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Recognition and clinical management of depression in patients with congestive heart failure¹ may be facilitated by monitoring the rate of speech hesitation pauses (SHPs) of 1 second or more, which correlated with (1) immobility in the face of stress, (2) the state of the circulatory system (angina and/or hypertension), and (3) a 6-fold incidence of clinical coronary heart disease in 2 groups of men with normal coronary structure observed prospectively for 10 years (P<.05). Neurobiological features are demonstrated by (1) reports that SHPs are behavioral correlates of mood; (2) the correlation of rate and variability in duration of SHPs with the left hemisphere and right hemisphere, respectively; (3) profound effects on angina of consciously focusing attention on breathing and intervening pauses; and (4) the association of reduction in blood pressure with longer, less recurrent SHPs (about 2 seconds). Additionally, the microvascular response to the onset of neural activity . . . [Full Text of this Article]

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