The Relationship between the Depression and Anxiety Stress Survey Questionnaire, Salivary Cortisol and Heart Rate Variability

Fateme  Sangtarash; Haniyeh  Choobsaz; Milad  Zarrin; Sousan  Salari; Ehsan Mokari  Manshadi; Ali Akbar  Esmaeili; Sayyed Hossein  Mozaffari; Boshra  Hatef

doi:10.18502/jmr.v19i1.17512

Fateme Sangtarash Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Haniyeh Choobsaz Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Milad Zarrin Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Sousan Salari Department of Clinical Psychology, Shahed University, Tehran, Iran.
Ehsan Mokari Manshadi Life Style Institute, Behavioral Science Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Ali Akbar Esmaeili Cognitive and Behavioral Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Sayyed Hossein Mozaffari Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Boshra Hatef Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jmr.v19i1.17512

Keywords: Anxiety; Salivary cortisol; Heart rate; Nonlinear analysis

Abstract

Introduction: Cortisol and heart rate variability (HRV) represent the activity of physiological stress axes. The depression and anxiety stress survey (DASS-42) is widely used to assess stress. This study examines the correlations between the DASS-42 questionnaire and stress markers, salivary cortisol levels and HRV.

Materials and 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. Differences in cortisol levels 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 the 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 (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 (SAM) activity. Clinicians can estimate the activity of this stress axis by using the anxiety subscale of the DASS questionnaire. Meanwhile, gender differences should be noted when assessing stress.