J. Med. Biol. Eng.
(2015) 35:833–844
DOI 10.1007/s40846-015-0095-7
ORIGINAL ARTICLE
ECG-based Mental Stress Assessment Using Fuzzy Computing
and Associative Petri Net
Hsiu-Sen Chiang1
Received: 8 April 2015 / Accepted: 15 July 2015 / Published online: 18 November 2015
 Taiwanese Society of Biomedical Engineering 2015
Abstract Medical reports suggest that long-term stress
can directly or indirectly lead to mental disorders and
cardiovascular disease. However, many people frequently
ignore their stress symptoms and fail to take remedial
action before developing serious psychological or physio-
logical health problems. Many previous studies have used
electrocardiograms (ECG) to evaluate mental stress.
However, ECG pattern recognition presents difficulties
because the time-varying morphology is subject to physi-
ological conditions and the presence of noise. Therefore,
how to achieve effective noise reduction and accurately
determine an individual’s exposure to mental stress under
various conditions is a recurring issue in engineering and
medical research. Heart rate variability is assessed using
time- and frequency-domain analyses. To accurately detect
mental stress, this research adopts both time and frequency
domains, two aspects of physiological characteristics. In
this study, a rule-based reasoning model is created for
mental stress assessment by combining fuzzy and asso-
ciative Petri net methodologies. It can serve as a basis for
clinical diagnosis and quickly measure the subject’s mental
condition and reduce subjective errors. Performance eval-
uation using Physionet’s stress recognition database shows
that the proposed approach compares well with data mining
methods and other proposed methods. Moreover, a proto-
type mental stress assessment system is proposed to help
users understand their mental condition.
& Hsiu-Sen Chiang
hschiang@nutc.edu.tw
1 trocardiogram (ECG) records the voltage change generated
Department of Information Management, National Taichung
University of Science and Technology, 129 Sanmin Road
Sec. 3, Taichung 40401, Taiwan
Keywords Electrocardiogram (ECG)  Mental stress 
Heart rate variability  Fuzzy theory  Associative Petri net
1 Introduction
Drastic changes to the social environment in the past few
years have created conditions that have significantly
increased mental tension in individuals [1]. While moder-
ate levels of mental stress can help people focus their
attention, and thus enhance learning and work efficiency,
excessive stress can seriously impact physical and psy-
chological health [2]. Long-term exposure to mental stress
leads to feelings of exhaustion [3]. The human body sends
out physiological warnings or generates symptoms in
response. Ignoring these symptoms leaves both the nervous
and immune systems increasingly susceptible to damaging
conditions or disease, including cardiovascular disease,
depression, cancer, and neurological disease [4, 5]. In
addition, excessive mental stress is one of the main causes
of emotional instability or suicide [6]. This raises the
importance of stress relief and management. However,
most people are unaware of or disregard their excessive
physical and mental stress because of overly busy work
schedules or because they are accustomed to being under a
certain degree mental stress, leaving them indifferent to
these physiological warning signals, thus allowing contin-
ued deterioration until the damage may be irreversible [7].
Currently, diagnosis of psychological stress was mostly
performed in a hospital using rating scales [8, 9]. This
involved completing questionnaires, which is time-con-
suming and prone to errors due to subjectivity. An elec-
while the heart tissue contracts and expands and can reflect
one’s mental and physical conditions in real time. Many
123
834
studies related to the assessment of mental stress have
analyzed ECG data to obtain biological parameters such as
heart rate variability (HRV) and autonomic nervous system
(ANS) activity [10]. ECG signals, however, are not steady
and contain a lot of noise. As such, even if the same
instrument is used on the same person, the generated ECG
signals can vary significantly at different points in time and
under different physical conditions, easily resulting in
measurement errors [11, 12].
Therefore, when applying ECG signals in the diagnosis
of mental stress, it is necessary to take the following points
into consideration: (1) how to effectively eliminate noise
and retrieve personal physiological parameters without loss
of information, (2) how to provide users with timely
warnings of the onset of excessive mental stress and
reminders of how to deal with it, and (3) how to provide
timely and objective clinical assessments of the degree of
mental stress. This study combines various approaches,
such as singular value decomposition (SVD), fuzzy theory,
and the associative Petri net (APN), to develop a non-in-
vasive, rapid, and objective mental stress assessment model
to assist doctors in making clinical diagnoses and to
develop a prototype mental stress warning system to pro-
vide users with real-time alerts regarding the onset of
excessive mental stress.
2 Literature Review
2.1 Heart Rate Variability
Mental stress is an abstract, subjective phenomenon and
cannot be measured directly. Relative mental stress, how-
ever, can be analyzed and assessed through changes of
physiological response. Some physiological parameters,
such as HRV and ANS activity, have been found to be
highly sensitive to external stimulation and changes and are
thus useful for the diagnosis of mental stress [13–15].
The ANS is composed of two major parts, namely the
sympathetic nervous system and the parasympathetic ner-
vous system. It is responsible for reflecting and managing
physical changes inside the human body related to the
external environment [16]. Mental stress gives rise to
unstable and negative emotions, such as anxiety, anger, and
dissatisfaction, affecting the ANS and resulting in
increased or decreased activity in the sympathetic and
parasympathetic nervous systems, which is manifested in
the heart rhythm [17–20]. HRV is the small cyclic differ-
ence between consecutive heart rate intervals as a result of
ANS regulation under the sinus rhythm and reflects the
balance between the sympathetic and parasympathetic
nervous systems [21, 22]. The HRV value is the R–R
interval calculated on the basis of the ECG wave peaks, as
123
H.-S. Chiang
shown in Fig. 1. Among ECG components, the QRS
complex group is a significant wave because it contains the
highest R peak, which can be used to quickly and precisely
calculate the HRV value [23].
The HRV analysis method mainly deals with the time
and frequency domains. All of the indicators obtained after
analysis reflect physiological characteristics and informa-
tion related to mental stress [24–26]. The time-domain
analysis is used to calculate the heart beat interval to
generate various indicator values, including mean value,
standard deviation, square and root mean square, differ-
ential, and ratio, all of which can be used to assess mental
stress. Frequency-domain analysis is used to calculate the
power spectral density (PSD) of the heart beat interval to
estimate power distribution within the overall signal fre-
quency range [27, 28]. ANS response in the frequency
domain of ECG signals can be primarily divided into three
frequency bands, namely very low frequency (VLF) (from
the regulation of the distal vasomotor tone, which is related
to temperature regulation), low frequency (LF) (which is
related to the baroreceptor reflex and blood pressure reg-
ulation), and high frequency (HF) (which is related to
respiration). Variance and power ratios for the changes in
energy at these three frequency bands are calculated to
assess ANS regulation [17, 29].
2.2 Related Works
Pagani et al. [30] used the short-term R–R interval and
cardiovascular systolic blood pressure in their spectral
analysis to investigate how mental stress influences the
ANS and the circulatory system. They found that the VLF
energy was higher than usual when the subject was under
unusual stress. Satish et al. [31] investigated large intestine
activity and cardiovascular pressure change by changing
the temperature of the hands to control physical and mental
stress. Leor-Librach et al. [32] administered cardiac stim-
ulants in mice to induce controlled increased heart rates
and to investigate the correlation between the changes to
Fig. 1 R–R interval
ECG-based Mental Stress Assessment Using Fuzzy Computing…
Fig. 2 Example of stress test
data. Recognition of stress test
scenario in driving
the VLF amplitude among HRV signals and sympathetic
nervous system excitement. Shusterman and Barnea [33]
studied the correlation between body surface temperature,
vascular changes, and the activity of the sympathetic ner-
vous system with three indicators (HRV, epidermal tem-
perature change, and distal vasomotor nerve activity) under
conditions of mental stress and biofeedback. They found
that the degree of sympathetic nervous system activity can
be used to measure mental stress. Based on HRV analysis,
many scholars have successfully identified different mental
stress states by applying the wavelet transforms to filter out
noise and by combining several categorization approaches,
such as fuzzy neural networks (FNN) and k-nearest
neighbor (KNN) [13, 34]. The pupil diameter ratio, pupil
constriction rate, blood pressure, and HRV have been used
to detect mental condition [35]. A self-designed fuzzy filter
method was used to filter noise in individual parameters,
and was applied with the fuzzy support vector machine to
identify mental stress states. One study [36] applied fuzzy
logic to the calculation of galvanic skin response (GSR)
and heart rate to identify mental stress states. Window
detrended fluctuation analysis was used to calculate the
energy of the R–R sequence within a particular time win-
dow, which was then used to determine the mental stress
state [37].
3 Materials and Methods
This section briefly describes our research methods,
including signals processing, HRV analysis, membership
function generation, and the detection of mental condition
using the proposed APN.
3.1 Dataset
This study uses the stress recognition in automobile drivers
(SRAD) dataset from the Physionet database [38]. The
dataset is composed of 16 consecutive logs, each used to
record multiple pieces of physical information for a single
healthy subject undergoing stress tests, including ECG,
835
electromyogram, GSR, and Respiratory rate. These ECG
signals were filtered through a 0.5 s mean filter and
resampled at 15.5 Hz.
For the SRAD dataset, stress was induced through three
consecutive scenarios, namely with the subject at rest,
driving on a city road, and driving on a freeway. The entire
experiment, including all three scenarios, lasted around
65–93 min. During a stress induction experiment, subjects
were first instructed to relax in the car for 15 min with their
eyes closed to help them enter a stress-free (or low-stress)
state, and then drive the car on a city road for approxi-
mately 12–15 min. During the test, the test subject was
asked to remain fully focused on the heavy traffic, which
appears to induce a high-stress state. After leaving the city,
the subject engaged in freeway driving for around
7–10 min. The wide, straight lanes, and relatively light
traffic put the subject in a medium-stress state. The subject
then followed the same path from the freeway back to the
city road and then the garage, where they rested for 15 min
and completed the stress experiment. The SRAD scenario
is shown in Fig. 2.
3.2 Singular Value Decomposition
When ECG signals are retrieved, they contain noise due to
external factors, and often include current noise from the
instrument itself, static electricity noise generated when
electrodes contact human skin, and baseline drift [39].
Prior studies have found that most noise processing
methods can effectively remove signal noise, but issues
related to high calculation cost, signal distortion, and
symmetrical imbalance remain. SVD can effectively
decompose signals into their individual components while
retaining important characteristics, and thus is frequently
used to remove noise during signal processing. SVD is
calculated as [40]:
X
S¼U VT ð1Þ
where S is an m 9 n matrix, U is an m 9 m orthogonal
P
matrix, V is an n 9 n orthogonal matrix, and is an
m 9 n diagonal matrix:
123
836 H.-S. Chiang

2 3
a1  0 the onset position of the QRS complex has been
X 6 . .. .. 7 detected. The comparison continues and the max-
¼ 4 .. . . 5 ð2Þ
imum value found is where the R peak is located.
0  an
Step 4 When the R peak is found, the maxi value in
T Eq. (7) should be updated immediately. The
First, the cross product of the S S matrix is calculated to
P
obtain the eigenvalue (singular value) matrix and the Filter_Parameter can be set to be 2, 4, 8, or
eigenvector V-matrix. The eigenvalue is then divided by 16. The maxi value is updated using Eq. (8) and
the eigenvector value to obtain the U-matrix. Once the U, First_max is updated using Eq. (9).
P
, and V matrices are obtained, Eq. (3) is used to calculate First max  maxi
the sum of mean singular values. A singular value smaller maxi ¼  maxi ð8Þ
Filter Parameter
than the mean is reset to 0. n is the quantity of singular
First max ¼ Height of R peaks point
values and a is the singular value after conversion.
Pi  n  Height of QRS onset ð9Þ
ai if ai  Avg; a0i ¼ 0
Avg ¼ i¼1 0 ð3Þ Step 5 After the maxi value has been updated, the threshold
n else ai ¼ ai
is re-calculated using Eq. (7) and then the location
Then, Eq. (4) is used to re-calculate and obtain the new of the next R peak is detected. The detection process
singular value. repeats until all signals have stopped.
2 0 3
a1    0
X 0
6 7
¼ 4 ... . . . ... 5 ð4Þ 3.4 Fast Fourier Transform
0
0    an
0
The fast Fourier transform (FFT) algorithm computes the
0
X 0 discrete Fourier transform (DFT) of a sequence, or its
S ¼U V ð5Þ
inverse that converts a signal from its time domain to a
Finally, post-calculation matrices are re-combined to representation in the frequency domain. The Cooley–Tukey
produce the filtered signal matrix, as in Eq. (5). FFT is adopted in this paper. The DFT is defined by the
Eq. (10), where x(n) is the original signal and x0, ...., xN-1 are
3.3 R Peak Detection Method complex numbers.
XN1 j2pkn
X ðkÞ ¼ xðnÞe N n ¼ 0; 1; 2; 3; . . .; N  1 ð10Þ
For HRV analysis, the maximum slope method is adopted n¼0
to detect the R peak of ECG signals and obtain the R–R By calculating the PSD, one can quickly obtain the power
interval [41]. This method offers high precision and speed, size of ECG signals at different bands in order to obtain the
with minimal calculation cost, and can be used in real-time physiological characteristics. According to the Wiener–
detection. The detection process is described as follows: Khinchin theorem, the power spectral density Sxx(f) of the
Step 1 The Slope(n) at each signal point X[n] is obtained function with discrete values x(n), is shown in Eq. (11). The
with the first-order derivative: Eq. (12) is the discrete autocorrelation function of x(n).
Being a sampled and discrete-time sequence, the spectral
SlopeðnÞ ¼ 2X ðn  2Þ  X ðn  1Þ þ X ðn þ 1Þ
density is periodic in the frequency domain.
þ 2X ðn þ 2Þ
kX
¼1
ð6Þ
Sxx ð f Þ ¼ Rxx ðkÞej2pkf ð11Þ
Step 2 The detection threshold is set. The threshold k¼1

parameter can be 2, 4, 8, or 16. maxi is the
maximum slope. The default is the maximum
slope among the first 250 points (peaks) of the
ECG signals. The threshold is calculated using:
Threshold Parameter
Slope Threshold ¼
16
 maxi
Step 3 The threshold is compared with Slope(n) at each
signal peak; when the slope of two consecutive
peaks is greater than the set threshold, it means that
Rxx ðkÞ ¼ Eð xðnÞx ðn  kÞÞ ð12Þ
3.5 Minimize Entropy Principle Approach
The minimize entropy principle approach (MEPA) creates
the fuzzy membership function by applying information
ð7Þ
entropy. Through MEPA, data are divided into different
segments using the interval partition method. The mini-
mized information entropy method is then used to assess
the degree of information entropy within each specific data

123
ECG-based Mental Stress Assessment Using Fuzzy Computing…
interval. The interval partition of the minimum information
entropy can be determined from this assessment [42, 43].
For example, to find a partition threshold line xi within a
certain dataset interval [a, b], divide the dataset into two
segments [a, a ? x] and [a ? x, b]. To find the most
appropriate partition threshold line with MEPA, a partition
threshold line is created at every point within the dataset
interval [a, b], where data categories and patterns differ. In
this way, the set of a partition threshold line X, xi [ X can
be obtained. Equations (13), (14), and (15) are then applied
to calculate the entropy value obtained for the threshold
line xi created at each point where data categories differ.
The threshold line of the minimum entropy is the deter-
mined partition line. The partition line xpri determined for
Stage 1 is referred to as the partition line (PRI), which can
divide the whole data section into two segments, [a, a ? x]
and [a ? x, b]. These two segments are respectively called
Segment f and Segment g. The entropy for each value of x
in the region between a and b is expressed as [42]:
EðxÞ ¼ f ðxÞEf ðxÞ þ gðxÞEg ðxÞ ð13Þ
Ef ðxÞ ¼ ½f1 ðxÞ þ ln f1 ðxÞ þ f2 ðxÞ þ ln f2 ðxÞ ð14Þ
Eg ðxÞ ¼ ½g1 ðxÞ þ ln g1 ðxÞ þ g2 ðxÞ þ ln g2 ðxÞ ð15Þ
f ðxÞ þ gðxÞ ¼ 1 ð16Þ
where fk(x) and gk(x) respectively represent the conditional
probability of class k samples in [a, a ? x] and [a ? x, b].
A value of x that gives the minimum entropy is the optimal
threshold value. Estimated fk(x), gk(x), f(x), and g(x) values
are calculated as follows:
nk ðxÞ þ 1
fk ðxÞ ¼ ð17Þ
nðxÞ þ 1
Nk ðxÞ þ 1
gk ðxÞ ¼ ð18Þ
NðxÞ þ 1
nðxÞ
f ðxÞ ¼ ð19Þ
n propositions and consequence propositions, this study
gðxÞ ¼ 1  f ðxÞ ð20Þ
where nk(x) is the number of class k samples located in [a,
a ? x], n(x) is the total number of samples located in [a,
a ? x], Nk(x) is the number of class k samples located in
[a ? x, b], N(x) is the total number of samples located in
[a ? x, b], and n is the total number of samples in [a, b].
To continue dividing the segments, it is necessary to
create the threshold line xsec for Stage 2. In Segment [a,
a ? x], the partition threshold line xsec1 can be determined
following the same steps used during the Stage 1 parti-
tioning. Similarly, the partition threshold line xsec2 can also
be determined for Segment [a ? x, b]. Based on the MEPA
ideas, it is possible to minimize the data entropy in the
segment [43].
837
3.6 Associative Petri Net
The APN is a modified Petri-net-based structure that
combines the Apriori algorithm with association rules [44].
The APN is a directional graph that includes three types
of node, namely (1) place, which assumes an approximately
circular shape and describes or represents a state; (2) sup-
port, which assumes a square shape and represents the
threshold of association between an antecedent and a con-
sequence, and is used to assess whether the association
between two places exists; and (3) transition, which assumes
the shape of a long bar and contains an association function
G (also referred to as the certainty function (CF)) to convert
the relationship between different antecedents and conse-
quences to an appropriate indicator between zero and one.
The APN theory primarily focuses on describing dynamic
processes. As such, its implementation emphasizes ‘‘enable’’
and ‘‘fire’’, that is, enabled transition nodes. When a state
changes, inference is enabled to reflect different conditional
states and further explore the influence on, and degree of
association of antecedents with, consequences. The APN can
be expressed mathematically and graphically, and can be
defined as a 13-tuple, as shown in Fig. 3.
In an APN, all propositions are represented by a place and
proposition authenticity is indicated with a token. The
association degree between two propositions can be indi-
cated with transitions and the CF value. The consequence
proposition in the association production rule (APR) is
affected by all the connecting antecedent propositions. The
APN model consists of five APR types, each with its own
computing method [44]. Thus, the reasoning process
requires different operation and calculating methods based
on the characteristics of the various APRs. The different
antecedents are input places, and a unique computing
method is used to consider the CF between places and
transitions to thus infer the possible value of a consequence.
In light of the association degree between antecedent
applies the association rule idea in data mining to APN.
The Apriori algorithm for association rules [45] can be
used to find the association among interesting items
IT = {i1, i2,…, im} in a given dataset D containing a set of
database transactions. An association rule can be indicated
through A ? B, in which A , IT, B , IT, and A \ B = /
. The support means that the association rule A ? B in
dataset D contains the ratio of A [ B, indicated as s. The
confidence means that the association rule A ? B in
dataset D contains both the ratios of A and B when A is
upheld; confidence is indicated as c. The support and
confidence are respectively calculated as:
SupportðA ) BÞ ¼ PðA [ BÞ ð21Þ
ConfidenceðA ) BÞ ¼ PðB=AÞ ð22Þ
123
838 H.-S. Chiang

APN = (P, T , S , C , D, Λ, Γ, I , O, α , β , G, W )
Fig. 3 Definition of associative
Petri net

where
P = {p1 , p2 ,....... pn } is a finite set of places,

T = {t1 , t 2 ,.......ti } is a finite set of transitions,

S = {s1 , s 2 ,.......s m } is a finite set of supports,

C = {c1 , c2 ,.......ci } is a finite set of confidences,

D = {d1 , d 2 ,.......d n } is a finite set of propositions,

Λ = {τ 1 ,τ 2 ,.......τ m } is a finite set of thresholds of the supports,

Γ = {γ 1 , γ 2 ,.......γ i } is a finite set of thresholds of the confidences,

P T D = φ, P = D

I : T → P∞ is an input function, a mapping from transitions to bags of places,

O : T → P∞ is an output function, a mapping from transitions to bags of places,
α : P → [0,1] is an association function, a mapping from places to real values
between zero and one,
β :P→D is an association function, a bijective mapping from places to
propositions,
G : T → [0,1] is an association function which assigns a real value between zero to
one to each transition
W : S → [0,1] is an association function which assigns a real value between zero to
one to each support.

When the association rule satisfies the minimum support
and confidence thresholds sm, sm [ [0,1] and ci, ci [ [0,1],
respectively, the rule is considered interesting. These
thresholds can be set according to the user’s experience or
by subject matter experts. If the values of the support and
confidence are higher than their thresholds s and c, tran-
sition is enabled and the CF and the corresponding confi-
dence (CF = ci) are calculated using Eq. (22); otherwise,
no association exists and the corresponding confidence is 0
(CF = 0):

ci ; if sm  sm ; ci  ci
Gðti Þ ¼ ð23Þ
0; if sm  sm ; or ci  ci
where ci is the confidence value, ci is a threshold of the
confidence, sm is the support value, and sm is a threshold of
the support.
If all of pj [ I(ti), a(pj) C k, sm C sm, and ci C ci, k, sm,
ci [ [0,1] are activated, the transition ti is enabled and the
token passes through all support places from the input
places and transits to each output place. By connecting
related places and giving the transition an appropriate CF,
one can obtain the APN reasoning model that expresses the
association among professional knowledge.
4 Experimental Procedures
The experimental procedure for mental stress assessment is
divided into three stages. Stage 1 covers data preprocessing
and includes the retrieval of stress segments containing
ECG signals, the filtering of external noise, and the
removal of the signal band. Stage 2 is feature extraction,

123
ECG-based Mental Stress Assessment Using Fuzzy Computing…
which includes R peak detection and time- and frequency-
domain analysis. The final stage covers reasoning of mental
condition, in which the MEPA and the APN are used to
detect the degree of mental stress.
4.1 Data Sampling and Filtering
A total of 16 SRAD datasets were obtained from the Physionet
database. From each dataset, we obtained a total of 27 stress
segments, equally divided among low-, medium-, and high-
stress segments. The length of the retrieved segment was
1 min. To avoid influence from delayed onset of stress in
subjects due to scenario transition, retrieval of each stress
segment begins with the central time interval. For example, the
total time interval for low stress in the Drive05 log is 0–908 s,
so the segment from 181 to 240 s is retrieved. For a few logs
that do not include the final low stress segment, the previous
segment was retrieved. A total of 144 low stress segments, 144
medium stress segments, and 144 high stress segments were
retrieved for a total sample size of 432 segments.
Because instruments record external noise along with
ECG signals, the original signals were quite noisy. Filter-
ing with SVD produced more easily identifiable wave-
forms, as shown in Fig. 4. To obtain the QRS band where
the R peak is located, a Butterworth high-pass filter was
used to remove unnecessary bands.
4.2 Feature Extraction
Feature selection is important for enhancing the perfor-
mance of mental stress detection. After administering a
detailed survey, we used the 12 features listed in Table 1 to
construct our prototype. The feature extraction process was
as follows: (i) find the signal peak using the maximum
slope method, using default values for the Threshold_Pa-
rameter and the Filter_Parameter; (ii) obtain the R–R
interval sequence through R peak detection; (iii) measure
Fig. 4 Comparison of ECG signals before and after filtration
839
Table 1 Descriptions of features
Features Description
MEAN Mean of R–R interval
SDNN Standard deviation of R–R interval
RMSSD Root mean square of R–R interval
NN50 Number of R–R intervals differing
by [ 50 ms from adjacent intervals
pNN50 NN50 count divided by total number
of all NN intervals
VLF power Very-low-frequency heart rate power
LF power Low-frequency heart rate power
HF power High-frequency heart rate power
Total power Total power
Normalized LF LF power/(Total power-VLF power) 9 100 %
Normalized HF HF power/(Total power-VLF power) 9 100 %
LH/HF Ratio of low-to-high frequency power
the time-domain features by calculating the R–R interval
sequence; (iv) transform the time-domain signals into the
frequency domain through FFT; and (v) analyze the dis-
tribution of the heart beat interval power at various fre-
quencies through PSD and obtain frequency-domain
features for individual bands. To identify features most
closely associated with mental stress, the information gain
(IG) method was used to reduce the number of features
from 12 to 9. Experimental results show that the APN
feature reduction model provides performance advantages.
4.3 Mental Stress Reasoning
The MEPA is used to create the fuzzy membership func-
tion by calculating the entropy of all features for various
degrees of mental stress. The fuzzy membership function
for each feature is established through trapezoidal and tri-
angular fuzzy functions, as shown in Fig. 5. The response
status and criteria for each feature for different degrees of
mental stress are given a linguistic value and a membership
degree corresponding to the propositions and the degree of
truth of the input place in the APN.
As shown in Fig. 6, the structure of our APN model for
mental stress detection is constructed by integrating dif-
ferent types of APR, features of physiological parameters,
and the fuzzy membership function. Our APN model has
five inputs, four middle states, and one final state. All the
degrees of truth and states of the input places in the APN
are obtained from the membership functions. The degree of
truth of each middle place can be obtained using the CF
calculated using Eq. (23). An APN reasoning algorithm
from Shih et al. [45] is used to detect the degree of mental
stress. The most probable degree of mental stress is then
obtained under the condition of all physiological features.
123
840 H.-S. Chiang

1 of sij and cij are set to 0.05 and 0.02, respectively. The
reasoning example of our APN for the degree of mental
0.5 stress is as follows:
Step 1 From starting places p1, p2, p4: Places p1, p2,
0 and p4 are starting places and b(p1) = d1,
199.5 249.5 273
b(p2) = d2, b(p4) = d4 are three propositions
⎧1 x < 199.5
⎪ of starting places. IRS(ps) = {p3, p5}.
Low CFL ( x ) = ⎨ 249.5 − x
⎪⎩ 50 199.5 ≤ x < 224.5
Step 2: In descendant place pi, pi [ IRS(ps), s = 1, 2,
⎧ x − 199.5 224.5 ≤ x < 249.5
4; i = 3, 5.
⎪⎪ 50 APsi = {p1, p2, p4} and all transitions are
NN50 Median CFM ( x ) = ⎨
⎪ 273 − x 249.5 ≤ x < 261.25
enabled. Places p1, p2, and p4 aexist since
⎩⎪ 23.5 (a(ps) C k) and all the values of the support
⎧ x − 249.5 261.25 ≤ x < 273 and confidence are greater than thresholds s
⎪
High CFH ( x ) = ⎨ 23.5 and c (i.e. ssi C ssi = 0.05 and csi -
⎪⎩1 x > 273
C csi = 0.02, s = 1, 2,4; i = 3, 5). Tokens
Fig. 5 Fuzzy membership function of NN50 are moved from p1, p2 to p3 and from p4 to p5.
Since the antecedent portion or consequence
portion of APRs between p1, p2, p4 and p3, p5,
As illustrated in Fig. 6, our proposed APN model for the belongs to types 4 and 1, respectively, the
degree of mental stress reasoning has nine characteristics reasoning functions are the ‘‘Max’’ and ‘‘No’’
and one final state. Three characteristics, namely operators, respectively [44]. The degrees of
pNN50(x5), Normalized LF(x10), and LH/HF(x12), are truth of proposition of places p3 and p5 are:
deleted, since the information they provide is insufficient
for mental stress detection. For example, assume that five g ¼ aðpi Þ ¼ Maxfaðps Þ 
input characteristics [x2, x3, x4, x8, x11] of the HRV char- csi js ¼ 1; 2; 4; i ¼ 3; 5g; then
acteristics from the ECG signal are [0.981, 1.231, 268.3, aðp3 Þ ¼ Maxfaðp1 Þ 
0.992, 547.654]. From the membership functions, we can c13 ; aðp2 Þ  c23 g
obtain the membership degrees and the linguistic values of
¼ Maxf0:786  0:733; 1:0  0:884g
these HRV characteristics as [M, M, H, L, L] and [0.786,
1.0, 0.892, 0.93, 1.0], respectively. Then, a(p1) = 0.786, ¼ 0:884aðp5 Þ ¼ faðp4 Þ  c45 g
a(p2) = 1.0, a(p4) = 0.892, a(p6) = 0.93, and a(p8) = 1.0 ¼ f0:892  0:862g ¼ 0:768
are a mapping from places p1, p2,p4, p6, and p8 to their real Therefore; aðpi ji ¼ 3; 5Þ ¼ f0:884; 0:768g:
values, obtained by using the membership function. p1, p2,
and p4 are starting places, where k [ 0 indicates that the Step 3 At descendant place pj, pj [ IRS(pi), i = 3, 5,
proposition exists and k = 0 indicates that the proposition 6; j = 7.
does not exist. Let b(p1) = d1, b(p2) = d2,… b(p9) = d9 APij = {p3, p5, p6} and all transitions are
and d1, d2,…, d9 be nine propositions of HRV character- enabled. Places p3, p5, and p6 exist since
istics, as shown in Table 1. Let place p10 be a goal place, (a(pi) C k). All the values of the support and
d10 be the proposition of goal place p10, and a(p10) be the confidence are greater than thresholds s and c.
degree of truth of d10. Assume that all the threshold values (i.e. sij C sij = 0.05 and cij C cij = 0.02,

Fig. 6 Reasoning model for

degree of mental stress
classification

123
ECG-based Mental Stress Assessment Using Fuzzy Computing…
i = 3, 5, 6; j = 7). Tokens are moved from
p3, p5, p6 to p7. Since the antecedent portion
or consequence portion of APRs between p3,
p5, p6 and p7 belongs to type 4, the reasoning
function is the ‘‘Max’’ operator. The degree of
truth of proposition at place p7 is:
g ¼ aðpi Þ ¼ Maxfaðpi Þ
 cij ji ¼ 3; 5; 6; j ¼ 7g; then
aðp7 Þ ¼ Maxfaðp3 Þ  c37 ; aðp5 Þ
 c57 ; aðp6 Þ  c67 g
¼ Maxf0:884  0:852; 0:768  0:785; 0:93
 0:827g ¼ 0:769
Therefore; aðpj jj ¼ 7Þ ¼ f0:769g:
Step 4 At descendant place pk, pk [ IRS(pj), j = 7, 8;
k = 9. APij = {p7, p8} and all transitions are
enabled. Places p7, p8 exist since (a(pj) C k).
All the values of the support and confidence
are greater than thresholds s and c. (i.e.
skj C sjk = 0.05 and cjk C cjk = 0.02, j = 7,
8; k = 9). Tokens are moved from p7, p8 to
p9. Since the antecedent portion or conse-
quence portion of APRs between p7, p8 and p9
belongs to type 4, the reasoning function is
the ‘‘Max’’ operator. The degree of truth of
proposition at place p7 is:
   
g ¼ a pj ¼ Maxfa pj  cjk jj ¼ 7; 8; k ¼ 9g;
then aðp9 Þ ¼ Maxfaðp7 Þ  c79 ; aðp8 Þ  c89 g
¼ Maxf0:769  0:987; 1:0  0:824g
¼ 0:824Therefore; aðpk jk ¼ 9Þ ¼ f0:824g:
Step 5 At descendant place pg, since pg = p10 is the
goal place, place p9 exists (a(pk) C k) and all
the values of the support and confidence are
greater than thresholds s and c. The transitions
are enabled (i.e. skg C skg = 0.05 and ckg -
C ckg = 0.02, k = 9; g = 10). There is only
one successful reasoning path into goal place
p10. Since the APRs between p9 and p10
belong to type 1, the reasoning function is the
‘‘No’’ operator. Token are moved from p9 to
p10 and the degree of truth is:
   
a pg ¼ fa pg  ckg jk ¼ 9; g ¼ 10g; then
aðp10 Þ ¼ faðp9 Þ  c910 g ¼ 0:824  1:0
¼ 0:824
Finally, we can obtain the degree of truth proposition d10 as
0.824. Thus, we can assess a person’s degree of mental
stress (high mental stress state in this example).
841
5 Results and Discussion
SRAD datasets from the Physionet database were used to
evaluate the performance of the proposed APN model for
the detection of mental stress. A total of 432 samples were
used for both training and testing for comparison with other
data mining methods, namely decision tree (C4.5), neural
network (NN), support vector machine (SVM), Bayes net,
and naı̈ve Bayes (NB), running on Weka and MATLAB
2012a (see Table 2). Moreover, the proposed APN model
was evaluated using the following performance measures:
true positive (TP) rate (sensitivity) (= TP/(TP ? FN)), true
negative (TN) rate (specificity) (= TN/(FP ? TN)), false
positive (FP) rate (= FP/(FP ? TN)), and false negative
(FN) rate (= FN/(TP ? FN)). Accuracy is defined as fol-
lows: (TP ? TN)/(TP ? FP ? FN ? TN). The F-measure
combines precision TP/(TP ? FP) and recall TP/
(TP ? FN) on the prediction of the positive class (F-
measure = 2 9 precision 9 recall/precision ? recall). A
higher F-measure value indicates that the model performs
better on positive class balancing of FP and FN. G-mean is
the product of the prediction accuracy levels for both
pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
classes, which is TN=ðTN þ FPÞ  TP=ðTP þ FN Þ. As
shown in Table 2, C4.5 has higher TN rate and precision
rate than those of APN ? IG. C 4.5, Bayes net and
APN ? IG have good accuracy rates in detecting mental
stress. The proposed APN ? IG generally outperforms
other data mining methods in terms of sensitivity, recall
rate, F-measure, G-mean, and accuracy. Other measure-
ments also provided good results. Therefore, it can be
concluded that the proposed APN model is effective for
detecting mental stress states.
Table 3 summarizes other reported mental stress
assessment results obtained with video coding and ques-
tionnaires [19], principal component analysis [46], corre-
lation-based feature selection combined with C4.5, SVM,
NB, and k-nearest-neighbor (KNN) [47], and feature-based
transformation and KNN [48]. The method introduced by
Healey and Picard [19] produces the highest accuracy but
its implementation is time-consuming and is subject to
subjective errors and hence is not suitable for real-time
testing. The present method not only provides satisfactory
test accuracy but also allows for rapid and objective mea-
surements, making it suitable for use as an auxiliary
diagnostic tool in clinical settings.
6 Conclusion
In Fig. 7 shows an off-line prototype mental stress diag-
nosis system that uses Bluetooth to integrate an ECG
detector with mobile computing devices to realize real-time
123
842 H.-S. Chiang

Table 2 Performance of various classification methods

Method TP (%) TN (%) FP (%) FN (%) Precision rate (%) Recall rate (%) F-measure G-mean Accuracy

C4.5 96.18 91.67 8.33 3.82 95.85 96.18 0.960 0.939 0.947
NN 92.36 88.89 11.11 7.64 94.33 92.36 0.933 0.906 0.912
SVM 91.32 65.97 34.03 8.68 84.29 91.32 0.877 0.776 0.829
Bayes net 96.18 89.58 10.42 3.82 94.86 96.18 0.955 0.928 0.940
NB 61.81 89.58 10.42 38.19 92.23 61.81 0.740 0.744 0.711
APN 93.06 71.53 28.47 6.94 86.73 93.06 0.898 0.816 0.859
APN ? IG 97.22 90.97 9.03 2.78 95.56 97.22 0.964 0.940 0.951
TP true positive, TN true negative, FP false positive, FN false negative

Table 3 Comparison with other research

Classification Dimension reduction Accuracy (%) Authors

Video coding and questionnaires; continuous – 97 Healey and Picard [19]

correlations analysis
C4.5, SVM, NB, and KNN Principal component analysis (PCA) 68.31 Deng et al. [46]
C4.5, SVM, NB, and KNN Correlation-based feature selection (CFS) 85 Deng et al. [47]
KNN Feature-based Transformation algorithm 88.28 Wang et al. [48]
MEPA and APN Information gain (IG) 95.1 Proposed method

Fig. 7 Architecture of mental

stress detection system

and continuous mental stress monitoring. When the stress
value reaches a certain threshold, the system sends an alert
along with stress relief recommendations according to the
present stress level. We expect it will help patients to
reduce the likelihood of developing serious mental illness
or chronic disease as a result of long-term high stress.
In this study, SVD, MEPA, and APN were combined to
generate a mental stress assessment model. The proposed
model addresses signal noise and instability, and precisely
identifies the degree of mental stress. In HRV analysis, the
model uses time- and frequency-domain characteristic
variables. This model helps to provide immediate diagnosis

123
ECG-based Mental Stress Assessment Using Fuzzy Computing…
for mental stress by retrieving patients’ current ECG sig-
nals, thus limiting the impact of subjectivity.
Acknowledgments The author would like to express his sincere
appreciation for the financial support from the National Science
Council of Taiwan (grant NSC 100-2410-H-025-005).
References
1. Sharma, N., & Gedeon, T. (2012). Objective measures, sensors
and computational techniques for stress recognition and classifi-
cation: A survey. Computer Methods and Programs in Biome-
dicine, 108, 1287–1301.
2. Buckle, J. (2003). Clinical aromatherapy: Essential oils in
practice (pp. 228–246). New York: Churchill Livingstone.
3. Kopin, I. J., Eisenhofer, G., & Goldstien, D. (1988). Sympa-
thoadrenal medullary system and stress. Advances in Experi-
mental Medicine and Biology, 245, 11–23.
4. Block, J. P., He, Y., Zaslavsky, A. M., Ding, L., & Ayanian, J. Z.
(2009). Psychosocial stress and change in weight among US
adults. American Journal of Epidemiology, 170, 181–192.
5. Nielsen, N. R., Zhang, Z. F., Kristensen, T. S., Netterstrom, B.,
Schnohr, P., & Gronbak, M. (2005). Self reported stress and risk
of breast cancer: Prospective cohort study. British Medical
Journal, 331, 548–550.
6. Freeman, J. B., Garcia, A. M., Fucci, C., Karitani, M., Miller, L.,
& Leonard, H. L. (2003). Family-based treatment of early-onset
obsessive-compulsive disorder. Journal of Child and Adolescent
Psychopharmacology, 13, 71–80.
7. K. S. Yoo and W. H. Lee (2011) Mental stress assessment based
on pulse photoplethysmography, IEEE 15th International Sym-
posium on Consumer Electronics Electronics, 323–326
8. Ramirez, A. J., Graham, J., Richards, M. A., & Gregory, W. M.
(1996). Mental health of hospital consultants: the effects of stress
and satisfaction at work. The Lancet, 347, 724–728.
9. Prosser, D., Johnson, S., Kuipers, E., Szmukler, G., Bebbington,
P., & Thornicroft, G. (1997). Perceived sources of work stress
and satisfaction among hospital and community mental health
staff, and their relation to mental health, burnout and job satis-
faction. Journal of Psychosomatic Research, 43, 51–59.
10. Okada, Y., Yoto, T. Y., Suzuki, T., Sakuragawa, S., Sakakibara,
H., Shimoi, K., & Sugiura, T. (2013). Wearable ECG recorder
with acceleration sensors for monitoring daily stress. Journal of
Medical and Biological Engineering, 33, 420–426.
11. Tikkanen, P. E., Sellin, L. C., Kinnunen, H. O., & Huikuri, H. V.
(1999). Using simulated noise to define optimal QT intervals for
computer analysis of ambulatory ECG. Medical Engineering &
Physics, 21, 15–25.
12. Übeyli, E. D. (2007). ECG beats classification using multiclass
support vector machines with error correcting output codes.
Digital Signal Processing, 17, 675–684.
13. Chandola, T., Britton, A., & Brunner, E. (2008). Work stress and
coronary heart disease: what are the mechanisms? European
Heart Journal, 29, 640–648.
14. Kumar, M., Weippert, M., Vilbrandt, R., Kreuzfeld, S., & Stoll,
R. (2007). Fuzzy evaluation of heart rate signals for mental stress
assessment. IEEE Transactions on Fuzzy Systems, 15, 791–808.
15. Ranganathan, G., Rangarajan, R., & Bindhu, V. (2012). Estima-
tion of heart rate signals for mental stress assessment using neuro
fuzzy technique. Applied Soft Computing, 12, 1978–1984.
16. Langley, J. N. (1921). The autonomic nervous system, Part I.
Cambridge: W. Heffer and Sons.
17. Croiset, G., Nijsen, M. J., & Kamphuis, P. J. (2000). Role of
corticotrophin releasing factor, vasopressin and the autonomic
843
nervous system in learning and memory. European Journal of
Pharmacology, 405, 225–234.
18. Drolet, G., Dumont, E. C., Gosselin, I., Kinkead, R., Laforest, S.,
& Trottier, J. F. (2001). Role of endogenous opioid system in the
regulation of the stress response. Progress in Neuro-Psy-
chopharmacology & Biological Psychiatry, 25, 729–741.
19. Healey, J. A., & Picard, R. W. (2005). Detecting stress during
real-world driving tasks using physiological sensors. IEEE
Transactions on Intelligent Transportation Systems, 6, 156–166.
20. Von Borell, E., Langbein, J., Despres, G., Hansen, S., Leterrier,
C., Marchant-Forde, J., et al. (2007). Heart rate variability as a
measure of autonomic regulation of cardiac activity for assessing
stress and welfare in farm animals: A review. Physiology &
Behavior, 92, 293–316.
21. Zickmann, B., Hofmann, H. C., Pottkämper, C., Knothe, C.,
Boldt, J., & Hempelmann, G. (1996). Changes in heart rate
variability during induction of anesthesia with fentanyl and
midazolam. Journal of Cardiothoracic and Vascular Anesthesia,
10, 609–613.
22. Stein, P. K., Hagley, M. T., Cole, P. L., Domitrovich, P. P.,
Kleiger, R. E., & Rottman, J. N. (1999). Changes in 24 hour heart
rate variability during normal pregnancy. American Journal of
Obstetrics and Gynecology, 180, 978–985.
23. Achten, J., & Jeukendrup, A. E. (2003). Heart rate monitoring:
Applications and limitations. Sports Medicine, 33, 517–555.
24. Burger, A. J., Charlamb, M., & Sherman, H. B. (1999). Circadian
patterns of heart rate variability in normals, chronic stable angina
and diabetes mellitus. International Journal of Cardiology, 71,
41–48.
25. Niskanen, J. P., Tarvainen, M. P., Ranta-aho, P. O., & Kar-
jalainen, P. A. (2004). Software for advanced HRV analysis.
Computer Methods and Programs in Biomedicine, 76, 73–81.
26. Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010). The
relationship of autonomic imbalance, heart rate variability and
cardiovascular disease risk factors. International Journal of
Cardiology, 141, 122–131.
27. Hayes, M. H. (1996). Statistical digital signal processing and
modelling. New York: John Wiley & Sons.
28. Dorukl, A., Turkbay, T., Yelbo, Z., Ciyiltepe, M., Iyisoy, A.,
Sutcigil, L., & Ozflahin, A. (2008). Autonomic nervous system
imbalance in young adults with developmental stuttering. Bulletin
of Clinical Psychopharmacology, 18, 274–281.
29. Saul, J. P. (1990). Beat-to-beat variations of heart rate reflect
modulation of cardiac autonomic outflow. News in Physiological
Sciences, 5, 32–37.
30. Pagani, M., Rimoldi, O., Pizzinelli, P., Furlan, R., Crivellaro, W.,
Liberati, D., et al. (1991). Assessment of the neural control of the
circulation during psychological stress. Journal of the Autonomic
Nervous System, 35, 33–42.
31. Satish, S. C., Rao, M. D., Renae, A. H., Jerry, M. S., & Mindi, J.
C. (1998). Psychological and physical stress induce differential
effects on human colonic motility. American Journal of Gas-
troenterology, 93, 985–990.
32. Leor-Librach, R. J., Eliash, S., Kaplinsky, E., & Bobrovsky, B. Z.
(2003). Very low-frequency heart rate variability wave amplitude
and sympathetic stimulation-characterization and modeling.
IEEE Transactions on Biomedical Engineering, 50, 797–803.
33. Shusterman, V., & Barnea, O. (2005). Sympathetic nervous
system activity in stress and biofeedback relaxation. IEEE
Engineering in Medicine and Biology Magazine, 24, 52–57.
34. Karthikeyan, P., Murugappan, M., & Yaacob, S. (2011). ECG
signals based mental stress assessment using wavelet transform.
Proceedings of the 2011 IEEE International Conference on
Control System, Computing and Engineering, pp. 258–262.
35. Mokhayeri, F., & Akbarzadeh-T, M. R. (2011). Mental stress
detection based on soft computing techniques. Proceedings of
123
844
IEEE International Conference on Bioinformatics and Biomedi-
cine, pp. 430–433.
36. De Santos Sierra, A., Sanchez Avila, C., Bailador del Pozo, G., &
Guerra Casanova J. (2011). Stress detection by means of stress
physiological template. Proceedings of the 2011 Third World
Congress on Nature and Biologically Inspired Computing,
pp. 131–136.
37. Adnane, M., Jiang, Z., Mori, N., & Matsumoto, Y. (2011). An
automated program for mental stress and apnea/hypopnea events
detection. Proceedings of the 2011 7th International Workshop
on Systems, Signal Processing and their Applications, pp. 59–62.
38. Physionet Dataset: Stress Recognition in Automobile Drivers
(2015). http://physionet.nlm.nih.gov/pn3/drivedb/.
39. Friesen, G., Jannett, T., Jadallah, M., Yates, S., Quint, S., &
Nagle, H. (1990). A comparison of the noise sensitivity of nine
QRS detection algorithms. IEEE Transactions on Biomedical
Engineering, 37, 85–98.
40. Jung, W. H., & Lee, S. G. (2012). An R-peak detection method
that uses an SVD filter and a search back system. Computer
Methods and Programs in Biomedicine, 108, 1121–1132.
41. So, H. H., & Chan, K. L.(1997). Development of QRS detection
method for real-time ambulatory cardiac monitor. Proceedings of
IEEE 19th Annual International Conference. Engineering in
Medicine and Biology Society, pp. 289–292.
123
H.-S. Chiang
42. Christensen, R. (1980). Entropy minimax sourcebook volume III:
Computer implementation. Lincoln, Massachusetts: Entropy
Limited.
43. Ross, T. J. (2010). Fuzzy logic with engineering applications.
Hoboken: John Wiley & Sons Ltd.
44. Shih, D. H., Chiang, H. S., & Lin, B. (2007). A generalized
associative petri net for reasoning. IEEE Transactions on
Knowledge and Data Engineering, 19, 1241–1251.
45. Agrawal, R., Imielinski, T., & Swami, A. (1993). Database
mining: A performance perspective. IEEE Transactions on
Knowledge and Data Engineering, 5, 914–925.
46. Deng, Y., Hsu, D. F., Wu, Z. & Chu, C. H. (2012a). Feature
selection and combination for stress identification using correla-
tion and diversity, pervasive systems. Proceedings of the 12th
International Symposium on Algorithms and Networks,
pp. 37–43.
47. Deng, Y., Wu, Z., Chu, C. H., & Yang, T. (2012b). Evaluating
feature selection for stress identification. Proceedings of the IEEE
13th International Conference on Information Reuse and Inte-
gration, pp. 584–591.
48. Wang, J. S., Lin, C. W., & Yang, Y. T. (2013). A k-nearest-
neighbor classifier with heart rate variability feature-based
transformation algorithm for driving stress recognition. Neuro-
computing, 116, 136–143.