Stress in Children and Adolescents: Development and Validation of a New Questionnaire to Assess Stress

Individuals exposed to social stress in childhood are more predisposed to developing psychoemotional disorders in adulthood. Here we use an animal model to determine the influence of hostile social environment in adolescence on behavior during adult life. One-month-old adolescent male mice were placed for 2 weeks in a common cage with an adult aggressive male. Animals were separated by a transparent perforated partition, but the adolescent male was exposed daily to short attacks from the adult male. After exposure to social stress, some of the adolescent mice were placed for 3 weeks in comfortable conditions. Following this rest period, stressed young males and adult males were studied in a range of behavioral tests to evaluate the levels of anxiety, depressiveness, and communicativeness with an unfamiliar partner. In addition, adult mice exposed to social stress in adolescence were engaged in agonistic interactions. We found that 2 weeks of social stress result in a decrease of communicativeness in the home cage and diminished social interactions on the novel territory. Stressed adolescents demonstrated a high level of anxiety in the elevated plus-maze test and helplessness in the Porsolt test. Furthermore, the number of dividing (BrdU-positive) cells in the subgranular zone of the dentate gyrus was significantly lower in stressed adolescents. After 3 weeks of rest, most behavioral characteristics in different tests, as well as the number of BrdU-positive cells in the hippocampus, did not differ from those of the respective control mice. However, the level of anxiety remained high in adult males exposed to chronic social stress in childhood. Furthermore, these males were more aggressive in the agonistic interactions. Thus, hostile social environment in adolescence disturbs psychoemotional state and social behaviors of animals in adult life.

We investigated the effects of social instability stress (daily 1-hr isolation, change of cage partner, postnatal day 30-45) in adolescence in male rats on open field exploration and social behavior in adulthood. Social stressed rats had longer latencies to enter the center of an open field and then took longer to approach an object placed in the center of the field. When another rat was placed in the open field, stressed rats spent less time in social interaction than control rats, particularly when paired with another stressed, rather than a control, rat. The groups did not differ in social approach tests (when a stimulus rat was separated by wire mesh) nor in novel object exploration (when controlling for open field anxiety). The results suggest social stress in adolescence increases open field anxiety while maintaining exploratory behavior, and alters social interactions in adulthood.

Psychological aspects such as stress, emotions, illness behaviour or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD) and can influence medical outcome in some patients. The aim of the present study was to evaluate the efficacy of psychological intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-related GERD symptoms during a 1-year follow-up. Out of a sample of 196 consecutive patients who required LARS (Nissen fundoplication), a group of 89 (45%) believed that stress was a factor in the cause of their symptoms (stress-related versus stress-unrelated GERD patients). Patients with stress-related symptoms were randomly assigned to the psychological intervention (PI group; n = 42) or control group with routine surgical care (RC group; n =42). Five patients were excluded from the study. Assessments of surgical outcome were: objective clinical data such as DeMeester score or lower oesophageal sphincter pressure, Gastrointestinal Quality-of-Life Index (GIQLI), evaluation of potential side effects such as subjective degree of dysphagia, general impairment as a result of LARS, and patient satisfaction with surgery. There were no significant differences in objective clinical data between the different treatment groups before and after surgery. Before surgery, patients with stress-related symptoms had a lower GIQLI and an increased spectrum of gastrointestinal (GI) symptoms compared with patients without stress-related symptoms. A significant impact (P < 0.05-0.01) of psychological intervention on quality-of-life data, especially in GI symptoms, degree of dysphagia and general impairment, could be calculated after surgery. No differences in satisfaction with therapy were detectable. Comparing outcome, no significant differences between patients without stress-related GERD symptoms and the PI group were found. Generally, quality-of-life data in all patients improved significantly and patient satisfaction was excellent or good in 98.9% one year after surgery. In two patients a laparoscopic refundoplication was necessary because of a 'slipping Nissen'. These findings indicate that there is no impact of psychological intervention on objective clinical data. Patients with stress-related GERD symptoms profit significantly from psychological intervention in patient-related factors of surgical outcome such as quality of life or degree of several aspects such as dysphagia and general impairment. Generally, LARS in patients with stress-related GERD symptoms is an effective and safe procedure which improves quality of life with fewer side effects. Psychological intervention reduces non GERD-related GI symptoms and makes the outcome comparable to the outcome of patients without stress-related symptoms. We therefore suggest that surgical treatment alone in patients with stress-related GERD symptoms is incomplete and that psychological intervention can optimize surgical outcome in these patients.

BackgroundEnsuring lifelong health among aging populations necessitates comprehensive assessments of functional recovery and quality of life, particularly for vulnerable groups such as older adult stroke survivors. While the Stroke Impact Scale (SIS) 3.0 is a widely validated instrument for evaluating health-related quality of life (HRQoL) in stroke survivors, its psychometric properties have not yet been examined in the Vietnamese context. This study aimed to translate, culturally adapt, and validate the Vietnamese version of the SIS 3.0 (V-SIS 3.0), providing a robust tool to support holistic, multidimensional approaches to stroke rehabilitation in aging populations.MethodsA cross-sectional study was conducted from July to December 2021 at the National Geriatric Hospital in Hanoi, Vietnam. The study enrolled 256 stroke survivors aged 45 years or older who had experienced a stroke between 1 month and 1 year prior to participation. The V-SIS 3.0 questionnaire was developed through a rigorous forward and backward translation process. Its factorial structure was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed via Cronbach’s alpha, and convergent and divergent validity were evaluated through correlation analyses. Additionally, Item Response Theory (IRT) was employed to examine item discrimination and difficulty.ResultsEFA identified a four-factor structure consisting of Physical (28 items), Cognitive (12 items), Social Participation (10 items), and Emotional (8 items) domains. CFA supported this structure, indicating a good model fit (RMSEA = 0.080, CFI = 0.925, TLI = 0.918, SRMR = 0.053). The instrument demonstrated excellent internal consistency across all domains, with Cronbach’s alpha values of 0.971 for Physical, 0.950 for Cognitive, 0.949 for Social Participation, and 0.920 for Emotional. Convergent and divergent validity were confirmed by strong item correlations within each factor, while IRT analysis further indicated high discrimination and appropriate difficulty levels for most items.ConclusionThe V-SIS 3.0 is the first culturally adapted and validated tool to assess HRQoL in Vietnamese stroke survivors. By offering a reliable, multidimensional evaluation of physical, cognitive, emotional, and social wellbeing, this instrument enhances clinical assessments, informs targeted interventions, and ultimately contributes to more effective aging and lifestyle strategies for stroke survivors in Vietnam.

Background: Psychological aspects such as stress, emotions, illness behaviour or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD) and can influence medical outcome in some patients. The aim of the present study was to evaluate the efficacy of psychological intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-ralated GERD symptoms during a 1-year follow-up. Methods: Out of a sample of 196 consecutive patients who required LARS (Nissen fundoplication), a group of 89 (45%) believed that stress was a factor in the cause of their symptoms (stress-related versus stress-unrelated GERD patients). Patients with stress-related symptoms were randomly assigned to the psychological intervention (PI group; n = 42) or control group with routine surgical care (RC group; n = 42). Five patients were excluded from the study. Assessments of surgical outcome were: objective clinical data such as DeMeester score or lower oesophageal sphincter pressure, Gastrointestinal Quality-of-Life Index (GIQLI), evaluation of potential side effects such as subjective degree of dysphagia, general impairment as a result of LARS, and patient satisfaction with surgery. Results: There were no significant differences in objective clinical data between the different treatment groups before and after surgery. Before surgery, patients with stress-related symptoms had a lower GIQLI and an increased spectrum of gastrointestinal (GI) symptoms compared with patients without stress-related symptoms. A significant impact (P < 0.05-0.01) of psychological intervention on quality-of-life data, especially in GI symptoms, degree of dysphagia and general impairment, could be calculated after surgery. No differences in satisfaction with therapy were detectable. Comparing outcome, no significant differences between patients without stress-related GERD symptoms and the PI group were found. Generally, quality-of-life data in all patients improved significantly and patient satisfaction was excellent or good in 98.9% one year after surgery. In two patients a laparoscopic refundoplication was neccessary because of a 'slipping Nissen'. Conclusions: These findings indicate that there is no impact of psychological intervention on objective clinical data. Patients with stress-related GERD symptoms profit significantly from psychological intervention in patient-related factors of surgical outcome such as quality of life or degree of several aspects such as dysphagia and general impairment. Generally, LARS in patients with stress-related GERD symptoms is an effective and safe procedure which improves quality of life with fewer side effects. Psychological intervention reduces non GERD-related GI symptoms and makes the outcome comparable to the outcome of patients without stress-related symptoms. We therefore suggest that surgical treatment alone in patients with stress-related GERD symptoms is incomplete and that psychological intervention can optimize surgical outcome in these patients.

Identifying the factor structure of the Mother-to-Infant Bonding Scale for post-partum women and examining its consistency during pregnancy.

Background: Engaging in end-of-life care considerations is beneficial when the time is right. The purpose of this study is to provide a valid instrument to assess peoples readiness for end-of-life conversations before they are initiated.Materials and Methods: A community sample was recruited in study one for exploratory factor analysis of a 13-item questionnaire. In study two, psychometric properties were analyzed with structural equation modeling in a population affected by cancer. Convergent and discriminant validity were assessed with questionnaires measuring distress, depression, anxiety, fear of progression, and distress of death and dying.Results: In study one (N = 349) exploratory factor analysis resulted in three subscales readiness (α = 0.84), communication (α = 0.76), and values (α = 0.56) with a possible common factor (α = 0.84) for a community sample. In study two (N = 84) the three-factor solution with 13 items was not supported for cancer patients. Factor structure was adapted to 12 items with one common factor readiness (α = 0.87). Model fit was good: χ2(50) = 59.18, p>0.05 (Satorra-Bentler-correction = 1.27), with χ2/df = 1.184, rRMSEA = 0.053 (90%-CI[0.000;0.100]), and rSRMR = 0.072. Convergent validity was supported by moderate correlations to trait gratitude, ratings of readiness to provide a living will or talk with family about the end of life. Divergent validity was supported by no or small correlation with distress, depression, general and death anxiety and fear of progression, respectively.Conclusions: Results support usage of the REOLC Scale in different settings with adapted factor structure. The questionnaire is interpreted as valid and reliable instrument to assess objective readiness for end-of-life conversations.

Aim: Effect of cyclic meditation (CM) on quality of life (QOL) and perceive stress in female adolescence. Materials and Methods: This study was carried out in school students (58 adolescence girl). Participants age ranged from 14 to 17 years with a mean age of (mean ± standard deviation = 16.41 ± 0.56). All subjects were recruited from Bongo Sishu Balika Vidhalaya Bali Hawra (West Bengal) India. The variables (perceive stress scale and QOL enjoyment and satisfaction questionnaire) were assessed before the CM practices. All the student underwent CM practices daily for 30 min afternoon 3 pm to 3:30 pm, 5 days a week for 1-month under the guidance of a trainer yoga therapist. These CMs consisted of eight steps. The eight-step CM is the same, which is following in SVYASA Yoga University. After 30 days of intervention, the parameters were repeated. Results: The data analysis showed significant improvement in QOL (P < 0.05) and significant changes in perceive stress (P < 0.05) and there is no significant change in quality of satisfaction. The result shows significant value in both the variables month of CM one. Conclusion: These findings suggest that practice 1-month of CM showed that there is a significant impact on QOL and perceived stress in an adolescent girl.

Background:Perceived social support represents a key factor influencing both mental and physical health, yet brief Arabic measures are scarce.Objectives:To assess the psychometric properties of the Arabic version of the abbreviated 6-item Medical Outcomes Study–Social Support Survey (MOS-SSS-6) among Saudi adults.Methods:An online questionnaire was distributed via social media platforms to assess perceived social support, psychological distress, quality of life (QoL), and coping. Cronbach’s alpha (α), McDonald’s omega (ω), and corrected item-total correlations were used to evaluate the scale’s reliability. Exploratory factor analysis (EFA) was conducted on 50% of the sample, using maximum likelihood with varimax rotation to identify factor structure. Confirmatory factor analysis (CFA) validated the model in the other 50%, with fit assessed through RMSEA, SRMR, CFI, TLI, and other indices. Concurrent validity was evaluated through Pearson’s correlations with relevant psychological measures.Results:A total of 1028 Saudi adults completed the questionnaire. Suitability of the data for EFA was supported by a strong KMO value (0.83) and significant Bartlett’s test of sphericity (P < 0.001). Parallel analysis indicated that a three-factor solution was optimal, explaining 80% of the variance. CFA confirmed this model with excellent fit indices (CFI = 0.99, TLI = 0.98, RMSEA = 0.07, SRMR = 0.02, GFI = 0.99, AGFI = 0.95). Negative relationships with depression (r = −0.24, P < 0.01) and anxiety (r = −0.17, P < 0.01), and a positive correlation with QoL (r = 0.37, P < 0.01) and adaptive coping strategies provided evidence for concurrent validity. The Arabic MOS-SSS-6 exhibited high internal consistency (α = 0.90, ω = 0.90).Conclusions:The Arabic MOS-SSS-6 is a reliable and valid instrument for measuring perceived social support among Saudi adults, demonstrating significant correlations with psychological variables relevant for psychological assessments and interventions.

We examined the factor structure and psychometric properties of the Parent-Child Sleep Interactions Scale (PSIS) in families with children adopted from foster care. Data were collected from adoptive parents of 240 preschool-aged children, ages 3-6years, (M = 4.24years, SD = 1.06; 41.67% female) from across the U.S. Parents completed questionnaires assessing demographics, child sleep problems, and child depressive and anxiety symptoms. We randomly split the sample and conducted an exploratory factor analysis (EFA) in sample one, followed by a confirmatory factor analysis (CFA) in sample two. Internal consistency reliability and convergent validity of the final PSIS from the CFA were assessed. The EFA revealed the same three factors identified in the original 12-item measure: Sleep Reinforcement, Sleep Conflict, and Sleep Dependence. However, two items' factor loadings did not meet retention criteria. After removing these items, the three-factor solution was maintained, with good model fit. Internal consistency reliability for all PSIS subscales was good and all subscales were negatively correlated with sleep quality and positively correlated with total child sleep problems and symptoms of separation anxiety. Findings provide evidence for the reliability and validity of the revised PSIS for assessing sleep-related parent-child interactions among preschoolers with a history of placement in foster care.

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self-reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount.

Childhood stress, gender, and cognitive control: Midline theta power

ObjectivePatients with severe mental illnesses(SMIs) often experience a diminished quality of life(QOL), and a validated tool to assess their QOL remains lacking. This study aimed to evaluate the psychometric characteristics of SF-36v2 among Chinese SMIs patients to determine its suitability for assessing their QOL.MethodsWe conducted a cross-sectional study involving 924 randomly selected SMIs patients from 23 community health centers in Nanjing, China. The reliability of the SF-36v2 was assessed by Cronbach’s alpha and split-half reliability. Factor structure was examined by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity was evaluated using average variance extracted (AVE) and composite reliability (CR).ResultsThe SF-36v2 scale demonstrated good internal consistency, with a Cronbach’s alpha of 0.941 and split-half reliability of 0.965. A slight ceiling effect was observed in the Social Function dimension (17.6%). CFA confirmed the acceptability of the hypothesized model, with the measurement model meeting all relevant fit metrics (X2/ df = 1.552, p < 0.05, RMR = 0.037, GFI = 0.950, AGFI = 0.942, CFI = 0.984, NFI = 0.955, RMSEA = 0.024). For each dimension, AVE > 0.5 and CR > 0.7, indicating good convergent validity of the scale. The square root of the AVE from the variables was greater than the correlation between the dimensions in the model, supporting the scale’s discriminant validity. Additionally, the PCS (43.74 ± 10.28) and MCS (43.74 ± 10.28) scores of patients with SMIs were significantly lower than the Chinese general population norm (p < 0.001).ConclusionsThe SF-36v2 demonstrated robust psychometric properties, making it a reliable and valid tool for assessing QOL in SMIs patients. Its application can facilitate an objective evaluation of QOL in this population and inform treatment decisions accordingly.

General and transgender-specific quality of life in trans persons assigned female at birth: validation of the Essen Transgender Quality of Life-Inventory

Reducing participant burden is important in health research and clinical assessment. We examined the psychometric properties of the EUROHIS-QOL 8-item index, a short version of the 26-item World Health Organisation Quality of Life questionnaire (WHOQOL-Bref), in a sample of people receiving joint replacement surgery. Participants (n=1008) completed the WHOQOL-Bref at either 6, 12, 24 or 60months after hip or knee replacement. The factor structure, differential item functioning (DIF) and unidimensionality of the EUROHIS-QOL 8-item index were examined using exploratory and confirmatory factor analyses and Rasch analyses. Convergent validity was examined using correlations with the parent measure and other patient-reported outcome measures (Oxford scores, Western Ontario and McMaster Universities Osteoarthritis Index). Discriminant validity was assessed between groups reporting high versus low pain and function, and by joint replaced. The measure demonstrated high internal consistency (α=0.86), adequate convergent (r=0.47-0.82, p<0.001) and discriminant validity (p<0.001). Factor and Rasch analyses supported a unidimensional structure. However, there were also indications of multidimensionality, with support for a two-factor model focusing on general health and function, and psychosocial aspects of QOL. There was minimal evidence of DIF, with just one item evaluating energy level showing DIF for age. The EUROHIS-QOL 8-item index demonstrated adequate properties as a unidimensional scale and as a two-factor scale evaluating general health and function, and psychosocial aspects of quality of life. It is low on clinical and participant burden, showed minimal ceiling effects and showed good concurrent and discriminant validity.