Educational Level Modifies the Relationship between Standard Deviation of NN Intervals and Post-traumatic Stress Disorder Development over Two-years
Ji Min Yoo1, Ju-Wan Kim1, Hee-Ju Kang1, Hyunseok Jang2, Jung-Chul Kim2, Ju-Yeon Lee1, Sung-Wan Kim1, Il-Seon Shin1, Jae-Min Kim1
1Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
2Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
Correspondence to: Jae-Min Kim
Department of Psychiatry, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea
E-mail: jmkim@chonnam.ac.kr
ORCID: https://orcid.org/0000-0001-7409-6306
Received: June 11, 2024; Revised: July 13, 2024; Accepted: July 14, 2024; Published online: October 10, 2024.
© The Korean College of Neuropsychopharmacology. All rights reserved.

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Abstract
Objective: This study investigated how educational levels modify the relationship between the standard deviation of NN intervals (SDNN) of heart rate variability and the development of post-traumatic stress disorder (PTSD).
Methods: Participants with physical injuries were enrolled from a trauma center and monitored over two years. Initial assessments included SDNN and educational attainment, along with socio-demographic and clinical variables. PTSD diagnoses were made at 3, 6, 12, and 24 months post-injury using the Clinician-Administered PTSD Scale for DSM-5. Logistic regression analyses were conducted.
Results: Of the 538 participants, 58 (10.8%) developed PTSD during the follow-up period. A significant interaction effect was observed: lower SDNN was significantly linked to PTSD in individuals with higher education, but not in those with lower education.
Conclusion: The study identified education-dependent associations between SDNN and PTSD development, emphasizing the importance of tailored PTSD prevention strategies that consider both SDNN and educational levels.
Keywords: Stress disorders, post-traumatic; Education; Heart rate variability; SDNN; Longitudinal studies

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