Recent studies have demonstrated the feasibility of administering the Trier Social Stress Test (TSST) through the internet, with major implications for promoting international inclusivity in research participation through extending typical sampling procedures beyond traditional geographical boundaries. However, online TSST studies to date are limited by the lack of a control group, which may be particularly problematic for studies administered through video mediated platforms, given evidence these interactions may be inherently stressful due to a minimization of nonverbal cues and overemphasis on facial expression. Furthermore, there is a need for biological measures of stress reactivity that can be fully implemented online, as extant research has relied upon laboratory measures that must be shipped back and forth between laboratory and participant. Here, we test smartphone-based photoplethysmography as a measure of heart rate reactivity to an online variant of the TSST. Results demonstrate significant acceleration in heart rate and self-reported stress and anxiety in the TSST condition relative to a placebo version of the TSST. The placebo procedures lead to a significant increase in self-reported stress and anxiety relative to baseline levels, but this increase was smaller in magnitude than that observed in the TSST condition. These findings highlight the potential for smartphone-based photoplethysmography in internet-delivered studies of cardiac reactivity and demonstrate that it is critical to utilize random assignment to a control or stressor condition when administering acute stress online.
BackgroundA growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is a lack of research examining the experiences of moral injury among those working in long-term care settings during the COVID-19 pandemic. Given the drastic impact that the COVID-19 pandemic has had on long-term care facilities in Canada, it is important to understand the experiences of moral injury among those working in long-term care settings to inform the development of effective prevention and intervention strategies.Objectives & MethodThe objectives of this study were to understand the experiences and impact of moral injury among Canadian frontline long-term care workers (staff and management) during the COVID-19 pandemic. Participants (N = 32 long-term care staff and management working in Ottawa and Manitoba) completed in-depth, semi-structured qualitative interviews and clinical diagnostic assessments (Mini International Neuropsychiatric Interviews; MINI; Version 7.0.2) between March 2021-June 2021.FindingsThe core category of our qualitative grounded theory model of moral injury in long-term care exemplified four shared types of morally injurious experiences, paired with cognitive, affective, and physiological symptom domains. Seven associated main themes emerged, contributing to the experiences and impact of moral injury in long-term care: 1) Beliefs about older adults and long-term care; 2) Interpretation of morally injurious experiences; 3) Management of morally injurious experiences; 4) Long-term care pandemic impacts; 5) Personal pandemic impacts; 6) Structural impacts in long-term care; and 7) Mental health needs and supports. Clinical assessments demonstrated anxiety disorders (n = 4) and feeding and eating disorders (n = 3) were among the most frequently classified current psychiatric disorders among long-term care workers.ConclusionsThis is the first Canadian study to examine the experiences and impact of moral injury in long-term care during the COVID-19 pandemic using qualitative and clinical diagnostic methodologies. Implications and insights for screening and intervention are offered.
Heart rate is a transdiagnostic marker of affective states and the stress diathesis model of health. While most psychophysiological research has been conducted in laboratory environments, recent technological advances have provided the opportunity to index heart rate dynamics in real world environments with commercially available mobile health (mHealth) and wearable photoplethysmography (PPG) sensors that allow for improved ecologically validity of psychophysiological research. Unfortunately, adoption of wearable devices is unevenly distributed across important demographic characteristics, including race, ethnicity, socioeconomic, education, and age making it difficult to collect heart rate dynamics in diverse populations. Therefore, there is a need to democratize mHealth PPG research by harnessing more widely adopted smartphone-based PPG to both promote inclusivity and examine whether smartphone-based PPG can predict concurrent affective states. In the current preregistered study with open data and code, we examined the covariation of smartphone-based PPG and self-reported stress and anxiety during an online variant of the Trier Social Stress Test (TSST), as well as prospective relationships between PPG and future perceptions of stress and anxiety in a sample of 103 adult participants. Results demonstrated that smartphone-based PPG significantly covaries with self-reported stress and anxiety during acute digital social stressors. PPG heart rate was significantly associated with concurrent self-reported stress, but not stress at subsequent time points. These findings highlight the potential use of smartphone-based PPG as an inclusive metric to index heart rate in remote digital study designs and indicate that PPG can provide a proximal, but not subsequent, measure of stress.
Objective Heart rate is a transdiagnostic correlate of affective states and the stress diathesis model of health. While most psychophysiological research has been conducted in laboratory environments, recent technological advances have provided the opportunity to index pulse rate dynamics in real world environments with commercially available mobile health (mHealth) and wearable photoplethysmography (PPG) sensors that allow for improved ecologically validity of psychophysiological research. Unfortunately, adoption of wearable devices are unevenly distributed across important demographic characteristics, including socioeconomic status, education, and age making it difficult to collect pulse rate dynamics in diverse populations. Therefore, there is a need to democratize mHealth PPG research by harnessing more widely adopted smartphone-based PPG to both promote inclusivity and examine whether smartphone-based PPG can predict concurrent affective states. Methods In the current preregistered study with open data and code, we examined the covariation of smartphone-based PPG and self-reported stress and anxiety during an online variant of the Trier Social Stress Test (TSST), as well as prospective relationships between PPG and future perceptions of stress and anxiety in a sample of 102 university students. Results Smartphone-based PPG significantly covaries with self-reported stress and anxiety during acute digital social stressors. PPG pulse rate was significantly associated with concurrent self-reported stress and anxiety (b = 0.44, p = 0.018) as well as prospective stress and anxiety at the subsequent time points, although the strength of this association diminished the farther away pulse rate got from self-reported stress and anxiety (lag 1 Model: b = 0.42, p = .024; lag 2 model: b = 0.38, p = 0.044). Conclusions These findings indicate that PPG provides a proximal measure of the physiological correlates of stress and anxiety. Smartphone-based PPG can be used as an inclusive method for diverse populations to index pulse rate in remote digital study designs.
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