Association between Psychological Stress and Short-Term Heart Rate Variability in Healthy Indian Adults: A Systematic Review

Abstract

Background: Psychological stress alters autonomic balance, and heart rate variability (HRV) offers a non-invasive index of this regulation; however, India-specific evidence linking stress with HRV in healthy adults remains fragmented.

Objective: To synthesize India-based evidence (2015–2025) on the association between psychological stress – psychometric and task-evoked – and short-term heart rate variability (HRV) in healthy adults.

Methods: We conducted a PRISMA-guided systematic review of PubMed/MEDLINE, Scopus, and Embase (2015–2025; English; India-only) for observational or acute-stress studies in healthy adults reporting associations between stress (psychometric or task-evoked) and short-term HRV indices. Two reviewers independently screened, extracted data, and appraised risk of bias (NIH tool); findings were synthesized narratively without meta-analysis due to methodological heterogeneity.

 Results: Among 462 records (PubMed 124, Embase 156, Scopus 182), 300 unique citations were screened; 56 full texts were assessed and 6 studies (total N = 550) met inclusion. Four student-laboratory cohorts, one young-adult acute-stress study, and one community cohort uniformly used short-term, supine HRV with standard indices. Resting psychometric stress–HRV findings were heterogeneous: one dataset showed strong inverse correlations with vagal HRV (e.g., SDNN ρ −0.715; RMSSD ρ −0.662; HF ρ −0.681; total power ρ −0.733) and parallel haemodynamic elevations, whereas others reported non-significant between-group differences despite directional shifts toward higher LF/LFnu and LF/HF and lower HFnu. Acute stress consistently evoked autonomic reactivity: RMSSD during stress was lower in males than females (21.0±10.9 vs 33.7±15.3 ms; p=0.01), and heart rate rose (80→100 bpm; p<0.001) with QT shortening (353→325 ms; p<0.001) and QTc prolongation (397→418 ms; p<0.001). Overall stress prevalence ranged from 56% (community women) to 97.2% (students). Risk of bias was mostly fair; methodological heterogeneity precluded meta-analysis.

Conclusion: HRV reliably captures acute stress–related vagal withdrawal in healthy Indian adults, but cross-sectional links between perceived stress and resting HRV are heterogeneous and method-sensitive, underscoring the need for standardized protocols and broader, better-controlled cohorts.