Trends in Daily Heart Rate Variability Fluctuations Are Associated with Longitudinal Changes in Stress and Somatisation in Police Officers

Abstract

The emergence of wearable sensors that allow for unobtrusive monitoring of physiological and behavioural patterns introduces new opportunities to study the impact of stress in a real-world context. This study explores to what extent within-subject trends in daily Heart Rate Variability (HRV) and daily HRV fluctuations are associated with longitudinal changes in stress, depression, anxiety, and somatisation. Nine Dutch police officers collected daily nocturnal HRV data using an Oura ring during 15–55 weeks. Participants filled in the Four-Dimensional Symptoms Questionnaire every 5 weeks. A sample of 47 five-week observations was collected and analysed using multiple regression. After controlling for trends in total sleep time, moderate-to-vigorous physical activity and alcohol use, an increasing trend in the seven-day rolling standard deviation of the HRV (HRVsd) was associated with increases in stress and somatisation over 5 weeks. Furthermore, an increasing HRV trend buffered against the association between HRVsd trend and somatisation change, undoing this association when it was combined with increasing HRV. Depression and anxiety could not be related to trends in HRV or HRVsd, which was related to observed floor effects. These results show that monitoring trends in daily HRV via wearables holds promise for automated stress monitoring and providing personalised feedback.

The Use of Photoplethysmography in the Assessment of Mental Health: Scoping Review

“…One study specifically focused on anxiety and found a positive relationship between the LF/HF ratio and anxiety based on self-assessments using the State-Trait Anxiety Scale [ 50 ]. HR [ 34 , 35 ] and RMSDD increase during stress [ 46 ].…”

“…HR was elevated when participants were stressed, and PPG could accurately capture these physiological changes, including HR reduction during relaxing exercises [ 10 , 42 , 43 , 64 , 65 ]. In addition to stress, PPG also accurately detects patients who are depressed [ 32 - 34 , 37 , 38 , 40 , 41 , 44 , 45 , 48 , 49 , 52 , 54 ], including those with MDD. In other words, depression was associated with a lower HR in contrast to stress.…”

“…Confounds such as hospitalization or the use of pharmacological treatments are essential to control the study design and analysis. None of the included studies reported hospitalization or pharmacological treatments; however, 5 out of 24 studies [ 31 , 34 , 39 , 41 , 53 ] paid attention to possible confounding factors.…”

Wearable-Measured Sleep and Resting Heart Rate Variability as an Outcome of and Predictor for Subjective Stress Measures: A Multiple N-of-1 Observational Study

“…The analyzed participants all scored relatively well on the mental well-being questionnaires ( Table 1 ). Another article that was based on data from this same study population showed that some participants reported moderately elevated stress and somatization throughout the study period, but that there were no clinically relevant signs of anxiety and depression [ 41 ]. Future studies with a more mentally challenged sample need to verify the current findings for more challenging conditions.…”

“…Data were collected for two purposes: (1) comparing longitudinal (5-week) trends in daily resting HRV and fluctuations therein to full questionnaire outcomes for stress, somatization, anxiety, and depression, and (2) the assessment of potential bidirectional and/or multi-day associations of sleep and resting HRV with stress-related EMA outcomes. The results of the former are published elsewhere [ 41 ], whereas the results of the latter are presented in this paper. The study protocol was approved by the ethical committee of the Hanze University of Applied Sciences Groningen (heac.2020.012).…”