Factor Structure of the 10-Item Perceived Stress Scale and Measurement Invariance Across Genders Among Chinese Adolescents

Perceived stress and social support as correlates of sickle cell anaemia severity in a low-resource setting

BACKGROUND

The role of biological factors such as foetal haemoglobin in modifying the severity of Sickle Cell Anaemia (SCA) has been extensively investigated. However, the phenotypic variability of SCA cannot be explained by genetic factors alone. Hence, the need to determine other correlates of SCA severity such as perceived stress and social support.

METHODS

This was a hospital-based cross-sectional study involving 60 participants aged 8-17 years selected using simple random sampling technique. Standard rating scales (i.e., SCA scoring system, perceived stress scale, and child and adolescent social support scale) were used to assess the severity of SCA, perceived stress and social support, respectively. Foetal haemoglobin (HbF) was estimated using high performance liquid chromatography. The psychosocial predictors of sickle cell severity were analyzed using multivariate linear regression.

RESULTS

There was a negative moderate significant correlation between SCA severity and domains of social support: parents' (rho = -0.30, p = 0.03) and classmates' (rho = -0.50, p < 0.001). Of all the variables studied, only classmates' perceived social support emerged as the significant predictor of SCA severity when other confounders such as HbF were controlled for (β = -0.37, t = 2.41, p = 0.02).

CONCLUSION

The findings of this study support the available literature on the mediating effect of social support on SCA severity. These findings buttress the need for clinicians to consider psychosocial methods (e.g., family and classmates' support) in improving disease outcomes.

First-Time Father's Risk Factors of Paternal Perinatal Psychological Distress: A Scoping Review

Fathers can experience psychological distress during the paternal perinatal period. The effects of paternal perinatal psychological distress (PPPD) are multileveled. Little research is available about PPPD in first-time fathers. The purpose of this review is to explore the literature on risk factors contributing to PPPD in first-time fathers. The Arksey & O'Malley framework was used to guide this scoping review. The Population, Concept, and Context (PCC) framework was used for answering the review question "What evidence is available about factors contributing to PPPD in first-time fathers?" Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed) were used to retrieve relevant, full-text, English references from January 01, 2020, to January 04, 2023. A data extraction tool was developed to identify risk factors assessed in the included studies. The Socio-Ecological Model (SEM) was used for analyzing the extracted data according to the four socio-ecological levels, i.e., individual, relationship, community, and societal. A total of 18 references reporting on 16 studies were included in the review. Fifty-six tools were used for assessing the risk factors contributing to PPPD in first-time fathers. Limited understanding was established about risk factors because tools lacked gender sensitivity. Risk factors aligned with 12 domains (e.g., psychological, relationship, social, and physical). Most domains corresponded with the individual level of SEM. Only two domains corresponded with the societal level of SEM. The literature indicates there are few studies about PPPD experienced by first-time fathers. This scoping review adds to the literature on the mental health care gaps for this population. Further research on measuring PPPD may improve individual and family functioning during the perinatal period.

Perceived stress and health outcomes among Chinese university students: The chain mediating role of repetitive negative thinking and trait forgiveness

Stress around COVID-19 among university students is associated with higher physical symptom burden and worse overall health status. This study examined whether RNT and trait forgiveness mediate the link between perceived stress and health outcomes among Chinese university students. A total of 1342 students participated in a survey during the middle of the semester that assessed perceived stress, RNT, trait forgiveness, and various health outcomes. Results revealed significant mediating effects of both RNT and trait forgiveness on the relationship between perceived stress and health outcomes, including anxiety, depression, sleep quality, and physical health. Moreover, the interplay between RNT and trait forgiveness mediated this association. These findings provide a theoretical basis for understanding the interactions among perceived stress, RNT, trait forgiveness, and health outcomes, highlighting the importance of addressing stress and RNT to enhance forgiveness and overall well-being in university students.

Childhood Physical Fitness as a Predictor of Cognition and Mental Health in Adolescence: The PANIC Study

BACKGROUND

Cognitive and mental health problems are highly prevalent in adolescence. While higher levels of physical fitness may mitigate these problems, there is a lack of long-term follow-up studies on the associations of physical fitness from childhood with cognition and mental health in adolescence.

OBJECTIVE

We investigated the associations of physical fitness from childhood to adolescence over an 8-year follow-up with cognition and mental health in adolescence.

METHODS

The participants were 241 adolescents (112 girls), who were 6-9 years at baseline and 15-17 years at 8-year follow-up. Average and change scores for cardiorespiratory fitness (maximal power output [Wmax]; peak oxygen uptake [VO2peak]), motor fitness (10 × 5-m shuttle run), and muscular fitness (standing long jump; hand grip strength) were calculated. Global cognition score was computed from six individual cognitive tasks, and perceived stress and depressive symptoms were assessed at the 8-year follow-up. The data were analysed using linear regression models adjusted for age, sex, and parental education.

RESULTS

Average motor fitness was positively associated with global cognition score (standardised regression coefficient [β] - 0.164, 95% confidence interval [CI] - 0.318 to - 0.010) and inversely with perceived stress (β = 0.182, 95% CI 0.032-0.333) and depressive symptoms (β = 0.181, 95% CI 0.028-0.333). Average cardiorespiratory fitness was inversely associated with perceived stress (Wmax: β =  - 0.166, 95% CI - 0.296 to - 0.036; VO2peak: β =  - 0.149, 95% CI - 0.295 to - 0.002) and depressive symptoms (Wmax: β =  - 0.276, 95% CI - 0.405 to - 0.147; VO2peak: β =  - 0.247, 95% CI - 0.393 to - 0.102). A larger increase in cardiorespiratory fitness was associated with lower perceived stress (Wmax: β =  - 0.158, 95% CI - 0.312 to - 0.003; VO2peak: β =  - 0.220, 95% CI - 0.395 to - 0.044) and depressive symptoms (Wmax: β =  - 0.216, 95% CI - 0.371 to - 0.061; VO2peak: β =  - 0.257, 95% CI - 0.433 to - 0.080).

CONCLUSIONS

Higher levels of motor fitness in childhood and adolescence were associated with better cognition in adolescence. Higher levels of and larger increases in cardiorespiratory fitness from childhood to adolescence were associated with better mental health in adolescence.

Geographical Disparities of Uncertainty Stress and Life Stress Among University Students: A Study Across All Provinces in Mainland China

The study objective was to investigate geographical variation of uncertainty stress and life stress among university students in China. Respondents comprised 11,954 students from 50 universities and 31 provinces in China's mainland. Respondents completed the extended version of Global Health Professional Student Survey (GHPSS) on Tobacco Control in China, which added additional health, mental stress, and behavioural items on original version, and regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the logistic regression analysis. The prevalence of high uncertainty stress was 19.60% (95% CI: 15.90%, 23.30%), while the prevalence of life stress was 8.60% (95% CI: 7.20%, 10.70%). The prevalence rates varied significantly across the 31 provinces. The random parameters for uncertainty stress and life stress were statistically significant at the 0.01 level, with values of 0.2593 and 0.3971, respectively. The geographical distribution revealed two high uncertainty stress zones between the east coast and the middle area, as well as in the west area from south to north. High life stress, on the other hand, was concentrated in the central area. Multilevel logistic regression showed province level per capita disposal income of households partly contributed to uncertainty stress (OR = 0.52, 95% CI: 0.36, 0.94) and life stress (OR = 0.59, 95% CI: 0.52, 0.89). These findings underscore the importance of environmental contribution to mental stress among university students. Given that college students' mental stress is high, there is a need for environmental measurements to prevent and address multiple perceived stress in students.

Temperamental and Neurocognitive Predictors in Korean Basketball League Draft Selection

OBJECTIVE

This study hypothesized that physical status, temperament and characteristics, and neurocognitive functions of basketball players could predict the result of Korean Basketball League (KBL) draft selection.

METHODS

We recruited the number of 89 college elite basketball players (KBL selection, n=44; non-KBL selection, n=45), and the number of 82 age-matched healthy comparison subjects who major in sports education in college. All participants were assessed with the Temperament and Character Inventory, Sports Anxiety Scales, Beck Depression Inventory, Perceived Stress Scale-10, Trail Making Test, and Computerized Neuro-cognitive Test for Emotional Perception and Mental Rotation.

RESULTS

Current results showed that physical status, temperament and characteristics, and neurocognitive functions of college basketball players could predict the KBL draft selection. Among temperament and characteristics, novelty seeking and reward dependence were associated with KBL draft selection. The basketball performances including average scores and average rebound were associated with Emotional Perception and Mental Rotation.

CONCLUSION

In order to be a good basketball player for a long time, it was confirmed that temperamental factors and neurocognitive factors were very closely related. Furthermore, it is also judged that these results can be used as basic data to predict potential professional basketball players.

Psychometric properties of the perceived stress scale (PSS-10) among pregnant women in China

Background

Pregnancy, a transformative phase, is often fraught with considerable psychological stress. Within the context of Chinese culture, characterized by intricate family dynamics, societal expectations, and deeply rooted traditional beliefs, the manifestation of stress during pregnancy may present with distinct nuances. The adaptation and validation of the Perceived Stress Scale (PSS-10) for the Chinese context are pivotal for a nuanced understanding and effective intervention for the stressors encountered by pregnant women in China.

Methods

This study enrolled a cohort of 990 pregnant women who completed both the PSS-10 and the Chinese Mental Health Scale (CMHS). The internal consistency reliability was assessed using Cronbach's α and McDonald's omega. The construct validity was explored through Exploratory Factor Analysis (EFA), while Confirmatory Factor Analysis (CFA) was utilized to validate the scale's structural integrity. Criterion-related validity was established by correlating PSS-10 scores with CMHS scores, thereby assessing the scale's convergent and discriminant validity.

Results

The result demonstrated PSS-10 had robust internal consistency, with Cronbach's α coefficients and McDonald's omega (Composite reliability) were more than 0.70 for the scale and its constituent sub-factors. EFA and parallel analysis revealed two salient factors with eigenvalues surpassing 1.0, which accounted for 60.58% and 63.22% of the variance among the second and third trimester samples, respectively. The CFA confirmed the two-factor model's congruence with the PSS-10's structure in both sub-samples, with excellent model fit indicated by the fit indices: Standardized Root Mean Residual (SRMR) below 0.08 and both Comparative Fit Index (CFI) and Goodness of Fit Index (GFI) above 0.90. Additionally, the correlation analysis with CMHS scores substantiated the PSS-10's concurrent validity.

Conclusion

The PSS-10 exhibits commendable psychometric properties, rendering it a pertinent and reliable instrument for assessing perceived stress among pregnant women in China. This validation underscores the PSS-10's utility in psychological research and clinical practice pertaining to Chinese pregnant populations.

How to improve reward sensitivity - Predictors of long-term effects of a randomized controlled online intervention trial

BACKGROUND

Reward sensitivity is a central maintaining factor of depression. Current treatments fail at sufficiently and reliably modifying reward processing. Therefore, we employed interventions targeting reward sensitivity and evaluated the long-term efficacy of different online interventions, additionally exploring predictors of changes in reward sensitivity.

METHODS

This four-arm randomized controlled trial (RCT) tested the long-term stability of treatment effects during a four-month follow-up in 127 participants of a two-week online intervention (behavioral activation vs. mindfulness and gratitude vs. combination of both). In addition, we investigated predictors of treatment success defined as improvement in reward sensitivity. Predictors we investigated were depressive expectations, stress and the type of reward implemented in the exercises of the intervention (physical activities and social encounters).

RESULTS

The improvement concerning reward sensitivity, as well as the reduction of anhedonia and depressive symptoms was stable over a four-month follow-up. We did not find evidence for differences between the active intervention groups. Positive changes in depressive expectations were a significant predictor of long-term improvements in reward sensitivity.

LIMITATIONS

Only self-report measures were used and the interpretation of the long-term efficacy of the online interventions is limited since the waitlist control condition was not extended to the follow-up.

CONCLUSIONS

Clinicians should focus on violating depressive expectations to facilitate updating the prediction and anticipation of future rewarding experiences. This could be a vital mechanism of change in reward sensitivity. However, future research still needs to unravel what kind of interventions are most effective in targeting reward insensitivity.

Adverse Childhood Experiences, maladaptive coping behaviours and protective factors in undergraduate students: A cross-sectional study

Objectives: The purpose is to examine the relationship between Adverse Childhood Experiences (ACEs), protective factors, and select maladaptive coping behaviors in postsecondary students. Participants: Undergraduate students attending Dalhousie University. Methods: An online anonymous survey was conducted. Zero order one-tailed correlations were computed to measure relationships between ACEs, levels of maladaptive coping behaviors and protective factors. A structural equation mediation model examined direct and indirect pathways between measures. Results: 42.5% of respondents (n = 327) reported ≥3ACEs. Higher ACEs were associated with higher expression of maladaptive coping behaviors. Respondents with high ACEs and low levels of protective factors reported lower levels of hope and forgiveness and higher levels of stress and rumination. Conclusion: Higher levels of protective factors were associated with lower levels of maladaptive coping behaviors in students with high ACEs.

Inconsistency in psychological resilience and social support with mental health in early adolescents: A multilevel response surface analysis approach

BACKGROUND

Given the high prevalence of adolescent mental health problems, promoting understanding and implementation of protective factors is crucial for prevention and intervention efforts addressing adolescent mental health problems. This study aims to investigate whether consistency and inconsistency in protective factors are associated with adolescent mental health problems and to inform adolescent mental health interventions that target the unique needs of adolescents and promote adolescent mental health.

METHODS

We used multistage cluster sampling to conduct psychological resilience, social support, and mental health questionnaires from April to June 2023 among 10,653 Chinese adolescents (52.3 % were boys). Data were analyzed using polynomial regressions with response surface analysis.

RESULTS

The higher levels of psychological resilience and social support in adolescents were associated with fewer mental health problems (anxiety: a1 = -1.83, P < 0.001; depression: a1 = -2.44, P < 0.001; and perceived stress: a1 = -1.20, P < 0.001). When the level of psychological resilience was greater than social support, the greater the discrepancy the higher the perceived stress among adolescents (a3 = 1.19, P < 0.001). Moreover, the consistency of psychological resilience and social support had a greater impact on girls' mental health (anxiety: a1 = -1.97, P < 0.001; depression: a1 = -2.71, P < 0.001; perceived stress: a1 = -1.23, P < 0.001).

LIMITATIONS

The cross-sectional study design limited the inference of causal relationships between variables.

CONCLUSIONS

These results emphasize that adolescents need a balanced development of protective factors and targeted intervention programs for different mental health problems.

Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol

INTRODUCTION

Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA.

METHODS AND ANALYSIS

This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment.

ETHICS AND DISSEMINATION

This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78).

TRIAL REGISTRATION NUMBER

ChiCTR2200065178.

Depression and posttraumatic stress disorder in adolescents with nonsuicidal self-injury: comparisons of the psychological correlates and suicidal presentations across diagnostic subgroups

BACKGROUND

Nonsuicidal self-injury (NSSI) combined with suicide ideation increases the risk of suicidal behaviors. Depression and posttraumatic stress disorder (PTSD) are comorbidities of NSSI compounding this relationship. The present study compared diagnostic subgroups of NSSI based on current depression and PTSD on psychological correlates (i.e., vulnerabilities and impairment) and suicidal presentations (i.e., suicidal cognitions and behaviors) in a psychiatric sample of adolescents.

METHODS

Eighty-seven adolescents meeting DSM-5 criteria for NSSI and 104 age-range-matched nonclinical controls (NC) participated. Participants completed self-report measures on psychological vulnerabilities and impairment (e.g., emotion regulation difficulties, negative cognitions). Adolescents with NSSI also completed clinical interviews on psychiatric diagnoses and a recent self-injurious behavior (SIB). Scores on the psychological correlates of NSSI were compared between adolescents with NSSI and NC, and across three diagnostic subgroups of NSSI (A: NSSI+/depression-/PTSD-, n = 14; B: NSSI+/depression+/PTSD-, n = 57; C: NSSI+/depression+/PTSD+, n = 14). Differences between NSSI diagnostic subgroups were tested on the motives for SIB and accompanying suicidal presentations (e.g., desire, intent, motive, lethality).

RESULTS

Common comorbidities of NSSI included depression, panic disorder, generalized anxiety disorder, and PTSD. The NSSI subgroup classification was significantly associated with panic disorder, which was controlled for in the subsequent group comparisons. Overall, adolescents who engage in NSSI with vs. without depression reported more psychological vulnerabilities and impairment and a greater degree of suicidal thoughts/desire in SIB (i.e., groups B, C >A), which remained significant after controlling for panic disorder. An increased odds of the suicidal motive for SIB was found in adolescents with all three conditions (i.e., group C: NSSI+/depression+/PTSD+) compared to those with NSSI but neither depression nor PTSD (i.e., group A: NSSI+/depression-/PTSD-); however, this was not significant after controlling for panic disorder.

CONCLUSIONS

Psychological underpinnings of adolescent NSSI in clinical contexts may be largely associated with concurrent depression. Suicidal motives in adolescents who engage in NSSI in the presence of depression and PTSD may be confounded by the co-occurrence of panic disorder. This study warrants the importance of attending to the comorbid depression with NSSI in adolescents as it is related to an increase in suicidal desire accompanying SIB.

Association of perceived stress and sleep quality among medical students: the mediating role of anxiety and depression symptoms during COVID-19

COVID-19 has intensified the influence on medical students by changing the lifestyle, online study and clinical practice which bring out series of stress, sleep disturbance and mental health problems. This cross-sectional study aim to explore the association between perceived stress and sleep quality among medical students and investigated whether anxiety and depression mediated this association during pandemic. A total of 1,021 medical students in two universities who were from Guangdong Province, China participated this study and from January to September 2020 through the online question are, with 28.80% reporting sleep disturbances. The medical students were finished various self-reported questionnaires, including the Perceived Stress Scale-10, Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder-7 Scale, and Patient Health Questionnaire-9, the study found positive correlations among sleep quality, perceived stress, anxiety, and depression. The data was analyzed with The Amos 26.0 system. Result demonstrated that perceived stress was associated with poor sleep quality. Anxiety and depression partially mediated the association between perceived stress and poor sleep quality, explaining 73.08% of the association. This study's structural equation model offers a useful framework for assessing mechanisms mediating associations between perceived stress and sleep quality. The findings emphases the importance of addressing psychological factors in high-pressure situations, which can exacerbate sleep disturbances among medical students. It is important to screen the level of stress, mental health problems and investigate the risk factors of sleep quality among medical students during emergency public health events.

Factor structure and psychometric properties of the Perceived Stress Scale in Russian adolescents

This study involved a psychometric analysis of the 10-item Perceived Stress Scale (PSS-10). To investigate the Russian version of the PSS-10 for adolescents, 3530 adolescents aged 13-17 years were recruited. Confirmatory factor analysis revealed that the data corresponded to the expected two-factor configuration. Psychometric properties and factor structure were evaluated. As expected, the PSS-10 included two factors: perceived helplessness and perceived self-efficacy. Internal consistency demonstrated acceptable values (Cronbach's alpha was 0.82 for perceived helplessness, 0.77 for perceived self-efficacy, and 0.80 for the overall PSS score). Measurement invariance across sexes was assessed, and configural and metric invariance were confirmed. The developed diagnostic tool can be used both in the school system to alleviate the negative consequences of academic stress in adolescents and, in the future, in other areas, particularly in clinical practice.

Evaluation of the psychometric properties of the Italian version of the 10-item perceived stress scale in a sample of teachers

Background

The 10-item Perceived Stress Scale is a widely used questionnaire for measuring perceived stress.

Aim

This study aimed to assess the psychometric properties of the Italian version of the 10-item Perceived Stress Scale in a sample of Italian teachers during the COVID-19 pandemic.

Methods

A cross-sectional study was performed. A sample of 1,179 teachers of pre-primary, primary, and secondary schools anonymously completed an online questionnaire. A Confirmatory Factor Analysis was performed to compare the fit of a two-factor model against a one-factor solution of the scale. Multigroup CFA was run to test the measurement invariance of the two-factor PSS-10 solution across gender. The internal reliability of the scale was evaluated using Cronbach's alpha and McDonald' omega coefficients. Convergent validity with measures of subjective well-being and self-reported health was evaluated.

Results

The results of the Confirmatory Factor Analysis showed that the two-factor structure of the 10-items Perceived Stress Scale provided a better fit to the data and supported the adequacy of the Italian version of the scale. The two-factor model showed measurement invariance across female and male groups, as result of the multigroup CFA. The scale proved to have good internal reliability. Correlation analyses with measures of the Positive Affect and Negative Affect Schedule and self-reported health supported convergent validity.

Conclusion

These results suggest that the Italian version of the 10-item Perceived Stress Scale has good psychometric properties and can be considered a valid and reliable instrument to assess perceived stress.

Self-reported autistic traits and psychosocial outcomes among university students in Malaysia

LAY ABSTRACT

Most research on autism spectrum conditions is done on young children and not as much on young adults with autism spectrum conditions. Because of this, not much is known about how common autism spectrum conditions are in young adults and how they affect their mental and social health, especially in Southeast Asia. Based on self-reports, 2.8% of the 2732 university students we looked at in Malaysia might have been diagnosed or thought to have an autism spectrum condition. Students who said they had or thought they had autism spectrum conditions had lower self-efficacy, more stress and a lower quality of life than students who said they did not have autism spectrum conditions. The results showed that university students with autism spectrum condition are more likely to have bad psychological and social outcomes than their peers without autism spectrum condition. Also, the link between autistic traits and psychosocial outcomes could depend on the culture.

Effects of Online Mindful Somatic Psychoeducation Program on Mental Health During the COVID-19

OBJECTIVE

This study aims to determine the effects of online mindful somatic psychoeducation program (o-MSP) on mental health in female university students during the coronavirus disease-2019 (COVID-19).

METHODS

Thirty-eight female university students were randomly assigned to an intervention group (IG, n=19) or a control group (CG, n=19). IG received o-MSP for 2-hours per session, twice weekly for 4-weeks; CG maintained their usual daily routine for 4-weeks. Measurements were performed pre- and post-intervention to assess stress, anxiety, and social connectedness using Perceived Stress Scale, State-Trait Anxiety Inventory, and Social Connectedness Scale. A qualitative analysis of changes in soma and social connectedness, subjectification of the soma, and mind-body integration was conducted through online interviews.

RESULTS

Regarding stress and social connectedness, there were no significant difference between the groups (p>0.05). However, significant differences were observed in the main effect of time of measurement and time×group interaction, with IG showing significant improvement post-intervention, unlike CG (p<0.05). Regarding anxiety, there were significant differences in the main effect of time of measurement, time×group interaction, and group factor (p<0.05). Post-intervention, CG did not show a significant change, while IG showed a significant decrease (p<0.05). Qualitative analysis revealed that participants experienced "changes in soma and social connectedness," "subjectification of soma-body," and "embodiment of mind-body integration," and reported improved mental health.

CONCLUSION

The o-MSP effectively reduced stress and anxiety in female university students and improved social connectedness. This suggests that o-MSP can be used to manage the mental health of university students in various settings.

Construct validity of the perceived stress scale (PSS-10) in a sample of health professionals in family medicine in Bosnia and Herzegovina

Background

The 10-item Perceived Stress Scale (PSS-10) has not been translated into Bosnian, nor has a study been conducted employing a sample of family medicine physicians and nurses to examine the instrument's reliability, validity, and factorial structure. Thus, the goal of this study was to investigate the reliability and construct validity of the Bosnian version of the PSS-10 among family medicine professionals.

Study design

Cross-sectional descriptive study provided among healthcare professionals in family medicine, using Google forms questionnaire (PSS-10) in Bosnian language.

Methods

Translation of PSS-10 in Bosnian is performed according to the proposed set of standardized guidelines. The questionnaire was sent on the email addresses of family physicians and nurses in whole Bosnia and Herzegovina. The collected data were subjected to reliability testing, exploratory and confirmatory factor analysis, which tested three alternative plausible models suggested by the extant literature: single factor, correlated two-factor and bifactor.

Results

A total of 272 out of 440 (RR = 61.3) nurses and physician working in family medicine in Bosnia and Herzegovina completed the PSS-10 Bosnia and Herzegovina version (BH). Participants were aged 25 to 69, with a mean age of 44.7 (±10.55). Most participants were women (86.8%) and physicians (58.8%) with specialisation in family medicine (43%). The overall Cronbach's alpha was 0.87 and the test-retest reliability coefficient was 0.88. Exploratory Factor Analysis yielded 2 factors with eigenvalues of 4.77 and 1.35, accounting for 61.2% of variance. Factor 1 consisted of 6 items representing ''perceived distress'', whereas Factor 2 consisted of 4 items representing ''perceived coping''. The Confirmatory factor analysis indicated a very good fit of this bifactor model to this sample.

Conclusions

Our results implies that the PSS-10-BH, as a bifactor model with good reliability and validity, may accurately measure the stress levels of family medicine physicians and nurses.

Inflammatory biomarkers link perceived stress with metabolic dysregulation

Objective

Perceived stress has been identified as a risk factor for metabolic syndrome. However, the intermediate pathways underlying this relationship are not well understood. Inflammatory responses may be one process by which stress leads to metabolic dysregulation. Prior work has shown that chronic stress is associated with elevated systemic inflammation and that altered inflammatory activity contributes to the pathogenesis of metabolic syndrome. The current analyses tested this hypothesis by examining inflammation as a pathway by which perceived stress affects metabolic health.

Methods

Data from the Midlife in the United States Study (MIDUS) (N = 648; Mean age = 52.3) provided measures of perceived stress, inflammatory biomarkers [C-reactive protein (CRP), interleukin-6 (IL-6), E-selectin, fibrinogen, intracellular adhesion molecule-1 (ICAM-1)] and metabolic health markers. Confirmatory factor analysis (CFA) was used to confirm the fit of a hierarchical model of metabolic syndrome in our sample. Structural equation modeling (SEM) was used to test the assumption that inflammation mediates the association between perceived stress and the latent factor representing metabolic syndrome.

Results

The CFA of metabolic syndrome demonstrated excellent goodness of fit to our sample [CFI = 0.97, TLI = 0.95, RMSEA = 0.06, SMSR = 0.05]. Mediation analysis with SEM revealed that the indirect pathway linking stress to metabolic dysregulation through inflammation was significant [B = 0.08, SE = 0.01, z = 3.69, p < .001, 95% confidence interval CI (0.04, 0.13)].

Conclusions

These results suggest that inflammatory biomarkers are a viable explanatory pathway for the relationship between perceived stress and metabolic health consequences. Interventions that target psychosocial stress may serve as cost-effective and accessible treatment options for mitigating inflammatory health risks.

The feasibility, acceptability and efficacy of an app-based intervention (the Coping Camp) in reducing stress among Chinese school adolescents: A cluster randomised controlled trial

OBJECTIVES

This study aimed to determine the efficacies of the Coping Camp app in reducing stress, depression, and anxiety and improving stress-coping behaviours and mental health wellbeing. Additionally, feasibility and acceptability of Coping Camp were evaluated.

METHODS

In this unblinded cluster RCT, 540 participants from two high schools in China were randomly assigned to the Coping Camp intervention (n = 6 classes; 275 students) or treatment as usual (n = 5 classes; 265 students) at the class level. Coping Camp was an automated self-help app, consisting of 11 sessions delivered over 11 weeks, with primary outcomes including perceived stress, depression, anxiety, stress-coping behaviours, and mental health well-being. All outcomes were assessed at baseline, post-intervention (11 weeks), and follow-up (19 weeks), with efficacy analysed using linear mixed models and feasibility/acceptability measured by a 5-point Likert scale and qualitative feedback.

RESULTS

At post-intervention and follow-up assessments, 75.4% and 81.7% of participants respectively attended. On average, participants logged in for 8.56 out of 11 sessions. Compared to the control group, the intervention group had significant reductions in levels of perceived stress (p = 0.01, d = 0.15 at T1; p < 0.001, d = 0.18 at T2), anxiety (p = 0.11; d = 0.08 at T1; p = 0.01; d = 0.13 at T2) and depression (p = 0.04, d = 0.11 at T1; p = 0.05, d = 0.10 at T2) but did not have a greater increase in stress-coping behaviours (p = 0.10 at T1; p = 0.97 at T2) or mental health wellbeing (p = 0.93 at T1; p = 0.08 at T2). The average ratings for each session were above 4, and qualitative feedback showed that most participants found the intervention to be "great," "good," and "useful."

CONCLUSIONS

The Coping Camp is feasible, acceptable and effective in stress management among Chinese school adolescents.

Psychometric testing of the 10-item perceived stress scale for Chinese nurses

BACKGROUND

Nurses bear a lot of stressors at work. The 10-item Perceived Stress Scale (PSS-10) is a widely used self-reported scale for measuring the global perception of stress. However, there is a lack of use of the PSS-10 in Chinese nurses. This study aimed to test the psychometric properties of the PSS-10 among Chinese nurses.

METHODS

A total of 708 Chinese nurses completed the PSS-10, the Big Five Inventory (BFI), and the Depression Anxiety and Stress Scale (DASS). Confirmatory factor analysis (CFA) tested the factor structure of the PSS-10. Cronbach's α and test-retest correlation examined the scale reliability. Pearson correlation and hierarchical regression analyses tested the convergent, discriminant and criterion validity of the PSS-10.

RESULTS

CFA revealed that a two-factor model fits the structure of the PSS-10 in Chinese nurses (χ2/df = 6.25, p < 0.001; comparative fit index [CFI] = 0.94, non-normal fit index [NNFI] = 0.92, Tucker-Lewis index [TLI] = 0.91, root mean square error of approximation [RMSEA] = 0.08, standardized root mean square residual [SRMR] = 0.05). The scale demonstrated adequate internal consistency (α = 0.86) and test-retest reliability (r = 0.66, p < 0.001), satisfactory convergent and discriminant validity with relations to Big Five personalities, as well as good criterion validity such that the PSS-10 score could explain incremental variance in predicting anxiety, depression and stress.

CONCLUSIONS

Our findings suggest that PSS-10 is a reliable and valid measure of perceived stress among Chinese nurses and can be used in future research and practice on stress management and coping in Chinese nurses.

Psychometric evaluation of an adapted version of the perceived stress scale for ecological momentary assessment research

Ecological momentary assessment (EMA) methodologies are commonly used to illuminate the predictors and impacts of experiencing subjective stress in the course of daily life. The validity of inferences from this research is contingent on the availability of measures of perceived momentary stress that can provide valid and reliable momentary stress scores. However, studies of the development and validation of such measures have been lacking. In this study, we use an EMA data collection design to examine the within- and between- person reliability and criterion validity and between-person gender measurement invariance of a brief EMA-adapted measure of a widely used trait measure of stress: the Perceived Stress Scale (PSS). Scores showed high internal consistency reliability and significant correlations with a range of criterion validity measures at both the within- and between-person level. Gender measurement invariance up to the scalar level also held for scores. Findings support the use of the EMA-adapted PSS presented in the current study for use in community-ascertained samples to address research questions relating to the influences on and effects of momentary stress and their gender differences.

Adverse childhood experiences and stress among oral health students: a descriptive correlational study

Background

Stress is a challenge to many post-secondary students and, if prolonged and unmanaged, can affect academic success. Understanding factors that contribute to students' stress is important. One possible contributor may be adverse childhood experiences (ACEs); that is, traumatic events that occur during the first 18 years of life. Inverse relationships between the number of ACEs and indicators of poor mental well-being have been proposed.

Objective

To describe ACEs in oral health students (OHS) and the associations between the number and types of ACEs and levels of perceived stress, an indicator of mental well-being.

Methods

Invitations to participate in an anonymous online cross-sectional survey were sent to all OHS, 19 years and older, attending Dalhousie University in Halifax, Nova Scotia, Canada. Self-reports of ACEs and perceived stress were collected. Zero-order correlations and regression modelling were used to examine associations.

Results

Twenty-six percent (26%, n = 66) of OHS completed the survey. Respondents reported an average of 2.20 ACEs; 34.9% reported ≥ 3 ACEs. Emotional abuse (41%) was the most reported ACE. Associations were observed between numbers of ACEs and stress. Levels of stress increased with the number of ACEs (r = 0.23, p < 0.05). Regression modelling determined levels of stress were not affected by ACE type (F (3,62) = 2.24, p = 0.092).

Discussion

This was the first study to examine associations between ACEs and perceived stress in OHS. These students reported greater numbers of ACEs than age-matched general populations. Levels of stress were associated with numbers of ACEs.

Conclusion

Faculty in dental and dental hygiene programs should recognize the prevalence of ACEs among OHS and the potential impact on their mental well-being.

Prospective associations between adherence to 24-hour movement guidelines and mental well-being in Chinese adolescents

Most evidence regarding the relationships between adherence to 24-hour movement guidelines and adolescent mental health have been derived from cross-sectional studies or have ignored positive mental health indicators. The current prospective study examined the associations between adherence to 24-hour movement guidelines and changes in mental well-being among Chinese adolescents over three months. 816 Chinese adolescents (Mage = 14.76 years; SD = 0.81) completed baseline and follow-up scales of 24-hour movement behaviours, mental well-being, and covariates. Linear mixed-effects models were used for data analyses, with adjustments for covariates and mental well-being at baseline. There was a significant improvement in mental well-being across the three months, and the improvement in mental well-being was positively associated with meeting any single guidelines and both physical activity and sleep guidelines but not adherence to all three guidelines. Meeting both physical activity and sleep recommendations appears to exert more significant benefits on mental well-being than meeting one or two other recommendations. An integrative approach to mental health promotion by focusing on 24-hour movement behaviours (at least physical activity and sleep) may be more effective than focusing on a single behaviour alone.

Association Between Perceived Stress and Salivary Biomarkers of Allostatic Load Among Gender Minorities in Chennai: An Observational Cross-Sectional Study

Background Transgender individuals in India experience immense psychosocial stressors, stigma, and violence. In response to stress, the body exhibits adaptive responses that necessitate the production of organic chemicals ensuing in the detection of blood serum and saliva. There are currently no laboratory tests that are confirmatory for the diagnosis of stress and facilitate necessary treatment to be carried out in a timely manner. Thus, potential salivary biomarkers could be a helpful tool in overseeing the efficacy of pharmacological treatment prescribed by a psychiatrist. Aim This study aimed to assess the correlation between perceived stress and salivary stress biomarker levels in transgender and gender nonconforming (TGNC) individuals in Chennai, India. Methodology Twenty-two TGNC individuals and 22 age-matched controls in Chennai were administered the Perceived Stress Scale-10 questionnaire. Following this, their saliva samples were collected using the passive drool technique and subjected to sandwich enzyme-linked immunosorbent assay (ELISA) technique for measuring salivary cortisol, salivary tumor necrosis factor-alpha (TNF-alpha), and salivary C-reactive protein (CRP). Independent t-test was used to compare salivary stress biomarker levels between the TGNC and age-matched control groups. Pearson's correlation test was done to correlate perceived stress and salivary stress biomarker levels in the TGNC group. Results Significant difference was seen between the TGNC and control groups with respect to salivary cortisol and salivary TNF-alpha levels, with the levels being higher in the TGNC group. A significant positive correlation was seen between perceived stress and salivary cortisol and between perceived stress and salivary TNF-alpha levels. Conclusion There is a significant correlation between perceived stress and salivary biomarkers of stress among TGNC people in Chennai.

Assessing Available Adolescent Self-Reported Measures for Asthma Management: A Systematic Literature Review

Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management.

Validation of the Chinese version of the Perceived Stress Scale-10 integrating exploratory graph analysis and confirmatory factor analysis

OBJECTIVE

The study aimed to initially assess the measurement properties of the 10-item simplified Chinese version of the Perceived Stress Scale (PSS-C-10) and as a first, assess a longitudinal measurement invariance (LMI).

METHODS

A longitudinal survey was conducted with a convenient sample of healthcare students using the PSS-C-10. We assessed the PSS-C-10 mainly using composite analytical approaches, including exploratory graph analysis (EGA) and confirmatory factor analysis (CFA) to suggest the best-fit factor structure and assess measurement invariance.

RESULTS

The EGA identified a two-factor structural solution with an accuracy of 98.6% at baseline and 100% at a 7-day follow-up. The CFA subsequently confirmed this structure, with a comparative fit index of 0.963 at baseline and 0.987 at follow-up, Tucker-Lewis index of 0.951 at baseline and 0.982 at follow-up, and root mean square error of approximation of 0.111 at baseline and 0.089 at follow-up. The LMI was supported by the goodness-of-fit indices, and their changes fell within the recommended cut-off range. Additionally, Cronbach's alpha (0.885 at baseline and 0.904 at follow-up), McDonald's omega (0.885 at baseline and 0.902 at follow-up), and an ICC value of 0.816 for 7 days demonstrated the robust reliability of the PSS-C-10.

CONCLUSION

The PSS-C-10 exhibited a stable two-factor structure with promising LMI and measurement properties.

Childhood exposure to parental threatening behaviors and anxiety in emerging adulthood: Indirect effects of perceived stress

BACKGROUND

Although childhood exposure to parental threatening behaviors is associated with elevated anxiety in emerging adulthood, the underlying mechanisms remain unexplored. Perceived stress-a subjective experience comprised of feelings of helplessness (being unable to cope or exert control) and poor self-efficacy (confidence in one's ability to manage stressors)-is one candidate mechanism. The present investigation examined the underlying role of perceived stress in the association between childhood exposure to parental threatening behaviors and anxiety symptom severity in a sample of emerging adults.

METHODS

Participants (N = 855; Mage  = 18.75 years, SD = 1.05, range 18-24; 70.8% female) were recruited from a large state university and administered a battery of self-report questionnaires assessing constructs of interest.

RESULTS

Structural equation modeling (SEM) analyses indicated that only greater childhood exposure to maternal threatening behaviors was directly associated with greater feelings of helplessness and lower self-efficacy. Furthermore, only childhood exposure to maternal threatening behaviors was indirectly associated with anxiety severity through greater feelings of helplessness and lower self-efficacy. In contrast, childhood exposure to paternal threatening behaviors was neither directly nor indirectly associated with anxiety severity.

LIMITATIONS

Limitations include a cross-sectional design, use of self-report measures, and a nonclinical sample. Replicating these findings in a clinical sample and testing the hypothesized model in a longitudinal design is necessary.

CONCLUSIONS

Findings underscore the need for intervention efforts that screen for and target perceived stress in emerging adults exposed to negative maternal parenting behaviors.

Perceived Stress Mediating the Association Between Mindfulness and Resilience Among Registered Nurses

Purpose

Resilience continues to be an important concept in the nursing profession due to its significant role in personal healthcare, patients' healthcare, and leadership. The present study examined the mediating role of perceived stress in the association between mindfulness and resilience among registered nurses in order to understand their importance among those in the Taiwanese nursing profession.

Materials and Methods

Between October and November 2021, a total of 816 registered nurses participated in a cross-sectional survey including psychometric measures assessing perceived stress (Chinese Perceived Stress Scale-10), mindfulness (Chinese Mindful Attention Awareness Scale), and resilience (Chinese Questionnaire of Resilience).

Results

Results indicated that perceived stress mediated the association between mindfulness and resilience (standardized coefficient = 0.251, p<0.001), although there was no significant association between mindfulness and resilience (standardized coefficient = 0.042, p=0.16). This suggests that perceived stress may function as both distress and eustress because mindfulness was not directly associated with resilience but indirectly via perceived stress.

Conclusion

Nurses and their administrators should focus on different ways of coping with stress so that they become more resilient in facing other stressors. Future studies may be conducted to examine the mediating role of perceived stress in the association between other coping strategies and resilience among registered nurses.

Validity and reliability of the Sinhalese version of the perceived stress scale questionnaire among Sri Lankans

Introduction

Despite the availability of validated psychometrics tools to assess depression, there has not been any validated and reliable tool established to test perceived stress among Sri Lankans. The objective of this study is to test the validity and reliability of the Sinhalese Version of the Sheldon Cohen Perceived Stress Scale.

Materials and methods

Standard and systematic procedures were adopted to translate the original English version of the Perceived Stress Scale-10 questionnaire into Sinhalese. Consecutive sampling was employed to recruit the Type 2 Diabetes mellitus (T2DM) sample (n = 321), and a convenient sampling was used to recruit the Age and Sex matched Healthy Controls (ASMHC) (n = 101) and the Healthy Community Controls (HCC) groups (n = 75). Cronbach alpha was used to assess internal consistency and reliability was determined using test-retest method utilizing Spearman's correlation coefficient. Sensitivity was evaluated by comparing the mean scores of the Sinhalese Perceived Stress Scale (S-PSS-10) and Sinhalese Patient Health Questionnaire (S-PHQ-9) scores. Post-hoc comparisons were done using Bonferroni's method. Mean scores were compared between the T2DM, ASMHC, and HCC groups using the independent t-test. Explanatory Factor Analysis (EFA) was conducted using the principal component and Varimax rotation while the Confirmatory Factor Analysis (CFA) was performed to assess the goodness-of-fit of the factor structure extracted from the EFA. Concurrent validity was assessed using the Pearson correlation between the S-PSS-10 and Patient Health Questionnaire measured by S-PHQ-9 (p < 0.05).

Results

Cronbach alpha values of the three groups T2DM, ASMHC and HCC were 0.85, 0.81, and 0.79, respectively. Results of the ANOVA test suggested that there was a significant difference in the mean scores between groups (p < 0.00). EFA analysis revealed the existence of two factors with eigenvalues greater than 1.0. The factor loadings for the items ranged from 0.71-0.83. The CFA analysis demonstrated a good model fit for the two-factor model S-PSS-10. The S-PSS-10 significantly correlated with S-PHQ-9, indicating an acceptable concurrent validity.

Conclusion

Findings revealed that the S-PSS-10 questionnaire can be used to screen perceived stress among the majority of the Sri Lankan Sinhalese-speaking population specially with chronic illnesses. Further studies with higher sample sizes across different populations would enhance the validity and reliability of S-PSS-10.

Study protocol of the Our Futures Vaping Trial: a cluster randomised controlled trial of a school-based eHealth intervention to prevent e-cigarette use among adolescents

BACKGROUND

Effective and scalable prevention approaches are urgently needed to address the rapidly increasing rates of e-cigarette use among adolescents. School-based eHealth interventions can be an efficient, effective, and economical approach, yet there are none targeting e-cigarettes within Australia. This paper describes the protocol of the OurFutures Vaping Trial which aims to evaluate the efficacy and cost-effectiveness of the first school-based eHealth intervention targeting e-cigarettes in Australia.

METHODS

A two-arm cluster randomised controlled trial will be conducted among Year 7 and 8 students (aged 12-14 years) in 42 secondary schools across New South Wales, Western Australia and Queensland, Australia. Using stratified block randomisation, schools will be assigned to either the OurFutures Vaping Program intervention group or an active control group (health education as usual). The intervention consists of four web-based cartoon lessons and accompanying activities delivered during health education over a four-week period. Whilst primarily focused on e-cigarette use, the program simultaneously addresses tobacco cigarette use. Students will complete online self-report surveys at baseline, post-intervention, 6-, 12-, 24-, and 36-months after baseline. The primary outcome is the uptake of e-cigarette use at 12-month follow-up. Secondary outcomes include the uptake of tobacco smoking, frequency/quantity of e-cigarettes use and tobacco smoking, intentions to use e-cigarettes/tobacco cigarettes, knowledge about e-cigarettes/tobacco cigarettes, motives and attitudes relating to e-cigarettes, self-efficacy to resist peer pressure and refuse e-cigarettes, mental health, quality of life, and resource utilisation. Generalized mixed effects regression will investigate whether receiving the intervention reduces the likelihood of primary and secondary outcomes. Cost-effectiveness and the effect on primary and secondary outcomes will also be examined over the longer-term.

DISCUSSION

If effective, the intervention will be readily accessible to schools via the OurFutures platform and has the potential to make substantial health and economic impact. Without such intervention, young Australians will be the first generation to use nicotine at higher rates than previous generations, thereby undoing decades of effective tobacco control.

TRIAL REGISTRATION

The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662; date registered: 10/01/2023).

Validation of sociocultural attitudes towards appearance questionnaire and its associations with body-related outcomes and eating disorders among Chinese adolescents

INTRODUCTION

The Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised (SATAQ-4R) has been widely used in Western countries to link body appearance that is related to eating disorders and body dissatisfaction being commonly reported by adolescents. However, a comprehensive psychometric validation of the SATAQ-4R in Chinese adolescent samples is still lacking. To this end, the aim of the current study was to validate the gender-appropriate SATAQ-4R in a sample of Chinese adolescents, following by an investigation of its associations with body-related outcomes and eating disorder symptoms.

METHODS

Two gender-specific studies were conducted to examine the psychometric properties of the SATAQ-4R-Female and SATAQ-4R-Male respectively among adolescent girls (Study1, N=344, with 73 participants at retest) and boys (Study2, N=335, with 64 participants at retest). Confirmatory factor analysis was employed to examine the factor structure and their test-retest reliability, the internal consistency and convergent validity were subsequently examined.

RESULTS

For the SATAQ-4R-Females, the seven-factor model has a reasonable fit, with Chi-square =1112.769 (p < 0.001), CFI = 0.91, RMSEA = 0.071, SRMR = 0.067. For the SATAR-4R-Males, an acceptable seven-factor model with Chi-square = 982.92 (p<0.001), CFI = 0.91, RMSEA = 0.08, SRMR= 0.06 was observed. With respect to test-retest reliability, the internal consistency for 7 subscales was rated as good (Cronbach's alpha =0.74 to 0.95) among female adolescents, likewise the internal consistency of the seven subscales was also rated as good (Cronbach's alpha =0.70 to 0.96) among male participants. Good convergent validity was observed, reflected by associations of the subscales of the gender-specific SATAQ-4R with muscularity-related attitude, body image-acceptance, body appearance, perceived stress level, symptoms of eating disorder and self-esteem.

DISCUSSION

For women and men, the original 7-factor structure was validated among Chinese adolescents, internal reliability coefficients for the seven subscale scores were good and test-retest reliability was acceptable. Our results also confirmed the convergent validity of the two different gender-appropriate scales.

The Perceived Stress Scale for Kids (PeSSKi): Initial development of a brief measure for children aged 7-11 years

Perceived stress, a known risk factor for poor health, has been extensively assessed in adult populations. Yet an equivalent assessment tool for measurement of global perceived stress in children is lacking. This study aimed to develop and provide initial validation of a scale to measure perceived stress in children aged 7-11 years. Using a two-phase design, we conducted semi-structured interviews with thirteen child-parent dyads for development of items. In a sample of 123 children (age range 7-11 years, Mage = 9 years 7 months, 54.5% male) we administered the resulting Perceived Stress Scale for Kids (PeSSKi). Exploratory factor analysis of the 10-item PeSSKi yielded support for both a one-factor and a two-factor solution (negative, positive item wording). The PeSSKi was associated positively with the Penn-State Worry Questionnaire for Children (r = 0.748, p < 0.001) and negatively with the Students' Life Satisfaction Scale (r = 0.381, p < 0.001) indicating strong convergent/divergent validity respectively. Girls showed higher scores on the PeSSKi than boys with no effects observed by age. Initial psychometrics suggest the PeSSKi provides a robust scale for assessment of perceived stress in children. Further validation is needed across different child populations, over time and with physical measures of stress and health outcomes.

Dynamic changes in perfectionism dimensions and psychological distress among adolescents assessed before and during the COVID-19 pandemic

This prospective longitudinal study evaluated changes in psychological distress among adolescents, pre-pandemic to intra-pandemic, the extent to which within-person and between-person differences in trait multidimensional perfectionism were associated with such changes, and the role of stress in explaining associations between perfectionism and psychological distress. Adolescents (N = 187; 80% female; 78% White, 7% Asian Canadian, 2% Indigenous Peoples in Canada, 2% Black or African Canadian, 2% Latin Canadian, or 9% Other; M_age  = 17.96 years) completed online surveys assessing perfectionism (i.e., self-oriented perfectionism and socially prescribed perfectionism), depression, anxiety, and stress pre-pandemic (i.e., March 12, 2020 or earlier) and during Ontario, Canada's first (i.e., March 13, 2020 to July 24, 2020) and second (December 26, 2020 to February 7, 2021) government-mandated lockdowns. Between-person differences and within-person changes in multidimensional trait perfectionism were associated with increases in psychological distress and perceived stress. Perceived stress served as an intermediary pathway linking multidimensional trait perfectionism to psychological distress during the pandemic.

Effect of Physical Activity and Exercise on the Level of COVID-19 Antibodies and Lifestyle-Related Factors among Vaccinated Health Science Center (HSC) Students: A Pilot Randomized Trial

A vaccine is a type of medicine that increases immunity and the number of antibodies (IgM and IgG) when injected into the body, preparing it in case of an actual viral infection. It has been shown in several studies that there is a significant relationship between physical activity and vaccination. Furthermore, it has been documented that physical activity can play a major role in reducing stress. Evidence also shows the existence of a relationship between immunity, vaccine response, and sleep duration. To investigate the effects of physical activity on the level of COVID-19 antibodies and lifestyle-related factors, Health Science Center (HSC) students who had taken the third dose of the vaccine and had no prior infection of the COVID-19 virus were investigated. To serve the purpose of this study, an anti-SARS-CoV-2 test was applied by taking a blood sample from the students. The Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) questionnaires and the Borg’s 15-point scale were given to the participants to fill out. The study utilized a two-arm randomized control research design in which 40 participants were randomly assigned into one of two groups, either the control group (n = 20) or the treatment group (n = 20). All tests and assessments were performed before and after intervention for both groups. The control group walked less than 5000 steps every day for one month with a 20 min rest during the exercise session, while the treatment group walked more than 12,000 steps every day for the same time and exercise task session. The students’ steps were monitored using an Apple watch. There was a significant decrease in the IgG antibody level in the treatment group compared to the control group (p < 0.001). The IgM antibody level of all groups did not show any significant difference before starting the intervention. However, there was a significant (p < 0.05) decrease in the IgM level of the treatment group after treatment compared to before treatment. Moreover, there was a significant decrease in the treatment group’s stress level and sleep disruption, indicating better sleep quality, compared to the control group (p < 0.035). The levels of IgG and IgM did not improve for the treatment group. However, the treatment group improved their stress level and sleep disruption. Therefore, further rigorous research is needed to investigate vaccine efficacy among more physically active people.

Construct validity and reliability Amharic version of perceived stress scale (PSS-10) among Defense University students

BACKGROUND

Perceived stress scale (PSS) is the most widely used tool for assessing stressful life events and its management. However, its validity and Reliability in Ethiopian Amharic language is not assessed.

OBJECTIVE

To translate the perceived stress scale (version PSS-10) and assess its validity among Defense University students in Bishoftu, Ethiopia.

METHOD

From March to May 2020, an anonymous, self-managed questionnaire was used to collect the data on 758 undergraduate students of Defense University in Bishoftu, Ethiopia. Exploratory and Confirmatory factor analyses were employed to assess the factor structure and construct validity of Amharic version of the PSS-10. Composite reliability coefficient and Item total correlation were calculated to assess the internal consistency of Amharic version of the PSS-10.

RESULT

Exploratory factor analysis resulted in a two-dimensional PSS-10 with Eigenvalues of 3.4 and 1.6, which explained 50.7% of the variance. Confirmatory factor analysis indicates a good model fit of the two correlated factors (Comparative fit index (CFI) = 0.96 with root mean square error of approximation (RMSEA) = 0.04[0.03-0.06] and standardize root mean residual (SRMR) = 0.040). The internal consistency of PSS-10 and the Negative factor were in acceptable range, whereas the Positive factor was marginally acceptable (0.77, 0.78, and 0.68) respectively.

CONCLUSION

The Amharic translated version of PSS-10 was found to be a valid and reliable instrument to measure the perceived stress level among university students.

Association of Neighborhood Social Context and Perceived Stress Among Mothers of Young Children

BACKGROUND

Chronic parental stress may negatively impact health among both parents and children. Adverse neighborhood social conditions like crime may increase stress while a supportive neighborhood may buffer stress and promote well-being. Our objective was to examine associations between neighborhood social factors and stress among mothers of young children.

METHODS

We surveyed 300 mothers/female caregivers of Medicaid-enrolled 2 to 4-year-old children in Philadelphia. Maternal stress was measured via the 10-item Perceived Stress Scale (range 0-40). Mothers' perceived neighborhood safety and collective efficacy were assessed using validated scales. Addresses were geocoded to link census tract-level violent crime rates. We used multivariable linear regression to examine associations of neighborhood safety, collective efficacy, and crime with maternal stress, adjusted for demographics, household socioeconomic status, and neighborhood poverty.

RESULTS

Among mothers (mean age 31, 60% Black/African American), higher perceived neighborhood safety and collective efficacy were associated with lower stress scores after adjustment for covariates. Each 1-point increase (on a 5-point scale) in perceived neighborhood safety was associated with a 2.30-point decrease in maternal stress (95% CI: -3.07, -1.53). Similarly, each 1-point increase in perceived collective efficacy was associated with a 3.08-point decrease in maternal stress (95% CI: -4.13, -2.02). Police-recorded violent crime rates were not associated with maternal stress.

CONCLUSION

Mothers of young children who perceive their neighborhood social environment more favorably report less stress compared to those who feel their neighborhood environment is less safe and cohesive. Future work is warranted to investigate whether interventions that increase perceived neighborhood safety and collective efficacy reduce stress.

Protocol for a randomised placebo-controlled trial investigating the efficacy and safety of a vitamin-mineral formula targeting dysregulated emotions in teenagers: The balancing emotions of adolescents with micronutrients (BEAM) study

Background

Emotional dysregulation (ED) is a significant contributing factor to psychological distress in young people. ED is a transdiagnostic dimension characterized by an excessive reactivity to negative emotional stimuli with affective (anger) and behavioral (aggression) components, and is present across anxiety, mood and behavioral disorders. Due to early onset, high prevalence and persistence, ED in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions, with not enough children improving with conventional treatments. Clinical trials have established preliminary efficacy of micronutrients (vitamins and minerals) in the treatment of ED. This project expands the research to examine micronutrient efficacy for teenagers with ED.

Methods

This study is the first double-blind (participant and investigators) 8 week randomized controlled trial (with 8 week open-label extension and one year follow-up) designed to explore the efficacy and safety of micronutrients compared with placebo in 150 medication-free emotionally dysregulated youth (12–17 years), referred via self-referral, delivered remotely throughout New Zealand, using a website for monitoring symptoms, with a psychologist available online via text, email and video for assessment and monitoring. The primary outcome measures will be the Clinical Global Impression (CGI-I), the reactivity subscale of the Emotion Dysregulation Inventory (EDI) and the Clinician Rated Temper and Irritability Scale (CL-ARI).

Discussion

Micronutrient intervention delivered alongside online assessment and monitoring has the potential to transform delivery of mental health care to young people who may not be willing or able to access traditional therapies. We also hope that this intervention shows acceptability across different ethnicities.

The positive effects of combined breathing techniques and cold exposure on perceived stress: a randomised trial

A pranayama-inspired breathing technique, cold exposure, and their combined application were assessed for their potential to reduce perceived stress in adults and compared to a control group. An experiment involving four groups was conducted, yielding separate cells for breathing technique-only and cold exposure-only, as well as a combined treatment and a control group. Eighty-six individuals participated in the study. Perceived stress is measured employing the 10-item version of the Perceived Stress Scale (PSS-10) and the 20-item version of the Perceived Stress Questionnaire (PSQ). The instruments exhibit a substantial correlation (r = 0.842, p < 0.001). The combined group exhibited a medium to large positive effect on perceived stress compared to the control group. The breathing technique and cold exposure on their own were not found to yield substantial effects, indicating synergies between both exercises. Combinations of breathing techniques and cold exposure may be employed to decrease individuals' perceived stress.

Assessment of stress management coaching among Nigerian pre-service history teachers: A randomized controlled study

BACKGROUND

Studies have found that pre-service teachers commonly face stressful circumstances that prevent them from completing their academic tasks effectively. In terms of psychological factors and interventions, pre-service history teachers in Nigeria are the least studied group. The objective of this study was to investigate the effect of stress management coaching among Nigerian pre-service history teachers.

METHODS

The research participants consisted of a randomized sample of 109 pre-service history teachers from Nigerian public higher education institutions (55 pre-service history teachers composed the stress management coaching group while 54 pre-service history teachers composed the waitlist control group). The stress management coaching for the pre-service history teachers was guided by a coaching manual created using the theoretical framework of rational emotive behavior coaching.

RESULTS

Pre-service history teachers who participated in stress management coaching showed significantly reduced stress levels at the post-test and follow-up. There was an interaction effect between group and time on the stress of pre-service history teachers.

CONCLUSION

The study suggests that pre-service history teachers can benefit from a stress management coaching intervention that uses the rational emotive behavior coaching approach. The development of this form of stress management coaching program on a large scale among pre-service history teachers could prove beneficial to their academic and personal success. Studies may be conducted in the future to examine the stress of history teachers in colleges and the efficacy of stress management coaching.

Meditation Using a Mobile App Improves Surgery Trainee Performance: a simulation-based randomized controlled trial

PURPOSE

To primarily investigate: (1) whether a 10 min instant meditation practice using mobile app could enhance arthroscopy performance and (2) whether a 10-day app-based meditation could reduce short-term arthroscopic skills deterioration.

METHODS

Orthopedic residents with no previous experience in arthroscopy and meditation were randomly assigned to Groups A, B, and C. After initial standard competency-based arthroscopy training on the simulator on Day 1, a pretest was performed via simulator by all participants to assess their initial level of performance, then Groups A and B were required to practice app-based mindfulness meditation 10 min/day for 10 consecutive days, while Group C did nothing. On Day 11, all participants came back to perform a posttest. Prior to the posttest, the participants in Group A practiced app-based meditation (10 min) , whereas Groups B and C had no intervention.

RESULTS

43 participants were included and reached similar level of performance after initial training phase in Day1. In Day11, participants in Group A had statistically better instant arthroscopy performance than Group B, with higher total score (Mean Difference, 3.57; P<.001), less completion time (MD, -42.89s; P=.001), shorter camera (MD, -23.38cm; P<.001) and grasper (MD, -15.23cm; P=.002) path length and less cartilage injury (MD, -1.07%; P=.012). Participants in Group B had less skills deterioration than Group C, with better total score (MD, -5.42; P<.001), less completion time (MD, 51.96s; P=.002), camera path length (MD, 28.41cm; P=.007) and cartilage injury (MD, 1.19%; P=.038).

CONCLUSION

Meditation training using mobile app enhanced instant simulation-based arthroscopy performance and reduced short-term skills deterioration of orthopedic residents with no arthroscopy hands-on experience.

CLINICAL RELEVANCE

Meditation using mobile app for clinicians and educators should be incorporated into simulation-based arthroscopy curriculums and perhaps clinical settings to improve arthroscopy performance and mental health of orthopedic residents without any prior arthroscopy experience.

Emotional Dysregulation and Time Structure Mediate the Link between Perceived Stress and Insomnia among Unemployed Young People in China: A Cross-Sectional Study

In recent years, the problem of youth unemployment in China has become a great concern. Unemployed young people often find themselves under tremendous stress and vulnerable to sleep problems. The link between perceived stress and insomnia has been widely documented, but the potential mechanisms underlying this relationship have not been thoroughly revealed. The objective of this study was to examine the underlying mechanisms linking perceived stress to insomnia through testing the mediating effects of emotional dysregulation and time structure. Through a multiple-stage convenience sampling, 511 unemployed young people (38.6% women; mean age = 21.51; SD = 2.22) were measured using the 10-item Perceived Stress Scale (PSS-10), Insomnia Severity Index (ISI), 16-item Difficulties in Emotion Regulation Scale (DERS-16), and Time Structure Questionnaire (TSQ). Based on the statistical description of the sample, chi-squared tests, bivariate correlation analyses, and mediation analyses were performed. The study indicated that 53.0% (95% CI: 48.7-57.4%) of the participants reported probable insomnia, and both insomnia and perceived stress demonstrated strong associations with emotional dysregulation and time structure, which served as partial mediators between perceived stress and insomnia symptoms according to mediation analyses. Path analysis further revealed that, after controlling for age and gender, emotional dysregulation and time structure accounted for 31.8 and 17.6% of the effect of perceived stress on insomnia, respectively. This study provides empirical support for the association among perceived stress, emotional dysregulation, time structure, and insomnia symptoms. To improve the sleep quality and general wellbeing of unemployed young people, emotional dysregulation and time structure must be taken into consideration.

Cognitive-Emotional Benefits of Weekly Exposure to Nature: A Taiwanese Study on Young Adults

Empirical evidence of nature’s benefits to cognitive and emotional well-being is emerging. In this study, 48 Taiwanese young adults (24 indoors and 24 outdoors in urban greenspace) completed four weekly 45 min exposure sessions. The study explores whether the outdoor group surpasses the indoor group in cognitive and emotional well-being and nature connectedness. There were no significant differences for the indoor group across different measurements of rumination and connectedness to nature. However, the outdoor group displayed a significant reduction in rumination post-test compared to the one week prior and the first session. Similarly, for sessions two, three, and four and one month post-test, the outdoor group’s connectedness to nature was significantly higher than pre-test. Specific autobiographical memory was enhanced while overgeneral autobiographic memory was reduced during the third and fourth sessions, though these changes were not sustained at one-month follow-up. Surprisingly, both groups yielded similar results in decreased depression, anxiety, and stress. A significantly higher number of outdoor group participants had employed nature exposure for coping with stress or emotions after the program. We discuss the implications of this for counseling services for young adults and highlight future research possibilities, including formulating a nature-exposure protocol and a program evaluation for consolidating evidence-based nature prescription.

Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity

Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.

Prevalence of dry eye disease among Chinese high school students during the COVID-19 outbreak

Purpose

The study aimed to investigate the prevalence of dry eye disease (DED) and relevant risk factors among Chinese high school students during the COVID-19 outbreak.

Methods

A cross-sectional study was conducted from November to December 2020, and 4825 high school students from nine high schools in Shanghai were recruited. All students completed ocular surface disease index (OSDI) and perceived stress scale (PSS) questionnaires and answered other questions designed to ascertain information on the risk factors related to DED. DED was diagnosed when OSDI scores were greater than or equal to 13. The prevalence of symptomatic DED was determined. A T-test, Kruskal-Wallis test, Chi-square test, and logistic regression analysis were used to examine the possible risk factors.

Results

The prevalence of symptomatic DED among Chinese high school students was 70.5%. In univariate analysis, higher PSS scores (P<0.001), prolonged video display terminal (VDT) use (P<0.001), wearing contact lenses (P=0.001), poor sleep quality (P<0.001), and being female (P<0.001) were significantly correlated with dry eyes. In multivariate logistic regression analysis, higher PSS scores (P<0.001, OR=1.20), prolonged VDT use (P<0.001, OR=1.07), poor sleep quality (P<0.001, OR=1.84), and being female (P=0.001, OR=1.25) were significant risk factors associated with DED.

Conclusions

Due to the epidemic, most Chinese high school students are in a high-risk environment in which they are more likely to suffer from DED, such as long online courses and heavy stress from school. Relevant preventive measures that may have a positive impact on public health and quality of life for high school students should be brought to the forefront.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02408-9.

Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study

OBJECTIVES

To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China.

METHODS

A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0.

RESULTS

A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18-54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39-6.29), had low social support (aOR = 2.95, 95% CI 1.39-6.29), were non-local residents (aOR = 2.51, 95% CI 1.15-5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15-5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18-3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67-47.09), had completed higher education (aOR = 12.28, 95% CI 1.24-121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37-8.32).

CONCLUSIONS

The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.

Psychological stress; knowledge, attitude and practice and acceptance of antiviral therapy in pregnant women with hepatitis B in Zhejiang, China: a case comparison study

OBJECTIVES

To determine knowledge, attitude and practice (KAP) and antiviral therapy's acceptance during pregnancy of pregnant women with hepatitis B and influencing factors.

DESIGN

Case-comparison study.

SETTING

The study was conducted in Zhejiang province, China, from September 2019 to December 2020.

PARTICIPANTS

Pregnant and postpartum women with chronic hepatitis B.

PRIMARY AND SECONDARY OUTCOME MEASURES

The stress scores, self-assessed health score, KAP, antiviral therapy's acceptance rate during pregnancy and influencing factors were analysed. The Perceived Stress Scale-10 was used to assess stress. Logistic regression was used to analyse influencing factors on antiviral therapy.

RESULTS

The self-assessed health score of pregnant women without liver diseases (82.4±9.3) was significantly higher than that of pregnant women with chronic hepatitis B (75.5±9.5) and postpartum (75.1±14.1). Psychological stress of pregnant women with chronic hepatitis B was significantly high with a 14.9±3.6 score, but there was no significant difference between hepatitis B postpartum and non-liver disease women (12.7±3.5 vs 12.9±3.5, p=0.75). The acceptance rate of pregnant women with hepatitis B for antiviral therapy was 84.2%, while that of postpartum women was even higher. Logistic regression analysis showed that patients with positive hepatitis B e antigen (HBeAg) (OR, 3.35; 95% CI, 1.21 to 9.26) and higher scores on hepatitis B-related knowledge (OR, 3.52, 95% CI, 2.18 to 5.69) were more likely to accept antiviral therapy during pregnancy.

CONCLUSIONS

Pregnant women with hepatitis B in Zhejiang have heavy psychological stress and a high antiviral therapy acceptance rate during pregnancy. Acceptance is related to HBeAg status and level of understanding of hepatitis B during pregnancy. It is necessary to provide education on hepatitis B to reduce psychological stress and increase acceptance of antiviral therapy during pregnancy.

Anxiety, depression, stress, burnout, and professional quality of life among the hospital workforce during a global health pandemic

PURPOSE

Working in a hospital setting during a global health pandemic can lead to increased levels of anxiety, stress, burnout, and depression. Anecdotal evidence exists, but there is little research utilizing clinically validated tools to measure hospital staff psychological distress.

METHODS

In Summer 2021, 771 hospital staff in North Dakota responded to an electronic survey collecting demographic data and employing validated behavioral health screening tools to assess anxiety, depression, emotional distress, and work-related quality of life.

FINDINGS

Compassion satisfaction was significantly higher for those who worked in rural areas than urban [t(769) = -1.99, P = .0467]. The burnout rating was significantly higher for those who worked in urban areas than rural [t(769) = 2.23, P = .0261)]. There was no significant geographic variation in stress, anxiety, or depression. Anxiety, depression, burnout, and stress were all significantly higher for those who worked directly with COVID-19 patients than those who did not, regardless of hospital location.

CONCLUSIONS

Hospital staff caring for COVID-19 patients experienced equitable (and high) levels of depression and anxiety. However, data indicate that rural providers experienced greater protective factors, resulting in lower rates of burnout and higher compassion satisfaction. Rural communities, hospitals, and health systems may have characteristics that could be duplicated in urban areas to support hospital staff well-being. Support and promotion of mental wellness must also come from the hospital system, and health care and policy leaders. If we do not care for our hospital staff, there will not be hospital staff left to care for the community.