Factors associated with longitudinal psychological and physiological stress in health care workers during the covid-19 pandemic: Observational study using apple watch data

Robert P. Hirten, Matteo Danieletto, Lewis Tomalin, Katie Hyewon Choi, Micol Zweig, Eddye Golden, Sparshdeep Kaur, Drew Helmus, Anthony Biello, Renata Pyzik, Claudia Calcagno, Robert Freeman, Bruce E. Sands, Dennis Charney, Erwin P. Bottinger, James W. Murrough, Laurie Keefer, Mayte Suarez-Farinas, Girish N. Nadkarni, Zahi A. Fayad

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City's COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic.

Original languageEnglish
Article numbere31295
JournalJournal of Medical Internet Research
Issue number9
StatePublished - Sep 2021


  • App
  • Covid-19
  • Emotion
  • Health care worker
  • Heart rate
  • Heart rate variability
  • Mental health
  • Nervous system
  • Observational
  • Physiology
  • Psychological
  • Psychology
  • Quality of life
  • Resilience
  • Stress
  • Support
  • Wearable device


Dive into the research topics of 'Factors associated with longitudinal psychological and physiological stress in health care workers during the covid-19 pandemic: Observational study using apple watch data'. Together they form a unique fingerprint.

Cite this