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However, translation to digital mental health interventions (DMHI) requires computing and providing real\u2010time HRVB metrics in a personalized and user\u2010friendly fashion. To address these gaps, this study validates a real\u2010time HRVB feedback algorithm and characterizes the association of the main algorithmic summary metric\u2014HRVB amplitude\u2014with demographic, psychological, and health factors. We analyzed HRVB data from 5158 participants in a therapist\u2010supported DMHI incorporating slow\u2010paced breathing to treat depression or anxiety symptoms. A real\u2010time feedback metric of HRVB amplitude and a gold\u2010standard research metric of low\u2010frequency (LF) power were computed for each session and then averaged within\u2010participants over 2\u2009weeks. We provide HRVB amplitude values, stratified by age and gender, and we characterize the multivariate associations of HRVB amplitude with demographic, psychological, and health factors. Real\u2010time HRVB amplitude correlated strongly (<jats:italic>r<\/jats:italic>\u2009=\u2009.93, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) with the LF power around the respiratory frequency (~0.1\u2009Hz). Age was associated with a significant decline in HRVB (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.46, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), which was steeper among men than women, adjusting for demographic, psychological, and health factors. Resting high\u2010 and low\u2010frequency power, body mass index, hypertension, Asian race, depression symptoms, and trauma history were significantly associated with HRVB amplitude in multivariate analyses (<jats:italic>p<\/jats:italic>'s\u2009&lt;\u2009.01). Real\u2010time HRVB amplitude correlates highly with a research gold\u2010standard spectral metric, enabling automated biofeedback delivery as a potential treatment component of DMHIs. Moreover, we identify demographic, psychological, and health factors relevant to building an equitable, accurate, and personalized biofeedback user experience.<\/jats:p>","DOI":"10.1111\/psyp.14533","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T06:30:31Z","timestamp":1709879431000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Real\u2010time heart rate variability biofeedback amplitude during a large\u2010scale digital mental health intervention differed by age, gender, and mental and physical health"],"prefix":"10.1111","volume":"61","author":[{"given":"Kirstin","family":"Aschbacher","sequence":"first","affiliation":[{"name":"Meru Health  San Mateo California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Mather","sequence":"additional","affiliation":[{"name":"Leonard Davis School of Gerontology University of Southern California  Los Angeles California USA"},{"name":"Department of Psychology University of Southern California  Los Angeles California USA"},{"name":"Department of Biomedical Engineering University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9010-6129","authenticated-orcid":false,"given":"Paul","family":"Lehrer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Robert Wood Johnson Medical School Rutgers University  Monmouth Junction New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gevirtz","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, California School of Professional Psychology Alliant International University  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissa","family":"Epel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9154-0584","authenticated-orcid":false,"given":"Nicholas C.","family":"Peiper","sequence":"additional","affiliation":[{"name":"Meru Health  San Mateo California USA"},{"name":"Department of Epidemiology and Population Health University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877\u2010012\u20109424\u20103"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2018.0019"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2015.11.011"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2016.02.019"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2016.09.009"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000001230"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746\u2010020\u20100226\u20106"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/00221465211052568"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12920\u2010021\u201001056\u20100"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01404679"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11122198"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.93.5.1043"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2020.610626"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.1998.274.2.h709"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctcp.2021.101420"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC.2016.7590857"},{"key":"e_1_2_10_18_1","unstructured":"Downey A.(2014).Think DSP: Digital signal processing in python.https:\/\/greenteapress.com\/thinkdsp\/thinkdsp.pdf"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.1992.263.3.H798"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10484\u2010020\u201009458\u2010z"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.2196\/14284"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1099800419877442"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2021.102750"},{"key":"e_1_2_10_24_1","unstructured":"Gavin H. 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