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A COMPLETE ELECTROCARDIOGRAM (ECG) METHODOLOGY FOR

ASSESSMENT OF CHRONIC STRESS IN UNEMPLOYMENT

Chapter · January 2011

DOI: 10.1007/978-1-4614-0116-2_16

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2011 International Conference on Agricultural and Biosystems Engineering
Advances in Biomedical Engineering Vols. 1-2
An Integrated Electrocardiogram (ECG) Methodology
for Assessment of Chronic Stress in Unemployment
Wanqing Wu
Department of Computer Science and Engineering,
Pusan National University
Busan, South Korea
(0082)-51-510-3642
wqwu@pusan.ac.kr
Abstract-This article describes a complete ECG methodology
to detecting chronic stress in unemployed populations. The
approach relies on estimating the state of the autonomic
nervous system from an analysis of heart rate variability
(HRV). This methodology consists of a hardware platform, a
software application, and a set of algorithms for ECG signal
measurement, signal processing, QRS complex detection,
HRV analysis and Biofeedback. With this methodology,
emotional shift experiments were performed to evaluate its
performances and investigate the mechanism of Autonomic
nervous system (ANS) modulation in unemployment. 53 right-
handed volunteers were recruited in this experiment, and
HRV pattern analysis, time domain and frequency domain
analysis used to assess the influence of chronic stress in ANS
modulation and response. The results have shown that this
methodology was effective for HRV based stress detection and
much easier for emotion self-regulatory in unemployed
populations.
Keyword: ECG Methodology, Heart rate variability (HRV),
Chronic Stress, Autonomic nervous system (ANS) modulation,
Unemployed population
I INTRODUCTION
Since the nineties, markers of stress and other
psychosocial factors are associated with coronary disease.
Abundant research implicates mental and physical stress
associated with everyday living in the precipitation of
sudden cardiac death. Especially, work stress as a huge
problem in today’s society since about half of work-related
illnesses are directly or indirectly related to stress. Several
studies have shown a link between the level of work stress
and disease [1]. It is well accepted that work is perhaps the
greatest contributor to stress in our lives. Job insecurity and
rising unemployment have contributed greatly to high
stress rates and severe burnout among workers.
While most papers about HRV and stress focus on the
relation between the stress level, assessed by simple
questionnaires, and some HRV parameters, the goal of this
study is to investigate whether HRV can be used to detect
chronic mental and physical stress of unemployment
population. In order to perform ECG measurement and
978-0-9831693-9-0/10/$25.00 ©2011 IERI
176
Jungtae Lee
Department of Computer Science and Engineering, Pusan
National University
Busan, South Korea
(0082)-51-510-3642
jtlee@pusan.ac.kr
HRV analysis, an improved ECG methodology was
developed based on the principles of Ambulatory, Simple,
High-performance, Robust, and Cost effective. Moreover,
53 healthy volunteers participated in the experiment to
compare the variation trend of HRV features in different
stimulus mode between unemployment population and
normal subjects, accordingly investigated the influence of
chronic stress in unemployed population on ANS
modulation and psychology-physiological health.
II ECG METHODOLOGY
ECG methodology is an extensive interdisciplinary
science. Generally speaking, ECG methodology includes
three aspects: hardware platform (data
acquisition/communication), software application (signal
processing/monitoring), and analysis method
(algorithm/statistical analysis).
Fig.1. Framework of ECG Methodology
From the hardware point of view, it correlated with
bioengineering, bioinformatics, analog/digital circuit
design, printed circuit board (PCB) development, data
communication, signal processing and biosensor network,
etc. Correspondingly, in terms of software, it related to
software engineering, digital signal processing (DSP),
man-machine interface (MMI) design, and data
storage/management, etc. Put the eyes on physiological
signal analysis side, it also referred to multiple disciplines,
such as statistics, artificial intelligence, spectral analysis,
nonlinear system analysis, HRV analysis and so on. Due to
the characteristics of complexity, universality and
comprehensiveness, it is difficult to build on a universal
ICABE2011
standard for ECG methodology. In this paper, we put
forward a framework of ECG methodology based on the
principles Ambulatory, Simple, High-performance, Robust,
and Cost effective. The framework of this ECG
methodology illustrated in Fig.1.
A. Hardware platform
Typically, ECG signal that detected by the electrode is
very weak with amplitude of 1 mV to 3 mV. Its frequency
spectrum lies between 0.05 Hz to 150 Hz. According to the
technical requirements, this Bluetooth-enabled hardware
platform basically could be divided to six parts: Analog Fig.4 The flowchart of Software design
Circuit, Digital Circuit, Signal Condition Circuit,
Communication Interface and Power management Circuit.
As most of the energy of ECG waveforms is concentrated
in frequency up to 40 Hz only, the cutoff frequency of 5th
order Butterworth low-pass filter has set to 40 Hz. This not
only simplified the analogy circuit (60 Hz notch filter), but
also removed high frequency noise and power line noise
(60 Hz in Korea), the total amplifier gain was about 60dB
and the Common Mode Reject Ratio (CMRR) was adjusted
to 120dB by introducing Right Leg Driver (RLD) circuit.
Fig.2 had shown the block diagram of the hardware
Fig.5 Developed HRV analysis software and related HRV parameters
platform.
The ECG signal measurement was controlled by
B. Software Application
Atmega128 which is a low power CMOS 8-bit RISC
As shown in Fig.4, the application realized basic
microcontroller with a throughput of up to 1 MIPS per
functions include ECG data receive/decoding, Control
MHz; Expandable function circuit was optional, it
Command (start/stop control, time control), Real-time
comprised of a Secure Digital Card (SD card), a LCD
monitoring, raw data preprocessing, ECG data
display module, and a simplified Keypad (Fig.3). In this
storage/Playback and data post-processing.
hardware platform, communication interfaces were
composed of a serial port (RS232), a USB communicate It was well accepted that ECG signal was susceptible to
interface and a Bluetooth module which enabled us to artifacts due to power-line interference, electrode motion,
connect this platform to PC directly or wirelessly (Fig.3). baseline wander, high frequency contents and myoelectric
interference [2]. So it was necessary to integrate a 60Hz
notch filter for minimizing the power line interference in
real time. This digital filter is a Finite Impulse Response
(FIR) band-pass filter with hamming windows. The cut-off
frequency was set between 3 Hz to 40 Hz, which is screen
out other components such as P wave, T wave, and
baseline drift from human motion. The normal ECG
spectrum is around 3–40 Hz. The R wave frequency
spectrum is higher than 10 Hz, and lower than 40 Hz. The
Fig.2 The block diagram of hardware platform
cut off frequency at 40 Hz can protect the noise from
power line (60Hz). In this software application, we used
three scales MM to remove Impulsive noise (60Hz noise),
and extracted Baseline wander artifacts, Electrode
movement artifacts and Muscle contraction artifacts
simultaneously by applying three different SE
(SE1,SE2,SE3) to every scale. As a relative clean ECG
data was achieved through processing by 3M filter, it was
easier for us to detect QRS complex. An adaptive threshold
Fig.3 Interface design of the expandable circuit and the prototype of update algorithm has been designed in this application.
hardware platform

177
C. Analysis Method two opposite type’s image were used to induce positive
Analysis of HRV consists of a series of measurements of (pleasant images) and negative (unpleasant images)
successive RR interval (intervals between QRS complexes emotion respectively. Every session lasted for five minutes
of normal sinus depolarisation, or NN interval) variations for short term HRV analysis, one minute interval between
of sinus origin which provide information about autonomic every two sessions acted as a cushion for our experiment
tone (Fig.5). In 1996 a Task Force of the European Society protocols.
of Cardiology (ESC) and the North American Society of
Pacing and Electrophysiology (NASPE) defined and
established standards of measurement, physiological
interpretation and clinical use of HRV [3]. Time domain
indices, geometric measures and frequency domain indices
constitute nowadays the standard clinically used parameters.
In this application, we adopted standardized HRV
methodology for time domain and frequency domain
analysis.
III EXPERIMENT PROTOCOLS Fig.6 Experiment protocols and Experiment environment

53 healthy (female 9, male 44, 33 volunteers are

unemployed drawing the dole between 30 and 40 years,
Unemployed group; 20 volunteers are undergraduate
recruited from local university aged from 20 to 30 years,
Undergraduate group), right-handed volunteers participated
in the experiment. We treated the Unemployed group as
High Stress group, and served Undergraduate group as
Control group. All participants had normal auditory and
visual function; none had neurological disorders. This
study was approved by the Institutional Review Board
(IRB) of Pusan National University Hospital. All of them
were given written informed consent to complete the
questionnaires and the psycho-physiological protocols.
In this experiment, IAPS (International Affective Picture
System) was used to evoke emotion as visual stimulus to
investigate the ANS modulation in different pressure
groups. All subjects are tested during a rest state session
and two stimulus sessions. During the rest state session
(S1), no stimulus was presented. ECG recordings in the rest
state were performed over a period of 5 minutes. All Fig.7 HRV pattern of a subject in High stress Group during different
subjects were instructed to keep their eyes closed in order emotional states
to minimize blinking and eye movements, and asked to
adjust respiration rhythm. During the stimulus sessions,
Table I
HRV parameters in High stress group and Control group during three emotional states
Time domain Analysis(Mean ± STD) Frequency domain Analysis(Mean ± STD)
SDNN rMSSD pNN50 LF n.u. HF n.u. LF/HF ratio Total power
Unit ms ms % ms2 ms2 / ms2
RestH 35 ± 11.7 27.6 ± 13.6 10.7 ± 14.4 45.2 ± 23.6 54.8 ± 23.6 1.66 ± 3.1 1284 ± 1111
Un-pleasantH 41.9 ± 18.0* 29.9 ± 17.4 10.2 ± 14.3 59.9 ± 22.9* 40.1 ± 22.9 2.77 ± 2.9* 2061 ± 2374*
PleasantH 41.9 ± 17.1* 29.6 ± 16.1 11.1 ± 15.4 57.9 ± 20.9* 42.1 ± 20.8 2.32 ± 2.8* 1817 ± 2159*
RestC 55.9 ± 14.2 44.7 ± 12.3 24.4 ± 12.3 61.1 ± 16.4 38.9 ± 16.4 2.2 ± 1.8 3138 ± 1920
Un-pleasantC 50.4 ± 16.3* 37.3 ± 15.2* 16 ± 13.1* 53.9 ± 16.7* 46.1 ± 16.7* 1.56 ± 1.3* 2435 ± 1691*
PleasantC 60 ± 16.7 40.7 ± 15.9 20.5 ± 14.7 66.1 ± 12.2 33.9 ± 12.2 2.54 ± 1.3 3513 ± 2245
※ ※ ※ ※ ※ ※ ※

Abbreviations- std: standard deviation, *: p<0.05(paired t-test)-Unpleasant or pleasant vs. Rest, ※: p<0.05-Unpleasant vs. pleasant; H: High
stress group; C: Control group.

178
 IV RESULTS AND ANALYSIS
A. HRV pattern analysis
In HRV pattern analysis, there are two basic patterns:
Incoherent HRV pattern which implied low HRV and high
risk. The more coherent HRV pattern means high HRV and
low risk [4]. The HRV pattern of a subject in Control
Group during different emotional states was shown in Fig.7.
It was obvious that the modulatory function of ANS was
more powerful, and the reaction capacity of ANS was more
rapid when underwent different emotional state. In rest
session, there was a coherent pattern of HRV, and turned to
Incoherent pattern in Unpleasant session, this phenomenon
reflected the autonomic system’s attempt to achieve
homeostasis when suffered negative emotion. The Pleasant
session shifted the HRV back to coherent pattern also
indicated the mechanism of ANS modulation in normal
subjects.
Correspondingly, Fig.7 illustrated the HRV pattern of
High Stress Group in different emotional mode; there was
no significant difference among three sessions, the results
reflected that the modulatory function of ANS was weaken
by long term pressure in High stress group. Compared to
Control group, the emotional response of unemployed was
slowed due to ANS modulation damage. Negative
emotional states such as depression, anger, and anxiety
triggered by unemployment have induced Incoherence
HRV in High stress group.
B. Time domain analysis
In Control group, the mean SDNN, rMSSD and pNN50
between Rest and Unpleasant session have significant
difference (p<0.05), all of them were significantly higher
during Rest session (versus Unpleasant session).
Accordingly, the mean values in Pleasant session have
obvious difference compared to Unpleasant (p<0.05), these
results kept in line with HRV pattern analysis which
reflected the ANS modulation during different emotional
modes in normal subjects (Table I).
In High stress group (Table I), there was an abnormal
variation in time domain analysis. The mean SDNN was
significantly lower in Rest session (35 ± 11.7, versus
Unpleasant: 41.9 ± 18.0 or Pleasant: 41.9 ± 17.1 session;
p<0.05), and there was no difference between Unpleasant
and Pleasant session. Furthermore, the mean rMSSD and
pNN50 have slightly increased no matter which types of
emotional stimulus acted on subjects compared to Rest
session.
C. frequency domain analysis
The frequency domain analysis (Table I) also illustrated
the ANS modulatory function in normal subjects (Control
group). The mean Normalized LF component of
Unpleasant session (53.9 ± 16.7) decreased compared to
Rest session (61.1 ± 16.4) and the mean Normalized HF
179
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component of them increased correspondingly (46.1 ± 16.7
versus 38.9 ± 16.4). The increased HF n.u. and diminished
LF n.u. observed in this study may indicate a shift of
sympathy-vagal balance towards parasympathetic
predominance. In order to resist the negative stimulus, the
ANS attempted to achieve homeostasis by increasing the
vagal tone, and suppressing the sympathetic activity.
However, the mean total power of Unpleasant session
(2435 ± 1691) has a significantly decreased (p<0.05)
compared to Rest session (3138 ± 1920). These results kept
consistent with time domain and HRV pattern analysis. All
the mean values of frequency domain in High stress group
have a wholly reversed variation trend in contrasted with
Control group, no matter Pleasant or Unpleasant session,
the sympathy-vagal balance turned to sympathetic
predominance which implied the modulatory function and
reaction of ANS were weaken due to long term
unemployed pressure.
V CONCLUSION
This article described a complete ECG methodology to
detecting chronic stress in unemployed populations. With
this methodology, emotional shift experiments were
performed to evaluate its performances and investigate the
mechanism of Autonomic nervous system (ANS)
modulation in unemployment with chronic stress. The
results have shown that this methodology was effective for
HRV based stress detection and much easier for emotion
self-regulatory in unemployed populations. Further work is
still needed to use this platform to study the mechanism of
interaction between central nervous system (CNS) and
autonomic nervous system (ANS), and a wearable mobile
biofeedback system based on Wi-Fi PDA also need to be
developed.
ACKNOWLEDGMENT
This work was supported by Professor Jungtae Lee in
network laboratory of Pusan national university.
REFERENCES
[1] S. Vandeput, J. Taelman, A. Spaepen and S. Van Huffel. Heart Rate
Variability as a Tool to Distinguish Periods of Physical and Mental
Stress in a Laboratory Environment. Proc. of the 6th International
Workshop on Biosignal Interpretation (BSI), New Haven,
Connecticut, pp. 187-190. Jun. 2009.H. Simpson, Dumb Robots, 3rd
ed., Springfield: UOS Press, pp.6-9, 2004.
[2] Dipali Bansal, Munna Khan, A. K. Salhan. A Review of
Measurement and Analysis of Heart Rate Variability. International
Conference on Computer and Automation Engineering (iccae 2009),
pp.243-246, 08-10, Mar, 2009.
[3] Task Force of the European Society of Cardiology and the North
American Society of Pacing and Electrophysiology. Heart rate
variability. Standards of measurement, physiological interpretation,
and clinical use. Circulation; Vol.93, pp: 1043–1065, 1996.
[4] Lee Lipsenthal, MD. Heart Rate Variability and Emotional Shifting:
Powerful Tools for Reducing Cardiovascular Risk. Holistic Primary
Care. Vol.5 (4), pp: 2-4, 2004.