The Relationship between DASS-42 Questionnaire, Salivary Cortisol and Heart Rate Variability
-
Fatemeh Sangtarash
,
Haniyeh Choobsaz
,
Milad Zarrin
,
Sousan Salari
,
Ehsan Mokari Manshadi
,
Ali Akbar Esmaeili
,
Sayyed Hossein Mozaffari
,
Boshra Hatef
Abstract
Background and Objectives: Cortisol and heart rate variability (HRV) represent the activity of physiological stress axes. The depression and anxiety stress survey (DASS-42) has been widely used to assess stress. This study examines the correlations between the DASS-42 questionnaire and stress markers, salivary cortisol levels and HRV.
Methods: A total of 195 healthy volunteers (145 males and 50 females) participated in this study. At first, the DASS-42 survey form was completed. The salivary cortisol samples were collected, and the electrocardiograms were recorded, respectively. Differences in cortisol between baseline and post-trier social stress tests were recorded as changes in cortisol after stress (CCAS). Measurements were made to establish whether the overall DASS and its subscales (stress, anxiety, and depression) were correlated with baseline cortisol, CCAS, and HRV indices.
Results: The anxiety-DASS subscale score correlated negatively with the CCAS score in women (r = -0.429, P = 0.002). The DASS score was significantly correlated with heart rate (r = 0.25, P = 0.007) and SD2 of Poincare plot (r = -0.272, P = 0.004) in men. In contrast, women showed significant correlations between total DASS scores with very low-frequency power (r = -0.40, P = 0.005) and detrended fluctuation analysis-α1 (r = -0.30, P = 0.034). The anxiety-DASS subscale correlated with HRV in both genders.
Conclusion: The anxiety-DASS subscale represents the sympathetic-adrenal medulla activity. Clinicians can estimate the activity of this stress axis by using the anxiety subscale of DASS questionnaire. Meanwhile, gender differences should be noted when assessing stress.
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24. Azad-Marzabadi E, Fesharaki MG. Job stress and related factors among iranian male staff using a path analysis model. Iranian Red Crescent Medical Journal. 2016;18(6).
25. Beauchaine T. Vagal tone, development, and Gray's motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Development and psychopathology. 2001;13(2):183-214.
26. Electrophysiology TFotESoCtNASoP. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93(5):1043-65.
27. Friedman BH. An autonomic flexibility–neurovisceral integration model of anxiety and cardiac vagal tone. Biological psychology. 2007;74(2):185-99.
28. Michels N, Sioen I, Huybrechts I, Bammann K, Vanaelst B, De Vriendt T, et al. Negative life events, emotions and psychological difficulties as determinants of salivary cortisol in Belgian primary school children. Psychoneuroendocrinology. 2012;37(9):1506-15.
29. Crick NR, ZAHN–WAXLER C. The development of psychopathology in females and males: Current progress and future challenges. Development and psychopathology. 2003;15(3):719-42.
30. Szabo M, Lovibond PF. Development and psychometric properties of the DASS-Youth (DASS-Y): an extension of the depression anxiety stress scales (DASS) to adolescents and children. Frontiers in Psychology. 2022;13:766890.
31. Michels N, Sioen I, Clays E, De Buyzere M, Ahrens W, Huybrechts I, et al. Children's heart rate variability as stress indicator: Association with reported stress and cortisol. Biological psychology. 2013;94(2):433-40.
32. Chen C, Jin Y, Lo IL, Zhao H, Sun B, Zhao Q, et al. Complexity change in cardiovascular disease. International journal of biological sciences. 2017;13(10):1320.
33. Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: Predictions to later emotional temperament. Child development. 1995;66(1):1-13.
34. Fyfe-Johnson AL, Muller CJ, Alonso A, Folsom AR, Gottesman RF, Rosamond WD, et al. Heart rate variability and incident stroke: the atherosclerosis risk in communities study. Stroke. 2016;47(6):1452-8.
35. Schommer NC, Hellhammer DH, Kirschbaum C. Dissociation between reactivity of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary system to repeated psychosocial stress. Psychosomatic medicine. 2003;65(3):450-60.
36. Shaverdi Y, Jahromi GP, Meftahi GH, Sharif MS, Mojabi N, Hatef B. The effect of Islamic praying on the heart rate variation in the adult Muslims. Journal of Modern Rehabilitation. 2024.
37. Sobhani V, Mokari EM, Aghajani J, Hatef B. Islamic praying changes stress-related hormones and genes. Journal of Medicine and Life. 2022;15(4):483.
2. Hovsepian K, Al'Absi M, Ertin E, Kamarck T, Nakajima M, Kumar S, editors. cStress: towards a gold standard for continuous stress assessment in the mobile environment. Proceedings of the 2015 ACM international joint conference on pervasive and ubiquitous computing; 2015.
3. Mohammadi A, Emamgoli A, Shirinkalam M, Meftahi GH, Yagoobi K, Hatef B. The persistent effect of acute psychosocial stress on heart rate variability. Egypt Heart J. 2019;71(1):18-.
4. Altamura M, Iuso S, Balzotti A, Francavilla G, Dimitri A, Cibelli G, et al. Salivary alpha-amylase and cortisol responsiveness to stress in first episode, drug-naive patients with panic disorder. Neuroscience research. 2018;137:49-56.
5. Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Frontiers Media SA; 2013. p. 26.
6. Parkitny L, McAuley J. The depression anxiety stress scale (DASS). Journal of physiotherapy. 2010;56(3):204.
7. Chandola T, Heraclides A, Kumari M. Psychophysiological biomarkers of workplace stressors. Neuroscience & Biobehavioral Reviews. 2010;35(1):51-7.
8. Johnell O, Kanis J. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international. 2006;17:1726-33.
9. Rondó PHdC, Vaz AJ, Moraes F, Tomkins A. The relationship between salivary cortisol concentrations and anxiety in adolescent and non-adolescent pregnant women. Brazilian journal of medical and biological research. 2004;37:1403-9.
10. Sungkono MH, Nooryanto M, Arianti DE. Association of social support with Depression and Anxiety Stress Score (DASS) and salivary cortisol level in women post curettage due to first-trimester miscarriage. The Journal of Obstetrics and Gynecology Science. 2020;1(1):18-22.
11. Kotozaki Y, Kawashima R. Effects of the Higashi-Nihon earthquake: posttraumatic stress, psychological changes, and cortisol levels of survivors. PloS one. 2012;7(4):e34612.
12. صاحبی, اصغری, سالاری, سادات ر. اعتبار یابی مقیاس افسردگی اضطراب تنیدگی (DASS-21) برای جمعیت ایرانی. روانشناسی تحولی: روانشناسان ایرانی. 2005;1(4):36-54.
13. Mohammadi A, Emamgoli A, Shirinkalam M, Meftahi GH, Yagoobi K, Hatef B. The persistent effect of acute psychosocial stress on heart rate variability. The Egyptian Heart Journal. 2019;71(1):18.
14. Mirzaee O, Saneian M, Vani JR, Shahrivar K, Peyravi M, Shariat A, et al. The Psychophysiological Responses of the Chronic Ischemic Stroke Patients to the Acute Stress were Changed. Brazilian Archives of Biology and Technology. 2019;62.
15. Ashtiani AA, Shaygannejad V, Ghobadi F, Bathaie R, Shahyad S, Hatef B. Acute Response of Stress System in Multiple Sclerosis. Archives of Neuroscience. 2021;8(4):9.
16. Mohammadi Alireza, Asgar Emamgoli, Maryam Shirinkalam, GolamHossein Meftahi, Shima Shahyad, Keyvan Yagoobi, et al. the persistent response to acute psychosocial stress Biomedical Signal Processing and Control. 2018.
17. Mohammadi A, Emamgoli A, Shirinkalam M, Meftahi GH, Yagoobi K, Hatef B. The persistent effect of acute psychosocial stress on heart rate variability. The Egyptian Heart Journal. 2019;71(1):1-9.
18. McCormick CM, Lewis E, Somley B, Kahan TA. Individual differences in cortisol levels and performance on a test of executive function in men and women. Physiology & behavior. 2007;91(1):87-94.
19. Larsson CA, Gullberg B, Råstam L, Lindblad U. Salivary cortisol differs with age and sex and shows inverse associations with WHR in Swedish women: a cross-sectional study. BMC endocrine disorders. 2009;9:1-11.
20. Druzhkova T, Pochigaeva K, Yakovlev A, Gersamia A, Guekht A, Gulyaeva N. Effects of Childhood Trauma on the Biological Correlates of Stress in Men and Women with Borderline Mental Disorders. Neuroscience and Behavioral Physiology. 2019;49(7):916-20.
21. Takahashi T, Ikeda K, Ishikawa M, Kitamura N, Tsukasaki T, Nakama D, et al. Anxiety, reactivity, and social stress-induced cortisol elevation in humans. Neuroendocrinology Letters. 2005;26(4):351-4.
22. Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. International journal of Psychophysiology. 2009;72(1):67-73.
23. Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25(1):1-35.
24. Azad-Marzabadi E, Fesharaki MG. Job stress and related factors among iranian male staff using a path analysis model. Iranian Red Crescent Medical Journal. 2016;18(6).
25. Beauchaine T. Vagal tone, development, and Gray's motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Development and psychopathology. 2001;13(2):183-214.
26. Electrophysiology TFotESoCtNASoP. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93(5):1043-65.
27. Friedman BH. An autonomic flexibility–neurovisceral integration model of anxiety and cardiac vagal tone. Biological psychology. 2007;74(2):185-99.
28. Michels N, Sioen I, Huybrechts I, Bammann K, Vanaelst B, De Vriendt T, et al. Negative life events, emotions and psychological difficulties as determinants of salivary cortisol in Belgian primary school children. Psychoneuroendocrinology. 2012;37(9):1506-15.
29. Crick NR, ZAHN–WAXLER C. The development of psychopathology in females and males: Current progress and future challenges. Development and psychopathology. 2003;15(3):719-42.
30. Szabo M, Lovibond PF. Development and psychometric properties of the DASS-Youth (DASS-Y): an extension of the depression anxiety stress scales (DASS) to adolescents and children. Frontiers in Psychology. 2022;13:766890.
31. Michels N, Sioen I, Clays E, De Buyzere M, Ahrens W, Huybrechts I, et al. Children's heart rate variability as stress indicator: Association with reported stress and cortisol. Biological psychology. 2013;94(2):433-40.
32. Chen C, Jin Y, Lo IL, Zhao H, Sun B, Zhao Q, et al. Complexity change in cardiovascular disease. International journal of biological sciences. 2017;13(10):1320.
33. Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: Predictions to later emotional temperament. Child development. 1995;66(1):1-13.
34. Fyfe-Johnson AL, Muller CJ, Alonso A, Folsom AR, Gottesman RF, Rosamond WD, et al. Heart rate variability and incident stroke: the atherosclerosis risk in communities study. Stroke. 2016;47(6):1452-8.
35. Schommer NC, Hellhammer DH, Kirschbaum C. Dissociation between reactivity of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary system to repeated psychosocial stress. Psychosomatic medicine. 2003;65(3):450-60.
36. Shaverdi Y, Jahromi GP, Meftahi GH, Sharif MS, Mojabi N, Hatef B. The effect of Islamic praying on the heart rate variation in the adult Muslims. Journal of Modern Rehabilitation. 2024.
37. Sobhani V, Mokari EM, Aghajani J, Hatef B. Islamic praying changes stress-related hormones and genes. Journal of Medicine and Life. 2022;15(4):483.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Anxiety, Salivary cortisol, Heart rate, Nonlinear analysis | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sangtarash F, Choobsaz H, Zarrin M, Salari S, Mokari Manshadi E, Esmaeili AA, Mozaffari SH, Hatef B. The Relationship between DASS-42 Questionnaire, Salivary Cortisol and Heart Rate Variability. jmr. 2024;(-).
