Validation and application of the Chinese version of the Perceived Stress Questionnaire (C-PSQ) in nursing students

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.

Effect of a telecare-based intervention on stress levels in informal caregivers of older adults: protocol for a randomized controlled trial

Significance

Due to caregiving commitments, caregivers of older adults may not have the time to make use of the onsite community services available to them during the day. With the support of advanced technology, telecare could be a convenient and easily accessible channel for providing individualized caregiving advice to caregivers.

Objective

The aim of the study is to describe a research protocol that highlights the development of a telecare-based intervention program for reducing stress levels in informal caregivers of community-dwelling older adults.

Methods

It is a randomized controlled trial. The study is supported by two community centers. The study participants will be randomly assigned to either the telecare-based intervention group or the control group. The former will receive a 3-month program comprised of three components: online nurse case management supported by a health and social care team, an online resource center, and a discussion forum. The latter will receive the usual services that provided by the community centers. Data will be collected at two time points - pre-intervention (T1) and post-intervention (T2). The primary outcome is stress levels, while secondary outcomes include self-efficacy, depression levels, quality of life, and caregiving burden.

Discussion

Besides taking care of one or more older adults, informal caregivers have to deal with work, chores, and take care of their children. This study will add valuable information to the knowledge gap on whether telecare-based interventions with the support of an integrated health-social team can alleviate the stress levels of informal caregivers of community-dwelling older adults. If successful, policymakers and healthcare professionals should consider incorporating telecare modalities in a primary health setting for informal caregivers to correspond with them, to relieve their caregiving stress and promote a healthy life.

Clinical trial registration

https://www.clinicaltrials.gov/, NCT05636982.

The Chinese Version of the Perceived Stress Questionnaire-13: Psychometric Properties and Measurement Invariance for Medical Students

Purpose

Stress may relate to an increased risk of psychological and physical disorders. Thus, a brief and efficient measurement instrument for researchers to measure stress is essentially needed.

Participants and Methods

To assess measurement properties of the validated Chinese version of the Perceived Stress Questionnaire-13 (PSQ-C-13), we conducted a two-wave longitudinal study from September to December, 2021 with a convenient sample of medical students.

Results

A two-factor (constraint and imbalance) structure showed good fit indices (Comparative Fit Index [CFI] = 0.972, Tucker-Lewis Index [TLI] = 0.966, Root Mean Square Error of Approximation [RMSEA] = 0.062). Spearman correlations with the Chinese Perceived Stress Scale-10 illustrated that convergent validity of the PSQ-C-13 was relatively satisfactory (r = 0.678 [baseline], 0.753 [follow-up]). Measurement invariance was supported across subgroups (gender, age, home location, single-child status, monthly households' income, and part-time status) and time points. Internal consistency was sound (Cronbach's α = 0.908 [baseline], 0.922 [follow-up]; McDonald's ω = 0.909 [baseline], 0.923 [follow-up]). Stability between time points was good (Intraclass Correlation Coefficient = 0.834).

Conclusion

The two factors of the PSQ-C-13 including constraint and imbalance may adequately measure the level of stress on participants. The PSQ-C-13 is a convenient and efficient instrument that contains valid and reliable psychometric properties.

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.

Prevalence of stress among nursing students: A protocol for systematic review and meta-analysis

OBJECTIVE

Our main purpose is to evaluate the prevalence of stress among nursing students systematically.

METHODS

Adhering to the preferred reporting items for Systematic Reviews and Meta-analyses guidelines, we carefully searched ten databases, including PubMed, Cochrane, Web of Science, Scopus, ScienceDirect, SpringerLink, EMBASE, CNKI, Wanfang, and China Biomedical Literature Service System, to collect cross-sectional studies on nursing students. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies.

RESULTS

From 1397 studies, 27 cross-sectional studies were included, including 7116 subjects. Meta-analysis showed that the prevalence of low-level stress was 0.24% [95% CI (0.24% to 0.25%)], the prevalence of middle level stress was 0.35% [95% CI (0.35% to 0.35%)], and the prevalence of high-level stress was 0.10% [95% CI (0.10% to 0.10%)]. The results of subgroup analysis showed that stress levels are different in different genders, diagnostic criteria for stress, years of publication, and regions.

CONCLUSIONS

This review identified the stress levels of nursing interns, which were mainly moderate. This result makes nursing administrators and nursing educators pay more attention to the mental health problems of nursing interns, which can actively take measures to promote the physical and mental health of nursing students, improve the quality of nursing students' practice, and further promote the development of the nursing profession.

Cohort profile: Anhui Maternal-Child Health Study in China

PURPOSE

The Anhui Maternal-Child Health Study (AMCHS) aims to examine determinants of reproduction, pregnancy and postpartum maternal and child health outcomes in Chinese women who received assisted reproductive technology (ART).

STUDY DESIGN AND PARTICIPANTS

AMCHS is an ongoing cohort study starting from May 2017. AMCHS recruits participants from all couples who sought ART treatment in the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. The participants are interviewed to document baseline sociodemography, lifestyles, dietary intake and environmental exposure. Their clinical characteristics are obtained from hospital records. Samples of blood, follicular fluid and semen are collected at the clinic. Participants receive a standard long pituitary downregulation or a short protocol with an antagonist for the treatment. They are followed up from preconception to delivery, or discontinuation of ART treatment. Details of their children's health are documented through a questionnaire focusing on developmental status and anthropometry measurement.

FINDINGS TO DATE

Until April 2021, AMCHS had recruited 2042 couples in the study. 111 women withdrew from the study and 19 failed to retrieve oocytes. Among the 1475 confirmed pregnancies, 146 had miscarriages or terminated their pregnancies, 9 had stillbirths and 263 were ongoing pregnancies. The implantation failure increased with maternal age; adjusted OR was 1.43 (95% CI 1.16 to 1.77) in the age of 31-35 years, 1.97 (95% CI 1.46 to 2.66) in 35-39 years and 6.52 (95% CI 3.35 to 12.68) in ≥40 years compared with those aged 20-30 years. Among the 1057 couples with successful ART who were followed up for delivering babies, 576 had their children examined at age 30-42 days, 459 at 6 months and 375 at 12 months.

FUTURE PLANS

The AMCHS will identify comprehensive risk factors for poor ART outcomes and explore potential interaction effects of multiple factors including sociopsychological aspects of environmental exposure, dietary intake and genetics on maternal and child health.

Smartphone addiction and its associated factors among freshmen medical students in China: a cross-sectional study

BACKGROUND

With smartphone use widespread worldwide, smartphone addiction is an emerging epidemic. This study aims to investigate the prevalence of smartphone addiction among freshmen medical students and to explore its association with personal factors, mental health, and professional identity.

METHODS

This cross-sectional study was conducted from October 10th to November 10th, 2020 and included 2,182 first-year college students at Wannan Medical College, China. The smartphone addiction test, professional identity, and a 12-item general health questionnaire were used for this cross-sectional survey. Pearson's correlation coefficient (r) was employed to examine the correlations between smartphone addiction and mental health and professional identity. Binary logistic regression analysis was carried out to assess the factors influencing smartphone addiction. Of the 2,182 students, 866 (39.7%) were identified as having smartphone addiction. The logistic regression analysis shows that four factors (professional identity scale, poor mental health, smartphone use before sleep, and perceived study pressure) were significantly associated with smartphone addiction.

CONCLUSIONS

This cross-sectional study suggests that smartphone addiction is common among Chinese freshmen medical students. Smartphone addiction was common among the freshmen medical students surveyed. The findings imply that promotional programs, aimed at enhancing mental health and professional identity among freshmen medical students, help to reduce smartphone addiction in this population.

Preconception Dietary Patterns and Associations With IVF Outcomes: An Ongoing Prospective Cohort Study

There is a lack of research on preconception diet and reproductive outcomes conducted in the Chinese population using individual assessment. Between April 2017 and April 2020, 2,796 couples undergoing in vitro fertilization treatment were recruited in this ongoing prospective cohort, and 1,500 eligible couples were included in the final analysis. A validated semi-quantitative food frequency questionnaire was used to evaluate the maternal preconception diet. Other lifestyle factors, including smoking status, psycho-mental status, sleep quality, and physical activity, were also assessed. Five dietary patterns were identified using principal component analysis, namely "Fruits-Vegetables-Dairy-Eggs," "Fish/Seafood-Animal blood," "Tubers-Beans-Cereals," "Puffed food-Candy-Bakery," and "Dried Fruits-Organs-Rice." After adjusting for multiple confounders, we detected that the women who are more inclined to the "Fruits-Vegetables-Dairy-Eggs" pattern and less adherent to the "Tubers-Beans-Cereals" were more likely to achieve normally fertilized eggs and transferable embryos. Regarding pregnancy outcomes, we observed that a lower "Puffed food-Candy-Bakery" score and a higher "Dried fruits-Organs-Rice" score were related to a higher likelihood to achieve biochemical pregnancy. In terms of pregnancy complications, an inverse association between "Fish/Seafood-Animal blood" and hypertensive disorders was observed. We further clustered the dietary patterns based on the proportion of food groups consumed and found that dairy intake was beneficial to embryo quality, while frequent rice consumption was associated with a higher risk of macrosomia. Notably, in the stratified analysis, we observed that the positive relationship between the "Fruit-Dairy-Vegetables-Eggs" score and normal fertilization and the inverse association of the "Fish/Seafood-Animal blood" score with hypertensive disorders during pregnancy were exhibited only among women with body mass index ≥25 kg/m2. In conclusion, pre-treatment diets might be an important target for intervention to achieve a better reproductive outcome.

Status and factors related to post-traumatic growth in continuous ambulatory peritoneal dialysis: A multi-centre study

Aim

To investigate the extent of post‐traumatic growth, and the correlation between post‐traumatic growth and self‐perceived stress, post‐traumatic growth and self‐perceived burden among CAPD patients.

Design

A cross‐sectional study.

Methods

This was a multi‐centre study including 752 patients from 44 hospitals. Self‐perceived stress, self‐perceived burden and post‐traumatic growth were measured using the post‐traumatic growth inventory (PTGI), the Chinese version of the perceived stress questionnaire (CPSQ) and the self‐perceived burden scale (SPBS). A multiple stepwise regression analysis was fit with the total PTGI score as the outcome of interest.

Results

Patients concurrently experienced post‐traumatic growth and stress following peritoneal dialysis. The initiation of patients’ education level, employment status and self‐perceived stress were all found to relate to growth among Chinese CAPD patients. There was not sufficient evidence to suggest that self‐perceived burden was related to experiencing growth.

Effect of Aquatic Exercise on Sleep Efficiency of Adults With Chronic Musculoskeletal Pain

BACKGROUND

Aerobic exercise improves sleep for people who have difficulty in sleeping soundly, but most research to date has focused on land-based exercise. There has been only very limited research into the effect of aquatic exercise on people with chronic musculoskeletal (MSK) pain. The purpose of this study is to examine the effect of a 6-week aquatic exercise program on sleep efficiency among adults with chronic MSK pain.

METHODS

A total of 30 adults with chronic MSK pain were recruited by convenience sampling and assigned into intervention and control groups by a trained research assistant. Their sleep efficiency, sleep quality, activity level, stress level, and pain level were measured with ActiGraph GT3X accelerometer before and after the intervention group completed a 6-week, biweekly program of aquatic exercise.

RESULTS

Following intervention, the intervention group had significantly longer total true sleep time (by 27.6 min, P = .006); greater sleep efficiency (+3.01%, P = .005); and less pain (-1.33/10, P = .026). The control group had significantly shorter total true sleep time by 5.8 minutes (P = .036) while changes in the other outcomes were not significant.

CONCLUSIONS

Six weeks of moderate-intensity aquatic exercise may improve sleep efficiency and reduce pain for persons suffering chronic MSK pain.

The Association Between Second-hand Smoke Exposure and Psychiatric Distress Among Naturally Pregnant Women and Pregnant Women After Assisted Reproductive Technology Treatment: a Birth Cohort Study

Second-hand smoke (SHS) has been shown to be associated with psychiatric distress in pregnant women spontaneously conceived (SC), but this has never been investigated in pregnant women with assisted reproductive technology (ART) treatment. This study aimed to investigate and compare the associations of SHS with psychiatric distress among SC and ART pregnant women. Participants (1467 SC and 857 ART women) were from the sub-study of Chinese National Birth Cohort (CNBC) in Anhui Province. SHS was assessed by the self-reported questionnaire. The symptoms of depression, anxiety, stress, and poor sleep quality were assessed using CES-D, SAS, CPSS, and PSQI questionnaire. Multivariable linear regression was used to determine the association between SHS and psychiatric distress in each trimester. In SC women, SHS (yes or no) was associated with depression and anxiety symptoms in the 3rd trimester (β = 0.90, 95% CI 0.07-1.73 for depression and β = 1.21, 95% CI 0.39-2.04 for anxiety) and stress symptom and poor sleep quality in both the 2nd and 3rd trimesters (β = 0.85, 95% CI 0.20-1.49 in the 2nd trimester and β = 0.69, 95% CI 0.07-1.32 in the 3rd trimester for stress, and β = 1.32, 95% CI 0.68-1.96 in the 2nd trimester and β = 1.38, 95% CI 0.64-2.11 in the 3rd trimester for poor sleep quality). By contrast, in ART women, SHS was associated with depression and stress symptoms in the 1st trimester (β = 1.97, 95% CI 0.59-3.35 for depression and β = 1.18, 95% CI 0.24-2.12 for stress) and poor sleep quality throughout the pregnancy (β = 0.64, 95% CI 0.22-1.06 in the 1st trimester, β = 0.77, 95% CI 0.35-1.18 in the 2nd trimester, and β = 0.99, 95% CI 0.50-1.48 in the 3rd trimester, respectively). Our findings indicate a universal and detrimental effect of SHS on psychiatric health among both SC and ART pregnant women. However, the SHS impact may be more substantial at the early stage of pregnancy for ART women and at later stages for SC women. This implies the importance of reducing SHS exposure during pregnancy and the necessary to be aware of the difference in the effect of SHS on psychiatric distress between SC and ART women.

Testing Two Student Nurse Stress Instruments in Chinese Nursing Students: A Comparative Study Using Exploratory Factor Analysis

Background

The development and transformation of nursing within professional tertiary education have exerted a great pressure and challenge upon nursing students. Stress experienced by nursing students is a common precursor of psychological distress and attrition. However, no scale is specifically used to evaluate the sources of stress experienced by nursing students in Mainland China. Aims and Objective. This study is aimed at testing and comparing the reliability and validity including sensitivity and specificity of two nursing students' stress instruments, the Chinese version of Student Nurse Stress Index Scale (SNSI-CHI), and the Stressors in Student Nursing Scale (SINS-CN) in Chinese nursing students, and describing the stress status of nursing students in China.

Methods

A cross-sectional survey was conducted in two nursing schools in Henan Province from August 2017 to January 2018. Data were collected by using a questionnaire comprising the Chinese version of SNSI (SNSI-CHI), the Chinese version of SINS (SINS-CN), and the Chinese Perceived Stress Scale (CPSS). Homogeneity and stability, content, construct and concurrent validity, and sensitivity and specificity were assessed.

Results

The Cronbach's alpha (α) of SNSI-CHI was 0.90, and the item-to-total correlations ranged from 0.35 to 0.66. The Cronbach's α of SINS-CN was 0.93, and the item-to-total correlations ranged from 0.19 to 0.61. The findings of exploratory factor analysis (EFA) confirmed a good construct validity of SNSI-CHI and SINS-CN. The Pearson's rank correlation coefficients, between total scores of SNSI-CHI and CPSS and SINS-CN and CPSS, were assessed to 0.38 (P < 0.01) and 0.39 (P < 0.01), respectively. Regarding the CPSS, as the criterion, the cut-points of SNSI-CHI and SINS-CN for the area under the receiver operator characteristic (ROC) curve were 0.77and 0.66, respectively.

Conclusion

Both scales are valid and reliable for evaluating the source of stress of student nurses in China. Each has its own characteristics, but the SNSI-CHI demonstrated marginal advantage over the SINS-CN. The SNSI-CHI is short, is easily understood, and with clear dimension for the nursing students, and the SNSI-CHI is more acceptable for the users in China.

The Mediating Role of Perceived Stress in Associations Between Self-Compassion and Anxiety and Depression: Further Evidence from Chinese Medical Workers

Objective

Medical workers report high rates of stress, anxiety and depression, which need urgent attention. Providing evidence for intervention measures in the face of a mental health crisis, the present study validates the relation between self-compassion and anxiety and depression mediated by perceived stress amongst medical workers. The goal is also to replicate a similar mediation model though multigroup analysis.

Methods

Medical workers were randomly selected to investigate by paper-and-pencil survey among 1,223 medical workers from three hospitals in Shiyan, China. The measures were comprised of four parts: the Chinese version of the Goldberg Anxiety and Depression Scale (GADS), the Self-Compassion Scale-Short Form (SCS-SF), the Perceived Stress Questionnaire (PSQ) and a socio-demographic questionnaire. Applying structural equation modeling (SEM, single-group analysis), we estimated the effects of self-compassion on anxiety/depression through perceived stress. Furthermore, based on multigroup analysis, we used two sets of internal samples (gender groups, medical groups) and an external sample (nursing students) for testing multigroup invariance.

Results

The average scores of anxiety, depression, self-compassion and perceived stress in medical workers were 5.93 ± 2.46, 4.91 ± 2.62, 38.87 ± 4.66 and 71.96 ± 15.14, respectively. In some departments engaged in the research, the medical workers showed higher levels of anxiety and depression. The SEM results indicated that the original relationship between self-compassion and anxiety and depression was beta = -0.42 (P < 0.001) and reduced to beta = -0.17 (P < 0.001) while introducing perceived stress as a mediating variable. Perceived stress was positively associated with anxiety and depression (beta = 0.60, P < 0.001), and self-compassion was negatively associated with perceived stress (beta = -0.56, P < 0.001). Multigroup analysis showed acceptable changes in fit indices across gender (male and female), medical (clinician and non-clinician), and population (medical workers and nursing students) groups.

Conclusion

Medical workers were experiencing high levels of anxiety and depression and perceived stress. Perceived stress might have a partial mediating effect on self-compassion and anxiety and depression amongst medical workers, which was similar to a previous study in nursing students. The findings supported multigroup invariance across gender, medical and population groups. The study concluded that the mediation model may be generalized across these multiple samples. Psychological intervention could be used to improve levels of self-compassion of medical workers.

The Chinese version of the Perceived Stress Questionnaire: development and validation amongst medical students and workers

BACKGROUND

A valid and efficient stress measure is important for clinical and community settings. The objectives of this study were to translate the English version of the Perceived Stress Questionnaire (PSQ) into Chinese and to assess the psychometric properties of the Chinese version of the PSQ (C-PSQ). The C-PSQ evaluates subjective experiences of stress instead of a specific and objective status.

METHODS

Forward translations and back translations were used to translate the PSQ into Chinese. We used the C-PSQ to survey 2798 medical students and workers at three study sites in China from 2015 to 2017. Applying Rasch analysis (RA) and factor analysis (FA), we examined the measurement properties of the C-PSQ. Data were analyzed using the Rasch model for item fit, local dependence (LD), differential item functioning (DIF), unidimensionality, separation and reliability, response forms and person-item map. We first optimized the item selection in the Chinese version to maximize its psychometric quality. Second, we used cross-validation, by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), to determine the best fitting model in comparison to the different variants. Measurement invariance (MI) was tested using multi-group CFA across subgroups (medical students vs. medical workers). We evaluated validity of the C-PSQ using the criterion instruments, such as the Chinese version of the Perceived Stress Scale (PSS-10), the Short Form-8 Health Survey (SF-8) and the Goldberg Anxiety and Depression Scale (GADS). Reliability was assessed using internal consistency (Cronbach's alpha, Guttman's lambda-2, and McDonald's omegas) and reproducibility (test-retest correlation and intraclass correlation coefficient, [ICC]).

RESULTS

Infit and/or outfit values indicated that all items fitted the Rasch model. Three item pairs presented local dependency (residual correlations > 0.30). Ten items showed DIF. Dimensionality instruction suggested that eight items should be deleted. One item showed low discrimination. Thirteen items from the original PSQ were retained in the C-PSQ adaptation (i.e. C-PSQ-13). We tested and verified four feasible models to perform EFA. Built on the EFA models, the optimal CFA model included two first-order factors (i.e. constraint and imbalance) and a second-order factor (i.e., perceived stress). The first-order model had acceptable goodness of fit (Normed Chi-square = 8.489, TLI = 0.957, CFI = 0.965, WRMR = 1.637, RMSEA [90% CI] = 0.078 [0.072, 0.084]). The second-order model showed identical model fit. Person separation index (PSI) and person reliability (PR) were 2.42 and 0.85, respectively. Response forms were adequate, item difficulty matched respondents' ability levels, and unidimensionality was found in the two factors. Multi-group CFA showed validity of the optimal model. Concurrent validity of the C-PSQ-13 was 0.777, - 0.595 and 0.584 (Spearman correlation, P < 0.001, the same hereinafter) for the Chinese version of the PSS-10, SF-8, and GADS. For reliability analyses, internal consistency of the C-PSQ-13 was 0.878 (Cronbach's alpha), 0.880 (Guttman's lambda-2), and 0.880 (McDonald's omegas); test-retest correlation and ICC were 0.782 and 0.805 in a 2-day interval, respectively.

CONCLUSION

The C-PSQ-13 shows good metric characteristics for most indicators, which could contribute to stress research given its validity and economy. This study also contributes to the evidence based regarding between-group factorial structure analysis.

Examining psychometric properties and measurement invariance of a Chinese version of the Self-Compassion Scale - Short Form (SCS-SF) in nursing students and medical workers

BACKGROUND

Self-compassion has been regarded as a key psychological construct and a protective factor of mental health status. The focus of the present study was to adapt the Self-Compassion Scale (SCS) into Chinese, assess the validity and reliability of the measure and test measurement invariance (MI) across nursing students and medical workers.

METHODS

The current study assessed the psychometric properties and invariance of the SCS-Short Form (SCS-SF) in two samples of 2676 from nursing students and medical workers. For construct validity, confirmatory and exploratory factor analyses (CFAs and EFAs) were conducted. Using Perceived Stress Questionnaire , Short Form-8 Health Survey (SF-8) and Goldberg Anxiety and Depression Scale, we evaluated concurrent validity and convergent/divergent validity. For reliability, internal consistency and test-retest analysis were employed. Multi-group analyses were conducted to examine MI of the different SCS-models across populations.

RESULTS

CFA showed that the proposed six-factor second-order model could not be replicated and the six-factor first-order model was a reasonable to mediocre fitting model in both samples. EFA supported a three-factor structure which consisted of one positive and two negative factors. CFA confirmed that the hypothesized three-factor structure with 10 items ultimately was considered as the optimal model on the fitted results. The SCS-SF-10 (10 items form) also demonstrated acceptable internal consistency and test-retest reliability, as well as strong concurrent validity with measures of stress perception, health status, anxious and depressive symptoms. Convergent/divergent validity was not satisfactory. Multi-group CFAs provided support for the validity of the established models.

CONCLUSION

The Chinese version of the SCS-SF-10 has sound psychometric properties and can be applied to efficiently assess self-compassion in Chinese-speaking populations. The current study contributes to the identification and measurement of self-compassion after adversities.

Self-compassion may reduce anxiety and depression in nursing students: a pathway through perceived stress

OBJECTIVES

Nursing students report high levels of anxiety and depression, which requires urgent attention. A growing amount of evidence indicates that self-compassion may indirectly (through perceived stress) and directly influence anxiety and depression, yet the research to date has not fully examined the reasons for this association. The present study examines the effects of self-compassion on anxiety and depression through perceived stress and may thus provide an innovative starting point for developing effective interventions for affected nursing students.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Using structural equation modelling (SEM), we estimated the strength of the pathways between self-compassion, perceived stress and anxiety and depression among 1453 nursing students in Ningbo, China. The measurements included demographics, the Self-Compassion Scale-Short Form, the Chinese version of the Perceived Stress Questionnaire and the Goldberg Anxiety and Depression Scale.

RESULTS

Nursing students had an average score of 4.50 ± 2.44 on the Goldberg Anxiety Scale (GAS) and 3.58 ± 2.34 on the Goldberg Depression Scale (GDS), indicating high levels of anxiety and depression. The GAS and GDS scores were significantly different by the academic year, part-time employment and career prospects. The average scores for self-compassion and perceived stress were 38.99 ± 4.55 and 0.40 ± 0.14, respectively. The SEM results suggested that self-compassion was negatively associated with anxiety and depression (-0.44, P < 0.001). Perceived stress was positively associated with anxiety and depression (0.64, P < 0.001). Self-compassion was negatively associated with perceived stress (-0.65, P < 0.001). Self-compassion had no significant correlation with anxiety and depression in the effect of perceived stress (-0.14, P = 0.127). Thus, self-compassion indirectly influences anxiety and depression through perceived stress.

CONCLUSIONS

Self-compassion might reduce nursing students' anxiety and depression through perceived stress. Interventionists can consider using self-compassion training to alleviate perceived stress, anxiety and depression in nursing students.

Perceived Stress Levels in Adult Patients With Uveitis

Background: The aim of this study was to examine perceived stress levels in adult patients with uveitis. Patients and Methods: One hundred seventy-three adult consecutive uveitis patients (age range 18 to 85 years) were analyzed in a cross-sectional design for their perceived stress, according to the Perceived Stress Questionnaire (PSQ). Stress levels were classified into normal stress, moderate stress, and high stress. Results: In the majority of uveitis patients a normal stress level (82%) within the last 2 years was detected. In a subgroup analysis, perceived stress of the patients with active uveitis compared with patients with non-active uveitis was significantly higher within the last 2 years (n=80 active/n = 45 non-active; p = 0.005). Conclusions: Overall 18% of the uveitis patient had raised perceived stress, similar to the general population but patients with active uveitis were significantly more stressed. Therefore, consideration of stress levels may be important in the therapy of uveitis patients.