Abstract
BackgroundA 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.MethodsForward 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]).ResultsInfit 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.ConclusionThe 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.
Highlights
Stress has been as an old and a pivotal concept, but no commonly accepted definition of the term, in the health research since it is associated with various health outcomes and quality of life
Thirteen items from the original Perceived Stress Questionnaire (PSQ) were retained in the Chinese version of the PSQ (C-PSQ) adaptation (i.e. C-PSQ-13)
The C-PSQ-13 shows good metric characteristics for most indicators, which could contribute to stress research given its validity and economy
Summary
Stress has been as an old and a pivotal concept, but no commonly accepted definition of the term, in the health research since it is associated with various health outcomes and quality of life. The transactional model of stress concentrates on the evaluation of the degree and type of the challenge, threat, harm, or loss, as well as on the individual’s perceived abilities to cope with such stressors [4]; the view to support this model implies, further, that stress is not the product of an imbalance between objective demands and response capacity, but rather of the perception of these factors [5, 6]. Recognition around this general conceptualization over time, from which the construct of “perceived stress” arisen [7], the critical constructs underlying perceived stress have been more complex and challenging to evaluate. The C-PSQ evaluates subjective experiences of stress instead of a specific and objective status
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