Li Ruibei, Pasupulety Ujjwal, Chang Wellington, Frank Adam C
Los Angeles General Medical Center, Los Angeles, CA, United States.
Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
JMIR Form Res. 2025 Sep 5;9:e67822. doi: 10.2196/67822.
Residency is a critical period in a physician's training, characterized by significant physical, cognitive, and emotional demands that make residents highly susceptible to stress and associated negative health outcomes. While physiological signals such as heart rate have been explored as potential biomarkers of stress, their predictive utility in high-stress environments such as the intensive care unit (ICU) remains inconclusive, especially when factoring in atypical events that can further exacerbate resident stress levels.
This study aimed to investigate the relationship between daily average heart rate (AHR) and perceived stress among ICU residents and examine the moderating effect of atypical events on this relationship.
The TILES (Tracking Individual Performance With Sensors)-2019 dataset collected longitudinal data from 44 ICU residents who provided daily self-reported stress ratings and wore a Fitbit device to track physiological data over a 3-week period. The main predictor variables were AHR and the occurrence of atypical events (both work and life related and daily hassles). The primary outcome was the level of perceived stress measured on a 7-point Likert scale. Linear mixed models were used to analyze the relationship between AHR and stress, accounting for within-subject and between-subject variance. Interaction effects between AHR and atypical events were also examined.
The analysis revealed a significant positive association between AHR and perceived stress (β=0.032; P=.04) on standard days. However, this relationship was attenuated by the presence of negative atypical events (β=-0.076; P=.02). We further analyzed whether the severity of negative atypical events had an additional moderating effect but found no statistical significance.
AHR is a potential physiological marker for perceived stress in ICU residents, but its effect is moderated by negative atypical events. Future research should replicate these findings in more diverse cohorts, assess their generalizability to broader populations, and control for additional confounding variables. Incorporating negative atypical events into stress assessment could lead to more accurate and context-sensitive interpretations of physiological data.
住院医师培训阶段是医生职业生涯中的关键时期，在此期间，住院医师面临着巨大的身体、认知和情感压力，这使得他们极易受到压力及相关负面健康后果的影响。虽然心率等生理信号已被作为压力的潜在生物标志物进行研究，但其在重症监护病房（ICU）等高压力环境中的预测效用仍不明确，尤其是当考虑到可能进一步加剧住院医师压力水平的非典型事件时。
本研究旨在调查ICU住院医师的每日平均心率（AHR）与感知压力之间的关系，并检验非典型事件对这种关系的调节作用。
TILES（通过传感器跟踪个人表现）-2019数据集收集了44名ICU住院医师的纵向数据，这些住院医师在3周内每天提供自我报告的压力评分，并佩戴Fitbit设备来跟踪生理数据。主要预测变量为AHR以及非典型事件（包括与工作和生活相关的事件以及日常琐事）的发生情况。主要结果是使用7点李克特量表测量的感知压力水平。采用线性混合模型分析AHR与压力之间的关系，同时考虑个体内部和个体之间的差异。还检验了AHR与非典型事件之间的交互作用。
分析显示，在正常日子里，AHR与感知压力之间存在显著正相关（β=0.032；P=0.04）。然而，负面非典型事件的存在减弱了这种关系（β=-0.076；P=0.02）。我们进一步分析了负面非典型事件的严重程度是否具有额外的调节作用，但未发现统计学意义。
AHR是ICU住院医师感知压力的潜在生理标志物，但其作用受到负面非典型事件的调节。未来的研究应在更多样化的队列中重复这些发现，评估其对更广泛人群的可推广性，并控制其他混杂变量。将负面非典型事件纳入压力评估可能会对生理数据产生更准确且符合具体情况的解读。
