Perceived Stress Scale
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| name = Perceived Stress Scale
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| purpose =degree to which situations in one’s life are appraised as stressful
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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,{{cite journal|last=Cohen|first=S|author2=Kamarck T |author3=Mermelstein R |title=A global measure of perceived stress|journal=Journal of Health and Social Behavior|date=December 1983|volume=24|issue=4|pages=385–396|pmid=6668417|doi=10.2307/2136404|jstor=2136404|s2cid=21357701}} and has become one of the most widely used{{cite web|title=Perceived Stress Scale: Measuring the self-perception of stress|url=http://www.mindgarden.com/products/pss.htm|access-date=29 March 2011|year=2005}} psychological instruments for measuring nonspecific perceived stress. It has been used in studies assessing the stressfulness of situations,{{cite journal|last=Leon|first=KA|author2=Hyre AD |author3=Ompad D |author4=DeSalvo KB |author5=Muntner P |title=Perceived stress among a workforce 6 months following hurricane Katrina|journal=Social Psychiatry and Psychiatric Epidemiology|date=December 2007|volume=42|issue=12|pages=1005–1011|pmid=17932611|doi=10.1007/s00127-007-0260-6|s2cid=7785269}}{{cite journal|last=McAlonan|first=GM|author2=Lee AM |author3=Cheung V |author4=Cheung C |author5=Tsang KWT |author6=Sham PC |author7=Chua SE |author8=Josephine GWS |title=Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers|journal=The Canadian Journal of Psychiatry|date=April 2007|volume=52|issue=4|pages=241–247|pmid=17500305|doi=10.1177/070674370705200406|doi-access=free}} the effectiveness of stress-reducing interventions,{{cite journal|last=Cruess|first=DG|author2=Antoni MH |author3=Kumar M |author4=Ironson G |author5=McCabe P |author6=Fernandez JB |author7=Fletcher M |author8=Schneiderman N |title=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|journal=Psychoneuroendocrinology|date=July 1999|volume=24|issue=5|pages=537–549|pmid=10378240|doi=10.1016/S0306-4530(99)00010-4|s2cid=24081303|doi-access=free}}{{cite journal|last=Holzel|first=BK|author2=Carmody J |author3=Evans KC |author4=Hoge EA |author5=Dusek JA |author6=Morgan L |author7=Pitman RK |author8=Lazar SW |title=Stress reduction correlates with structural changes in the amygdala|journal=Social Cognitive and Affective Neuroscience|date=March 2010|volume=5|issue=1|pages=11–17|pmid=19776221|doi=10.1093/scan/nsp034|pmc=2840837}}{{cite journal|last=Lane|first=JD|author2=Seskevich JE |author3=Pieper CF |title=Brief meditation training can improve perceived stress and negative mood|journal=Alternative Therapies in Health and Medicine|date=Jan–Feb 2007|volume=13|issue=1|pages=38–44|pmid=17283740}}{{cite journal|last=Marcus|first=MT|author2=Fine PM |author3=Moeller FG |author4=Khan MM |author5=Pitts K |author6=Swank PR |author7=Liehr P |title=Change in Stress Levels Following Mindfulness-based Stress Reduction in a Therapeutic Community|journal=Addictive Disorders & Their Treatment|date=September 2003|volume=2|issue=3|pages=63–68|doi=10.1097/00132576-200302030-00001|s2cid=144212734}} and the extent to which there are associations between psychological stress and psychiatric and physical{{cite journal|last=Culhane|first=JF|author2=Rauh V |author3=McCollum KF |author4=Hogan VK |author5=Agnew K |author6=Wadhwa PD |title=Maternal stress is associated with bacterial vaginosis in human pregnancy|journal=Maternal and Child Health Journal|date=June 2001|volume=5|issue=2|pages=127–134|pmid=11573838|doi=10.1023/A:1011305300690|s2cid=25895511}}{{cite journal|last=Garg|first=A|author2=Chren MM |author3=Sands LP |author4=Matsui MS |author5=Marenus KD |author6=Feingold KR |author7=Elias PM |title=Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders|journal=Archives of Dermatology|date=January 2001|volume=137|issue=1|pages=53–59|pmid=11176661|doi=10.1001/archderm.137.1.53|doi-access=free}}{{cite journal|last=Kramer|first=JR|author2=Ledolter J |author3=Manos GN |author4=Bayless ML |title=Stress and metabolic control in diabetes mellitus: methodological issues and an illustrative analysis|journal=Annals of Behavioral Medicine |date=Winter 2000|volume=22|issue=1|pages=17–28|pmid=10892525|doi=10.1007/BF02895164|s2cid=3893086}} 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,{{cite journal|vauthors=Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM |title=Accelerated telomere shortening in response to life stress|journal=Proceedings of the National Academy of Sciences of the United States of America|date=December 2004|volume=101|issue=49|pages=17312–17315|pmid=15574496|doi=10.1073/pnas.0407162101|pmc=534658|doi-access=free}} cortisol levels,{{cite journal|last=Malarkey|first=WB|author2=Pearl DK |author3=Demers LM |author4=Kiecolt-Glaser JK |author5=Glaser R |title=Influence of academic stress and season on 24-hour mean concentrations of ACTH, cortisol, and beta-endorphin|journal=Psychoneuroendocrinology|year=1995|volume=20|issue=5|pages=499–508|pmid=7675934|doi=10.1016/0306-4530(94)00077-N|s2cid=30375128}}{{cite journal|last=Pruessner|first=JC|author2=Hellhammer DH |author3=Kirschbaum C |title=Burnout, perceived stress, and cortisol responses to awakening|journal=Psychosomatic Medicine|date=Mar–Apr 1999|volume=61|issue=2|pmid=10204973|pages=197–204|doi=10.1097/00006842-199903000-00012}}{{cite journal|last=van Eck|first=MM|author2=Nicolson NA|title=Perceived stress and salivary cortisol in daily life|journal=Annals of Behavioral Medicine |year=1994|volume=16|issue=3|pages=221–227|doi=10.1093/abm/16.3.221 }} immune markers,{{cite journal|last=Maes|first=M|author2=Van Bockstaele DR|title=The effects of psychological stress on leukocyte subset distribution in humans: evidence of immune activation|journal=Neuropsychobiology|year=1999|volume=39|issue=1|pages=1–9|pmid=9892853|doi=10.1159/000026552|s2cid=29829700}}{{cite journal|last=Burns|first=VE|author2=Drayson M |author3=Ring C |author4=Carroll D |title=Perceived stress and psychological well-being are associated with antibody status after meningitis C conjugate vaccination|journal=Psychosomatic Medicine|date=Nov–Dec 2002|volume=64|issue=6|pages=963–970|pmid=12461201|doi=10.1097/01.PSY.0000038936.67401.28|s2cid=24846620|doi-access=free}}{{cite journal|last=Cohen|first=S|author2=Doyle WJ |author3=Skoner DP |title=Psychological stress, cytokine production, and severity of upper respiratory illness|journal=Psychosomatic Medicine|date=Mar–Apr 1999|volume=61|issue=2|pages=175–180|pmid=10204970|doi=10.1097/00006842-199903000-00009|url=http://www.psychosomaticmedicine.org/content/61/2/175.long#content-block}}{{cite journal|last=Glaser|first=R|author2=Kiecolt-Glaser JK |author3=Marucha PT |author4=MacCullum RC |author5=Laskowski BF |author6=Malarkey WB |title=Stress-related changes in proinflammatory cytokine production in wounds|journal=Archives of General Psychiatry|date=May 1999|volume=56|issue=5|pages=450–456|pmid=10232300|doi=10.1001/archpsyc.56.5.450|doi-access=free}} depression,{{cite journal|last=Carpenter|first=LL|author2=Tyrka AR |author3=McDougle CJ |author4=Malison RT |author5=Owens MJ |author6=Nemeroff CB |author7=Price LH |title=Cerebrospinal fluid corticotropin-releasing factor and perceived early-life stress in depressed patients and healthy control subjects|journal=Neuropsychopharmacology|date=April 2004|volume=29|issue=4|pages=777–784|pmid=14702025|doi=10.1038/sj.npp.1300375|doi-access=free}} infectious disease,{{cite journal|last=Cohen|first=S|author2=Tyrrell DA |author3=Smith AP |title=Negative life events, perceived stress, negative affect, and susceptibility to the common cold|journal=Journal of Personality and Social Psychology|date=January 1993|volume=64|issue=1|pages=131–140|pmid=8421249|doi=10.1037/0022-3514.64.1.131}}{{cite journal|last=Dyck|first=DG|author2=Short R |author3=Vitaliano PP |title=Predictors of burden and infectious illness in schizophrenia caregivers|journal=Psychosomatic Medicine|date=Jul–Aug 1999|volume=61|issue=4|pages=411–419|pmid=10443748|doi=10.1097/00006842-199907000-00001|s2cid=17239469}} wound healing,{{cite journal|last=Ebrecht|first=M|author2=Hextall J |author3=Kirtley LG |author4=Taylor A |author5=Dyson M |author6=Weinman J |title=Perceived stress and cortisol levels predict speed of wound healing in healthy male adults|journal=Psychoneuroendocrinology|date=July 2004|volume=29|issue=6|pages=798–809|pmid=15110929|doi=10.1016/S0306-4530(03)00144-6|s2cid=8581924}} and prostate-specific antigen levels in men.{{cite journal|last=Stone|first=AA|author2=Mezzacappa ES |author3=Donatone BA |author4=Gonder M |title=Psychosocial stress and social support are associated with prostate-specific antigen levels in men: results from a community screening program|journal=Health Psychology|date=September 1999|volume=18|issue=5|pages=482–486|pmid=10519464|doi=10.1037/0278-6133.18.5.482}}
The Perceived Stress scale was developed by Sheldon Cohen and his colleagues.
History
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.{{Cite journal|title = Trait Influences on Stress Appraisal and Coping: An Evaluation of Alternative Frameworks|journal = Journal of Applied Social Psychology|date = 1999-04-01|issn = 1559-1816|pages = 685–704|volume = 29|issue = 4|doi = 10.1111/j.1559-1816.1999.tb02019.x|first1 = Richard M.|last1 = Shewchuk|first2 = Timothy R.|last2 = Elliott|first3 = Rebecca R.|last3 = MacNair-Semands|first4 = Stephen|last4 = Harkins}}
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.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. As a result, the PSS is commonly implemented using the 10-item form.{{Cite journal|title = Psychometric analysis of the Ten-Item Perceived Stress Scale.|journal = Psychological Assessment|pages = 90–101|volume = 27|issue = 1|doi = 10.1037/a0038100|pmid = 25346996|first = John M.|last = Taylor|year = 2015|s2cid = 10435407}} 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.
Factor structure
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.{{Cite journal|title = The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample|journal = Journal of Psychopathology and Behavioral Assessment|date = 1992-09-01|issn = 0882-2689|pages = 247–257|volume = 14|issue = 3|doi = 10.1007/BF00962631|first1 = Paul L.|last1 = Hewitt|first2 = Gordon L.|last2 = Flett|first3 = Shawn W.|last3 = Mosher|s2cid = 16079420}} 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.
Reliability
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.{{cite journal|last1=Roberti|first1=Jonathan W.|last2=Harrington|first2=Lisa N.|last3=Storch|first3=Eric A.|title=Further Psychometric Support for the 10-Item Version of the Perceived Stress Scale|journal=Journal of College Counseling|volume=9|issue=2|year=2006|pages=135–147|issn=1099-0399|doi=10.1002/j.2161-1882.2006.tb00100.x}} 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.{{cite journal | last1 = Graham | first1 = J. M. | year = 2006 | title = Congeneric and (essentially) tau-equivalent estimates of score reliability what they are and how to use them | journal = Educational and Psychological Measurement | volume = 66 | issue = 6| pages = 930–944 | doi=10.1177/0013164406288165| s2cid = 14762636 }} 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.
Translations and adaptations
Portuguese version:
Journal article (free PDF) [http://www.psy.cmu.edu/~scohen/Portuguese_PSS_and_ARTICLE_ABOUT.pdf] and scale only [http://www.psy.cmu.edu/~scohen/scales.html]