A systematic review of 38 studies found that wearable ECG and PPG can detect anxiety-related autonomic changes, but clinical translation is constrained by small sample sizes and lack of real-world validation.
Systematic Review
Can wearable ECG and PPG combined with data-driven analytics accurately detect anxiety?
While wearable ECG and PPG show promise for anxiety detection via autonomic markers, translation to routine care is hindered by a lack of real-world validation and demonstrated clinical utility.
Anxiety disorders affect hundreds of millions of people worldwide, yet objective and continuous assessment remains limited in clinical practice. To our knowledge, this is the first modality-specific, translational synthesis focusing on wearable ECG and PPG for anxiety detection. Wearable electrocardiography (ECG) and photoplethysmography (PPG), combined with data-driven analytics, have emerged as promising tools for anxiety monitoring, but translation into routine care has been slow. Here, we present a PRISMA-guided systematic review of 38 studies (2015–2025) investigating wearable ECG- and PPG-based anxiety detection. We analyze anxiety induction paradigms, sensor configurations, signal acquisition strategies, and analytical approaches, including statistical, machine learning, and hybrid methods. While autonomic markers derived from ECG and PPG consistently reflect anxiety-related physiological changes, substantial heterogeneity in study design, limited population diversity, and laboratory-centric validation constrain clinical generalizability. Critically, most studies lack evaluation in real-world settings and do not demonstrate clinical utility or impact on patient outcomes. We identify key translational barriers and propose a digital medicine roadmap emphasizing standardized protocols, robust validation across diverse populations, workflow integration, and outcome-driven evaluation to enable clinically actionable, real-world anxiety monitoring.
Elgendi et al. (Mon,) conducted a systematic review in Anxiety. Wearable ECG and PPG was evaluated on Anxiety detection. A systematic review of 38 studies found that wearable ECG and PPG can detect anxiety-related autonomic changes, but clinical translation is constrained by small sample sizes and lack of real-world validation.