Differentiating Physical and Psychological Stress Using Wearable Physiological Signals and Salivary Cortisol

TL;DR

This study demonstrates that combining wearable physiological signals with salivary cortisol measurements significantly improves the accuracy of distinguishing physical and psychological stress states.

Contribution

The paper introduces a multimodal approach integrating wearable data and cortisol to enhance stress classification accuracy, especially for psychological stress detection.

Findings

Wearable signals alone achieved 77.8% accuracy in stress classification.

Adding cortisol increased overall accuracy to 94.4%.

Cortisol reduced misclassification between psychological stress and rest.

Abstract

Objective: This study aimed to assess how wearable physiological signals, alone and combined with salivary cortisol, distinguish physical and psychological stress and their recovery states. Methods: Six healthy adults completed three laboratory sessions on separate days: rest, physical stress (high-intensity cycling), or psychological stress (modified Trier Social Stress Test). Heart rate, heart rate variability, electrodermal activity, and wrist accelerometry were recorded continuously, and salivary cortisol was sampled at five time points. Features were extracted in non-overlapping 10-minute windows and labelled as rest, physical stress, physical recovery, psychological stress, or psychological recovery. A gradient boosting classifier was trained using wearable features alone and with five additional cortisol features per window. Performance was evaluated using leave-one-participant-out cross-validation. Results: Wearable-only classification achieved 77.8% overall accuracy, with high accuracy for physical stress and recovery but frequent misclassification of psychological stress and recovery (recall 50.0% and 54.2%). Including cortisol improved overall accuracy (94.4%), particularly for psychological states, increasing recall to 83.3% and 87.5%. Cortisol also reduced misclassification between psychological stress and rest. Conclusion: Wearable signals alone were insufficient to reliably distinguish psychological stress from rest and recovery. Integrating salivary cortisol improved classification of psychological stress and recovery and reduced confusion with rest, highlighting the value of endocrine context alongside wearable physiology. Significance: These findings support multimodal stress monitoring and motivate larger, ecologically valid studies and scalable alternatives to repeated cortisol sampling.