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

Anxiety is a common mental disorder with high individual and public health costs. Psychometric scales are frequently applied to describe anxiety severity; however, their subjective nature reduces measurement precision. Heart rate variability (HRV) may serve as a complementary tool for assessing anxiety by adding physiological information beyond subjective symptom ratings.

We conducted a systematic review and meta-analysis, reported in accordance with PRISMA 2020 (PROSPERO: CRD42024623381). We considered studies on adult populations who had been given validated anxiety scales (BAI, HAM-A and STAI) as well as quantitative HRV parameters (HF, LF, LF/HF, RMSSD, and SDNN). Correlation coefficients quantifying the associations for multiple psychometric scale - HRV parameter pairs were synthesised employing an inverse-variance random- effects meta-analysis framework.

A total of 79 studies were included, of which 39 were eligible in a quantitative analysis. Three statistically significant associations were identified: (1) BAI and HF showed a weak negative correlation (r = -0.09, p = .0239), (2) HAM-A and HF had a moderate negative correlation (r = -0.32, p = .0423), while (3) STAI and LF/HF ratio showed a positive correlation (r = 0.39, p = .0017). Other parameters did not show significant associations.

Selected HRV parameters showed associations with anxiety severity, especially HF with BAI and HAM-A, and LF/HF with STAI. While HRV is not a replacement for psychometric scales, it may contribute as a complementary tool for characterising autonomic regulation associated with anxiety severity.