Interpretable Stress Detection from ECG Signals Using Motif-Based Anomaly Analysis

Vision Transformers have shown tremendous success in numerous computer vision applications; however, they have not been exploited for stress assessment using physiological signals such as Electrocardiogram (ECG). In order to get the maximum benefit from the vision transformer for multilevel stress assessment, in this paper, we transform the raw ECG data into 2D spectrograms using short time Fourier transform (STFT). These spectrograms are divided into patches for feeding to the transformer encoder. We also perform experiments with 1D CNN and ResNet-18 (CNN model). We perform leave-onesubject-out cross validation (LOSOCV) experiments on WESAD and Ryerson Multimedia Lab (RML) dataset. One of the biggest challenges of LOSOCV based experiments is to tackle the problem of intersubject variability. In this research, we address the issue of intersubject variability and show our success using 2D spectrograms and the attention mechanism of transformer. Experiments show that vision transformer handles the effect of intersubject variability much better than CNN-based models and beats all previous state-of-the-art methods by a considerable margin. Moreover, our method is end-to-end, does not require handcrafted features, and can learn robust representations. The proposed method achieved 71.01% and 76.7% accuracies with RML dataset and WESAD dataset respectively for three class classification and 88.3% for binary classification on WESAD.

Electrocardiography (ECG) remains central to cardiovascular screening, yet interpretation remains largely manual and episodic. Clinical practice relies on brief resting ECGs and, when required, long-duration ambulatory recordings, both generating data that require resource-intensive review. Consequently, subtle morphological changes or progressive drift preceding clinically apparent abnormalities may go unnoticed. We propose a motif-based framework that defines beat-aligned ECG motifs as interpretable cardiac signatures and quantifies morphological drift and deviation across short and long-term monitoring. Motifs are representative cardiac cycles capturing dominant morphology. We introduce three interpretable drift metrics: deviation from a normal sinus rhythm (NSR), deviation from a personalised baseline, and a motif instability index. Motifs are extracted by selecting beats that minimise Dynamic Time Warping (DTW) distance within fixed windows. We evaluate these metrics on short (PTB-XL) and long-duration (MIT-BIH Arrhythmia) ECG datasets. Interpretability is achieved through representative motif overlays and fiducial-based visualisations, enabling direct inspection of morphological changes. In MIT-BIH, the proposed metrics significantly separated predominantly normal from arrhythmic subjects (p<0.01). In PTB-XL, NSR deviation distinguished normal from abnormal ECGs across major diagnostic subtypes (p<1e-4, Cliff's delta up to 0.93). ECG motifs provide an interpretable representation of cardiac morphology, supporting scalable longitudinal monitoring and early detection of morphology-driven change.

Continuous stress forecasting could potentially contribute to lifestyle interventions. This paper presents a novel, explainable, and individualized approach for stress prediction using physiological data from consumer-grade smartwatches. We develop a time series forecasting model that leverages multivariate features, including heart rate variability, activity patterns, and sleep metrics, to predict stress levels across 16 temporal horizons (History window: 3, 5, 7, 9 days; forecasting window: 1, 3, 5, 7 days). Our evaluation involves 16 participants monitored for 10-15 weeks. We evaluate our approach across 16 participants, comparing against state-of-the-art time series models (Informer, TimesNet, PatchTST) and traditional baselines (CNN, LSTM, CNN-LSTM) across multiple temporal horizons. Our model achieved performance with an MSE of 0.053, MAE of 0.190, and RMSE of 0.226 in optimal settings (5-day input, 1-day prediction). A comparison with the baseline models shows that our model outperforms TimesNet, PatchTST, CNN-LSTM, LSTM, and CNN under all conditions, representing improvements of 36.9%, 25.5%, and 21.5% over the best baseline. According to the explanability analysis, sleep metrics are the most dominant and consistent stress predictors (importance: 1.1, consistency: 0.9-1.0), while activity features exhibit high inter-participant variability (0.1-0.2). Most notably, the model captures individual-specific patterns where identical features can have opposing effects across users, validating its personalization capabilities. These findings establish that consumer wearables, combined with adaptive and interpretable deep learning, can deliver relevant stress assessment adapted to individual physiological responses, providing a foundation for scalable, continuous, explainable mental health monitoring in real-world settings.