PSS-10 Score Research Articles

Changes and predictors of psychological stress among elderly stroke survivors 6months after hospital discharge.

The aim of this study was to analyse the changes in psychological stress and identify its basal predictors among elderly stroke survivors after 6months following discharge from hospital to home directly, rather than to a rehabilitation facility. The sample comprised 50 elderly stroke survivors. Data were collected at 2weeks (T1), at 3months (T2), and at 6months (T3) after hospital discharge. The following instruments were applied: Perceived Stress Scale-10 items (PSS-10), National Institute of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale-15 items. Study records indicated that the age of the study participants ranged from 60 to 87years old (mean=70.3; standard deviation=7.6). The number of male and female participants was similar. The PSS-10 score decreased almost 6 points between T1 (mean=15.1) and T3 (mean=9.7; p<.001). Both Functional Independence Measure (p=.025) and Geriatric Depression Scale-15 (p=.017) scores at T1 predicted the PSS-10 score at T3. The study thus demonstrated that elderly stroke survivors experienced significant stress after hospital discharge, which tended to improve over the next 6months. Depression and lower functional independence 2weeks after discharge were predictors of a greater level of psychological stress at 6months following discharge.

Association between Emotional Intelligence and Perceived Stress in Undergraduate Dental Students.

This study investigated the association of emotional intelligence (EI) and other factors with perceived stress (PS) in undergraduate dental students. A total of 234 undergraduate dental students at the School of Dental Sciences, Universiti Sains Malaysia (USM), in the academic year of 2009/2010, participated in this cross-sectional study. Self-administered questionnaires, the Assessing Emotions Scale and the Perceived Stress Scale (PSS-10), were used to evaluate EI and PS, respectively. The mean EI score was 121.2 (SD 11.85). The scores were significantly higher in females than males, and in students who chose dentistry based on their own interest rather than in those who were motivated by others to study dentistry. The mean PSS-10 score was 21.2 (SD 5.08). Pearson correlation analysis indicated a significant inverse relationship between EI and PSS-10 scores (r = -0.337). Multi-variable regression analysis also indicated a significant negative linear association between EI and PSS-10 scores (b = -0.156, 95% CI: -0.207, -0.104). PSS-10 scores were significantly higher for students who were in the clinical years rather than the preclinical years. This study of USM undergraduate dental students shows that a low EI, female sex, and being in the clinical years were significant predictors of PS.

Stress and coping styles in postgraduate medical students: A medical college-based study

Background: Medical education is inherently stressful. Postgraduate medical students, in particular are vulnerable to experience stress. Considering the paucity of research on stress in postgraduate medical students, this study was conducted to assess their perceived stress and coping strategies. The study intends to provide inputs for future interventions to manage their stress. Objective: To study perceived stress, coping styles and psychological morbidity in postgraduate medical students Material & methods: This was a cross sectional study conducted on all postgraduate students willing to participate in the study, studying at this medical college and hospital. They were asked to fill a structured proforma to assess socio-demographic details and domains of stress. Stress was assessed by Perceived stress scale (PSS-10), coping strategies using BRIEF COPE and psychological morbidity screened by Self reporting questionnaire (SRQ). Descriptive analysis &Pearson correlation was done between stress levels, psychological morbidity and various coping strategies. Results: Postgraduate medical students had mean PSS-10 score of 17.96. Pearson correlation revealed positive correlation between stress levels measured by PSS-10 and psychological morbidity measured by SRQ (Correlation coefficient 0.639). There was also positive correlation independently between higher stress score and psychological morbidity with higher use of dysfunctional coping strategies (Correlation coefficient 0.44 & 0.421 respectively). Conclusion: Postgraduate students using dysfunctional coping strategies had higher stress and psychological morbidity, whereas those using healthy emotion focused coping strategies had lower stress levels and lower psychological morbidity.

Design and evaluation of a park prescription program for stress reduction and health promotion in low-income families: The Stay Healthy in Nature Everyday (SHINE) study protocol

BackgroundContact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol. MethodsBehavioral change theory and environmental education literature informed the intervention. Outcomes were selected after review of the literature and field tested procedures to determine what was feasible and ethical in a busy clinic serving vulnerable populations. DesignWe designed a randomized controlled trial to examine two levels of intensity in behavioral counseling about the health benefits of nature. Dyads consisting of a caregiver and a child aged 4 to 18 who access our pediatric primary care center are eligible. All dyads receive a pediatrician's recommendation to visit parks to experience nature and written resources (a “park prescription”). The intervention group receives added case management and an invitation to three group outings into nature with transportation, meals and activities provided. Primary outcomes measured at baseline, one month and three months post-enrollment are caregiver stress measured by PSS-10 score and salivary α-amylase; secondary outcomes are park prescriptions adherence, physical activity recorded by pedometer and journaling, loneliness, family cohesion and affinity to nature as measured by a validated scales. Both groups receive incentives to participation. DiscussionOur intervention represents a feasible integration of recent research findings on the health benefits of nature and primary care practice.

The association of perceived stress and verbal memory is greater in HIV-infected versus HIV-uninfected women.

In contrast to findings from cohorts comprised primarily of HIV-infected men, verbal memory deficits are the largest cognitive deficit found in HIV-infected women from the Women's Interagency HIV Study (WIHS), and this deficit is not explained by depressive symptoms or substance abuse. HIV-infected women may be at greater risk for verbal memory deficits due to a higher prevalence of cognitive risk factors such as high psychosocial stress and lower socioeconomic status. Here, we investigate the association between perceived stress using the Perceived Stress Scale (PSS-10) and verbal memory performance using the Hopkins Verbal Learning Test (HVLT) in 1009 HIV-infected and 496 at-risk HIV-uninfected WIHS participants. Participants completed a comprehensive neuropsychological test battery which yielded seven cognitive domain scores, including a primary outcome of verbal memory. HIV infection was not associated with a higher prevalence of high perceived stress (i.e., PSS-10 score in the top tertile) but was associated with worse performance on verbal learning (p < 0.01) and memory (p < 0.001), as well as attention (p = 0.02). Regardless of HIV status, high stress was associated with poorer performance in those cognitive domains (p's < 0.05) as well as processing speed (p = 0.01) and executive function (p < 0.01). A significant HIV by stress interaction was found only for the verbal memory domain (p = 0.02); among HIV-infected women only, high stress was associated with lower performance (p's < 0.001). That association was driven by the delayed verbal memory measure in particular. These findings suggest that high levels of perceived stress contribute to the deficits in verbal memory observed in WIHS women.

Qi-gong training reduces basal and stress-elicited cortisol secretion in healthy older adults

IntroductionQi-gong, a mind–body practice combining meditation, physical movement and controlled breathing, is reported to improve psychological well-being and physical function in older adults. However, the effects of Qi-gong on hypothalamic–pituitary–adrenal (HPA) axis activity and reactivity to stress in older people are elusive. An uncontrolled, before-and-after study in a group of healthy older adults was conducted to investigate the possible benefits of 12-week Qi-gong training on self-rated distress symptoms and cortisol secretion under basal and stimulated conditions. MethodsBefore (T0) and after (Tf) Qi-gong training, participants (n=28), men and women, mean age 65 years;(smokers, obese subjects, persons with chronic diseases and oral pathologies, and subjects reporting major stressful events in their recent past were excluded) answered the PSS-10 questionnaire. Salivary samples were collected for cortisol detection at various times of the day during a challenging mental task. ResultsQi-gong training reduced basal cortisol output across the day, notably in the morning. In subjects who responded to the stressor at T0 (n=16, baseline-to-peak increment >1.5nmol/l), cortisol response to cognitive challenge was markedly blunted after training, accompanied by a decreasing trend of PSS-10 score. ConclusionQi-gong practice in elderly people appears to improve control on HPA axis activity, reducing daytime cortisol levels and attenuating cortisol responses to mental stress. Ameliorating the profile of basal and stimulated HPA activity, may reflect better adaptation to stress, and may favor successful aging and positive health outcomes. Present findings encourage the implementation of programs aimed at further disseminating Qi-gong practice among the older population.

A study of the relationship between food group recommendations and perceived stress: findings from black women in the Deep South.

Black women in the Deep South experience excess morbidity/mortality from obesity-related diseases, which may be partially attributable to poor diet. One reason for poor dietary intake may be high stress, which has been associated with unhealthy diets in other groups. Limited data are available regarding dietary patterns of black women in the Deep South and to our knowledge no studies have been published exploring relationships between stress and dietary patterns among this group. This cross-sectional study explored the relationship between stress and adherence to food group recommendations among black women in the Deep South. Participants (n = 355) provided demographic, anthropometric, stress (PSS-10), and dietary (NCI ASA-24 hour recall) data. Participants were obese (BMI = 36.5 kg/m2) and reported moderate stress (PSS-10 score = 16) and minimal adherence to Dietary Guidelines for Americans food group recommendations (1/3 did not meet recommendations for any food group). Participants reporting higher stress had higher BMIs than those reporting lower stress. There was no observed relationship between stress and dietary intake in this sample. Based on these study findings, which are limited by potential misreporting of dietary intake and limited variability in stress measure outcomes, there is insufficient evidence to support a relationship between stress and dietary intake.

Interventions to reduce postpartum stress in first-time mothers: a randomized-controlled trial.

BackgroundThe postpartum period can be a challenging time particularly for first-time mothers. This study aimed to assess two different interventions designed to reduce stress in the postpartum among first-time mothers.MethodsHealthy first-time mothers with healthy newborns were recruited from hospitals in Beirut, Lebanon after delivery. The two interventions were a 20-minute film addressing common stressors in the postpartum period and a 24-hour telephone support hotline. Participants were randomized to one of four study arms to receive either the postpartum support film, the hotline service, both interventions, or a music CD (control). Participants were interviewed at eight to twelve weeks postpartum for assessment of levels of stress as measured by the Cohen Perceived Stress Scale (PSS-10).ResultsOf the 632 eligible women, 552 (88%) agreed to participate in the study. Of those, 452 (82%) completed the study. Mean PSS-10 scores of mothers who received the film alone (15.76) or the film with the hotline service (15.86) were significantly lower than that of the control group (18.93) (p-value <0.01). Among mothers who received the hotline service alone mean PSS-10 score (16.98) was also significantly lower than that of the control group (p-value <0.05).ConclusionsBoth our postpartum support film and the 24-hour telephone hotline service reduced stress in the postpartum period in first-time mothers. These simple interventions can be easily implemented and could have an important impact on the mental wellbeing of new mothers.Trial registrationThe trial was registered with clinicaltrials.gov (identifier # NCT00857051) on March 5, 2009.

Level of agreement between self-rated and clinician-rated instruments when measuring major depressive disorder in the Thai elderly: a 1-year assessment as part of the THAISAD study

PurposeWhether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found.Patients and methodsThis was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months.ResultsAmong the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet’s AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD.ConclusionThe level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances.

Pilot Study of Impact of Medical-Legal Partnership Services on Patients’ Perceived Stress and Wellbeing

Medical-legal partnerships (MLPs) bring legal services into health care settings to address patients' unmet legal needs. This pilot project examined whether MLP services impact patients' perceptions of stress and wellbeing. Providers referred patients with legal concerns to the Tucson Family Advocacy Program (TFAP), an MLP within a family medicine clinic. Stress levels and wellbeing were assessed before and after legal services using self-administered 10-item Perceived Stress Scale (PSS-10) and Measure Yourself Concerns and Wellbeing (MYCaW) instruments. Sixty-seven participants completed pre- and post-service questionnaires. Within this group, the mean PSS-10 score decreased 8.1 points. Wellbeing scores improved by 1.8 points. Individual changes in perceived stress were strongly related to participants' level of concern regarding the particular legal issues addressed. Services in patient-centered medical homes to address unmet legal needs have the potential to reduce perceived stress and improve overall wellbeing. Additional studies concerning MLPs and patient outcomes are needed.

Negative Affect Mediates Effects of Psychological Stress on Disordered Eating in Young Chinese Women

BackgroundThe bi-relationships between psychological stress, negative affect and disordered eating has been well studied in western culture, while tri-relationship among them, i.e. how some of those factors influence these bi-relationships, has rarely been studied. However, there has been little related study in the different Chinese culture. This study was conducted to investigate the bi-relationships and tri-relationship between psychological stress, negative affect, and disordered eating attitudes and behaviors in young Chinese women.MethodologyA total of 245 young Chinese policewomen employed to carry out health and safety checks at the 2010 Shanghai World Expo were recruited in this study. The Chinese version of the Perceived Stress Scale (PSS-10), Beck Depression Inventory Revised (BDI-II), Beck Anxiety Inventory (BAI), and Eating Attitude Test (EAT-26) were administered to all participants.Principal FindingsThe total scores of PSS-10, BDI-II and BAI were all highly correlated with that of EAT-26. The PSS-10 score significantly correlated with both BDI-II and BAI scores. There was no statistically significant direct effect from perceived stress to disordered eating (–0.012, 95%CI: –.038∼0.006, p = 0.357), however, the indirect effects from PSS-10 via affect factors were statistically significant, e.g. the estimated mediation effects from PSS to EAT-26 via depression and anxiety were 0.036 (95%CI: 0.022∼0.044, p<0.001) and 0.015 (95%CI: 0.005∼0.023, p<0.01), respectively.ConclusionsPerceived stress and negative affects of depression and anxiety were demonstrated to be strongly associated with disordered eating. Negative affect mediated the relationship between perceived stress and disordered eating. The findings suggest that effective interventions and preventative programmes for disordered eating should pay more attention to depression and anxiety among the young Chinese female population.

Correlation Between Stress and Kidney Stone Disease

Prevalence of kidney stone disease is increasing worldwide, and several factors may be involved. We aimed to establish a correlation between stress and kidney stones. We prospectively evaluated 200 patients with a diagnosis of kidney stone disease having them self-respond to a validated questionnaire to measure stress (Perceived Stress Scale-10 [PSS-10]). Stone-related characteristics and potential stressing factors were assessed. Variables that were significant on the univariate analysis were used to construct a model that was able to explain the variability in PSS-10 score in our patients. Mean PSS-10 score was 15.3 ± 1.1. Female sex (P=0.014), occurrence of death or serious illness of a family member or close friend within the last 6 months of the interview (P=0.044), occurrence of other psychological trauma (P<0.0001) all proved to be significant factors. Stone-related aspects associated with stress were presence of symptoms at the time of the interview (P=0.012) and passage of two or more stones per year (P=0.022). We were able to construct a model that explains 34% of the variability of the PSS-10 between subjects. Employment status was the only significant variable, but sex, age, and presence of symptoms at the time of questionnaire administration had to be kept in to achieve a model that explains the largest variability. Passage of two or more stones per year and presence of symptoms proved to be factors related to elevated stress in patients with a diagnosis of kidney stone disease. Female sex, age, and unemployment may also contribute to a stressed state in this population.

Stress and Psychological Distress among SARS Survivors 1 Year after the Outbreak

Our study examined the stress level and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak. During the SARS outbreak in 2003, we used the 10-item Perceived Stress Scale (PSS-10) to assess SARS survivors treated in 2 major hospitals (non-health care workers, n = 49; health care workers, n = 30). We invited SARS survivors from the same hospitals (non-health care workers, n = 63; health care workers, n = 33) to complete the PSS-10 again in 2004. At that time, they were also asked to complete the General Health Questionnaire (GHQ-12) and measures of depression, anxiety, and posttraumatic symptoms. PSS-10 scores were also obtained from matched community control subjects during the outbreak (n = 145) and again in 2004 (n = 112). SARS survivors had higher stress levels during the outbreak, compared with control subjects (PSS-10 scores = 19.8 and 17.9, respectively; P < 0.01), and this persisted 1 year later (PSS-10 scores = 19.9 and 17.3, respectively; P < 0.01) without signs of decrease. In 2004, SARS survivors also showed worrying levels of depression, anxiety, and posttraumatic symptoms. An alarming proportion (64%) scored above the GHQ-12 cut-off that suggests psychiatric morbidity. During the outbreak, health care worker SARS survivors had stress levels similar to those of non-health care workers, but health care workers showed significantly higher stress levels in 2004 (PSS-10 score = 22.8, compared with PSS-10 score = 18.4; P < 0.05) and had higher depression, anxiety, posttraumatic symptoms, and GHQ-12 scores. One year after the outbreak, SARS survivors still had elevated stress levels and worrying levels of psychological distress. The situation of health care worker SARS survivors is particularly worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an important role in rehabilitation.

Immediate and Sustained Psychological Impact of an Emerging Infectious Disease Outbreak on Health Care Workers

To assess the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak. At the peak of the 2003 SARS outbreak, we assessed health care workers in 2 acute care Hong Kong general hospitals with the Perceived Stress Scale (PSS-10). One year later, we reassessed these health care workers with the PSS-10, the 21-Item Depression and Anxiety Scale (DASS-21), and the Impact of Events Scale-Revised (IES-R). We recruited high-risk health care workers who practised respiratory medicine and compared them with nonrespiratory medicine workers, who formed the low-risk health care worker control group. In 2003, high-risk health care workers had elevated stress levels (PSS-10 score = 17.0) that were not significantly different from levels in low-risk health care worker control subjects (PSS-10 score = 15.9). More high-risk health care workers reported fatigue, poor sleep, worry about health, and fear of social contact, despite their confidence in infection-control measures. By 2004, however, stress levels in the high-risk group were not only higher (PSS-10 score = 18.6) but also significantly higher than scores among low-risk health care worker control subjects (PSS-10 score = 14.8, P < 0.05). In 2004, the perceived stress levels in the high-risk group were associated with higher depression, anxiety, and posttraumatic stress scores (P < 0.001). Posttraumatic stress scores were a partial mediator of the relation between the high risk of exposure to SARS and higher perceived stress. Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety. Front-line staff could benefit from stress management as part of preparation for future outbreaks.