Psychological Stress Measure Research Articles

Building Resilience in an Urban Police Department.

The aim of this study is to examine a resilience training intervention that impacts autonomic responses to stress and improves cardiovascular risk, psychological, and physiological outcomes in police. Officers [(n = 38) 22 to 54 years] modified emotional and physical responses to stress using self-regulation. Measurements include psychological and physiological measures [eg, heart rate variability (HRV), blood pressure, C-reactive protein)] obtained at three time intervals. Age was significantly (P < 0.05) associated with changes on several measures of psychological stress (eg, critical incident stress, emotional vitality, and depression). Associations were found between coherence and improved HbA1c (r = -0.66, P < 0.001) and stress due to organizational pressures (r = -0.44, P = 0.03). Improvements in sympathetic and parasympathetic contributors of HRV were significant (P < 0.03). A stress-resilience intervention improves certain responses to job stress with greater benefits for younger participants.

Social action art therapy as an intervention for compassion fatigue

This study evaluated the effectiveness of a social action art therapy session to address symptoms of stress and compassion fatigue in counsellors working in domestic violence (DV) and sexual assault (SA) services. Participants were adult women (N=30) who work with client survivors of DV and SA. Participants participated in three groups based on their workplace, and were asked to create art for a group peace pole. The peace pole has currency within the DV support community as a symbol of hope and safety. After creating individual artworks, each member glued their canvas squares onto the peace pole to create a unified group piece of art. The Compassion Fatigue Self-Test was used as a measure of compassion fatigue, and the Psychological Stress Measure 9 provided information regarding pre and post measures of symptomology changes. The results supported the hypothesis that participation in a social action art therapy based session could significantly reduce stress.

Association between objectively measured physical activity, chronic stress and leukocyte telomere length.

Physical activity (PA) attenuates chronic stress and age-related and cardiovascular disease risks, whereby potentially slowing telomere shortening. We aimed to study the association between seven-day objectively measured habitual PA, chronic stress and leukocyte telomere length. Study participants were African (N.=96) and Caucasian (N.=107) school teachers of the Sympathetic activity and Ambulatory Blood Pressure in Africans study. All lifestyle characteristics (including PA) were objectively measured. The general health questionnaire and serum cortisol were assessed as psychological and physical measures of chronic stress. Leukocyte telomere length was measured using the quantitative real-time polymerase chain reaction. Africans had significantly shorter telomeres (P<.0001) and greater psychological distress (P=0.001) than Caucasians, whereas no group difference was seen for cortisol levels. Higher age (ß=-0.28 [-0.40, -0.16, P≤0.000), higher alcohol consumption (ß=-0.21 [-0.36, -0.08], P=0.003) and increased central obesity (ß=-0.17 [-0.30, -0.03], P=0.017) were all significantly associated with shorter telomeres. Habitual PA of different intensity was not significantly associated with markers of chronic stress or telomere length. However, more time spent with light intensity PA time was significantly and independently correlated with lower waist circumference (r=-0.21, P=0.004); in turn, greater waist circumference was significantly associated shorter telomeres (β=-0.17 [-0.30, -0.03], P=0.017). Habitual PA of different intensity was not directly associated with markers of chronic stress and leukocyte telomere length in this biethnic cohort. However, our findings suggest that light intensity PA could contribute to lowered age-related disease risk and healthy ageing by facilitating maintenance of a normal waist circumference.

Measures of Maternal Stress and Mood in Relation to Preterm Birth.

To investigate the relationships between psychological and physiologic measures of stress, mood, and gestational age at delivery and preterm birth. This prospective cohort study recruited healthy women in the early second trimester who were 18-45 years of age. Validated psychological measures of perceived stress, depressive symptoms, and anxiety were completed at 16, 22, 28, 34, and 40 weeks of gestation. Cortisol concentration was measured in maternal hair at 16, 28, and 40 weeks of gestation to approximate first-, second-, and third-trimester levels of physiologic stress. Statistical methods included: analyses of variance, t tests, χ, Pearson correlations, regression modeling, and mediation analysis as appropriate. Hair cortisol concentrations were natural log-transformed to normalize values. Eleven (12%) of the 90 included women had a spontaneous preterm birth or preterm premature rupture of membranes. Perceived stress at 16 weeks of gestation correlated with both second-trimester cortisol concentration (r=0.28, P=.007) and earlier gestational age at delivery (r=-0.30, P<.01). Gestational age at delivery was also negatively correlated with cortisol concentration in the second trimester (r=-0.25, P=.02) and second-trimester cortisol concentration was higher in preterm- (2.7 ± 0.4 log-transformed pg/mg) compared with term- (2.0 ± 0.7 log-transformed pg/mg, P<.001) delivered women. Using mediation statistics, the association between the psychological measure, the physiologic measure, and gestational age at delivery was mainly driven by increased physiologic stress (hair cortisol concentration) in the second trimester (difference in coefficients [standard error]=-0.05 [0.02]). Higher perceived stress in the second trimester is associated with both elevated second-trimester hair cortisol concentration and gestational age at delivery. Physiologic measure of stress in the second trimester appears most strongly associated with preterm birth. Identification and amelioration of early pregnancy stressors may attenuate physiologic stress and ultimately affect preterm birth.

An examination of the equivalency of self-report measures obtained from crowdsourced versus undergraduate student samples.

Increasingly, researchers have begun to explore the potential of the Internet to reach beyond the traditional undergraduate sample. In the present study, we sought to compare the data obtained from a conventional undergraduate college-student sample to data collected via two online survey recruitment platforms. In order to examine whether the data sampled from the three populations were equivalent, we conducted a test of equivalency using inferential confidence intervals-an approach that differs from the more traditional null hypothesis significance testing. The results showed that the data obtained via the two online recruitment platforms, the Amazon Mechanical Turk crowdsourcing site and the virtual environment of Second Life, were statistically equivalent to the data obtained from the college sample, on the basis of means of standardized measures of psychological stress and sleep quality. Additionally, correlations between the sleep and stress measures were not statistically different between the groups. These results, along with practical considerations for the use of these recruitment platforms, are discussed, and recommendations for other researchers who may be considering the use of these platforms are provided.

Effectiveness of a Dental Students Stress Management Program

The dental education stress effects and sources were explored thoroughly in the literature, but the effectiveness of stress management programs received less attention. This study introduced a new stress management program, named Dental Education Stress Management (DESM) program. It showed its effectiveness in a quasi-experimental pretest-posttest-follow-up-control group design. The new program was based on the principle of psychoeducation and consisted of three 90-min sessions, to teach dental students how to better deal with their stress symptoms and to reduce their general stress level. Two instruments were used to assess the level of stress of the dental students, namely the Dental Environment Stress questionnaire (DES), and the Psychological Stress Measure (PSM-9). Results show that the DESM program has the desired effect of decreasing the stress levels of its participants, and these effects lasted for at least two weeks. Because of several methodological limitations of the study more research is needed to draw more generalizable conclusions.

The Stressometer: A Simple, Valid, and Responsive Measure of Psychological Stress in Inflammatory Bowel Disease Patients.

Psychological stress is associated with inflammatory bowel disease [IBD], but the nature of this relationship is complex. At present, there is no simple tool to screen for stress in IBD clinical practice or assess stress repeatedly in longitudinal studies. Our aim was to design a single-question 'stressometer' to rapidly measure stress and validate this in IBD patients. In all, 304 IBD patients completed a single-question 'stressometer'. This was correlated with stress as measured by the Depression Anxiety Stress Scales [DASS-21], quality of life, and disease activity. Test-retest reliability was assessed in 31 patients who completed the stressometer and the DASS-21 on two occasions 4 weeks apart. Stressometer levels correlated with the DASS-21 stress dimension in both Crohn's disease [CD] (Spearman's rank correlation coefficient [rs] 0.54; p < 0.001) and ulcerative colitis [UC] [rs 0.59; p < 0.001]. Stressometer levels were less closely associated with depression and anxiety [rs range 0.36 to 0.49; all p-values < 0.001]. Stressometer scores correlated with all four Short Health Scale quality of life dimensions in both CD and UC [rs range 0.35 to 0.48; all p-values < 0.001] and with disease activity in Crohn's disease [rs 0.46; p < 0.001] and ulcerative colitis [rs 0.20; p = 0.02]. Responsiveness was confirmed with a test-retest correlation of 0.43 [p = 0.02]. The stressometer is a simple, valid, and responsive measure of psychological stress in IBD patients and may be a useful patient-reported outcome measure in future IBD clinical and research assessments.

Psychophysiological Assessment of Stress Under Ecological Settings

Abstract. Stress can negatively impact one’s health and well-being, however, despite the recent evolution in stress assessment research methodologies, there is still little agreement about stress conceptualization and assessment. In an attempt to summarize and reflect on this evolution, this paper aims to systematically review research evidence of ecological approaches on psychophysiological stress assessment. Thus, a literature search of electronic databases was conducted spanning 22 years (1990–2012) and 55 studies were reviewed. Studies were considered for inclusion if they contemplated both psychological and physiological measures of stress under ecological settings. This review focuses on five themes: methodology terminology, research population, study design, measurement, and technology. Findings support the need to use a common methodology terminology in order to increase scientific rigor. Additionally, there seems to be an increasing tendency for the use of these methods by multidisciplinary teams among both clinical and nonclinical populations aiming to understand the relationship between stress and disease. Most of the studies reviewed contemplated a time-based protocol and different conceptualizations of stress were found, resulting in the use of different subjective measures. Findings reinforce the importance of combining subjective and objective measures while also controlling for possible time- or situation-dependent confounders’. Advances in technology were evident and different assessment techniques were found. The benefits and challenges of ecological protocols to assess stress are discussed and recommendations for future research are provided, aiming to overcome previous limitations and advance scientific knowledge in the area.

Stress During Pregnancy

High levels of stress during pregnancy are associated with a number of adverse psychological and physiological outcomes for mother and child. These effects seem to be transmitted in part by one of the major stress-responsive systems, namely the hypothalamic-pituitary-adrenal (HPA) axis, which includes the hormone cortisol. However, as inconsistent study results indicate, methodology poses a substantial challenge to the investigation of stress during pregnancy. For example, although measures of maternal psychological stress and stress hormones are independently related to adverse pregnancy outcome, they seldom have been found to correlate with one another directly. Repeated measurement of psychological and biological responses to acute standardized stress challenges appears to reveal stronger associations. This article reviews the literature on experienced stress and stress hormones in pregnant women and presents studies that used standardized stress challenges (e.g., the Trier Social Stress Test, the cortisol response to morning awakening) to examine maternal stress reactivity more systematically. This review also takes a look at the few studies that examined the protective effects of psychological and psychosocial resources or stress interventions on experienced stress and stress hormones in pregnant women. Overall, results indicate that baseline stress hormone levels advance incrementally during gestation, presumably to prepare mother and fetus for delivery, while responses to acute stress appear to be increasingly attenuated. Moreover, the acute maternal stress response seems to be predictive of neonatal birth outcome and maternal well-being postpartum. Preliminary findings also suggest that much can be done toward coping with stress during pregnancy. Further research and a closer collaboration between science and clinical practice are required.

Background music in the dissection laboratory: impact on stress associated with the dissection experience.

Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on stress associated with the dissection experience. After 8 wk of normal dissection without BM, various genres of BM were introduced into the cadaver dissection sessions of 260 medical and dental students for 3 wk. Feedback on the impact of BM on students in the CDL and students' attitude were accessed using a questionnaire. Psychological stress assessment was done using Psychological Stress Measure 9. Two batches of 30 students each were made to dissect same areas of the body for 2 h, one batch with BM playing and the other batch without. The same examination was given to both groups at the end. Over 90% of the participants expressed a desire to incorporate BM into the CDL; 87% of the sampled population that expressed love for music also reported BM to be a very useful tool that could be used to enhance learning conditions in the CDL. A strong positive relationship was established between love for music and its perception as a tool for learning in the CDL (P < 0.001). Students that studied under the influence of BM had significantly higher scores (P < 0.001) in the overall examination result. BM reduced the level of stress associated with the dissection experience by ∼33%.

Effects of Emotional Stress on Neuroendocrine and Autonomic Functions in Skydiving

By using a psycho-physiological approach we investigated the stress response during parachute jumping, a wellcharacterized stress model to study emotional and physical stress in humans. Besides the observation of hormone reactivity in response to such a short-term stressful event, this study focused on the correlations among competitive state anxiety components, hormonal and autonomic responses. Seven male sport-parachutists, aged 35.7 ± 17.5 years, took part in the study after giving their informed consent. Neuroendocrine and autonomic variables were measured 12 h before jumping (basal), within 60 s (jump) and 90 min after touching the ground (post-jump). Prior to boarding, participants were administered the Competitive State Anxiety Inventory-2 (CSAI-2) questionnaire. Salivary cortisol (Cort) and α-amylase (A-A) concentrations were measured by spectrophotometry using commercial kits. For heart rate (HR) and galvanic skin response (GSR) assessments data were acquired by holter recording, within an interval time of 5 min following saliva collection. Parachute jumping led to a strong response of Cort, A-A, as well as HR and GSR, as shown by the values noted as basal and at jump, meaning that the psychological arousal linked to this condition acts on different systems. In examining bioumoral correlates and psychological measures of stress and anxiety we found correlations between neuroendocrine parameters and anxiety components. However, no relationship between Cort and somatic or cognitive anxiety was noted, suggesting that this physiological measure is not a good index of stress during parachuting. As revealed by the differences in cognitive or somatic state anxiety, stress related to sport parachuting differentially affected salivary indices. Alpha-amylase seems to be a better physiological indicator than cortisol to examine the relationship between neuroendocrine parameters and state anxiety components. Finally, this is the first report that GSR significantly correlated with A-A and the somatic component of competitive state anxiety, confirming its potential to provide researchers with a tool for objectively measuring stress during operational conditions. On the whole, these findings have contributed to our understanding of hormone-behavior relationships.

Examination of cortisol and state anxiety at an academic setting with and without oral presentation

Holding oral presentations in a university course is perceived as stressful and can increase stress hormone concentrations and state anxiety. In such a naturalistic setting, further attention should be paid to the relationship between psychological and hormonal measures of acute stress, as well as women’s intake of hormonal contraceptives as a potential moderating variable. In the present study, 76 healthy students gave saliva samples before and after their oral presentations in a university course as well as on a second, control day in the same course without giving an oral presentation. Anticipatory state anxiety was rated on both days. Cortisol concentrations as well as state anxiety were substantially higher on the presentation relative to the control day. During the oral presentation, an increase in cortisol concentrations was observed, whereas a decrease occurred on the control day. Nearly the same picture emerged for both variables when looking at men, women taking hormonal contraceptives and free-cycling women separately. A positive correlation was found between the change in anticipatory state anxiety in the presentation compared to the control day and cortisol concentrations before and after the oral presentation. Concluding, oral presentations constitute a potent stressor and do not seem to be substantially different between men, free-cycling women and women taking hormonal contraceptives. Future studies may want to explore changes associated with specific menstrual cycle phases and with specific hormonal contraceptives.

On feeling good at work: the role of regulatory mode and passion in psychological adjustment

AbstractThe major postulate of this work is that regulatory modes influence the type of passion people experience with regard to an activity, which in turn influences their psychological adjustment. Integrating regulatory mode theory and the dualistic model of passion, we hypothesized that locomotion—associated with intrinsic and autonomous motivations—would positively predict harmonious passion, which in turn would enhance workers' psychological adjustment. In contrast, we hypothesized that assessment—associated with extrinsic and non‐autonomous motivations—would positively predict obsessive passion, which in turn would reduce workers' psychological adjustment. Two field studies supported these hypotheses with psychological adjustment measures of stress (Study 1) and burnout (Study 2) in different work contexts.

It's Funny Here. Is It There?

Last month’s column focused on theories of humor – the motivations behind humor – and the therapeutic use of humor and laughter as an adjuvant to medical treatment for patients with a variety of illnesses (Flaskerud, 2014). The theoretical motivations for humor described in the last column included several based on psychology – the expression of negative emotions, such as aggression and superiority; a coping mechanism for tension release; a means to resolve incongruity; a benign violation of various norms; and reverse engineering, an evolutionary development to correct errors in perception, based on neuroscience. The positive aspects of humor and the therapeutic use of laughter were explored also (Flaskerud, 2014). Several reports have demonstrated that laughter appears to improve mood, lessen anxiety, reduce psychological measures of stress, and reduce perception of pain (Christie & Moore, 2005). There are also physiological factors involved. Laughter can lead to changes in heart rate, skin temperature, blood pressure, pulmonary ventilation, skeletal muscle activity, and brain activity, which may improve overall wellbeing. Additionally, laughter may improve immune function by blocking the production of stress hormones, such as cortisol, and by increasing the release of immune-enhancers, such as beta-endorphin (Cancer Treatment Centers of America, 2013; Christie & Moore, 2005). Two other aspects of humor will be addressed here, as they apply to cultural differences and the use of humor. The first is: Are there other theoretical explanations of humor that do not rely on Western psychology and neuroscience? And second: Are humor and laughter used therapeutically in other cultures? It should be noted that humor and laughter are considered human traits: only humans have humor and we communicate it

Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

The present study investigated whether psychological and/or physiological measures of stress would impede induction onto methadone maintenance and predict early (<6months) discontinuation. Compared with controls, opioid-dependent subjects displayed increased distress on the perceived stress scale (PSS) and post-traumatic stress disorder checklist (PCLC); 60% exhibited abnormal cortisol. Addiction severity index (ASI), drug-use, and stress indices explained between 17 and 37% of the variance in engagement including attendance, opioid abstinence, and methadone stabilization. Participants who discontinued treatment displayed poor engagement, abnormal cortisol, elevated withdrawal symptoms, higher distress, and increased ongoing opioid use versus compliant individuals. Discontinuation was initially related to drug-use severity; however, by 6months, retention depended primarily upon cortisol abnormalities, which increased an individual's discontinuation risk by 7.7-fold. These findings support admission screening with the ASI/cortisol for drop out, and stress/drug-use indices for engagement that together may enable clinically-relevant early recognition and interventions for prevention of stress-induced relapse in opioid-dependent populations.

Anxiety and Psychological Stress Before Prenatal Screening in First-Time Mothers Who Conceived Through IVF/ICSI or Spontaneously

Mothers’ general anxiety, anxiety about the well-being of the child and psychological stress before prenatal testing was studied by comparing women who conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with women who conceived naturally. Before the first trimester screening test for Down’s syndrome, a group of 51 women who conceived through IVF/ICSI and a group of 54 women who conceived spontaneously completed the State Scale of the State-Trait Anxiety Inventory (S-Anxiety; Spielberger, 1983), the Fear of Bearing a Physically or Mentally Handicapped Child Subscale of the Pregnancy-related Anxiety Questionnaire (PRAQ-R; Huizink et al., 2004), the Psychological Stress Measure (PSM; Lemyre & Tessier, 1988), and the Prenatal Psychosocial Profile (PPP; Curry, Campbell, & Christian, 1994). Women who conceived through IVF/ICSI had more elevated levels of general anxiety and psychological stress than the women who conceived naturally; however, no difference was observed between the two groups for anxiety specifically related to the health of the child. These results underline the need to monitor women’s emotional state after conception via IVF/ICSI—when counseling usually ends—and around the time of the first trimester screening. Counseling might thus be extended.

Prevalence rates for depression by industry: a claims database analysis.

To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database. Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002-2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc. (Pittsburgh and Camp Hill, PA). Rates were adjusted for age, gender, and employee share of health care costs. National industry measures of psychological distress, work stress, and physical activity at work were also compiled from other data sources. Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity. Additional research is needed to help identify industries with relatively high rates of depression in other regions and on the national level, and to determine whether these differences are due in part to specific work stress exposures and physical inactivity at work. Claims database analyses may provide a cost-effective way to identify priorities for depression treatment and prevention in the workplace.

Predictors of changes in health status between and within patients 12 months post left ventricular assist device implantation

Improving patient-reported outcomes (e.g. health status) has become an important goal in left ventricular assist device (LVAD) therapy, in addition to reducing mortality and morbidity. We examined predictors of changes in health status scores between and within patients 12 months post LVAD implantation. Health status [Kansas City Cardiomyopathy Questionnaire (KCCQ); Short-Form 12 (SF-12)] were assessed at 3-4 weeks after implantation, and at 3, 6 and 12 months follow up in 54 LVAD patients (74% men; mean age 54 ± 9 years). Patients experienced significant improvements in health status between baseline and 3 months follow-up as assessed by the KCCQ (clinical summary score: F = 33.49, P < 0.001; overall summary score: F = 31.13, P < 0.001) and the SF-12 (physical component score: F = 31.59, P < 0.001; mental component score: F = 21.77, P < 0.001), but not between 3 months and 12 months follow-up (P > 0.05 for all). Higher scores on anxiety and depression over time, older age, lower ejection fraction, and more co-morbidity were associated with poorer health status scores on one or both of the KCCQ and SF-12 subscales. The majority of the between-patient variance of the mental component summary scores (82.6%), but not the KCCQ overall summary score (41.9%), KCCQ clinical summary score (36.2%) and physical component summary scores (23.2%), was explained by the sociodemographic, clinical and psychological factors. The majority of LVAD patients show a significant improvement in health status after LVAD implantation. However, there are large differences in individual health status score trajectories which are only partly explained by measures of disease severity pre-LVAD, co-morbidity and psychological stress.

Consistent associations between measures of psychological stress and CMV antibody levels in a large occupational sample

Cytomegalovirus (CMV) is a herpes virus that has been implicated in biological aging and impaired health. Evidence, largely accrued from small-scale studies involving select populations, suggests that stress may promote non-clinical reactivation of this virus. However, absent is evidence from larger studies, which allow better statistical adjustment for confounding and mediating factors, in more representative samples. The present study involved a large occupational cohort (N=887, mean age=44, 88% male). Questionnaires assessed psychological (i.e., depression, anxiety, vital exhaustion, SF-12 mental health), demographic, socioeconomic (SES), and lifestyle variables. Plasma samples were analyzed for both the presence and level of CMV-specific IgG antibodies (CMV-IgG), used as markers for infection status and viral reactivation, respectively. Also assessed were potential biological mediators of stress-induced reactivation, such as inflammation (C-reactive protein) and HPA function (awakening and diurnal cortisol). Predictors of CMV infection and CMV-IgG among the infected individuals were analyzed using logistic and linear regression analyses, respectively. Confirming prior reports, lower SES (education and job status) was positively associated with infection status. Among those infected (N=329), higher CMV-IgG were associated with increased anxiety (β=.14, p<.05), depression (β=.11, p=.06), vital exhaustion (β=.14, p<.05), and decreased SF-12 mental health (β=-.14, p<.05), adjusting for a range of potential confounders. Exploratory analyses showed that these associations were generally stronger in low SES individuals. We found no evidence that elevated inflammation or HPA-function mediated any of the associations. In the largest study to date, we established associations between CMV-IgG levels and multiple indicators of psychological stress. These results demonstrate the robustness of prior findings, and extend these to a general working population. We propose that stress-induced CMV replication warrants further research as a psychobiological mechanism linking stress, aging and health.

Perceived stress is related to health‐related quality of life in patients with chronic rhinosinuitis

Background Chronic rhinosinusitis (CRS) is a common disorder with a significant impact on health-related quality of life (HRQL). Due to symptoms based diagnosis, disease severity is usually estimated using questionnaires which evaluate subjective scores on severity of symptoms and deterioration of HRQL, like Sino-Nasal Outcome Test-22 Questionnaire (SNOT-22). Objective severity staging is rather based on computerized tomography (CT) scores than on severity of inflammation. There is recent evidence that perceived stress has significant impact on asthma incidence and hospitalization, as well as on allergic rhinitis. As CRS is comorbidity of asthma and allergic rhinitis, we hypothesized that perceived stress may have impact on severity of CRS. The aim of the study is to correlate objective and subjective outcome measures with perceived stress. Method The study was conducted in 29 patients with CRS, with and without nasal polyps, scheduled for surgical treatment. After giving their informed consent, patients filled in SNOT-22 and Measure of Psychological Stress for assessment of perceived stress. We divided SNOT-22 Questionnaire into questions related to nasal symptoms (SNOT-22 nasal) and to other symptoms (HRQL SNOT-22). These results were correlated with Lund-MacKay CT score and semi-quantitative scoring of inflammatory cells infiltration of sinus mucosa. Results There are significant positive correlations between HRQL SNOT-22 set of questions and MPS score (Pearson test, r=0, 49, p=0, 008) and between total SNOT-22 and MPS score (r=0, 45, p=0, 013). Correlation between scores of nasal and HRQL SNOT-22 is also significant (r=0, 53, p=0, 003) There is also significant correlation between scores of eosinophilic and mononuclear of infiltration (r=0, 63, p=0, 001). The only difference between CRSwNP and CRSsNP patients is significantly higher mononuclear infiltration in CRSsNP, and higher CT score in CRSwNP. Conclusion Results are suggesting that subjective scoring of disease severity is related to perceived stress in CRS patients. As no correlation was found between perceived stress and inflammation severity or CT severity scores, further research in order to evaluate possible cause-and-effect relationship should be undertaken. Our results suggest that CRS staging based on combined symptoms and HRQL scoring, may be moderated by patients' stress exposure and perception.