Skip to main content
Download PDF

Psychometric testing of the 10-item perceived stress scale for Chinese nurses

BMC Nursing volume 22, Article number: 430 (2023) Cite this article

Abstract

Background

Nurses bear a lot of stressors at work. The 10-item Perceived Stress Scale (PSS-10) is a widely used self-reported scale for measuring the global perception of stress. However, there is a lack of use of the PSS-10 in Chinese nurses. This study aimed to test the psychometric properties of the PSS-10 among Chinese nurses.

Methods

A total of 708 Chinese nurses completed the PSS-10, the Big Five Inventory (BFI), and the Depression Anxiety and Stress Scale (DASS). Confirmatory factor analysis (CFA) tested the factor structure of the PSS-10. Cronbach’s α and test-retest correlation examined the scale reliability. Pearson correlation and hierarchical regression analyses tested the convergent, discriminant and criterion validity of the PSS-10.

Results

CFA revealed that a two-factor model fits the structure of the PSS-10 in Chinese nurses (χ2/df = 6.25, p < 0.001; comparative fit index [CFI] = 0.94, non-normal fit index [NNFI] = 0.92, Tucker-Lewis index [TLI] = 0.91, root mean square error of approximation [RMSEA] = 0.08, standardized root mean square residual [SRMR] = 0.05). The scale demonstrated adequate internal consistency (α = 0.86) and test-retest reliability (r = 0.66, p < 0.001), satisfactory convergent and discriminant validity with relations to Big Five personalities, as well as good criterion validity such that the PSS-10 score could explain incremental variance in predicting anxiety, depression and stress.

Conclusions

Our findings suggest that PSS-10 is a reliable and valid measure of perceived stress among Chinese nurses and can be used in future research and practice on stress management and coping in Chinese nurses.

Peer Review reports

Background

Stress is significantly associated with many psychological health conditions such as depression, anxiety, and fatigue [1,2,3]. Stress in the working environment has proved to have a close relation with decreased job satisfaction and increased burnout of healthcare workers, which may further lead to poor job performance [4]. Nursing has been confirmed as an occupation with high levels of stress. For example, a study of a sample of trauma nurses in New York has shown that the nurses’ perceived stress scores are higher than the average perceived stress scores observed in previous studies focusing on other populations [5]. An epidemiological study of 850 Chinese nurses revealed a prevalence of depression, anxiety and stress at 35.8%, 37.3% and 41.1% respectively, which are almost three times higher than in a survey with a cohort of 5719 Chinese general adults [6]. Moreover, a study concerning occupational stress in Iranian nurses found that 78.4% of respondents reported high work pressure [7]. Long working hours, irregular schedules, heavy workloads, and lack of positive professional recognition are all contributors to stress perception among nurses [7, 8]. Therefore, it is of great necessity to pay more attention to stress and strengthen stress management and prevention programs (e.g., mindfulness-based intervention [9]) for nurses.

Perceived stress refers to the extent to which situations in one’s life are evaluated as stressful, uncontrollable and unpredictable [10]. In contrast to the research focusing on the type or frequency of stressful events, perceived stress reflects an individual’s global subjective perception of stress and his/her ability to deal with it [11]. As a self-reported instrument for measuring perceived stress, the Perceived Stress Scale (PSS) was initially developed as the 14-item PSS, which was later simplified into the 10-item PSS (PSS-10) and 4-item PSS (PSS-4) for phone screenings [12]. A review of PSS has shown that the psychometric properties of the PSS-10 are superior to those of the PSS-14 and PSS-4, and thus recommending the use of PSS-10 for measuring perceived stress both in practice and research [13]. This scale has two dimensions: perceived helplessness (with loadings on six negative items: 1, 2, 3, 6, 9, and 10) and perceived self-efficacy (with loadings on four positive items: 4, 5, 7, and 8) [12, 13]. The PSS-10 has been widely used in investigating stressful life events, physical and mental illness, and stress management and prevention [14, 15]; and it has been translated into over 25 languages and employed in more than 20 countries [16]. The PSS-10 demonstrates internal consistency with Cronbach’s α ranging from 0.80 to 0.86 in different areas of research in various countries, such as Swedish adults [17], Vietnamese older women [16], and Iranian infertile women [18]. It also shows criterion validity with significant relations to distress symptoms including anxiety (r = 0.43 to 0.67, p < 0.001) and depression (r = 0.42 to 0.62, p < 0.001) [19, 20].

Although the PSS-10 has been validated in many countries as an economical and effective stress assessment tool, there is a lack of use of the PSS-10 in Chinese nurses. Leung et al. first compared the appropriateness of the three versions of PSS in 1860 cardiac patients with poor smoking habits in Hong Kong, and they found that the PSS-10 had higher internal consistency (α = 0.83) and was suitable for the promotion program [21]. Further psychometric evidence of PSS-10 has been evaluated in different Chinese populations (e.g., people with common mental disorders [22], patients with systemic lupus erythematosus [23], elderly service workers [24], policewomen [25], and general adolescents [20]). The findings of these studies revealed adequate internal consistency (α > 0.7), and satisfied criterion validity with significant links to anxiety (r = 0.29 to 0.68, p < 0.001) and depression (r = 0.43 to 0.67, p < 0.001) [20, 22,23,24,25]. However, to our knowledge, the psychometric properties of PSS-10 in Chinese nurses remain unexamined. The availability of human resources for health is extremely insufficient in China. Up to 2019, the density of nurses and midwives in China is 31.6 per 10,000 people, which is far lower than the requirement of an 80% universal health coverage target (70.6 per 10,000 population) [26]. More than a quarter of nurses suffer from burnout, depression or anxiety in China; and long working hours (more than 55 h per week) and frequent night shifts (monthly > 4 times) are held accountable for this stressor [27]. Given that perceived stress is an important risk factor for physical and psychological health problems among nurses [28], a valid and reliable stress measurement is particularly necessary to understand the perceived stress levels of Chinese nurses.

This study aimed to examine the psychometric properties of PSS-10 in a sample of Chinese nurses. First, confirmatory factor analysis (CFA) was conducted to evaluate the factor structure of PSS-10. Second, Cronbach’s α and test-retest correlation analyses were calculated to evaluate the reliability of PSS-10. Third, we examined the convergent validity and discriminant validity of PSS-10 by correlating scores between PSS-10 and Big Five personalities. Particularly, general personality traits have been identified as playing an important role in perceiving stressors and assigning meaning to them [29]. The five-factor model is the most widely accepted model of general personalities, where the five factors are neuroticism, extraversion, agreeableness, conscientiousness, and openness [30]. Evidence has indicated that individuals high on neuroticism are more likely to suffer high levels of stress, anxiety, depression, tension, sadness, and nervousness [31]. A recent meta-analytic review has revealed that all of the Big Five personalities are significantly linked with perceived stress, and the absolute effect size of the neuroticism-perceived stress link (r = 0.36) is larger than that of the links of other Big Five personalities with perceived stress (r = -0.14 to -0.07) [32]. Finally, we measured the criterion validity by testing whether PSS-10 scores could predict anxiety, depression and stress beyond other sociodemographic variables using hierarchical regression analyses. Specifically, we used standard anxiety and depression scales as the measure of predictive criterion, given that perceived stress has been found to be a stable predictor for depression and anxiety in different populations [33,34,35,36,37,38]. In addition, we used a well-validated stress scale as the measure of concurrent criterion.

Methods

Study type

This is a cross-sectional survey study aimed at examining the psychometric properties of the PSS-10 in Chinese nurses. The present study was conducted in line with the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines for scale validation [39] (the details: see Supplemental Material).

Sample and sampling

A total of 756 nurses participated in this survey as part of a larger project aimed at examining the determinants of mental health and job performance among nurses in hospitals in southwest China [40]. Six hospitals in Chengdu and Kunming were selected using convenience sampling. Participants were included based on the following criteria: (1) having no history of neurological or psychiatric illnesses; (2) working at least one year in clinical nursing or nursing management; and (3) obtaining a nurse qualification certificate and registering as a nurse in China. Participants were excluded if they were: (1) retired; (2) training or practice nurses; and (3) on leave during the testing period. Of all participants, there were 708 valid responses and 48 participants who failed to pass the bogus items were excluded (see Data collection). Table 1 lists the sociodemographic characteristics of the valid participants. Besides, 182 participants from one of the included hospitals completed the retest of PSS-10 after three months.

Table 1 Sociodemographic characteristics of the sample (N = 708)
Full size table

Research measures

The research measures included demographic information surveys, the PSS-10, the 44-item Big Five Inventory (BFI-44), and the 21-item Depression Anxiety and Stress Scale (DASS-21). All measures were written in the subjects’ native language (i.e., Mandarin Chinese). The demographic information surveys included sex, age, education level, marital status, professional title, and length of nursing work.

PSS-10. This is a self-reported scale that assesses how often each item occurred in the past month for the participants [12]. Scores on each item are rated on a 5-point Likert scale ranging from 1 (never) to 5 (always). The ten items included six negative items (1, 2, 3, 6, 9, and 10), interpreted as perceived helplessness, and four positive items (4, 5, 7, and 8), interpreted as perceived self-efficacy [12, 13]. The scores for positive items need to be inverted to calculate the total score and higher scores indicate higher levels of perceived stress. The Chinese version of PSS-10 used in this study was revised by Chu & Kao, which has shown satisfactory reliability and validity in different Chinese samples [20, 41, 42].

BFI-44. The Big Five personality model proposes that individual personality consists of five basic dimensions: extraversion, neuroticism, conscientiousness, agreeableness, and openness [43]. As a popular measure of Big Five personalities, the BFI-44 includes 44 items that are rated on a 5-point Likert scale ranging from 1 (disagree strongly) to 5 (agree strongly). Prior studies have shown adequate validity and reliability of the BFI-44 in different Chinese samples [44,45,46]. The Cronbach’s αs for BFI-44 subscales in this study were acceptable: extraversion (0.72), agreeableness (0.72), conscientiousness (0.80), neuroticism (0.78), and openness (0.78).

DASS-21. This is a set of three self-report scales designed to measure the emotional states of anxiety, depression, and stress experienced in the past week [47]. Each scale includes 7 items, and participants are asked to respond to each item from 1 (not at all) to 4 (very much so). The DASS-21 has shown satisfactory psychometric properties in different Chinese samples [48, 49]. The Cronbach’s αs for anxiety, depression and stress of DASS-21 in this study were 0.85, 0.86, and 0.86, respectively, indicating adequate internal reliability.

Data collection

All participants were recruited via a notification to introduce the study from the nursing department of the hospitals. They completed a multi-section questionnaire survey via Sojump (http://www.sojump.com), an efficient, reliable and valid online data collection website, which can avoid missing questions [50]. Each nurse completed the survey anonymously (i.e., no name information was collected) under the guidance of an investigator at each hospital who had been trained by the researchers. The investigator needed to answer questions from participants according to unified guidelines. To ensure that participants filled in the questionnaires honestly and discriminately, we used bogus items (e.g., I have five fingers on my left hand) that had only one correct answer in the tests [51] and 48 participants were excluded during this process. This study was approved by the local research ethics committee of West China Hospital and online informed consent was obtained from all participants before the investigation.

Data analyses

First, we calculated descriptive statistics for each item of PSS-10 using SPSS 26.0 (IBM, New York, NY, USA), including means, standard deviations (SD), skewness, kurtosis, and discrimination index (DI). Skewness is a measure of asymmetry and kurtosis is a measure of the peakedness of the distribution [52], and the absolute values of skewness and kurtosis smaller than 1 represent a normal distribution for the scores [53]. DI is an indicator to determine the extent to which each item distinguishes individuals with high scores from those with low scores [54, 55]. In general, DI should not be lower than 0.20, otherwise, the item would be considered too easy or too difficult; an item with DI greater than 0.40 is considered excellently acceptable [56].

Second, given that previous studies have established a two-factor structure model of the PSS-10 [17, 20, 57], a CFA was performed with AMOS 26.0 (IBM, New York, NY, USA) to test the two-factor model in the current sample. We calculated the comparative fit index (CFI), non-normal fit index (NNFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root means square residual (SRMR) to evaluate the model’s fitness; and the results with CFI > 0.90, NNFI > 0.90, TLI > 0.90 and RMSEA < 0.08, SRMR < 0.08 can be considered a good fit [58, 59].

Third, Cronbach’s αs were calculated to evaluate the scale’s internal reliability and test-retest correlation analyses were performed to assess the test-retest reliability of the PSS-10. Then, Pearson correlation coefficients between scores of the PSS-10 and the BFI-44 were computed to evaluate the convergent and discriminant validity of the PSS-10. Next, we evaluated the criterion validity of the PSS-10 by testing whether the PSS-10 scores explained additional variance in predicting anxiety, depression and stress based on hierarchical regression analyses. In the hierarchical regression model, the first-level variables were sex, age, education level, professional title, length of nursing work, and Big Five personalities, while PSS-10 scores were treated as a second-level predictor variable, with the dependent variables being anxiety, depression and stress, respectively.

Results

Item descriptive statistics

Descriptive statistics for the PSS-10 items are presented in Table 2. The means for each item ranged from 2.44 to 3.16 and SD ranged from 0.73 to 0.94. The absolute skewness and kurtosis values were smaller than 1, indicating that the scores of the items were normally distributed [53]. The DI of each item was greater than 0.20, ranging from 0.30 to 0.44, implying that each item of PSS-10 was well differentiated.

Table 2 Descriptive statistics of PSS-10 items
Full size table

Factor structure of PSS-10

The CFA examined the factor structure of the PSS-10. The two-factor model, comprised of negative items (Factor 1: perceived helplessness) and positive items (Factor 2: perceived self-efficacy), showed a good fit (χ2/df = 6.25, p < 0.001; CFI = 0.94, NNFI = 0.92, TLI = 0.91, RMSEA = 0.08, SRMR = 0.05). As shown in Fig. 1, the factor loadings for perceived helplessness and perceived self-efficacy were 0.67 and 0.81, respectively, and all loadings ranged from 0.55 to 0.82. In summary, CFA provided evidence for a two-factor structure model of the PSS-10.

Fig. 1
figure 1

Standardized factor loadings for the two-factor structure model of the 10-item Perceived Stress Scale among Chinese nurses (N = 708)

Full size image

Reliability assessment

The Cronbach’s α for the PSS-10 total score was 0.85, and for the two subscales were 0.87 (perceived helplessness) and 0.74 (perceived self-efficacy), respectively, which indicated adequate internal consistency reliability. To confirm the test-retest reliability, 182 participants (116 females and 66 males; mean age = 31.74, SD = 7.38) completed the PSS-10 twice within a 3-month interval. The test-retest correlation coefficients were acceptable for the total score (r = 0.66, p < 0.001) and for the two subscales (perceived helplessness: r = 0.67, p < 0.001; perceived self-efficacy: r = 0.55, p < 0.001).

Convergent validity and discriminant validity

Table 3 shows the descriptive statistics (i.e., mean, SD, Skewness and Kurtosis) and bivariate correlations of the study measures. Given that all scores of the measures were normally distributed with the absolute skewness and kurtosis values being smaller than 1 [53], Pearson correlation was used to explore the association of PSS-10 with other measures. PSS-10 score was positively correlated with neuroticism (r = 0.67, p < 0.001), and negatively correlated with extraversion (r = -0.38, p < 0.001), agreeableness (r = -0.40, p < 0.001), conscientiousness (r = -0.43, p < 0.001), and openness (r = -0.31, p < 0.001). Importantly, we compared the absolute correlation values between the PSS-10 and BFI-44 neuroticism with PSS-10 and the other BFI-44 facets. The results found that PSS-10 score was more strongly associated with neuroticism than extraversion (Steiger’s Z test: Z = 9.26, p < 0.001), agreeableness (Steiger’s Z test: Z = 8.48, p < 0.001), conscientiousness (Steiger’s Z test: Z = 7.83, p < 0.001), and openness (Steiger’s Z test: Z = 10.46, p < 0.001). These results suggest that PSS-10 was more correlated with conceptually related constructs (i.e., BFI-44 neuroticism is characterized by emotional instability, anxiety, depression, and stress) than conceptually unrelated constructs (i.e., the other BFI-44 facets). In summary, the PSS-10 showed good convergent and discriminant validity.

Table 3 Descriptive statistics and bivariate correlations of study measures
Full size table

Criterion validity

To evaluate the predictive and concurrent validity of PSS-10, we first conducted correlation analyses to test the relationship between scores of the PSS-10 and the DASS-21. As shown in Table 3, PSS-10 scores were positively correlated with scores of anxiety, depression, and stress in the DASS-21. Next, we evaluated incremental validity based on hierarchical regression analyses to demonstrate whether PSS-10 could significantly predict anxiety, depression, and stress after controlling for other variables. As depicted in Table 4, the PSS-10 score explained an additional variance of 11% when predicting anxiety (R2 = 0.11, β = 0.45, p < 0.001), an additional variance of 12% when predicting depression (R2 = 0.12, β = 0.49, p < 0.001), and an additional variance of 13% when predicting stress (R2 = 0.13, β = 0.50, p < 0.001) beyond the variance explained by variables in the first level. Therefore, the PSS-10 demonstrated excellent criterion validity for predicting anxiety, depression and stress.

Table 4 Hierarchical regression models for predicting anxiety, depression and stress
Full size table

Discussion

To our knowledge, this study is the first to evaluate the psychometric properties of the PSS-10 among Chinese nurses. DI suggested that all items of PSS-10 had sufficient discrimination between high-score and low-score groups. CFA showed that the PSS-10 fitted well in a two-factor structure model. Besides, the PSS-10 revealed adequate internal consistency and test-retest reliability, satisfactory convergent and discriminant validity, and criterion validity for predicting anxiety, depression and stress. Overall, our study demonstrated that the PSS-10 is suitable for measuring perceived stress levels in Chinese nurses.

The two-factor structure of PSS-10 was well supported in this study, which is consistent with previous studies based on other populations, such as some patients (e.g., asthma [60], chronic headache [57], infertility [18], mental disorders [22], and systemic lupus erythematosus [23]), normal adults [1, 17, 19, 61], and general students [20, 62]. Although the two-factor structure dominates the research field of PSS-10, a study based on 60 suicide survivors has reported a one-factor structure [63]. A possible explanation for this is that the sample size was too small for this study [13]. Additionally, the factor loadings for all items ranged from 0.55 to 0.82 in the current study, which indicated that all items of PSS-10 contributed significantly to the measurement of perceived stress in nurses. Although studies have consistently supported the two-factor structure of PSS-10, there is still a disagreement about the explanation of the two factors. For example, Roberti et al. suggested that the two dimensions could be used as subscales [64]. Nevertheless, Cohen and Williamson, the authors of the original scale, suggested that the two factors were irrelevant and only reflected item directionality [12]. Given that there are no theoretical grounds for the use of the two subscales [17], we argued that the subscale scores should be cautiously used in future studies and practices [24, 65].

Consistent with previous psychometric assessments with other languages, PSS-10 showed adequate internal consistency and test-retest reliability in this sample, which was comparable to those in other versions, such as the German version [1], the South African version [62], and the Vietnamese version [16]. In sum, PSS-10 has acceptable reliability among Chinese nurses.

Big Five personalities play an important role in the way people perceive and cope with stress [66]. Particularly, neuroticism is a personality tendency to experience negative emotions and is more likely to cope with stress in a negative way [64, 67]. Meta-analyses have shown that anxiety and depression are linked with BFI personalities, and neuroticism is the most relevant factor in this context [68]. This study extends these findings by showing that the PSS-10 score had a stronger association with neuroticism than other BFI personalities. Meanwhile, the PSS-10 score has shown a significant association with conceptually similar variables including anxiety [62] and depression [18, 25]. Moreover, the PSS-10 score could predict anxiety, depression, and stress even after controlling for other variables. Altogether, our results suggested that the PSS-10 has satisfactory convergent, discriminant and criterion validity.

This study has several limitations. First, the current sample included mostly females compared to males, thus the conclusion might be limited to female nurses. Future studies with more balanced gender are needed to examine the measurement invariance across genders [20]. Second, nursing is a special occupation, which has a complex clinical environment and a tense nurse-patient relationship. The ability to bear stress and the sensitivity to perceive stress may vary across nurses in different levels of hospitals [25, 69]. The participants in this study were from Triple-A level hospitals in southwest China, which may limit the generalizability of the findings to other nurses. Third, only self-reported measures were used in this study, thus the participants’ responses may be biased to some extent due to the impact of subjectivity like social desirability [70]. Employing more objective behavioral tests is warranted in future research to circumvent this problem.

Conclusion

This study supported a two-factor structure of the PSS-10 among Chinese nurses, with adequate internal consistency and test-retest reliability, and satisfactory convergent, discriminant and criterion validity. In a word, PSS-10 is a reliable and valid measure of perceived stress in Chinese nurses. This scale is very short and can be filled out in a few minutes, providing a suitable measurement for future research and practice on individual stress management and coping among Chinese nurses. The findings of this study may also advance the development of psychoradiology, a burgeoning field at the intersection of psychology, psychiatry and radiology [71,72,73,74].

Data Availability

The authors confirmed that all relevant data are included in the article.

Abbreviations

BFI-44:

44-item Big Five Inventory

CFA:

confirmatory factor analysis

CFI:

comparative fit index

COSMIN:

COnsensus-based Standards for the selection of health status Measurement INstruments

DASS-21:

21-item Depression Anxiety and Stress Scale

DI:

discrimination index

NNFI:

non-normal fit index

PSS:

Perceived Stress Scale

PSS-10:

10-item Perceived Stress Scale

RMSEA:

root mean square error of approximation

SD:

standard deviations

SRMR:

standardized root means square residual

TLI:

Tucker-Lewis index

References

  1. Klein EM, Brahler E, Dreier M, Reinecke L, Muller KW, Schmutzer G, Wolfling K, Beutel ME. The German version of the perceived stress scale - psychometric characteristics in a representative German community sample. BMC Psychiatry. 2016;16:159.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hirani S, Sajjad S, Gowani A, James HMS, Gupta A, Kennedy M, Norris CM. Psychosocial interventions and mental health in patients with Cardiovascular Diseases living in low- and middle-income countries: a systematic review and meta-analysis. J Psychosom Res. 2023;172:111416.

    Article  PubMed  Google Scholar 

  3. Hirani S, Gowani A, Sajjad S, Kennedy M, Norris CM. Psychosocial interventions and mental health in patients with Cardiovascular Diseases living in low and middle-income countries: a systematic review protocol. PLoS ONE. 2022;17(7):e0271955.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Khamisa N, Oldenburg B, Peltzer K, Ilic D. Work-related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health. 2015;12(1):652–66.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Munnangi S, Dupiton L, Boutin A, Angus LDG. Burnout, perceived stress, and job satisfaction among Trauma nurses at a Level I Safety-Net Trauma Center. J Trauma Nurs. 2018;25(1):4–13.

    Article  PubMed  Google Scholar 

  6. Cheung T, Yip PS. Depression, anxiety and symptoms of stress among Hong Kong nurses: a cross-sectional study. Int J Environ Res Public Health. 2015;12(9):11072–100.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kakemam E, Raeissi P, Raoofi S, Soltani A, Sokhanvar M, Visentin D, Cleary M. Occupational stress and associated risk factors among nurses: a cross-sectional study. Contemp Nurse. 2019;55(2–3):237–49.

    Article  PubMed  Google Scholar 

  8. Li H, Zhao M, Shi Y, Xing Z, Li Y, Wang S, Ying J, Zhang M, Sun J. The effectiveness of aromatherapy and massage on stress management in nurses: a systematic review. J Clin Nurs. 2019;28(3–4):372–85.

    Article  PubMed  Google Scholar 

  9. Fadzil NA, Heong WO, Kueh YC, Phang CK. The Effect of a mindfulness-based intervention on nurses in Kelantan, Malaysia. Malays J Med Sci. 2021;28(6):121–8.

    PubMed  PubMed Central  Google Scholar 

  10. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.

    Article  CAS  PubMed  Google Scholar 

  11. Phillips AC. Perceived Stress. In: Encyclopedia of Behavioral Medicine edn. Edited by Gellman MD, Turner JR. New York, NY: Springer New York; 2013: 1453–1454.

  12. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: The social psychology of health The Claremont Symposium on applied social psychology edn. Edited by Spacapan, Oskamp S. Thousand Oaks, CA, US: Sage Publications, Inc; 1988: 31–67.

  13. Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(4):121–7.

    PubMed  Google Scholar 

  14. Zhai X, Wu N, Koriyama S, Wang C, Shi M, Huang T, Wang K, Sawada SS, Fan X. Mediating effect of perceived stress on the Association between Physical Activity and Sleep Quality among Chinese College Students. Int J Environ Res Public Health 2021, 18(1).

  15. Stepowicz A, Wencka B, Bienkiewicz J, Horzelski W, Grzesiak M. Stress and anxiety levels in pregnant and Post-partum women during the COVID-19 pandemic. Int J Environ Res Public Health 2020, 17(24).

  16. Dao-Tran TH, Anderson D, Seib C. The Vietnamese version of the perceived stress scale (PSS-10): translation equivalence and psychometric properties among older women. BMC Psychiatry. 2017;17(1):53.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nordin M, Nordin S. Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale. Scand J Psychol. 2013;54(6):502–7.

    Article  PubMed  Google Scholar 

  18. Maroufizadeh S, Foroudifard F, Navid B, Ezabadi Z, Sobati B, Omani-Samani R. The perceived stress scale (PSS-10) in women experiencing infertility: a reliability and validity study. Middle East Fertility Society Journal. 2018;23(4):456–9.

    Article  Google Scholar 

  19. Baik SH, Fox RS, Mills SD, Roesch SC, Sadler GR, Klonoff EA, Malcarne VL. Reliability and validity of the perceived stress Scale-10 in hispanic americans with English or Spanish language preference. J Health Psychol. 2019;24(5):628–39.

    Article  PubMed  Google Scholar 

  20. Liu X, Zhao Y, Li J, Dai J, Wang X, Wang S. Factor structure of the 10-Item perceived stress scale and measurement Invariance Across Genders among Chinese adolescents. Front Psychol. 2020;11:537.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Leung DY, Lam TH, Chan SS. Three versions of perceived stress scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health. 2010;10:513.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shih S, Chan A, Yeung E, Tsang A, Chiu R, Chu M, Poon M. Psychometric properties and correlates of Chinese version of perceived stress scale (CPSS-10) in people with common mental disorders with different employment statuses. Hong Kong J Occup Ther. 2021;34(2):103–12.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sun Y, Gao L, Kan Y, Shi BX. The perceived stress Scale-10 (PSS-10) is reliable and has construct validity in Chinese patients with systemic Lupus Erythematosus. Lupus. 2019;28(2):149–55.

    Article  CAS  PubMed  Google Scholar 

  24. Ng SM. Validation of the 10-item Chinese perceived stress scale in elderly service workers: one-factor versus two-factor structure. BMC Psychol. 2013;1(1):9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Xie Z, Wang A, Chen B. Nurse burnout and its association with occupational stress in a cross-sectional study in Shanghai. J Adv Nurs. 2011;67(7):1537–46.

    Article  PubMed  Google Scholar 

  26. Collaborators GBDHRH. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the global burden of Disease Study 2019. Lancet. 2022;399(10341):2129–54.

    Article  Google Scholar 

  27. Wang P, Tang YL, Chen Y, He Y, Li L, Han X, Liu Y, Liu T, Liu H, Jiang F, et al. Mental health status of mental health nurses in China: results from a national survey. J Psychiatr Ment Health Nurs. 2023;30(3):547–57.

    Article  PubMed  Google Scholar 

  28. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors Associated with Nurse Burnout in the US. JAMA Netw Open. 2021;4(2):e2036469.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Epel ES, Crosswell AD, Mayer SE, Prather AA, Slavich GM, Puterman E, Mendes WB. More than a feeling: a unified view of stress measurement for population science. Front Neuroendocrinol. 2018;49:146–69.

    Article  PubMed  PubMed Central  Google Scholar 

  30. John OP, Srivastava S. The big five trait taxonomy: history, measurement, and theoretical perspectives. Handbook of personality: theory and research. 2nd ed. New York, NY, US: Guilford Press; 1999. pp. 102–38.

    Google Scholar 

  31. John OP, Naumann LP, Soto CJ. Paradigm shift to the integrative Big Five trait taxonomy: history, measurement, and conceptual issues. In: Handbook of personality: theory and research. 3rd edn. New York, NY, US: The Guilford Press; 2008. p. 114–58.

  32. Luo J, Zhang B, Cao M, Roberts BW. The Stressful personality: a Meta-Analytical Review of the relation between personality and stress. Pers Soc Psychol Rev. 2023;27(2):128–94.

    Article  PubMed  Google Scholar 

  33. Williams SG, Turner-Henson A, Davis S, Soistmann HC. Relationships among perceived stress, bullying, cortisol, and depressive symptoms in Ninth-Grade adolescents: a pilot study. Biol Res Nurs. 2017;19(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  34. Cai X, Li G, Feng H, Wang X, He L, Luo D, Xu C, Huang Y, Qiu S. Association of perceived stress with Depression among Vaccinated Healthcare workers during the SARS-CoV-2 variant outbreak: the mediating role of Compassion fatigue. Psychiatry Investig. 2023;20(4):307–14.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Spinoni M, Singh Solorzano C, Grano C. The impact of prepartum pandemic-related perceived stress on anxiety symptoms in the postpartum: the role of perceived Childbirth experiences. J Anxiety Disord. 2023;99:102762.

    Article  PubMed  Google Scholar 

  36. Feng Q, Li Y, Liu C, Wang X, Tang S, Tie B, Li X, Qiu J. Functional connectivity mediating passive coping style and perceived stress in predicting anxiety. J Affect Disord. 2023;340:828–34.

    Article  PubMed  Google Scholar 

  37. Tsai HJ, Chang FK. Associations of various perceived-stress situations with depressive symptoms in 50-year-old Taiwanese men and women: results from the Taiwan Longitudinal Study on Aging. Arch Gerontol Geriatr. 2016;67:113–9.

    Article  PubMed  Google Scholar 

  38. Wang S, Zhao Y, Zhang L, Wang X, Wang X, Cheng B, Luo K, Gong Q. Stress and the brain: perceived stress mediates the impact of the superior frontal gyrus spontaneous activity on depressive symptoms in late adolescence. Hum Brain Mapp. 2019;40(17):4982–93.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539–49.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Yang C, Yang L, Wu D. The influence of grit on nurse job satisfaction: mediating effects of perceived stress and moderating effects of optimism. Front Psychol. 2022;13:1094031.

    Article  PubMed  Google Scholar 

  41. Chu L-C. The benefits of meditation vis-à-vis emotional intelligence, perceived stress and negative mental health. Stress Health. 2010;26(2):169–80.

    Article  Google Scholar 

  42. Chu L-C, Kao HSR. The moderation of meditation experience and emotional intelligence on the relationship between perceived stress and negative mental health. Chinese J Psychology. 2005;47:157–79.

    Google Scholar 

  43. McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers. 1992;60(2):175–215.

    Article  CAS  PubMed  Google Scholar 

  44. Carciofo R, Yang J, Song N, Du F, Zhang K. Psychometric evaluation of Chinese-Language 44-Item and 10-Item big five personality inventories, including correlations with Chronotype, mindfulness and Mind Wandering. PLoS ONE. 2016;11(2):e0149963.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Schmitt DP, Allik J, McCrae RR, Benet-Martinez V, Alcalay L, Ault L, Austers I, Bennett KL, Bianchi G, Boholst F, et al. The geographic distribution of big five personality traits - patterns and profiles of human self-description across 56 nations. J Cross-Cult Psychol. 2007;38(2):173–212.

    Article  Google Scholar 

  46. Wang JL, Jackson LA, Zhang DJ, Su ZQ. The relationships among the big five personality factors, self-esteem, narcissism, and sensation-seeking to Chinese University students’ uses of social networking sites (SNSs). Comput Hum Behav. 2012;28(6):2313–9.

    Article  CAS  Google Scholar 

  47. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression anxiety stress scales (DASS) with the Beck Depression and anxiety inventories. Behav Res Ther. 1995;33(3):335–43.

    Article  CAS  PubMed  Google Scholar 

  48. Chan RC, Xu T, Huang J, Wang Y, Zhao Q, Shum DH, O’Gorman J, Potangaroa R. Extending the utility of the Depression anxiety stress scale by examining its psychometric properties in Chinese settings. Psychiatry Res. 2012;200(2–3):879–83.

    Article  PubMed  Google Scholar 

  49. Wang K, Shi HS, Geng FL, Zou LQ, Tan SP, Wang Y, Neumann DL, Shum DH, Chan RC. Cross-cultural validation of the Depression anxiety stress Scale-21 in China. Psychol Assess. 2016;28(5):e88–e100.

    Article  PubMed  Google Scholar 

  50. Li JG, Lin L, Zhao YJ, Chen J, Wang S. Grittier Chinese adolescents are happier: the mediating role of mindfulness. Pers Indiv Differ. 2018;131:232–7.

    Article  Google Scholar 

  51. DeSimone JA, Harms PD, DeSimone AJ. Best practice recommendations for data screening. J Organizational Behav. 2015;36(2):171–81.

    Article  Google Scholar 

  52. Kim H-Y. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dentistry Endodontics. 2013;38(1):52–4.

    Article  Google Scholar 

  53. Marcoulides GA, Hershberger SL. Multivariate statistical methods: a first course. Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc; 1997.

    Google Scholar 

  54. Johnson AP. Notes on a suggested index of item validity: the U-L Index. J Educ Psychol. 1951;42(8):499–504.

    Article  Google Scholar 

  55. Kelley TL. The selection of upper and lower groups for the validation of test items. J Educ Psychol. 1939;30:17–24.

    Article  Google Scholar 

  56. Martinková P, Drabinová A. ShinyItemAnalysis for Teaching Psychometrics and to enforce routine analysis of Educational tests. R J. 2018;10:503.

    Article  Google Scholar 

  57. Khalili R, Sirati Nir M, Ebadi A, Tavallai A, Habibi M. Validity and reliability of the Cohen 10-item perceived stress scale in patients with chronic headache: persian version. Asian J Psychiatr. 2017;26:136–40.

    Article  PubMed  Google Scholar 

  58. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107(2):238–46.

    Article  CAS  PubMed  Google Scholar 

  59. Hu LT, Bentler PM. Cutoff criteria for fit indexes in Covariance structure analysis: conventional criteria Versus New Alternatives. Struct Equ Modeling. 1999;6(1):1–55.

    Article  Google Scholar 

  60. Maroufizadeh S, Zareiyan A, Sigari N. Reliability and validity of Persian version of perceived stress scale (PSS-10) in adults with Asthma. Arch Iran Med. 2014;17(5):361–5.

    PubMed  Google Scholar 

  61. Michaelides MP, Christodoulou A, Kkeli N, Karekla M, Panayiotou G. Factorial structure of the perceived stress scale and implications for scoring. Eur Rev Appl Psychology-Revue Europeenne De Psychologie Appliquee. 2016;66(6):309–16.

    Article  Google Scholar 

  62. Makhubela M. Assessing psychological stress in South African university students: measurement validity of the perceived stress scale (PSS-10) in diverse populations. Curr Psychol. 2022;41(5):2802–9.

    Article  Google Scholar 

  63. Mitchell AM, Crane PA, Kim Y. Perceived stress in survivors of Suicide: psychometric properties of the perceived stress scale. Res Nurs Health. 2008;31(6):576–85.

    Article  PubMed  Google Scholar 

  64. Johansson L, Guo X, Duberstein PR, Hallstrom T, Waern M, Ostling S, Skoog I. Midlife personality and risk of Alzheimer Disease and distress: a 38-year follow-up. Neurology. 2014;83(17):1538–44.

    Article  PubMed  Google Scholar 

  65. Wang Z, Chen J, Boyd JE, Zhang H, Jia X, Qiu J, Xiao Z. Psychometric properties of the Chinese version of the perceived stress scale in policewomen. PLoS ONE. 2011;6(12):e28610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. You M, Laborde S, Dosseville F, Salinas A, Allen MS. Associations of chronotype, big five, and emotional competences with perceived stress in university students. Chronobiol Int. 2020;37(7):1090–8.

    Article  PubMed  Google Scholar 

  67. Specht J, Egloff B, Schmukle SC. Stability and change of personality across the life course: the impact of age and major life events on mean-level and rank-order stability of the big five. J Pers Soc Psychol. 2011;101(4):862–82.

    Article  PubMed  Google Scholar 

  68. Jeronimus BF, Kotov R, Riese H, Ormel J. Neuroticism’s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants. Psychol Med. 2016;46(14):2883–906.

    Article  CAS  PubMed  Google Scholar 

  69. Qi YK, Xiang YT, An FR, Wang J, Zeng JY, Ungvari GS, Newhouse R, Yu DS, Lai KY, Ding YM, et al. Nurses’ work-related stress in China: a comparison between psychiatric and general hospitals. Perspect Psychiatr Care. 2014;50(1):27–32.

    Article  PubMed  Google Scholar 

  70. Holtgraves T. Social desirability and self-reports: testing models of socially desirable responding. Pers Soc Psychol Bull. 2004;30(2):161–72.

    Article  PubMed  Google Scholar 

  71. Lin J, Li L, Pan N, Liu X, Zhang X, Suo X, Kemp G, Wang S, Gong Q. Neural correlates of neuroticism: a coordinate-based meta-analysis of resting-state functional brain imaging studies. Neurosci Biobehav Rev. 2023;146:105055.

    Article  Google Scholar 

  72. Wang S, Zhao Y, Li J. True grit and brain: trait grit mediates the connection of DLPFC functional connectivity density to posttraumatic growth following COVID-19. J Affect Disord. 2023;325:313–20.

  73. Gong Q, Kendrick KM, Lu L. Psychoradiology: a new era for neuropsychiatric imaging. Psychoradiology. 2021;1(1):1–2.

  74. Lai H, Zhao Y, Li J, Gong Q, Wang S. Neuroanatomical signatures associated with dispositional optimism predict COVID-19-related posttraumatic stress symptoms. Cereb Cortex. 2023;33(15):9387–98.

Download references

Acknowledgements

The authors sincerely thank all the nurses who participated in this study.

Funding

This work was supported by the Key Research and Development Program of Sichuan Province (Grant No. 2023YFS0084) and the Post-Doctor Research Project, West China Hospital, Sichuan University (Grant No. 2020HXBH092).

Author information

Author notes

  1. Xiaoyu Du and Xiqin Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China

    Xiaoyu Du, Xiqin Liu & Song Wang

  2. School of Education and Psychology, Southwest Minzu University, Chengdu, China

    Yajun Zhao

Authors
  1. Xiaoyu Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiqin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yajun Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Song Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S.W designed the study. X.D, X.L and Y.Z contributed to the data collection. X.D and X.L performed the data analysis, results interpretation, original draft writing and editing. S.W and Y.Z provided interpretive advice and critically revised the manuscript, which all authors reviewed and approved for publication.

Corresponding author

Correspondence to Song Wang.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of West China Hospital of Sichuan University (approval number: 2020HXBH092). Written informed consent was obtained from all participants in this study. All methods were implemented based on the relevant guidelines and regulations contained in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Du, X., Liu, X., Zhao, Y. et al. Psychometric testing of the 10-item perceived stress scale for Chinese nurses. BMC Nurs 22, 430 (2023). https://doi.org/10.1186/s12912-023-01602-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12912-023-01602-4

Keywords

BMC Nursing

ISSN: 1472-6955

Contact us