Abstract
The way people respond to stressful situations (i.e., stress reactivity) varies widely. Researchers typically measure stress reactivity in controlled studies, but this is limited because laboratory stressors cannot capture the variety, severity, or duration of stressors that individuals face in their daily lives. The present study examined the feasibility of using ecological momentary assessment (EMA) and a wireless electrocardiography (ECG) patch to develop an understanding of stress reactivity in natural settings. Thirty-five adult women completed EMA surveys about stressors they were exposed to while wearing a wireless ECG monitor for 7 consecutive days. Daily stressors were measured using seven questions adapted from the Daily Inventory of Stressful Events and a stressor interval was defined as the presence of at least one stressor during the EMA survey prompt. Participants wore the Cardea SOLO wireless ECG monitor (Cardiac Insight Inc., Bellevue, WA) to continuously track their heart rate. Participant-specific differences in 5-minute heart rate variability (HRV) between intervals when participants did and did not report stressors were calculated and displayed in a heat map. Survey response rate was satisfactory (72.0%, n = 588) and nearly all participants (33 out of 35) reported both stressor and non-stressor intervals. Each participant reported at least one stressor on approximately 35% of completed surveys while wearing the ECG patch. Mean wear time (6.6 days) and the duration of analyzable data with an ECG monitor were close to the 7-day study period. While many participants had lower HRV during stressor versus non-stressor intervals, the magnitude and direction of these differences varied widely. In summary, we found that a 7-day sampling scheme combining ecological momentary assessment (EMA) with HRV measured using continuous ECG monitoring was feasible and effective in capturing a variety of daily stressors and measuring autonomic stress reactivity.
Highlights
IntroductionWhile there is evidence of the contributions of stress to a variety of poor health outcomes, we know that psychosocial stressors are not internalized in the same way by everyone [1, 2]
Autonomic stress reactivity typically refers to changes in heart rate (HR) and heart rate variability (HRV) or blood pressure due to hyperactivation of the sympathetic nervous system and deactivation of the parasympathetic nervous system in response to stressors [11]
During the period they wore the patch, participants responded to 72.0% of all ecological momentary assessment (EMA) prompts and completed a total of 588 EMA surveys
Summary
While there is evidence of the contributions of stress to a variety of poor health outcomes, we know that psychosocial stressors are not internalized in the same way by everyone [1, 2]. When an individual appraises a stressor as threatening, their brain elicits a variety of emotional and physiological responses This includes activation of the autonomic nervous system as a result of sympathovagal imbalance due to the activation of the sympathetic nervous system and the withdrawal of the parasympathetic nervous system [4, 5]. Parasympathetic withdrawal contributes to heart rate and blood pressure elevations [8, 10] It is normal and healthy for your body to mount this type of response to a stressful situation, responses can be harmful when they do not adequately match the demands of the situation. Autonomic stress reactivity typically refers to changes in heart rate (HR) and heart rate variability (HRV) or blood pressure due to hyperactivation of the sympathetic nervous system and deactivation of the parasympathetic nervous system in response to stressors [11]. Lower HRV stress reactivity has been linked to general increased threat perception as well as depression, cardiovascular disease, and mortality [15, 16]
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