Design of a Remote Multiparametric Tool to Assess Mental Well-Being and Distress in Young People (mHealth Methods in Mental Health Research Project): Protocol for an Observational Study

BACKGROUND

Mental health conditions have become a substantial cause of disability worldwide, resulting in economic burden and strain on the public health system. Incorporating cognitive and physiological biomarkers using noninvasive sensors combined with self-reported questionnaires can provide a more accurate characterization of the individual's well-being. Biomarkers such as heart rate variability or those extracted from the electrodermal activity signal are commonly considered as indices of autonomic nervous system functioning, providing objective indicators of stress response. A model combining a set of these biomarkers can constitute a comprehensive tool to remotely assess mental well-being and distress.

OBJECTIVE

This study aims to design and validate a remote multiparametric tool, including physiological and cognitive variables, to objectively assess mental well-being and distress.

METHODS

This ongoing observational study pursues to enroll 60 young participants (aged 18-34 years) in 3 groups, including participants with high mental well-being, participants with mild to moderate psychological distress, and participants diagnosed with depression or anxiety disorder. The inclusion and exclusion criteria are being evaluated through a web-based questionnaire, and for those with a mental health condition, the criteria are identified by psychologists. The assessment consists of collecting mental health self-reported measures and physiological data during a baseline state, the Stroop Color and Word Test as a stress-inducing stage, and a final recovery period. Several variables related to heart rate variability, pulse arrival time, breathing, electrodermal activity, and peripheral temperature are collected using medical and wearable devices. A second assessment is carried out after 1 month. The assessment tool will be developed using self-reported questionnaires assessing well-being (short version of Warwick-Edinburgh Mental Well-being Scale), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) as the reference. We will perform correlation and principal component analysis to reduce the number of variables, followed by the calculation of multiple regression models. Test-retest reliability, known-group validity, and predictive validity will be assessed.

RESULTS

Participant recruitment is being carried out on a university campus and in mental health services. Recruitment commenced in October 2022 and is expected to be completed by June 2024. As of July 2023, we have recruited 41 participants. Most participants correspond to the group with mild to moderate psychological distress (n=20, 49%), followed by the high mental well-being group (n=13, 32%) and those diagnosed with a mental health condition (n=8, 20%). Data preprocessing is currently ongoing, and publication of the first results is expected by September 2024.

CONCLUSIONS

This study will establish an initial framework for a comprehensive mental health assessment tool, taking measurements from sophisticated devices, with the goal of progressing toward a remotely accessible and objectively measured approach that maintains an acceptable level of accuracy in clinical practice and epidemiological studies.

TRIAL REGISTRATION

OSF Registries N3GCH; https://doi.org/10.17605/OSF.IO/N3GCH.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51298.

Autonomic reactivity during acute social stress: exploratory investigation of an interaction by threat interpretation bias and emotion regulation difficulties

Objective: This preliminary study examined the interactive influences of interpretation bias and emotion dysregulation in predicting autonomic stress response.Methods: Participants (N = 72 college students; ages 18-25, 70% female, 47% Hispanic/Latinx), completed a performance-based assessment of threat interpretation bias and self-report measures of emotion regulation difficulties. Electrodermal activity (EDA; skin conductance level) was collected while participants completed a standardized psychosocial stressor task.Results: Interpretation bias and emotion regulation difficulties interacted to predict EDA trajectories (β = 0.054, SE = .001, CI:.007, .002, p < .001) during acute stress: presence of either interpretation bias toward threat (β = 6.950, SE = 2.826, CI: 1.407, 12.488, p = .013) or emotion regulation difficulties (β = 9.387, SE = 3.685, CI: 2.141, 16.636, p = .011) was associated with greater reactivity and poorer recovery; presence of both was associated with the lowest resting state EDA and blunted reactivity (β = 1.340, SE = 3.085, CI: -4.721, 7.407, p = .66).Conclusions: Preliminary findings support interpretation bias and emotion regulation difficulties, and their distinct interactive patterns, as predictors of autonomic reactivity trajectories during stress. Interpretation bias modification and emotion regulation skills may be important intervention targets for common psychological conditions that are influenced by aberrant psychophysiological processes.

Acute and Chronic Stress Associations With Blood Pressure: An Ecological Momentary Assessment Study on an App-Based Platform

OBJECTIVE

This study examined the within- and between-person associations of acute and chronic stress with blood pressure (BP) and heart rate (HR) using an app-based research platform.

METHODS

We examined data from 31,964 adults (aged 18-90 years) in an app-based ecological momentary assessment study that used a research-validated optic sensor to measure BP.

RESULTS

Within-person associations revealed that moments with (versus without) acute stress exposure were associated with higher systolic (SBP; b = 1.54) and diastolic BP (DBP; b = 0.79) and HR ( b = 1.53; p values < .001). During moments with acute stress exposure, higher acute stress severity than usual was associated with higher SBP ( b = 0.26), DBP ( b = 0.09), and HR ( b = 0.40; p values < .05). During moments without acute stress, higher background stress severity than usual was associated with higher BP and HR (SBP: b = 0.87, DBP: b = 0.51, HR: b = 0.69; p values < .001). Between-person associations showed that individuals with more frequent reports of acute stress exposure or higher chronic stress severity had higher SBP, DBP, and HR ( p values < .05). Between-person chronic stress severity moderated within-person physiological responses to stress such that individuals with higher chronic stress severity had higher average BP and HR levels but showed smaller responses to momentary stress.

CONCLUSIONS

Technological advancements with optic sensors allow for large-scale physiological data collection, which provides a better understanding of how stressors of different timescales and severity contribute to momentary BP and HR in daily life.

The association between self-reported stress and cardiovascular measures in daily life: A systematic review

BACKGROUND

Stress plays an important role in the development of mental illness, and an increasing number of studies is trying to detect moments of perceived stress in everyday life based on physiological data gathered using ambulatory devices. However, based on laboratory studies, there is only modest evidence for a relationship between self-reported stress and physiological ambulatory measures. This descriptive systematic review evaluates the evidence for studies investigating an association between self-reported stress and physiological measures under daily life conditions.

METHODS

Three databases were searched for articles assessing an association between self-reported stress and cardiovascular and skin conductance measures simultaneously over the course of at least a day.

RESULTS

We reviewed findings of 36 studies investigating an association between self-reported stress and cardiovascular measures with overall 135 analyses of associations between self-reported stress and cardiovascular measures. Overall, 35% of all analyses showed a significant or marginally significant association in the expected direction. The most consistent results were found for perceived stress, high-arousal negative affect scales, and event-related self-reported stress measures, and for frequency-domain heart rate variability physiological measures. There was much heterogeneity in measures and methods.

CONCLUSION

These findings confirm that daily-life stress-dynamics are complex and require a better understanding. Choices in design and measurement seem to play a role. We provide some guidance for future studies.

Implementing a Quantified Occupational Health Sensing Platform in the Aviation Sector: an Exploratory Study in Routine Air Traffic Control Work Shifts

Occupational stress is a complex process affecting health and performance. Air Traffic Control is a complex and demanding profession. The current study demonstrates the concept of using a biomonitoring wearable platform (BWP), that combines self-report measures with biomarkers, to track stress among Air Traffic Controllers. A wearable ECG device was used to gather continuously medical-grade ECG data along with a mobile app for daily stress perception, symptoms and events annotation. A total of 256 hours of data from 32 routine work shifts and 5 days-off, from 5 ATCs was recorded with 35 tagged events using Heart Rate Variability metrics- AVNN, RMSSD, pNN50 and LF/HF were computed from ECG data and analyzed during a) shifts vs days off; b) events vs non-events and c) before and after working pauses. ATCs showed low levels of chronic stress using self-reports. Results showed that stress symptomatology slightly increase from the beginning to the end of the shift (Md=1 to Md=2; p<0.05). Statistical significant physiological changes were found between shifts and days off for AVNN and LF/HF (p<0.05), showing higher physiological activation during shifts. A significant reduction of physiological arousal was verified after working pauses, particularly for AVNN and LF/HF (p<0.001). Self-reported data also suggests the same trend (p<0.005). Findings reinforced the discriminatory power of AVNN and LF/HF for short-term stress classification using HRV measurements. Results suggest that the rotating working system, with pause/resting periods included, effective acted as a recovery period.Clinical Relevance-Results provide important clues to the impact of stress on health, particularly cardiac reactivity and the identification of stress quantitative biomarkers as diagnostic indicators, providing a more reliable source for stress monitoring than currently behavioral or subjective measures. Findings will help on the design of stress management programs and prevention actions in order to avoid the negative effects of stress.

HPA axis responses to psychological challenge linking stress and disease: What do we know on sources of intra- and interindividual variability?

Stress is an ubiquitous phenomenon with significant impact on human physiology when it lasts too long, when it is too intense, or when it hits vulnerable individuals. Examining the mechanisms linking stress exposure with health and disease is an important endeavor in psychoneuroendocrine research. Empirical evidence so far revealed large intra- as well as inter-individual variability in hypothalamic-pituitary-adrenal (HPA) axis responses to acute psychosocial stress, showing that the HPA axis is a highly adaptive system. Thus, the characterization of intra- und inter-individual patterns of HPA axis reactivity is of high scientific interest and forms the basis on which mechanistic links between stress response (dys)regulation and health impairments can be examined. To date, basic knowledge has been, and still is, accumulated on demographic, biological (including genetic and epigenetic) factors, lifestyle behavioral variables, consumption of substances and medication, psychological and personality factors, as well as on methodological aspects. Besides this, there is also very recent progress in respect to the development of laboratory stress paradigms that can be applied in virtual reality or inside an MRI-scanner. In sum, the present review updates our current knowledge on moderating and intervening factors as sources of intra- und inter-individual variability in human cortisol stress responses and offers recommendations for future research designs.

Stress among on-duty firefighters: an ambulatory assessment study

BACKGROUND

Stress at work has been broadly acknowledged as a worldwide problem and has been the focus of concern for many researchers. Firefighting, in particular, is frequently reported as a highly stressful occupation. In order to investigate firefighters' occupational health in terms of stress events, perceptions, symptoms, and physiological reactions under real-world conditions, an ambulatory assessment protocol was developed.

METHODS

Seventeen firefighters' cardiac signal was continuously monitored during an average of three shifts within a working week with medical clinically certified equipment (VitalJacket®), which allows for continuous electrocardiogram (ECG) and actigraphy measurement. Psychological data were collected with a software application running on smartphones, collecting potential stressful events, stress symptoms, and stress appraisal.

RESULTS

A total of 450.56 h of medical-quality ECG were collected, and heart rate variability (HRV) analysis was performed. Findings suggest that although 'fire' situations are more common, 'accidents' are more stressful. Additionally, firefighters showed high levels of physiological stress (based on AVNN and LF/HF HRV metrics) when compared to normative healthy population values that may not be diagnosed using merely self-reports.

DISCUSSION

The proposed ambulatory study seems to be useful for the monitoring of stress levels and its potential impact on health of first responders. Additionally, it could also be an important tool for the design and implementation of efficient interventions and informed management resolutions in real time. Potential applications of this research include the development of quantified occupational health (qOHealth) devices for real life monitoring of emergency personnel stress reactions.

Psychophysiological Stress Assessment Among On-Duty Firefighters

Firefighting is a hazardous profession commonly exposed to high stress that can interfere with firefighter's health and performance. Nevertheless, on-duty stress levels quantitative evaluations are very rare in the literature. In order to investigate firefighters' occupational health in terms of stress perceptions, symptoms, and quantified physiological reactions under real-world conditions, an ambulatory assessment protocol was developed. Therefore, cardiac signal from firefighters ($N =6$) was continuously monitored during two shifts within a working week with a medical clinically certified equipment (VitalJacket®), allowing continuous electrocardiogram (ECG) and actigraphy measurement. Psychological data were collected with an android application, collecting potential stressful events, stress symptoms, and stress appraisal. A total of 130 hours of medical-quality ECG were collected, from which heart rate variability (HRV) metrics were extracted and analyzed. Statistical significant differences were found in some HRV metrics - AVNN, RMSSD, pNN50 and LF/HF - between events and non-events, showing higher levels of physiological stress during events (p<0.05). Stress symptoms increase from the beginning to the end of the shift (from 1.54 ± 0.52 to 2.01 ± 0.73), however the mean stress self-perception of events was very low (3.22 ± 2.38 in a scale ranging from 0 to 10). Negative and strong correlations were also found between stress symptoms and some time-domain ECG measures (AVNN, SDNN and pNN50). It can be concluded that stress may not always be detected when using merely self-reports. These results enhance the importance of combining both self-report and ambulatory high-quality physiological stress measures in occupational health settings. Future studies should investigate not only what causes stress but also its impact on health and well-being of these professionals, in order to contribute to the design of efficient stress-management interventions.