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



Sangtarash F¹ ; Choobsaz H¹ ; Zarrin M¹ ; Salari S² ; Manshadi EM³ ; Esmaeili AA⁴ ; Mozaffari SH⁵ ; Hatef B⁵
Source: Journal of Modern Rehabilitation Published:2025

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. © 2025 Tehran University of Medical Sciences.