Heart rate variability and anxiety severity: A systematic review and meta-analysis

Area of Science:

• Psychophysiology
• Mental Health Research
• Biomedical Engineering

Background:

• Anxiety is a prevalent mental disorder with significant health and economic burdens.
• Subjective anxiety scales lack precision; objective physiological measures are needed.
• Heart rate variability (HRV) offers a potential objective measure for anxiety assessment.

Purpose of the Study:

• To systematically review and meta-analyze associations between psychometric anxiety scales and HRV parameters.
• To determine the utility of HRV as a complementary tool for quantifying anxiety severity.

Main Methods:

• Systematic review and meta-analysis following PRISMA 2020 guidelines.
• Inclusion of studies using validated anxiety scales (BAI, HAM-A, STAI) and HRV parameters (HF, LF, LF/HF, RMSSD, SDNN).
• Synthesis of correlation coefficients using inverse-variance random-effects meta-analysis.

Main Results:

• Three significant associations identified: BAI-HF (weak negative), HAM-A-HF (moderate negative), and STAI-LF/HF ratio (positive).
• High-frequency (HF) component of HRV correlated with Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HAM-A).
• Low-frequency to high-frequency ratio (LF/HF) of HRV correlated with State-Trait Anxiety Inventory (STAI).

Conclusions:

• Selected HRV parameters, particularly HF and LF/HF, demonstrate associations with anxiety severity.
• HRV can serve as a complementary, objective measure to psychometric scales in anxiety assessment.
• HRV provides valuable physiological data on autonomic regulation related to anxiety.