampEn and RMSSD were analyzed with marginal and generalized linear models. The study also modeled the relationship between cardiac reactivity and emotion regulation while controlling for psychopathology. The two groups differed significantly in vmHRV-reactivity, with seemingly higher vagal-withdrawal in the control group. SampEn increased significantly during the film, but less in subjects with higher psychopathology. Higher reactive entropy was a significant predictor of better emotion regulation as measured by the ERC. Internalizing subjects and controls showed significantly different vmHRV-reactivity. Higher reactive cardiac entropy was associated with lower internalizing psychopathology and better emotion regulation and may reflect on organizational features of the neurovisceral system relevant for adaptive emotion regulation.


Cardiac complexity Reactive HRV Reactive complexity Negative emotion Emotion regulation 



The authors wish to thank the families who participated. The authors also wish to acknowledge professor Birgit Svendsen who contributed to the project before her passing in 2016, and student-assistants Mira Aasen and Marie Næss who helped with parts of the data collection. We also want to thank Drs. Matthew Long, Julian F. Thayer, Anita L. Hansen and Patrick Vogel for valuable discussions and input on the results. Finally, we wish to thank the reviewers for helpful comments on the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Authors and Affiliations

  1. 1.Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Department of Child and Adolescent PsychiatrySt. Olav’s University HospitalTrondheimNorway
  3. 3.Department of PsychologyThe Arctic UniversityTromsøNorway
  4. 4.Department of PsychologyThe University of the Balearic IslandsPalmaSpain

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