# Using Smartwatches in Stress Management, Mental Health, and Well-Being: A Systematic Review
## 3 Smartwatches as Stress Assessment Tools
### Smartwatches for Mental Health Monitoring
The goal was to assess whether biometric data from smartwatches could predict relapses and support clinical decision-making. The methodology involved the use of the mHealth device Empatica Embrace2, a smartwatch equipped with sensors tracking activity, sleep, cardiorespiratory function, and electrodermal activity (EDA). Patients wore the smartwatches for six months, with real-time data monitored by clinicians. The results showed that changes in sleep and EDA preceded hospitalizations in two cases, indicating that smartwatch data could serve as early warning signs for clinical intervention. In addition, [PERSON] et al. [45] also investigated anxiety detection using smartwatches through HRV (heart rate variability) and EDA. Their study found that smartwatch sensors capturing fluctuations in cardiorespiratory frequency and electrodermal activity provide useful insights for daily anxiety management. However, the authors noted that these devices lack the precision of medical-grade tools. [PERSON] et al. [23] focused on mental health management via the smartwatch tracking of EDA and cardiorespiratory frequency. While EDA data may not always match subjective stress perception, it still offers valuable indicators when used alongside psychiatric assessments. Moreover, [PERSON] et al. [46] conducted a systematic review evaluating the role of wearables in the self-management of subclinical mental disorders (e.g., anxiety, depression, sleep disorders). Using biometric data from 12 devices, including EDA and HR, and ML models such as SVM, they found that while wearables provide useful monitoring data, limitations persist in reliably predicting subclinical conditions. Finally, [PERSON] et al. [47] evaluated the Apple Watch's ability to monitor physiological indicators related to mental health, such as heart rate and HRV. Figure 4 provides a broader overview of the applications of wearable devices in healthcare, highlighting key biosignals (e.g., heart rate, blood pressure, glucose) and the sensor technologies used to capture them. Although the results showed promise for detecting mild anxiety, the study also highlighted limitations in accuracy during intense movement, calling for further sensor validation and research into Apple Watch applications in mental health. According to the study by [PERSON] et al. [48], consumer wearable devices have shown potential for monitoring and predicting mental and physical health in individuals with severe mental illnesses (SMIs). The research focused on how devices such as smartphones and smartwatches can detect indicators associated with psychiatric relapse, such as sleep disturbances, cardiovascular changes, and physical activity patterns. The analysis revealed that although smartwatches can track real-time data, challenges remain in accurately correlating this information with mental health status due to variability in measurement methods and devices. The study concluded that wearables could offer timely and valuable insights for mental health monitoring but require improved understanding and validation for psychiatric use. At the same time, [PERSON] et al. [49] proposed combining cognitive behavioral therapy (CBT) with physiological monitoring through smartwatches for managing anxiety and cardiovascular depression. Their app integrated metrics such as heart rate and blood oxygen saturation, and the results showed over 80% improvement in patient-reported outcomes, with therapists positively evaluating its usefulness for promoting mental well-being. Moreover, [PERSON] et al. [50] examined the impact of the COVID-19 pandemic on mental health, highlighting the increase in anxiety, depression, and insomnia due to social distancing and uncertainty. The authors stressed the importance of digital technologies and wearables in remote mental health support, noting that smartphones and smartwatches can effectively detect and monitor psychological conditions by anonymously tracking indicators like respiration rate, activity, and electrodermal activity (EDA).