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

On January 12th, 2022, Healthcare published our latest peer-reviewed research on Heart Rate Variability (HRV). The paper is titled “Trends in Daily Heart Rate Variability Fluctuations Are Associated with Longitudinal Changes in Stress and Somatisation in Police Officers” and is part of a special issue on Mental and Behavioral Healthcare. In this blogpost, I will attempt to summarize the article and how it complements our prior research in more lay language.

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.

Occupational stress can cause health problems, productivity loss or absenteeism. Resilience interventions that help employees positively adapt to adversity can help prevent the negative consequences of occupational stress. Due to advances in sensor technology and smartphone applications, relatively unobtrusive self-monitoring of resilience-related outcomes is possible. With models that can recognize intra-individual changes in these outcomes and relate them to causal factors within the employee's context, an automated resilience intervention that gives personalized, just-in-time feedback can be developed. This paper presents the conceptual framework and methods behind the WearMe project, which aims to develop such models. A cyclical conceptual framework based on existing theories of stress and resilience is presented as the basis for the WearMe project. The operationalization of the concepts and the daily measurement cycle are described, including the use of wearable sensor technology (e.g., sleep tracking and heart rate variability measurements) and Ecological Momentary Assessment (mobile app). Analyses target the development of within-subject (n=1) and between-subjects models and include repeated measures correlation, multilevel modelling, time series analysis and Bayesian network statistics. Future work will focus on further developing these models and eventually explore the effectiveness of the envisioned personalized resilience system.

This week, JMIR (Journal of Medical Internet Research) Cardio published our paper ‘Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured With a Wearable and Smartphone App: Within-Subject Design Using Continuous Monitoring‘. In this blogpost, I’ll attempt to break down the paper’s key findings in relatively lay language.

Background The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual’s resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes.

Presentatie CREUVENT evenement De Haagse Hogeschool. Een evenement gerelateerd aan o.a. juridische en ethische aspecten rondom het doen van onderzoek onder werknemers met behulp van wearables en apps.

Poster presentatie interne conferentie Marian van Os Centrum voor Ondernemerschap

Occupational stress can cause health problems, productivity loss or absenteeism. Resilience interventions that help employees positively adapt to adversity can help prevent the negative consequences of occupational stress. Due to advances in sensor technology and smartphone applications, relatively unobtrusive self-monitoring of resilience-related outcomes is possible. With models that can recognize intra-individual changes in these outcomes and relate them to causal factors within the employee's context, an automated resilience intervention that gives personalized, just-in-time feedback can be developed. This paper presents the conceptual framework and methods behind the WearMe project, which aims to develop such models. A cyclical conceptual framework based on existing theories of stress and resilience is presented as the basis for the WearMe project. The operationalization of the concepts and the daily measurement cycle are described, including the use of wearable sensor technology (e.g., sleep tracking and heart rate variability measurements) and Ecological Momentary Assessment (mobile app). Analyses target the development of within-subject (n=1) and between-subjects models and include repeated measures correlation, multilevel modelling, time series analysis and Bayesian network statistics. Future work will focus on further developing these models and eventually explore the effectiveness of the envisioned personalized resilience system.

Occupational stress can cause all kinds of health problems. Resilience interventions that help employees deal with and adapt to adverse events can prevent these negative consequences. Due to advances in sensor technology and smartphone applications, relatively unobtrusive self-monitoring of resilience-related outcomes is possible. With models that can recognize intra-individual changes in these outcomes and relate them to causal factors within the employee’s own context, an automated resilience intervention that gives personalized, just-in-time feedback can be developed. The Wearables and app-based resilience Modelling in employees (WearMe) project aims to develop such models. A cyclical conceptual framework based on existing theories of stress and resilience is presented, as the basis for the WearMe project. The included concepts are operationalized and measured using sleep tracking (Fitbit Charge 2), heart rate variability measurements (Elite HRV + Polar H7) and Ecological Momentary Assessment (mobile app), administered in the morning (7 questions) and evening (12 questions). The first (ongoing) study within the WearMe project investigates the feasibility of the developed measurement cycle and explores the development of such models in social studies students that are on their first major internship. Analyses will target the development of both within-subject (n=1) models, as well as between-subjects models. The first results will be shared at the Health By Tech 2019 conference in Groningen. If successful, future work will focus on further developing these models and eventually exploring the effectiveness of the envisioned personalized resilience system.

Occupational stress can cause all kinds of health problems. Resilience interventions that help employees deal with and adapt to adverse events can prevent these negative consequences. Due to advances in sensor technology and smartphone applications, relatively unobtrusive self-monitoring of resilience-related outcomes is possible. With models that can recognize intra-individual changes in these outcomes and relate them to causal factors within the employee’s own context, an automated resilience intervention that gives personalized, just-in-time feedback can be developed. The Wearables and app-based resilience Modelling in employees (WearMe) project aims to develop such models. A cyclical conceptual framework based on existing theories of stress and resilience is presented, as the basis for the WearMe project. The included concepts are operationalized and measured using sleep tracking (Fitbit Charge 2), heart rate variability measurements (Elite HRV + Polar H7) and Ecological Momentary Assessment (mobile app), administered in the morning (7 questions) and evening (12 questions). The first (ongoing) study within the WearMe project investigates the feasibility of the developed measurement cycle and explores the development of such models in social studies students that are on their first major internship. Analyses will target the development of both within-subject (n=1) models, as well as between-subjects models. The first results will be shared at the Health By Tech 2019 conference in Groningen. If successful, future work will focus on further developing these models and eventually exploring the effectiveness of the envisioned personalized resilience system.