{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:29:13Z","timestamp":1782433753788,"version":"3.54.5"},"reference-count":72,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Federal Ministry of Education and Research","doi-asserted-by":"publisher","award":["01EL2003"],"award-info":[{"award-number":["01EL2003"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Stress management interventions aim to reduce the disease risk that is heightened by work stress. Possible pathways of risk reduction include improvements in the autonomous nervous system, which is indexed by the measurement of heart rate variability (HRV). A randomized controlled trial on improving stress management skills at work was conducted to investigate the effects of intervention on HRV. A total of 174 lower management employees were randomized into either the waiting list control group (CG) or the intervention group (IG) receiving a 2-day stress management training program and another half-day booster after four and six months. In the trial, 24 h HRV was measured at baseline and after 12 months. Heart rate (HR), root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), and standard deviation of the average of normal-to-normal intervals (SDANN) were calculated for 24 h and nighttime periods. Age-adjusted multilevel mixed effects linear regressions with unstructured covariance, time as a random coefficient, and time \u00d7 group interaction with the according likelihood-ratio tests were calculated. The linear mixed-effect regression models showed neither group effects between IG and CG at baseline nor time effects between baseline and follow-up for SDANN (24 h), SDNN (24 h and nighttime), RMSSD (24 h and nighttime), and HR (24 h and nighttime). Nighttime SDANN significantly improved in the intervention group (z = 2.04, p = 0.041) compared to the control group. The objective stress axis measures (SDANN) showed successful stress reduction due to the training. Nighttime SDANN was strongly associated with minimum HR. Though the effects were small and only visible at night, it is highly remarkable that 3 days of intervention achieved a measurable effect considering that stress is only one of many factors that can influence HR and HRV.<\/jats:p>","DOI":"10.3390\/ijerph19073841","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:05:18Z","timestamp":1648166718000},"page":"3841","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Stress Management Intervention for Leaders Increases Nighttime SDANN: Results from a Randomized Controlled Trial"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4172-2689","authenticated-orcid":false,"given":"Elisabeth Maria","family":"Balint","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany"},{"name":"Burnout Section, Privatklinik Meiringen, 3860 Meiringen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Angerer","sequence":"additional","affiliation":[{"name":"Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, 40204 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Guendel","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitt","family":"Marten-Mittag","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universit\u00e4t Muenchen, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc N.","family":"Jarczok","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.socscimed.2018.02.028","article-title":"Healthy Working Days: The (Positive) Effect of Work Effort on Occupational Health from a Human Capital Approach","volume":"202","author":"Urtasun","year":"2018","journal-title":"Soc. Sci. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8073","DOI":"10.1161\/JAHA.117.008073","article-title":"Association between Work-Related Stress and Coronary Heart Disease: A Review of Prospective Studies through the Job Strain, Effort-Reward Balance, and Organizational Justice Models","volume":"7","author":"Sara","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1016\/S0140-6736(12)60994-5","article-title":"Job Strain as a Risk Factor for Coronary Heart Disease: A Collaborative Meta-Analysis of Individual Participant Data","volume":"380","author":"Nyberg","year":"2012","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1017\/S003329171600355X","article-title":"Job Strain as a Risk Factor for Clinical Depression: Systematic Review and Meta-Analysis with Additional Individual Participant Data","volume":"47","author":"Madsen","year":"2017","journal-title":"Psychol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Theorell, T., Hammarstr\u00f6m, A., Aronsson, G., Tr\u00e4skman Bendz, L., Grape, T., Hogstedt, C., Marteinsdottir, I., Skoog, I., and Hall, C. (2015). A Systematic Review Including Meta-Analysis of Work Environment and Depressive Symptoms. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-1954-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/S2215-0366(18)30137-8","article-title":"The Role of Job Strain in Understanding Midlife Common Mental Disorder: A National Birth Cohort Study","volume":"5","author":"Harvey","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1038\/nrcardio.2017.189","article-title":"Effects of Stress on the Development and Progression of Cardiovascular Disease","volume":"15","author":"Steptoe","year":"2018","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/S2213-8587(18)30140-2","article-title":"Work Stress and Risk of Death in Men and Women with and without Cardiometabolic Disease: A Multicohort Study","volume":"6","author":"Pentti","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9282","DOI":"10.1038\/s41598-017-07508-x","article-title":"Work Stress, Anthropometry, Lung Function, Blood Pressure, and Blood-Based Biomarkers: A Cross-Sectional Study of 43,593 French Men and Women","volume":"7","author":"Westerlund","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00392-019-01488-w","article-title":"Significance of Psychosocial Factors in Cardiology: Update 2018: Position Paper of the German Cardiac Society","volume":"108","author":"Albus","year":"2019","journal-title":"Clin. Res. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical PracticeDeveloped by the Task Force for Cardiovascular Disease Prevention in Clinical Practice with Representatives of the European Society of Cardiology and 12 Medical Societies With the Special Contribution of the European Association of Preventive Cardiology (EAPC)","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.psyneuen.2018.10.027","article-title":"HPA Axis Responses to Psychological Challenge Linking Stress and Disease: What Do We Know on Sources of Intra- and Interindividual Variability?","volume":"105","author":"Bellingrath","year":"2019","journal-title":"Psychoneuroendocrinology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/psyp.13804","article-title":"Stress and Aging: A Neurovisceral Integration Perspective","volume":"58","author":"Thayer","year":"2021","journal-title":"Psychophysiology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Benarroch, E.E. (2014). Central Autonomic Network. Autonomic Neurology, Oxford University Press.","DOI":"10.1093\/med\/9780199920198.001.0001"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.neubiorev.2011.11.009","article-title":"A Meta-Analysis of Heart Rate Variability and Neuroimaging Studies: Implications for Heart Rate Variability as a Marker of Stress and Health","volume":"36","author":"Thayer","year":"2012","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1146\/annurev-psych-062520-122331","article-title":"Stress and Health: A Review of Psychobiological Processes","volume":"72","author":"Thayer","year":"2021","journal-title":"Annu. Rev. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.neubiorev.2016.05.001","article-title":"A Meta-Analysis of Non-Invasive Brain Stimulation and Autonomic Functioning: Implications for Brain-Heart Pathways to Cardiovascular Disease","volume":"74","author":"Makovac","year":"2017","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","article-title":"An Overview of Heart Rate Variability Metrics and Norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.neubiorev.2017.12.010","article-title":"Stress, Autonomic Imbalance, and the Prediction of Metabolic Risk: A Model and a Proposal for Research","volume":"86","author":"Wulsin","year":"2018","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.ijcard.2012.02.002","article-title":"Heart Rate Variability Is Associated with Glycemic Status after Controlling for Components of the Metabolic Syndrome","volume":"167","author":"Jarczok","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1176\/appi.ajp.2014.13121605","article-title":"Effects of Depression, Anxiety, Comorbidity, and Antidepressants on Resting-State Heart Rate and Its Variability: An ELSA-Brasil Cohort Baseline Study","volume":"171","author":"Kemp","year":"2014","journal-title":"Am. J. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.neubiorev.2017.09.006","article-title":"From Psychological Moments to Mortality: A Multidisciplinary Synthesis on Heart Rate Variability Spanning the Continuum of Time","volume":"83","author":"Kemp","year":"2017","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_23","first-page":"1","article-title":"Circadian Variation of Cardiac Autonomic Modulation in a Rigorously Healthy Working Population: Results from the MICS-Cohort","volume":"77","author":"Jarczok","year":"2015","journal-title":"Psychosom. Med."},{"key":"ref_24","unstructured":"Pavol, S. (2019). Circadian Rhythms of the Autonomic Nervous System: Scientific Implication and Practical Implementation. Chronobiology\u2014The Science of Biological Time Structure, IntechOpen."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1089\/rej.2010.1019","article-title":"Metabolic Syndrome and Short-Term and Long-Term Heart Rate Variability in Elderly Free of Clinical Cardiovascular Disease: The PROOF Study","volume":"13","author":"Pichot","year":"2010","journal-title":"Rejuvenation Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3196","DOI":"10.1161\/STROKEAHA.110.607697","article-title":"Decreased Nighttime Heart Rate Variability Is Associated with Increased Stroke Risk","volume":"42","author":"Binici","year":"2011","journal-title":"Stroke"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Siegrist, J., and Li, J. (2017). Work Stress and Altered Biomarkers: A Synthesis of Findings Based on the Effort-Reward Imbalance Model. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14111373"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1016\/j.neubiorev.2013.07.004","article-title":"Autonomic Nervous System Activity and Workplace Stressors\u2014A Systematic Review","volume":"37","author":"Jarczok","year":"2013","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_29","unstructured":"T\u00f6res, T. (2020). Work Stress and Autonomic Nervous System Activity. Handbook of Socioeconomic Determinants of Occupational Health\u2014From Macro-Level to Micro-Level Evidence, Springer International Publishing."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Theorell, T. (2020). Handbook of Socioeconomic Determinants of Occupational Health, Springer International Publishing.","DOI":"10.1007\/978-3-030-31438-5"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1080\/1359432X.2017.1347157","article-title":"Meta-Analytic Evidence of the Effectiveness of Stress Management at Work","volume":"26","author":"Doebler","year":"2017","journal-title":"Eur. J. Work Organ. Psychol."},{"key":"ref_32","unstructured":"Diener, E., Oishi, S., and Tay, L. (2018). Stress Management Interventions: Improving Subjective Psychological Well-Being in the Workplace Stress Management Interventions: A Typology and Description. Handbook of Well-Being, DEF Publishers."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.ahj.2004.10.015","article-title":"Effects of a Psychosocial Skills Training Workshop on Psychophysiological and Psychosocial Risk in Patients Undergoing Coronary Artery Bypass Grafting","volume":"150","author":"Bishop","year":"2005","journal-title":"Am. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Jarczok, M.N., Kleber, M.E., Koenig, J., Loerbroks, A., Herr, R.M., Hoffmann, K., Fischer, J.E., Benyamini, Y., and Thayer, J.F. (2015). Investigating the Associations of Self-Rated Health: Heart Rate Variability Is More Strongly Associated than Inflammatory and Other Frequently Used Biomarkers in a Cross Sectional Occupational Sample. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117196"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Oyeleye, M., Chen, T., Titarenko, S., and Antoniou, G. (2022). A Predictive Analysis of Heart Rates Using Machine Learning Techniques. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19042417"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Staffini, A., Svensson, T., Chung, U.I., and Svensson, A.K. (2021). Heart Rate Modeling and Prediction Using Autoregressive Models and Deep Learning. Sensors, 22.","DOI":"10.3390\/s22010034"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Massaro, A., Maritati, V., Savino, N., and Galiano, A. (2018, January 3\u20135). Neural Networks for Automated Smart Health Platforms Oriented on Heart Predictive Diagnostic Big Data Systems. Proceedings of the 2018 AEIT International Annual Conference, Bari, Italy.","DOI":"10.23919\/AEIT.2018.8577362"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Massaro, A., Ricci, G., Selicato, S., Raminelli, S., and Galiano, A. (2020, January 3\u20135). Decisional Support System with Artificial Intelligence Oriented on Health Prediction Using a Wearable Device and Big Data. Proceedings of the 2020 IEEE International Workshop on Metrology for Industry 4.0 & IoT, Roma, Italy.","DOI":"10.1109\/MetroInd4.0IoT48571.2020.9138258"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ni, A., Azarang, A., and Kehtarnavaz, N. (2021). A Review of Deep Learning-Based Contactless Heart Rate Measurement Methods. Sensors, 21.","DOI":"10.3390\/s21113719"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Cheng, C.H., Wong, K.L., Chin, J.W., Chan, T.T., and So, R.H.Y. (2021). Deep Learning Methods for Remote Heart Rate Measurement: A Review and Future Research Agenda. Sensors, 21.","DOI":"10.3390\/s21186296"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Bonsaksen, T., Th\u00f8rrisen, M.M., Skogen, J.C., and Aas, R.W. (2019). Who Reported Having a High-Strain Job, Low-Strain Job, Active Job and Passive Job? The WIRUS Screening Study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0227336"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"472","DOI":"10.5465\/amr.2005.17293355","article-title":"Executive Job Demands: New Insights for Explaining Strategic Decisions and Leader Behaviors","volume":"30","author":"Hambrick","year":"2005","journal-title":"Acad. Manag. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1136\/oem.2009.054148","article-title":"Stress Management Interventions in the Workplace Improve Stress Reactivity: A Randomised Controlled Trial","volume":"68","author":"Limm","year":"2010","journal-title":"Occup. Environ. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"235","DOI":"10.30773\/pi.2017.08.17","article-title":"Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature","volume":"15","author":"Kim","year":"2018","journal-title":"Psychiatry Investig."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/SLA.0b013e318209a594","article-title":"Stress Management Training for Surgeons-a Randomized, Controlled, Intervention Study","volume":"253","author":"Wetzel","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_46","unstructured":"(2011). Hospital Anxiety and Depression Scale\u2014Deutsche Version (HADS-D), Verlag Hans Huber. 3. aktualisierte und neu normierte Auflage."},{"key":"ref_47","first-page":"227","article-title":"Fragebogen Zur Messung Beruflicher Gratifikationskrisen","volume":"25","author":"Siegrist","year":"2004","journal-title":"Z. Differ. Diagn. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.neubiorev.2016.03.007","article-title":"Sex Differences in Healthy Human Heart Rate Variability: A Meta-Analysis","volume":"64","author":"Koenig","year":"2016","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart Rate Variability. Standards of Measurement, Physiological Interpretation, and Clinical Use","volume":"93","author":"Camm","year":"1996","journal-title":"Circulation"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1016\/j.jacc.2004.01.050","article-title":"Dissection of Long-Range Heart Rate Variability","volume":"43","author":"Roach","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.numecd.2017.04.004","article-title":"Resting Heart Rate and the Risk of Cardiovascular Disease, Total Cancer, and All-Cause Mortality\u2014A Systematic Review and Dose\u2013Response Meta-Analysis of Prospective Studies","volume":"27","author":"Aune","year":"2017","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1111\/j.1532-5415.2007.01455.x","article-title":"Estimated Functional Capacity Predicts Mortality in Older Adults","volume":"55","author":"Sui","year":"2007","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1016\/j.ijcard.2012.12.103","article-title":"Predictive Value of Night-Time Heart Rate for Cardiovascular Events in Hypertension. The ABP-International Study","volume":"168","author":"Palatini","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/S1389-9457(08)70013-3","article-title":"Metabolic Consequences of Sleep and Sleep Loss","volume":"9","author":"Spiegel","year":"2008","journal-title":"Sleep Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/a0019612","article-title":"Sleep and Cognitive Failures Improved by a Three-Month Stress Management Intervention","volume":"17","author":"Willert","year":"2010","journal-title":"Int. J. Stress Manag."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1007\/s12529-013-9374-2","article-title":"Sleep Quality and Fatigue after a Stress Management Intervention for Women with Early-Stage Breast Cancer in Southern Florida","volume":"21","author":"Vargas","year":"2014","journal-title":"Int. J. Behav. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/HJR.0b013e3283030a97","article-title":"Effects of Drug, Biobehavioral and Exercise Therapies on Heart Rate Variability in Coronary Artery Disease: A Systematic Review","volume":"15","author":"Nolan","year":"2008","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jpsychores.2016.02.003","article-title":"Heart Rate Variability Predicts Therapy Outcome in Pain-Predominant Multisomatoform Disorder","volume":"83","author":"Angelovski","year":"2016","journal-title":"J. Psychosom. Res."},{"key":"ref_59","first-page":"61","article-title":"Association of 24-Hour Heart Rate Variability and Daytime Physical Activity: ALLSTAR Big Data Analysis","volume":"8","author":"Hayano","year":"2018","journal-title":"Int. J. Biosci. Biochem. Bioinform."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/FBP.0000000000000383","article-title":"Heart-Rate Variability: A Biomarker to Study the Influence of Nutrition on Physiological and Psychological Health?","volume":"29","author":"Young","year":"2018","journal-title":"Behav. Pharmacol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"353","DOI":"10.3389\/fnhum.2018.00353","article-title":"How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing","volume":"12","author":"Zaccaro","year":"2018","journal-title":"Front. Hum. Neurosci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ijpsycho.2018.01.001","article-title":"Adding HRV Biofeedback to Psychotherapy Increases Heart Rate Variability and Improves the Treatment of Major Depressive Disorder","volume":"131","author":"Caldwell","year":"2018","journal-title":"Int. J. Psychophysiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/S0277-9536(03)00351-4","article-title":"The Measurement of Effort-Reward Imbalance at Work: European Comparisons","volume":"58","author":"Siegrist","year":"2004","journal-title":"Soc. Sci. Med."},{"key":"ref_64","first-page":"21","article-title":"\u00dcbergewicht Und Adipositas Bei Erwachsenen in Deutschland","volume":"2","author":"Schienkiewitz","year":"2017","journal-title":"J. Health Monit."},{"key":"ref_65","unstructured":"Jahnsen, K., Strube, H., and Starker, A. (2008). Hypertonie, Robert-Koch-Institut."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3389\/fnins.2021.600865","article-title":"24 H-Heart Rate Variability as a Communication Tool for a Personalized Psychosomatic Consultation in Occupational Health","volume":"15","author":"Jarczok","year":"2021","journal-title":"Front. Neurosci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.hrthm.2016.12.016","article-title":"New Reference Values of Heart Rate Variability during Ordinary Daily Activity","volume":"14","author":"Sammito","year":"2017","journal-title":"Hear. Rhythm."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Mulfinger, N., Sander, A., Stuber, F., Brinster, R., Junne, F., Limprecht, R., Jarczok, M.N., Seifried-D\u00fcbon, T., Rieger, M.A., and Zipfel, S. (2019). Cluster-Randomised Trial Evaluating a Complex Intervention to Improve Mental Health and Well-Being of Employees Working in Hospital\u2014A Protocol for the SEEGEN Trial. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7909-4"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"LaMontagne, A.D., Martin, A., Page, K.M., Reavley, N.J., Noblet, A.J., Milner, A.J., Keegel, T., and Smith, P.M. (2014). Workplace Mental Health: Developing an Integrated Intervention Approach. BMC Psychiatry, 14.","DOI":"10.1186\/1471-244X-14-131"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Michaelis, M., Balint, E.M., Junne, F., Zipfel, S., G\u00fcndel, H., Lange, R., Rieger, M.A., and Rothermund, E. (2019). Who Should Play a Key Role in Preventing Common Mental Disorders That Affect Employees in the Workplace? Results of a Survey with Occupational Health Physicians, Primary Care Physicians, Psychotherapists, and Human Resource Managers. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16081383"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Ruotsalainen, J.H., Verbeek, J.H., Marin\u00e9, A., and Serra, C. (2015). Preventing Occupational Stress in Healthcare Workers. Cochrane Database Syst. Rev., 2015.","DOI":"10.1002\/14651858.CD002892.pub5"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Lehmann, J.A.M., Schwarz, E., Azad, Z.R., Gritzka, S., Diebig, M., Gast, M., Kilian, R., Nater, U., Jarczok, M., and Kessemeier, F. (2021). Effectiveness and Cost Effectiveness of a Stress Management Training for Leaders of Small and Medium Sized Enterprises\u2014Study Protocol for a Randomized Controlled-Trial. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10398-4"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/7\/3841\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:42:03Z","timestamp":1760136123000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/7\/3841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,24]]},"references-count":72,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19073841"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19073841","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,24]]}}}