Key result
Greater anterior insula BOLD activation during cardiac interoception links to worse depressive symptoms in postmenopausal women.
Why the study?
The study aimed to determine whether subclinical depressive symptoms in postmenopausal women are associated with anterior insula BOLD activity during cardiac interoceptive awareness, and whether this differs by HIV status.
Cross-Sectional (n=50)
No
Effect estimate: β = 0.290 (left insula), β = 0.318 (right insula)
p-value: p=0.032 (left), 0.018 (right)
Greater BOLD signal in the anterior insula during cardiac interoception with distracting stimuli is associated with depressive symptom severity in postmenopausal women, regardless of HIV status.
May link anterior insula activity to depressive severity in postmenopausal women; hypothesis-generating, prospective studies required before clinical translation.
OBJECTIVE: This study aimed to determine whether subclinical symptoms of depression in postmenopausal women are associated with blood oxygen level-dependent (BOLD) activity within the anterior insula during cardiac interoceptive awareness and whether this association differs for persons living with the human immunodeficiency virus (PWH). METHOD: Twenty-three postmenopausal (mean [standard deviation] age = 56.5 [4.8] years) and 27 HIV-negative women (mean [standard deviation] age = 56.4 [8.0]) underwent functional magnetic resonance imaging while performing a heartbeat detection task. BOLD activation within the bilateral anterior insula based on the contrast of a heartbeat detection condition with and without a distracting tone was entered along with age, HIV status, and psychological stress into two multivariate regression models with self-reported depressive symptom severity as the outcome. RESULTS: Depressive symptoms did not vary by HIV status, nor was there a main effect or interaction for PWH on insula BOLD activation. Depressive symptoms were positively associated with psychological stress for the left ( β = 0.310, t (49) = 2.352, p = .023) and right brain models ( β = 0.296, t (49) = 2.265, p = .028) as well as the magnitude of BOLD activation in the left insula ( β = 0.290, t (49) = 2.218, p = .032) and right insula ( β = 0.318, t (49) = 2.453, p = .018), respectively. Exploratory analyses revealed that greater magnitude of BOLD activation attributed to exteroceptive noise (tone) was also correlated with self-reported distrust and preoccupation with interoceptive sensations. CONCLUSIONS: Results support an active interference model for interoceptive awareness wherein greater BOLD signal in the anterior insula in the presence of distracting exteroceptive stimuli may reflect greater prediction error, a feature of depression.
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McIntosh et al. (2022) conducted a cross-sectional in Subclinical depressive symptoms in HIV-positive and HIV-negative postmenopausal women (n=50). Cardiac interoceptive awareness task (heartbeat detection with and without distracting tone) vs. HIV-negative postmenopausal women was evaluated on Association between depressive symptom severity and BOLD activation in the anterior insula during cardiac interoception (H - HT contrast) (β = 0.290 (left insula), β = 0.318 (right insula), p=0.032 (left), 0.018 (right)). Greater magnitude of BOLD activation in the left (β = 0.290) and right (β = 0.318) anterior insula during a cardiac interoception task with distracting noise was positively associated with depressive symptom severity in postmenopausal women, regardless of HIV status.
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