Perceived Stress Scale
The Perceived Stress Scale was developed to measure the degree to which situations in one’s life are appraised as stressful. Psychological stress has been defined as the extent to which persons perceive (appraise) that their demands exceed their ability to cope.
The PSS was published in 1983, and has become one of the most widely used psychological instruments for measuring nonspecific perceived stress. It has been used in studies assessing the stressfulness of situations, the effectiveness of stress-reducing interventions, and the extent to which there are associations between psychological stress and psychiatric and physical disorders.
The PSS predicts both objective biological markers of stress and increased risk for disease among persons with higher perceived stress levels. For example, those with higher scores (suggestive of chronic stress) on the PSS fend worse on biological markers of aging, cortisol levels, immune markers, depression, infectious disease, wound healing, and prostate-specific antigen levels in men.
Prior to the development of the PSS, assessment of stress tended to focus on objective indicators (e.g., frequencies) of specific stressors (e.g., chronic illness, family loss, new family members). This tendency subsequently overlooks the influence an individual’s subjective interpretation of a stressor might have upon the experience of a stressor. Cohen et al. (1983) viewed the void of the subjective component in assessing stress as an unwanted quality and developed the PSS in response. Specifically, the PSS is based upon Lazarus's original transactional model of stress that argues the experience of a stressor is influenced by evaluations on the part of the person as to how well they can manage a stressor given their coping resources.
The original PSS consists of 14 items that are purported to form a unidimensional scale of global perceived stress. Although scores on the 14-item PSS tend to exhibit good reliability estimates across the literature, four of the items tend to perform poorly when evaluated using exploratory factor analysis. As a result, the PSS is commonly implemented using the 10-item form. Cohen et al. (1988) further reduced the PSS to a four item form for quick measurements; however, scores on the 4-item PSS tend to exhibit lower reliability estimates than researchers would like.
Although Cohen et al. (1983) originally argued the PSS to be a unidimensional measure of perceived stress, the research community generally views the 14- and 10-item forms as two dimensional. The predominant forms consist of positively and negatively phrased items. Under exploratory factor analysis the negatively phrased items have been found to load onto a second factor separate from the positively phrased items, giving the appearance of a method effect. That is, a significant portion of the variability in the responses to a subset of the items is a product of how the items are phrased. However, inspection of the items suggests a substantive difference in the positively phrased items versus the negatively phrased items with the negatively phrased items on their face characterizing perceived helplessness while the positively phrased items may be characterizing perceived self-efficacy. Some support for this conceptualization has emerged. For example, Hewitt et al. (1992) found that the perceived helplessness items tended to predict depression in both men and women while the positively phrased items tended to predict depression in women only. The pattern of differential prediction of depression between genders tends to indicate the negatively phrased items are tapping something substantive rather than a method effect. Although the preponderance of evidence is on the side of a multidimensional measure, the issue has not been fully resolved owing in part to limitations in the methodological knowledge available on distinguishing between substantive and method variance.
Across diverse conditions, researchers report relatively satisfactory reliability estimates for scores on the 14- and 10-item forms. For example, Roberti et al. (2006) reported reliability estimates of .85 and .82 in a university sample for scores on the perceived helplessness and perceived self-efficacy scales, respectively. Highly similar results were reported in Taylor (2015) in a sample of middle-aged adults. However, one of the limitations for much of the reliability estimates reported in the extant literature is the overly restrictive requirement of tau-equivalence for accurate reliability estimates. Tau-equivalence requires each item of a scale to have approximately the same size of relationship with the unobserved characteristic (e.g., perceived self-efficacy) driving responses to the items as well as consistent reliability regardless of the latent level driving the responses to the items. Therefore, it is largely unknown whether items on the PSS assign scores with the same degree of reliability for respondents with high latent levels (e.g., perceived helplessness) as respondents with low latent levels. One exception is in Taylor (2015), where the graded response model was utilized to study the reliability levels across levels of the two latent variables. Taylor (2015) reported that the perceived self-efficacy and perceived helplessness subscales tended to estimate scores reliably across levels of the latent variables except among respondents with exceptionally low levels of perceived helplessness and exceptionally high levels of perceived self-efficacy. Finally, much less is known about the reliability of scores from the 4-item form.
- Psychological testing
- Cohen, S; Kamarck T; Mermelstein R (December 1983). "A global measure of perceived stress". Journal of Health and Social Behavior. 24 (4): 385–396. doi:10.2307/2136404. JSTOR 2136404. PMID 6668417.
- "Perceived Stress Scale: Measuring the self-perception of stress". 2005. Retrieved 29 March 2011.
- Leon, KA; Hyre AD; Ompad D; DeSalvo KB; Muntner P (December 2007). "Perceived stress among a workforce 6 months following hurricane Katrina". Social Psychiatry and Psychiatric Epidemiology. 42 (12): 1005–1011. doi:10.1007/s00127-007-0260-6. PMID 17932611.
- McAlonan, GM; Lee AM; Cheung V; Cheung C; Tsang KWT; Sham PC; Chua SE; Josephine GWS (April 2007). "Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers". The Canadian Journal of Psychiatry. 52 (4): 241–247. doi:10.1177/070674370705200406. PMID 17500305.
- Cruess, DG; Antoni MH; Kumar M; Ironson G; McCabe P; Fernandez JB; Fletcher M; Schneiderman N (July 1999). "Cognitive-behavioral stress management buffers decreases in dehydroepiandrosterone sulfate (DHEA-S) and increases in the cortisol/DHEA-S ratio and reduces mood disturbance and perceived stress among HIV-seropositive men". Psychoneuroendocrinology. 24 (5): 537–549. doi:10.1016/S0306-4530(99)00010-4. PMID 10378240.
- Holzel, BK; Carmody J; Evans KC; Hoge EA; Dusek JA; Morgan L; Pitman RK; Lazar SW (March 2010). "Stress reduction correlates with structural changes in the amygdala". Social Cognitive & Affective Neuroscience. 5 (1): 11–17. doi:10.1093/scan/nsp034. PMC 2840837. PMID 19776221.
- Lane, JD; Seskevich JE; Pieper CF (Jan–Feb 2007). "Brief meditation training can improve perceived stress and negative mood". Alternative Therapies in Health and Medicine. 13 (1): 38–44. PMID 17283740.
- Marcus, MT; Fine PM; Moeller FG; Khan MM; Pitts K; Swank PR; Liehr P (September 2003). "Change in Stress Levels Following Mindfulness-based Stress Reduction in a Therapeutic Community". Addictive Disorders & Their Treatment. 2 (3): 63–68. doi:10.1097/00132576-200302030-00001.
- Culhane, JF; Rauh V; McCollum KF; Hogan VK; Agnew K; Wadhwa PD (June 2001). "Maternal stress is associated with bacterial vaginosis in human pregnancy". Maternal and Child Health Journal. 5 (2): 127–134. doi:10.1023/A:1011305300690. PMID 11573838.
- Garg, A; Chren MM; Sands LP; Matsui MS; Marenus KD; Feingold KR; Elias PM (January 2001). "Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders". Archives of Dermatology. 137 (1): 53–59. doi:10.1001/archderm.137.1.53. PMID 11176661.
- Kramer, JR; Ledolter J; Manos GN; Bayless ML (Winter 2000). "Stress and metabolic control in diabetes mellitus: methodological issues and an illustrative analysis". Annals of Behavioral Medicine. 22 (1): 17–28. doi:10.1007/BF02895164. PMID 10892525.
- Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM (December 2004). "Accelerated telomere shortening in response to life stress". Proceedings of the National Academy of Sciences of the United States of America. 101 (49): 17312–17315. doi:10.1073/pnas.0407162101. PMC 534658. PMID 15574496.
- Malarkey, WB; Pearl DK; Demers LM; Kiecolt-Glaser JK; Glaser R (1995). "Influence of academic stress and season on 24-hour mean concentrations of ACTH, cortisol, and beta-endorphin". Psychoneuroendocrinology. 20 (5): 499–508. doi:10.1016/0306-4530(94)00077-N. PMID 7675934.
- Pruessner, JC; Hellhammer DH; Kirschbaum C (Mar–Apr 1999). "Burnout, perceived stress, and cortisol responses to awakening". Psychosomatic Medicine. 61 (2): 197–204. doi:10.1097/00006842-199903000-00012. PMID 10204973.
- van Eck, MM; Nicolson NA (1994). "Perceived stress and salivary cortisol in daily life". Annals of Behavioral Medicine. 16 (3): 221–227.
- Maes, M; Van Bockstaele DR (1999). "The effects of psychological stress on leukocyte subset distribution in humans: evidence of immune activation". Neuropsychobiology. 39 (1): 1–9. doi:10.1159/000026552. PMID 9892853.
- Burns, VE; Drayson M; Ring C; Carroll D (Nov–Dec 2002). "Perceived stress and psychological well-being are associated with antibody status after meningitis C conjugate vaccination". Psychosomatic Medicine. 64 (6): 963–970. doi:10.1097/01.PSY.0000038936.67401.28. PMID 12461201.
- Cohen, S; Doyle WJ; Skoner DP (Mar–Apr 1999). "Psychological stress, cytokine production, and severity of upper respiratory illness". Psychosomatic Medicine. 61 (2): 175–180. doi:10.1097/00006842-199903000-00009. PMID 10204970.
- Glaser, R; Kiecolt-Glaser JK; Marucha PT; MacCullum RC; Laskowski BF; Malarkey WB (May 1999). "Stress-related changes in proinflammatory cytokine production in wounds". Archives of General Psychiatry. 56 (5): 450–456. doi:10.1001/archpsyc.56.5.450. PMID 10232300.
- Carpenter, LL; Tyrka AR; McDougle CJ; Malison RT; Owens MJ; Nemeroff CB; Price LH (April 2004). "Cerebrospinal fluid corticotropin-releasing factor and perceived early-life stress in depressed patients and healthy control subjects". Neuropsychopharmacology. 29 (4): 777–784. doi:10.1038/sj.npp.1300375. PMID 14702025.
- Cohen, S; Tyrrell DA; Smith AP (January 1993). "Negative life events, perceived stress, negative affect, and susceptibility to the common cold". Journal of Personality and Social Psychology. 64 (1): 131–140. doi:10.1037/0022-35188.8.131.52. PMID 8421249.
- Dyck, DG; Short R; Vitaliano PP (Jul–Aug 1999). "Predictors of burden and infectious illness in schizophrenia caregivers". Psychosomatic Medicine. 61 (4): 411–419. PMID 10443748.
- Ebrecht, M; Hextall J; Kirtley LG; Taylor A; Dyson M; Weinman J (July 2004). "Perceived stress and cortisol levels predict speed of wound healing in healthy male adults". Psychoneuroendocrinology. 29 (6): 798–809. doi:10.1016/S0306-4530(03)00144-6. PMID 15110929.
- Stone, AA; Mezzacappa ES; Donatone BA; Gonder M (September 1999). "Psychosocial stress and social support are associated with prostate-specific antigen levels in men: results from a community screening program". Health Psychology. 18 (5): 482–486. doi:10.1037/0278-6184.108.40.2062. PMID 10519464.
- Shewchuk, Richard M.; Elliott, Timothy R.; MacNair-Semands, Rebecca R.; Harkins, Stephen (1999-04-01). "Trait Influences on Stress Appraisal and Coping: An Evaluation of Alternative Frameworks". Journal of Applied Social Psychology. 29 (4): 685–704. doi:10.1111/j.1559-1816.1999.tb02019.x. ISSN 1559-1816.
- Cohen, S., & Williamson, G. M. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on Applied Social Psychology (pp. 3-67). Newbury Park, CA: Sage.
- Taylor, John M. (2015). "Psychometric analysis of the Ten-Item Perceived Stress Scale". Psychological Assessment. 27 (1): 90–101. doi:10.1037/a0038100. PMID 25346996.
- Hewitt, Paul L.; Flett, Gordon L.; Mosher, Shawn W. (1992-09-01). "The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample". Journal of Psychopathology and Behavioral Assessment. 14 (3): 247–257. doi:10.1007/BF00962631. ISSN 0882-2689.
- Roberti, Jonathan W.; Harrington, Lisa N.; Storch, Eric A. (2006). "Further Psychometric Support for the 10-Item Version of the Perceived Stress Scale". Journal of College Counseling. 9 (2): 135–147. doi:10.1002/j.2161-1882.2006.tb00100.x. ISSN 1099-0399.
- Graham, J. M. (2006). "Congeneric and (essentially) tau-equivalent estimates of score reliability what they are and how to use them". Educational and Psychological Measurement. 66 (6): 930–944. doi:10.1177/0013164406288165.