Perceived Stress Scale: reliability and validity study in Greece

Validation of the PHQ-9 for Suicidal Ideation in Persons with Inflammatory Bowel Disease

BACKGROUND

Suicide is a leading cause of death worldwide. Transition from suicidal ideation (SI) to suicide attempt is high within a year of SI onset. The risk of suicide and SI is elevated in persons with inflammatory bowel disease (IBD) versus the general population. We aimed to validate the Patient Heath Questionnaire (PHQ)-9 as a screening tool for SI in IBD and to determine factors associated with SI in IBD.

METHODS

IBD participants (n = 247) recruited from the community and clinics completed the PHQ-9 and participated in the Structured Clinical Interview for DSM-IV (SCID). We determined the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of the PHQ-9 in identifying SI as compared to the SCID. Using logistic regression we examined the association of SI with demographic and clinical factors.

RESULTS

SI was endorsed by 24 (9.7%) participants on the PHQ-9 and 5 (2.0%) based on the SCID. The PHQ-9 had good sensitivity (100%), specificity (92.2%), and NPV (100%) but low PPV (20.8%) for SI. On univariate analysis, factors strongly associated with SI were depression (OR 13.1; 95%CI: 4.46, 40.5), anxiety (OR 11.3; 95%CI: 4.46, 28.6), and active disease (OR 3.87; 95%CI: 1.54, 9.71). On multivariable analysis, depression (OR 5.54; 95%CI: 1.67, 18.4) and pain (OR 1.14; 95%CI: 1.03, 1.25) were associated with SI.

CONCLUSIONS

Overall the PHQ-9 is a valid screening tool for SI in IBD patients, and routine implementation of this tool would support screening for depression and SI effectively and efficiently in clinical practice.

Cross-sectional study of cognitive stress appraisal and related factors among workers in metropolitan areas of Japan

OBJECTIVE

Stress has major socioeconomic implications for all spheres of employment. It is a trigger for depression, and affects absenteeism, turnover, productivity, morale and suicide. Positive or negative cognitive stress appraisal can be a self-care strategy that affects workers' ability to cope with stress. This study examined cognitive stress appraisal among workers and identified related individual and environmental factors.

DESIGN

Cross-sectional study using self-administered postal questionnaires.

SETTING

Companies located in two metropolitan areas of Japan (Tokyo and Kanagawa prefectures).

PARTICIPANTS

2311 employees of 48 companies in metropolitan areas in Japan. In total, 341 questionnaires were returned (response rate: 14.8%), 337 of which were suitable for analysis (effective response rate: 98.8%).

PRIMARY MEASURES

Cognitive stress appraisal was assessed using the Japanese version of the Perceived Stress Scale (PSS). Potential variables related to stress appraisal included demographic, individual and environmental factors. Multiple regression analysis was used to identify factors related to cognitive stress appraisal.

RESULTS

Participants' mean±SD age was 42.8±11.7 years, and two-thirds were male. The mean±SD PSS score was 25.8±6.2. The multiple regression analysis controlled for age, sex and depression showed that those with poorer economic status (β=0.171, p<0.001), lower electronic health (eHealth) literacy (β=-0.113, p=0.012), higher traditional organisational climate (β=0.131, p=0.004) and lower perceived social support (β=-0.205, p<0.001) experienced significantly higher levels of negatively perceived stress.

CONCLUSIONS

The results show individual and environmental factors related to cognitive stress appraisal among workers. An effective strategy to improve mental health among workers may involve an interprofessional approach by public health nurses and health practitioners that includes enhanced self-coping skills using individual workers' eHealth literacy, improvement of organisational climates in workplaces and community-based social support.

Perceived stress among Primary Health Care Professionals in Brazil

Objective:

To evaluate the perceived stress (PS) of professionals in Primary Health Care and its association with the characteristics of the teams in the Family Health Program (FHP). The association between PS and self-referred morbidity was also investigated.

Methods:

This is a cross-sectional study conducted with 450 employees from 60 teams in 12 Basic Health Units (BHUs) in a region of São Paulo. The differences in the total score in the Perceived Stress Scale were evaluated through multiple linear regression models.

Results:

Higher levels of PS were observed in those who had been working for one year or more in the same team, in the categories of doctors, nurses and community health workers, females, non-religious, and in BHU professionals in incomplete teams (absence of a physician). Lower perceived stress was found in widowers. It was observed that individuals with higher levels of PS have higher chances of reporting chronic health problems.

Conclusion:

It can be concluded that the perception of stress in this population is associated with individual, professional factors, and the composition of teams in healthcare units.

Factors associated with parents' levels of stress in pediatric wards

Hospitalization of a child is a stressful experience, increasing parents' anxiety and deteriorating their satisfaction with the health-care services. This study aimed to assess the level of stress that parents of hospitalized children experienced and evaluate the association of parent's stress and satisfaction and identify its predictors. Three hundred and fifty-two parents whose children were hospitalized in two pediatric hospitals were enrolled in the study, from February 2015 to April 2015. The Perceived Stress Scale was used to estimate parental stress and the Pyramid Questionnaire was used for assessing parents' overall satisfaction with care. Parents expressed mild to moderate overall levels of stress. Less-stressed parents felt more satisfied. Being single ( p < .001), having lower educational level ( p = .005), one's child been hospitalized for more than 14 days ( p = .001), and one's have visited the hospital many times in the past ( p = .014) were the predictors of experiencing high levels of stress. During pediatric hospitalization, parental needs (communication, interpersonal health care, continuous information, involvement in child's care) should be considered, so as stress levels to be decreased and parents get more satisfied by the quality of health care provided.

Carvacrol and human health: A comprehensive review

Carvacrol (CV) is a phenolic monoterpenoid found in essential oils of oregano (Origanum vulgare), thyme (Thymus vulgaris), pepperwort (Lepidium flavum), wild bergamot (Citrus aurantium bergamia), and other plants. Carvacrol possesses a wide range of bioactivities putatively useful for clinical applications such antimicrobial, antioxidant, and anticancer activities. Carvacrol antimicrobial activity is higher than that of other volatile compounds present in essential oils due to the presence of the free hydroxyl group, hydrophobicity, and the phenol moiety. The present review illustrates the state-of-the-art studies on the antimicrobial, antioxidant, and anticancer properties of CV. It is particularly effective against food-borne pathogens, including Escherichia coli, Salmonella, and Bacillus cereus. Carvacrol has high antioxidant activity and has been successfully used, mainly associated with thymol, as dietary phytoadditive to improve animal antioxidant status. The anticancer properties of CV have been reported in preclinical models of breast, liver, and lung carcinomas, acting on proapoptotic processes. Besides the interesting properties of CV and the toxicological profile becoming definite, to date, human trials on CV are still lacking, and this largely impedes any conclusions of clinical relevance.

Stress, cognitive appraisal, coping, and event free survival in patients with heart failure

OBJECTIVES

To describe self-reported stress level, cognitive appraisal and coping among patients with heart failure (HF), and to examine the association of cognitive appraisal and coping strategies with event-free survival.

METHODS

This was a prospective, longitudinal, descriptive study of patients with chronic HF. Assessment of stress, cognitive appraisal, and coping was performed using Perceived Stress Scale, Cognitive Appraisal Health Scale, and Brief COPE scale, respectively. The event-free survival was defined as cardiac rehospitalization and all-cause death.

RESULTS

A total of 88 HF patients (mean age 58 ± 13 years and 53.4% male) participated. Linear and cox regression showed that harm/loss cognitive appraisal was associated with avoidant emotional coping (β = -0.28; 95% CI: -0.21 - 0.02; p = 0.02) and event free survival (HR = 0.53; 95% CI: 0.28 - 1.02; p = 0.05).

CONCLUSIONS

The cognitive appraisal of the stressors related to HF may lead to negative coping strategies that are associated with worse event-free survival.

Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: A cross-sectional study

BACKGROUND

There is a growing evidence of increased prevalence of psychological problems (stress, depression, anxiety, and substance abuse) and feelings of burnout among medical professionals all over the world and this has been shown to be associated with lapses in patient care. Data from India in this regard are limited.

AIMS

To assess the various psychological problems (depression, perceived stress, and burnout) among medical professionals working in a government-funded tertiary care institute of India.

MATERIALS AND METHODS

An online e-mail survey was carried out among resident doctors and faculty members (a total of 1721 doctors). A total of 445 doctors (response rate-27.69%) responded to the survey. The survey included Patient Health Questionnaire-9 (PHQ-9), Cohen's Perceived Stress Scale, and Maslach Burnout Inventory.

RESULTS

Of the eligible 1607 participants, 445 responders, 376 (77.75%) were resident doctors and 69 (15.5%) were faculty. As per the PHQ-9, 30.1% of participants were found to have depression and 16.7% of participants reported suicidal ideations. About two-thirds of the sample experienced moderate level of stress (67.2%) and another 13% of participants reported high level of stress. More than 90% of the participants reported some level of burnout. Compared to faculty, higher proportion of the residents reported stress, depression, and burnout. Presence of depression, stress, or burnout was associated with lower indulgence in recreational activities, experiencing verbal or physical abuse in the hand of patients/caregivers, feelings that seniors do not show empathy toward patients, and seniors do not show empathy toward them.

CONCLUSIONS

The present study suggests that a significantly higher proportion of doctors in Indian setting experience stress, depression, and burnout. The presence of stress, depression, and burnout is associated with long working hours and negative patient-related outcomes, adverse doctor-patient interactions, and interpersonal interactions among the colleagues.

Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study

BACKGROUND

Immune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood.

OBJECTIVE

The objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants.

METHODS

Between November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations.

RESULTS

The final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001).

CONCLUSIONS

This paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.

Association of Epidemiological and Biochemical Factors with Premature Graying of Hair: A Case-Control Study

Background:

Premature hair graying (PHG) is often a matter of great concern for patients as it is viewed as a sign of increasing age, debility, decreasing vigor, and may lead to low self-esteem and psychological morbidity. Its etiopathogenesis is not completely understood but genetic, and various acquired factors have been implicated. The present study was undertaken to evaluate various epidemiological and biochemical variables associated with PHG.

Materials and Methods:

A cross-sectional case–control study was conducted at a tertiary care hospital in North India for 1 year which comprised 120 patients and equal number of controls. Various epidemiological variables were recorded and compared to controls. Serum ferritin, serum calcium, serum Vitamin D, serum Vitamin B12, lipid profile, thyroid profile, and fasting blood sugar were measured and compared among cases and controls.

Results:

Significantly higher proportion of cases had atopic diathesis, sedentary lifestyle, family history, history of smoking, and higher perceived stress values as compared to controls. Hair oiling seemed to protect against premature graying. Significantly, lower levels of serum calcium, ferritin, Vitamin B12, high-density lipoprotein-cholesterol, and high low-density lipoprotein-cholesterol were observed among cases.

Conclusion:

In the light of the present study, further studies with larger sample size are required to establish the definite etiological significance of these variables and formulate various preventive and therapeutic targets to prevent and treat PHG.

Psychometric properties of the Perceived Stress Scale in a sample of German dementia patients and their caregivers

BACKGROUND

The aim of the present study was to investigate the psychometric characteristics of the Perceived Stress Scale (PSS) in a sample of dementia patients and their spousal caregivers.

METHODS

We investigated the reliability and validity of the 14-item PSS in a sample of 80 couples, each including one spouse who had been diagnosed with mild to moderate dementia (mean age 75.55, SD = 5.85, 38.7% female) and one spousal caregiver (mean age 73.06, SD = 6.75, 61.3% female). We also examined the factor structure and sensitivity of the scale with regard to gender differences.

RESULTS

Exploratory factor analysis of the PSS revealed a two-factor solution for the scale; the first factor reflected general stress while the second factor consisted of items reflecting the perceived ability to cope with stressors. A confirmatory factor analysis verified that the data were a better fit for the two-factor model than a one-factor model. The two factors of the PSS showed good reliability for patients as well as for caregivers ranging between α = 0.73 and α = 0.82. Perceived stress was significantly positively correlated with depressive symptomatology in both caregivers and patients. Mean PSS scores did not significantly differ between male and female patients nor did they differ between male and female caregivers.

CONCLUSION

The present data indicate that the PSS provides a reliable and valid measure of perceived stress in dementia patients and their caregivers.

Perceived Stress Scale: confirmatory factor analysis of the PSS14 and PSS10 versions in two samples of pregnant women from the BRISA cohort

This study aimed to assess the dimensional structure, reliability, convergent validity, discriminant validity, and scalability of the Perceived Stress Scale (PSS). The sample consisted of 1,447 pregnant women in São Luís (Maranhão State) and 1,400 in Ribeirão Preto (São Paulo State), Brazil. The 14 and 10-item versions of the scale were assessed using confirmatory factor analysis, using weighted least squares means and variance (WLSMV). In both cities, the two-factor models (positive factors, measuring resilience to stressful situations, and negative factors, measuring stressful situations) showed better fit than the single-factor models. The two-factor models for the complete (PSS14) and reduced scale (PSS10) showed good internal consistency (Cronbach's alpha ≥ 0.70). All the factor loadings were ≥ 0.50, except for items 8 and 12 of the negative dimension and item 13 of the positive dimension. The correlations between both dimensions of stress and psychological violence showed the expected magnitude (0.46-0.59), providing evidence of an adequate convergent construct validity. The correlations between the scales' positive and negative dimensions were around 0.74-0.78, less than 0.85, which suggests adequate discriminant validity. Extracted mean variance and scalability were slightly higher for PSS10 than for PSS14. The results were consistent in both cities. In conclusion, the single-factor solution is not recommended for assessing stress in pregnant women. The reduced, 10-item two-factor scale appears to be more appropriate for measuring perceived stress in pregnant women.

Prevalence of psychological distress and its association with socio-demographic and HIV-risk factors in South Africa: Findings of the 2012 HIV prevalence, incidence and behaviour survey

BACKGROUND

In South Africa, there are limited nationally representative data on the prevalence and factors associated with psychological distress. This study used a 2012 nationally representative population-based household survey to investigate factors associated with psychological distress in South Africa.

METHODS

The survey is based on a multistage stratified cross-sectional design. Univariate and multivariate logistic regression models were fitted to identify factors associated with psychological distress.

RESULTS

Out of a total 25860 participants, 23.9% reported psychological distress. Higher likelihood of reporting psychological distress was significantly associated with being female [OR = 1.68 (95% CI: 1.34-2.10), p < 0.001], aged 25 to 49 years [OR = 1.35 (95% CI: 1.08-1.70), p = 0.010] and 50 years and older [OR = 1.44 (95% CI: 1.06-1.97), p = 0.023)], Black Africans [OR = 1.61 (95% CI: 1.24-2.10), p < 0.001)], a high risk drinker [OR = 1.37 (95% CI: 1.02-1.83), p = 0.037], a hazardous drinker [OR = 4.76 (95% CI: 2.69-8.42), p < 0.001] and HIV positive, [OR = 1.79 (95% CI:1.55-2.08) p < 0.001], while lower likelihood of reporting psychological distress was significantly associated with being married [OR = 0.78 (95% CI: 0.62-0.98), p = 0.031), employed [OR = 0.71 (95% CI: 0.57-0.88), p = 0.002], and living in a rural formal area [OR = 0.73 (95% CI: 0.55-0.97), p = 0.033].

CONCLUSION

There is a need to develop strategies to alleviate psychological distress in the general population, with a particular focus on those who may be more vulnerable to distress such as females, the aged, excessive alcohol users, the unemployed, people living with HIV and those residing in urban areas as identified in the current findings.

Measurement of Perceived Stress in Age-Related Macular Degeneration

PURPOSE

To validate the Perceived Stress Scale (PSS) in patients with age-related macular degeneration (AMD) using Rasch analysis.

METHODS

Study participants with AMD were recruited from the retina service of the Department of Ophthalmology at the Ohio State University during clinical visits for treatment or observation. Visual acuity with habitual distance correction was assessed. A 10-item version of the PSS was administered in large print or by reading the items to the patient. Rasch analysis was used to investigate the measurement properties of the PSS, including fit to the model, ability to separate between people with different levels of perceived stress, category response structure performance, and unidimensionality.

RESULTS

A total of 137 patients with a diagnosis of AMD were enrolled. The mean (±SD) age of participants was 82 ± 9 years. Fifty-four percent were female. Median Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity of the better eye was 65 letters (Snellen 20/50), with a range of approximately 20/800 to 20/15. Forty-seven percent of participants were receiving an anti-VEGF injection on the day of the study visit. The response category structure was appropriate. One item, "How often have you felt confident in your ability to handle your personal problems?" was removed due to poor fit statistics. The remaining nine items showed good fit to the model, acceptable measurement precision as assessed by the Rasch person separation statistic, and unidimensionality. There was some evidence of differential item functioning by age and visual acuity.

CONCLUSIONS

The Perceived Stress Scale demonstrated acceptable measurement properties and may be useful for the measurement of perceived stress in patients with AMD.

Prenatal stress potentiates febrile seizure and leads to long-lasting increase in cortisol blood levels in children under 2years old

Neurological disorders can be exacerbated in an offspring that is exposed to stress prenatally. This study is aimed to investigate the severity of febrile seizures (FS) in the offspring under 2years old that were prenatally stressed. In this study, 158 children below 2years old with FS were selected. Information about convulsion including seizure lasting, recurrence of seizure, age of the first seizure and type of FS was gathered. Blood samples were obtained from the offspring to measure the cortisol blood levels. Questionnaire was filled in to evaluate the perceived stress and exposure or non-exposure to major stresses during pregnancy. Results of this study showed that both high Perceived Stress Scores (PSS) during pregnancy and exposure to major stresses during pregnancy significantly increased seizure duration and seizure intensity. Also, the appearance of complex FS was significantly higher in prenatally stressed children than the unexposed ones. Further, cortisol blood levels were significantly higher in prenatally stressed subjects. It can be concluded that both higher PSS and/or exposure to major stresses during pregnancy potentiate FS parameters and lead to long lasting increase in cortisol blood levels in the offspring.

The Buffer Effect of Therapy Dog Exposure on Stress Reactivity in Undergraduate Students

Stress is an insidious health risk that is commonly reported among university students. While research suggests that dog exposure may facilitate recovery from a stress response, little is known about the buffer effect of dog exposure on the stress response to a future stressor. This study examined whether interaction with a therapy dog could reduce the strength of the physiological stress response when exposed to a subsequent stressor. Sixty-one university students were randomly assigned to either a therapy dog (TD, n = 31) or a no-dog control (C, n = 30) group. The stress response was measured by electrodermal activity (EDA) in response to the Paced Auditory Serial Addition Test (PASAT). Participants also completed questionnaires that assessed pet attitude, general stress levels, and affect. Analyses of covariance (ANCOVAs) showed that increase in EDA was significantly more pronounced in the C group than in the TD group (p < 0.01). Pet attitudes did not modulate the buffer effect of therapy dog exposure. Results suggest that therapy dog exposure may buffer the stress response in university students, which has implications for the promotion of a viable stress management program on university campuses.

The German Version of the Perceived Stress Scale (PSS-10): Evaluation of Dimensionality, Validity, and Measurement Invariance With Exploratory and Confirmatory Bifactor Modeling

The Perceived Stress Scale (PSS) is a popular instrument for measuring the degree to which individuals appraise situations in their lives as excessively uncontrollable and overloaded. Despite its widespread use (e.g., for evaluating intervention effects in stress management studies), there is still no agreement on its factor structure. Hence, the aim of the present study was to examine the dimensionality, measurement invariance (i.e., across gender, samples, and time), reliability, and validity of the PSS. Data from 11,939 German adults (73% women) were used to establish an exploratory bifactor model for the PSS with one general and two specific factors and to cross-validate this model in a confirmatory bifactor model. The model displayed strong measurement invariance across gender and was replicated in Study 2 in data derived from six randomized controlled trials investigating a web-based stress management training. In Study 2 (overall N = 1,862), we found strong temporal invariance. Also, our analyses of concurrent and predictive validity showed associations with depressive symptoms, anxiety, and insomnia severity for the three latent PSS factors. These results show the implications of the bifactor structure of the PSS that might be of consequence in empirical research.

Validity and reliability of the Cohen 10-item Perceived Stress Scale in patients with chronic headache: Persian version

BACKGROUND

The Cohen Perceived Stress Scale is being used widely in various countries. The present study evaluated the validity and reliability of the Cohen 10-item Perceived Stress Scale (PSS-10) in assessing tension headache, migraine, and stress-related diseases in Iran.

METHODS

This study is a methodological and cross-sectional descriptive investigation of 100 patients with chronic headache admitted to the pain clinic of Baqiyatallah Educational and Therapeutic Center. Convenience sampling was used for subject selection. PSS psychometric properties were evaluated in two stages. First, the standard scale was translated. Then, the face validity, content, and construct of the translated version were determined.

RESULTS

The average age of participants was 38 years with a standard deviation (SD) of 13.2. As for stress levels, 12% were within the normal range, 36% had an intermediate level, and 52% had a high level of stress. The face validity and scale content were remarkable, and the KMO coefficient was 0.82. Bartlett's test yielded 0.327 which was statistically significant (p<0.0001) representing the quality of the sample. In factor analysis of the scale, the two elements of "coping" and "distress" were determined. A Cronbach's Alpha coefficient of 0.72 was obtained. This confirmed the remarkable internal consistency and stability of the scale through repeated measure tests (0.93).

CONCLUSION

The Persian PSS-10 has good internal consistency and reliability. The availability of a validated Persian PSS-10 would indicate a link between stress and chronic headache.

The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial

Background

Coronary heart disease (CHD) is the most prevalent type of cardiac disease among adults worldwide, including those in Singapore. Most of its risk factors, such as smoking, physical inactivity and high blood pressure, are preventable. mHealth has improved in the last decade, showing promising results in chronic disease prevention and health promotion worldwide. Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention (SBCHDP) programme in improving awareness and knowledge of CHD, perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore.

Methods

The smartphone app “Care4Heart” was developed as the main component of the programme. App content was reviewed and validated by a panel of experts, including two cardiologists and two experienced cardiology-trained nurses. A pilot randomised controlled trial was conducted. Eighty working people were recruited and randomised to either the intervention group (n = 40) or the control group (n = 40). The intervention group underwent a 4-week SBCHDP programme, whereas the control group were offered health promotion websites only. The participants’ CHD knowledge, perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Questionnaire-2, Perceived Stress Scale, and Behavioural Risk Factor Surveillance System.

Results

After the SBCHDP programme, participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore (X²  = 6.486, p = 0.039), a better overall CHD knowledge level (t = 3.171, p = 0.002), and better behaviour concerning blood cholesterol control (X² = 4.54, p = 0.033) than participants in the control group.

Conclusion

This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population. Due to the small sample size and short follow-up period, this study was underpowered to detect significant differences between groups. A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0623-y) contains supplementary material, which is available to authorized users.

Perceived stress and quality of life of pharmacy students in University of Ghana

BACKGROUND

Stress among pharmacy students could greatly affect their learning activities and general well-being. It is therefore necessary to investigate how stress relates with the quality of life of students to maintain and/or improve their personal satisfaction and academic performance. A school-based longitudinal study was used to investigate the relationship between stress and quality of life of undergraduate pharmacy students. The 10-item perceived stress scale and the shorter version of the WHO quality of life scale were administered to the same participants at two time points i.e. Time 1 (4 weeks into the semester) and Time 2 (8 weeks afterwards). The correlations and differences between the study variables were tested using the Pearson's coefficient and independent sample t test.

RESULTS

The mean stress scores were higher at Time 2 compared to Time 1 for the first and second years. However, there was no significant difference in stress for different year groups-Time 1 [F (3) = 0.410; p = 0.746] and Time 2 [F(3) = 0.909; p = 0.439]. Female students had higher stress scores at Time 2 compared to male students. The main stressors identified in the study were; large volume of material to be studied (88.2%), laboratory report writing (78.2%), constant pressure to maintain good grades (66.4%) and the lack of leisure time (46.4%). Even though most students employed positive stress management strategies such as time management (68.2%), other students resorted to emotional eating (9.1%) and alcohol/substance use (1.8%). At Time 2, perceived stress scores were significantly negatively correlated with social relationship (r = -0.40, p ≤ 0.0001), environmental health (r = -0.37, p ≤ 0.0001), physical health (r = -0.49, p ≤ 0.0001) and psychological health (r = -0.51, p ≤ 0.0001).

CONCLUSION

The study reported significant correlations between stress and various domains of quality of life of undergraduate pharmacy students. It is thus necessary to institute some personal and institutional strategies to ameliorate the effect of stress on the quality of life of pharmacy students while encouraging the use of positive stress management strategies.

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia

INTRODUCTION

Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia.

METHOD

Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline.

RESULTS

Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels.

CONCLUSION

In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.

Perceived stress and fatigue among students in a doctor of chiropractic training program

OBJECTIVE

High levels of stress and fatigue are associated with decreased academic success, well-being, and quality of life. The objective of this research was to quantify levels of perceived stress and fatigue among chiropractic students to identify sources of and student coping mechanisms for perceived stress and fatigue and to identify the relationship between students' perceived stress and fatigue.

METHODS

A survey comprised of the Perceived Stress Scale, the Undergraduate Sources of Stress Survey, and the Piper Fatigue Scale was administered to chiropractic students in their 2nd, 5th, and 8th trimesters of doctoral study. Data were analyzed by descriptive statistics, 1-way analysis of variance, and linear correlation tests.

RESULTS

Students reported having moderate to high levels of stress and fatigue, with higher levels of stress and fatigue seen in women than in men. A nonsignificant difference among stress scores and a significant difference among fatigue scores were observed based on program term. Levels of stress predicted levels of fatigue, and stress was strongly correlated with psychological health, relationships with family members, mood, and need for learning accommodations. Fatigue was strongly correlated with psychological health, academic demands, and conflicts between studies and other activities.

CONCLUSION

There are differences in the reporting of perceived stress and fatigue levels in this chiropractic student population based on gender. The correlation between fatigue and stress also suggests that measures that may alleviate one may likely affect the other.

Increased hair cortisol and antecedent somatic complaints in children with a first epileptic seizure

OBJECTIVE

Stress is the most frequent seizure-precipitating factor reported by patients with epilepsy, while stressful life events may increase seizure susceptibility in humans. In this study, we investigated the relations between both biological and behavioral measures of stress in children with a first epileptic seizure (hereafter called seizure). We hypothesized that hair cortisol, a biomarker of chronic stress reflecting approximately 3months of preceding exposure, might be increased in children with a first seizure. We also employed standardized questionnaires to examine presence of stress-related behavioral markers.

METHODS

This was a cross-sectional clinical study investigating stress-related parameters in children with a first seizure (First Epileptic Seizure Group (FESG), n=22) in comparison to healthy children without seizures (Control Group, n=29). Within 24h after a first seizure, hair samples were collected from children for the determination of cortisol. In parallel, perceived stress and anxiety and depressive symptoms were examined with appropriate self- and parent-completed questionnaires, and history of stressful life events during the past year was recorded. Emotional and behavioral problems were also assessed by parent-reported validated and widely-used questionnaires.

RESULTS

Higher hair cortisol measurements were observed in the FESG than control children (7.5 versus 5.0pg/mg respectively, p=0.001). The former were more likely to complain of somatic problems than the latter (59.8 vs. 55.4 according to DSM-oriented Scale, p=0.021); however, there were no differences in perceived stress and anxiety or depressive symptoms between the two groups. Using ROC analysis of hair cortisol measurements for predicting disease status, the maximum sensitivity and specificity were observed for a cut-off point of 5.25pg/mg.

SIGNIFICANCE

Increased hair cortisol indicates chronic hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis prior to the first seizure. This might have contributed to the epileptogenesis process and may help explain the higher incidence of antecedent somatic complaints in the first seizure group.

Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial

OBJECTIVE

The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit.

STUDY DESIGN

A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group.

DATA COLLECTION

Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels.

RESULTS

The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p<0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003).

CONCLUSION

Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.

Depression and its associated factors among people living with HIV/AIDS: Can it affect their quality of life?

Introduction:

Depression, being the most common neuropsychiatric complication of HIV, is also associated with increased health-care utilization, decreased quality of life (QOL), and poor adherence to antiretroviral therapy (ART). Depression is a multidimensional disorder affected by a variety of biological, psychological, and social determinants and this relation becomes more complicated in HIV patients. The current study therefore aimed to investigate the sociodemographic and clinical determinants of depression and assess difference in the QOL of HIV patients not having depression and those suffering from depression.

Materials and Methods:

A cross-sectional study was conducted at an ART center in a tertiary care hospital in HIV/AIDS patients of 18 years of age. Sociodemographic and clinical characteristics were studied, depression anxiety and stress scale-21 was used to assess depression, and QOL assessment was done using WHOQOL-HIV BREF questionnaire.

Results and Conclusions:

Out of 754 study subjects, 377, i.e., 50% suffered from depression and nearly 75.9% of them were in the age group of 25–44 years. The prevalence of depression was higher in females, illiterates, and unemployed HIV patients as compared to males, literates, and employed subjects, respectively. HIV patients who were depressed had significantly lower QOL than the subjects not suffering from depression, more so in the environment and social relationships domains.

Stressful life transitions and wellbeing: A comparison of the stress buffering hypothesis and the social identity model of identity change

The relationship between stressful life transitions and wellbeing is well established, however, the protective role of social connectedness has received mixed support. We test two theoretical models, the Stress Buffering Hypothesis and the Social Identity Model of Identity Change, to determine which best explains the relationship between social connectedness, stress, and wellbeing. Study 1 (N=165) was an experiment in which participants considered the impact of moving cities versus receiving a serious health diagnosis. Study 2 (N=79) was a longitudinal study that examined the adjustment of international students to university over the course of their first semester. Both studies found limited evidence for the buffering role of social support as predicted by the Stress Buffering Hypothesis; instead people who experienced a loss of social identities as a result of a stressor had a subsequent decline in wellbeing, consistent with the Social Identity Model of Identity Change. We conclude that stressful life events are best conceptualised as identity transitions. Such events are more likely to be perceived as stressful and compromise wellbeing when they entail identity loss.

Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study

Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N = 10) admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position) once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing), psychological variables (depression, anxiety, and experiences with injustice), mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1) anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18) = 4.74, p < .05, and η_p² = .35, (2) Self-Compassion Scale-Short Form, F(2,18) = 3.71, p < .05, and η_p² = .29, and (3) Magnification subscale of the Pain Catastrophizing Scale, F(2,18) = 3. 66, p < .05, and η_p² = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.

Job stress and burnout in the care staff of Leros PIKPA Asylum 25 years after the first Deinstitutionalisation and Rehabilitation Greek Project

Aims and method To identify correlates between burnout and job stress of care staff at Leros PIKPA Asylum. Forty-nine asylum employees were assessed by Maslach's Burnout Inventory, a sociodemographic questionnaire, the Perceived Stress Scale and the Job Content Questionnaire. Results Emotional exhaustion is related negatively to social support (P = 0.010, r = -0.362). Lack of job achievements is related positively to overall job responsibility (P = 0.040) and negatively to lack of job satisfaction (r = -0.430). Depersonalisation was negatively associated with support from superiors (P = 0.036). Employees with high levels of perceived stress reported higher levels of fatigue (P = 0.050). Positive associations of perceived stress with depression (P = 0.011) and sleep problems (P<0.001) were also detected. Positive correlation was found between monthly salary and lack of sense of personal achievement (P = 0.020). Clinical implications It is necessary to address these issues through staff education and stress management.

Associations of Perceived Stress, Resilience and Social Support with Sleep Disturbance Among Community-dwelling Adults

Sleep disturbance is often described as sleeping poorly, difficulty falling asleep and maintaining sleep, and waking early. Currently, most studies examining sleep disturbance have focused on negative psychological variables; however, few studies have combined both negative and positive psychosocial factors to assess sleep. The aim of this study was to investigate the prevalence of sleep disturbance and psychosocial correlates in Chinese community-dwelling adults. A total of 1471 adults, between 18 and 60 years old, from eight selected community settings in Jinan, China, were surveyed using the Pittsburgh Sleep Quality Index, Perceived Stress Scale, 10-item Connor-Davidson Resilience Scale and Multidimensional Scale of Perceived Social Support and provided sociodemographic information. We found that the prevalence of sleep disturbance was 33.9%. After adjusting for age, employment status and physical co-morbidity, perceived stress was significantly associated with sleep disturbance [odds ratio (OR) = 1.14, p < 0.001], while resilience and social support were associated with a low likelihood of sleep disturbance (OR = 0.90, p < 0.001; OR = 0.97, p < 0.001). Furthermore, regression analysis showed that the interaction between perceived stress and resilience was significant (p < 0.05). Resilience buffered the negative impact of perceived stress on sleep disturbance. Given the close relationship between sleep disturbance and psychosocial correlates, the development of effective intervention programmes to improve sleep quality in this population should be considered. Copyright © 2015 John Wiley & Sons, Ltd.

Reliability and Validity of the 4-Item Version of the Korean Perceived Stress Scale

This study was designed to evaluate the reliability (internal consistency, reproducibility over time, and measurement precision) and validity (factorial, convergent, and concurrent validity) of the 4-item Korean Perceived Stress Scale in comparison to the 10-item Korean Perceived Stress Scale. Participants were 650 students from seven schools of nursing in South Korea. Measures included Korean versions of the Perceived Stress Scale, the Pittsburgh Sleep Quality Index, and a single-item quality-of-life measure. The 4-item Perceived Stress Scale had lower Cronbach alpha than the 10-item Perceived Stress Scale (.65 vs. .80), but its item-total correlations (.35-.47) and split-half coefficient (.81) were comparable to the 10-item Perceived Stress Scale (item-total correlations = .20-.56; split-half coefficient = .82). Reproducibility of the 4-item scale after a 1-week interval (r = .67, ICC absolute agreement = .64) was similar to the 10-item scale (r = .70, ICC absolute agreement = .65). The standard error of measurement was slightly higher in the 4-item scale. Scale constructs of the two were identical in exploratory factor analysis. The two scales were highly correlated (r = .93) and showed similar levels of concurrent validity with sleep quality and quality of life. In conclusion, the 4- and 10-item Korean Perceived Stress Scale are similar in psychometric qualities. © 2016 Wiley Periodicals, Inc.

Association between the CLOCK gene 3111 T > C polymorphism and an irregular menstrual cycle in Korean adolescents

The menstrual cycle is an example of a human infradian rhythm, but an altered sleep-wake cycle or a disrupted circadian rhythm can change the regularity of the menstrual cycle. In this study, we investigated whether an irregular menstrual cycle is associated with polymorphisms in the CLOCK (3111T > C) and/or PER3 (variable number tandem repeat, VNTR) genes, which are known to have an impact on the circadian rhythm. One hundred ninety-seven postmenarchal, adolescent girls from two girls' high schools in Seoul, Korea, were studied. All participants were requested to complete the Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) to assess the emotional distress that might cause menstrual irregularity. Every participant donated a blood sample from which DNA was extracted and genotyped for the CLOCK 3111T > C and PER3 VNTR polymorphisms. A significant association was found between the CLOCK 3111T > C genotype and irregular menstrual cycles. Subjects with the 3111T > C genotype had a high risk of an irregular menstrual cycle compared with 3111T/T homozygous subjects (odds ratio [OR] = 2.88; 95% confidence interval [CI]: 1.26-6.55). When multivariate logistic regression analysis was performed to adjust for age, PSS, STAI, BDI and BMI, subjects with the 3111T > C polymorphism showed a significantly increased OR for irregular menstrual cycles (OR = 3.09; 95% CI: 1.32-7.21). There was no significant association between the PER3 VNTR polymorphism and the irregularity of the menstrual cycle (p > 0.05). The results of this study suggest that the CLOCK 3111T > C polymorphism could be an independent risk factor for irregular menstrual cycles, irrespective of psychological distress and endocrine or metabolic conditions, and could be used as a molecular marker for gynecological studies on this aspect.

Validation of theoretical pathway between discrimination, diabetes self-care and glycemic control

AIMS

This study examined the mechanisms through which discrimination influences diabetes self-care and glycemic control in patients with diabetes by using structured equation modeling.

METHODS

615 patients were recruited from two adult primary care clinics in the southeastern United States. Measures were based on a theoretical model and included perceived discrimination, social support, social cohesion, and perceived stress. Structured equation modeling examined the relationship with diabetes self-care and glycemic control.

RESULTS

The final model (chi2(211)=328.82, p<0.0001, R(2)=0.99, RMSEA=0.03 and CFI=0.98) shows that higher stress is directly significantly related to a decreased self-care (r=-0.59, p <0.001) and increased HbA1c (r=0.27, p<0.05). There was no significant direct association between discrimination, social support or social cohesion, and glycemic control or self-care. There was, however, a direct significant association between increased discrimination (r=0.46, p<0.001), decreased social support (r=-0.34, p<0.001), increased social cohesion (r=0.14, p<0.05) and increased stress.

CONCLUSIONS

These results support the hypothesized pathway of discrimination on health outcomes, showing both a direct and indirect influence through stress on HbA1c in adults with diabetes. Understanding the pathways through which discrimination influences diabetes outcomes is important for providing more comprehensive and effective care. These results suggest future interventions targeting patients with diabetes should take discrimination-induced stress into account.

The evaluation of perceived stress and associated factors in elderly caregivers

OBJECTIVE

Factors associated with perceived stress in older people have been studied previously, but this investigation in elderly caregivers is still scarce in the literature. Our aim was to assess factors that are associated with perceived stress in a sample of elderly caregivers.

METHODS

This cross-sectional investigation assessed 341 elderly caregivers who cared for a dependent older person at home. They answered questionnaires including the Perceived Stress Scale (PSS-14), a sociodemographic and care characterization, health and cognitive status, and burden related to care.

RESULTS

The mean score in PSS-14 was 18.5±9.9. Self-reported pain, difficult to sleep, "very poor/poor" self-rated health, impaired cognitive status, more people living in the house and higher levels of burden related to care were associated with higher levels of perceived stress.

DISCUSSION

The results highlight the importance of the development of stress-reduced interventions directed to elderly caregivers focusing on the associated variables in this study. Attention should be given to cognitive decline prevention and strategies to avoid or reduce burden in the elderly caregivers.

Effect of a stress management program on subjects with neck pain: A pilot randomized controlled trial

BACKGROUND

Studies have shown that stress is implicated in the cause of neck pain (NP).

OBJECTIVES

The purpose of this study is to examine the effect of a simple, zero cost stress management program on patients suffering from NP.

METHODS

This study is a parallel-type randomized clinical study. People suffering from chronic non-specific NP were chosen randomly to participate in an eight week duration program of stress management (N= 28) (including diaphragmatic breathing, progressive muscle relaxation) or in a no intervention control condition (N= 25). Self-report measures were used for the evaluation of various variables at the beginning and at the end of the eight-week monitoring period. Descriptive and inferential statistic methods were used for the statistical analysis.

RESULTS

At the end of the monitoring period, the intervention group showed a statistically significant reduction of stress and anxiety (p= 0.03, p= 0.01), report of stress related symptoms (p= 0.003), percentage of disability due to NP (p= 0.000) and NP intensity (p= 0.002). At the same time, daily routine satisfaction levels were elevated (p= 0.019). No statistically significant difference was observed in cortisol measurements.

CONCLUSIONS

Stress management has positive effects on NP patients.

Effectiveness of the blended care self-management program "Partner in Balance" for early-stage dementia caregivers: study protocol for a randomized controlled trial

BACKGROUND

The benefits of e-health support for dementia caregivers are becoming increasingly recognized. Reaching early-stage dementia caregivers could prevent high levels of burden and psychological problems in them in the later stages of dementia. An iterative step-wise approach was employed to develop the blended care self-management program "Partner in Balance" for early-stage dementia caregivers. The design of a study evaluating the process characteristics and effects is presented.

METHODS/DESIGN

A mixed-method, single-blind, randomized controlled trial with 80 family caregivers of community-dwelling people with (very) mild dementia will be conducted. Participants will be randomly assigned to either the 8-week blended care self-management program "Partner in Balance" or a waiting-list control group. Data will be collected pre intervention and post intervention and at 3-, 6- and 12-month follow-ups. Semi-structured interviews will be conducted post intervention. A process evaluation will investigate the internal and external validity of the intervention. Primary outcomes will include self-efficacy and symptoms of depression. Secondary outcomes will include goal attainment, mastery, psychological complaints (feelings of anxiety and perceived stress), and quality of life. Possible modifying variables such as caregiver characteristics (quality of the relationship, neurotic personality) and interventional aspects (coach) on the intervention effect will also be evaluated. A cost-consequence analysis will describe the costs and health outcomes.

DISCUSSION

We expect to find a significant increase in self-efficacy, goal attainment and quality of life and lower levels of psychological complaints (depression, anxiety and stress) in the intervention group, compared with the control group. If such effects are found, the program could provide accessible care to future generations of early-stage dementia caregivers and increase dementia care efficiency.

TRIAL REGISTRATION

Dutch trial register NTR4748 .

The construct validity of the Perceived Stress Scale

OBJECTIVE

Stress impacts the quality of life and is associated with increased risk of mental and physical disorders. The Perceived Stress Scale (PSS) is widely used for measuring psychological distress. Although the instrument was originally defined as a single construct, several studies based on classical test theory suggest that a two-dimensional structure is more dominant. We aimed to explore the construct validity and dimensionality of the PSS-10 using modern test theory to determine if the scale is predominantly for a one- or a two-dimensional model.

METHODS

The study population consisted of 32,374 citizens who completed the PSS-10 as part of the Danish National Health Survey in 2010. We investigated the construct validity of the PSS-10 by CFA. We examined the scalability by investigating the fit of the data distribution in a unidimensional Rasch model and performing modification of response categories, persons and items. The scale dimensionality was additionally assessed by Mokken and Rasch analysis.

RESULTS

The PSS-10 did not fit the Rasch model. Item four indicated the largest misfit, and items four and seven displayed disordered thresholds. Unidimensionality could not be established although the data showed improved fit to the Rasch model for the two dimensions respectively with the positive and negative items. Mokken analysis revealed fit to the unidimensional model, but disordered thresholds were shown for item four.

CONCLUSION

Our large population-based study indicated scalability problems in the current version of the PSS-10. The conducted analysis overall revealed better statistical fit for a two-dimensional than a unidimensional model.

Stress Sources and Manifestations in a Nationwide Sample of Pre-Primary, Primary, and Secondary Educators in Greece

Background

Teachers experience high levels of stress as a result of their professional duties, and research has shown a growing interest in this phenomenon during the recent years. Aim of this study was to explore the associations of stress sources and manifestations with individual and job-related characteristics in educators of all levels.

Methods

In a cross-sectional design, following an informative e-campaign on the study aims through the official and the main teachers’ portals in Greece, respondents completed online the teachers stress inventory (TSI) and the 14-item Perceived Stress Scale. Nine hundred seventy-four male and 2473 female pre-primary, primary, and secondary educators with a mean age of 41.2 years responded.

Results

Women and younger teachers reported significantly higher levels of stress, mainly due to lack of time and other work-related stressors, and also more emotional and gastronomic manifestations. Increased age and working experience were associated with lower levels of several stress sources. Teachers of administrative positions had increased time management stressors, but less professional distress, professional investment, and discipline and motivation stressors. Additionally, working and residing far from family increased teachers’ stress levels associated with control, motivation, and investment. Teachers of pre-primary education had reduced professional investment and motivation stress factors, while vocational lyceum teachers of secondary education reported less work-related stressors and manifestations and more discipline and motivation-related ones. Having students supported or in need of support from special educators and students with difficulties in speaking or comprehension was associated with most of the teachers’ stress sources and manifestations (i.e., TSI subscales). Finally, colleagues’ and mainly supervisors’ support seemed to provide a strong and consistent protection against both stress sources and manifestations.

Conclusion

Stress factors and manifestations vary among educators by gender, seniority, and teaching level. Training in coping and communication skills starting in teachers’ undergraduate studies might have a major impact on their stress alleviation.

Confirmatory Factor Analysis of the Perceived Stress Scale-4 in a Community Sample

Although the Perceived Stress Scale (PSS) is among the most widely used measures of perceived stress, it has only recently begun to be tested in independent psychometric validation studies, and the four-item version of the PSS (PSS-4) (the briefest version of this measure) has never undergone testing to examine and confirm the originally proposed structure. To address this paucity of research, the present study (a) tested the structure of the PSS-4 in the first confirmatory factor analysis of the instrument and (b) tested for item-level gender differences in the PSS that have been demonstrated in other versions of this scale. Results indicated that the PSS four-item measure does not fit its proposed model. Additionally, score differences were observed for one item across genders.

Acute effects of coffee consumption on self-reported gastrointestinal symptoms, blood pressure and stress indices in healthy individuals

Background

It has been suggested that coffee may affect the gut-brain axis with conflicting outcomes. Moreover, there is insufficient evidence to determine whether the type or temperature of coffee consumed will have a different impact on the gut-brain axis. The purpose of this study was to investigate the effects of acute coffee consumption on the following: 1. self-reported GI symptoms and salivary gastrin, 2. stress indices [salivary cortisol and alpha-amylase (sAA)] and psychometric measures, and 3. blood pressure (BP), in healthy, daily coffee consuming individuals in non-stressful conditions.

Methods

This was a randomized, double blind, crossover clinical trial, in which 40 healthy individuals (20 men, 20 women), 20–55 years of age, randomly consumed four 200 ml coffee beverages containing 160 mg caffeine (hot and cold instant coffee, cold espresso, hot filtered coffee), 1 week apart. Salivary samples and psychometric questionnaires were collected at baseline and post-coffee consumption at 15,30, and 60 min for salivary gastrin and sAA measurements and at 60,120, and 180 min for cortisol measurements. BP was measured at beginning and end of each intervention. ClinicalTrials.gov ID: NCT02253628

Results

Coffee consumption significantly increased sAA activity (P = 0.041), with significant differences only between cold instant and filter coffee at 15 and 30 min post-consumption (P < 0.05). Coffee temporarily increased salivary gastrin, without differences between coffee types. Coffee did not affect salivary cortisol or self-reported anxiety levels. Coffee consumption significantly increased BP, within the healthy physiological levels, in a gender specific manner at the end of the experimental periods, without differences between coffee types.

Conclusion

Acute coffee consumption in non-stressful conditions activated sAA and BP but not salivary cortisol, indicating activation of the sympathetic nervous system. Post-coffee sAA increase without a concomitant cortisol increase may also indicate that coffee may have some anti-stress properties.

COPD characteristics and socioeconomic burden in Hellenic correctional institutions

Background

The high prevalence of smoking (80%) in Greek correctional institutions is anticipated to result in high prevalence of COPD in such settings.

Aim

The aim of the Greek obstructive luNg disease epidemiOlogy and health economics Study In corrective institutionS (GNOSIS) is to determine the prevalence of smoking and COPD among inmates and to assess the health-related quality of life.

Methods

GNOSIS, a cross-sectional epidemiological study, was conducted between March 2011 and December 2011 in seven correctional institutions in Greece.

Results

A total of 552 participants, 91.3% male, median age of 43.0 years (interquartile range: 35–53), were enrolled. COPD prevalence was 6.0% and was found to increase with age (18.6% among those ≥60 years), length of prison stay, and length of sentence. Of the participants diagnosed with COPD, 36.4% were diagnosed with Global initiative for chronic Obstructive Lung Disease (GOLD) stage I and 51.5% were diagnosed with stage II. Dyspnea severity was assessed as grades 0–1 on the medical research council dyspnea scale for 88.3%, while 31% reported ≥2 COPD exacerbations in the past year. Seventy-nine percent of the total number of the participants were smokers, with a median smoking of 20.0 cigarettes per day, while 42.9% were assessed as having a strong addiction to nicotine. The median EuroQol visual analog scale score was 70.0 (interquartile range: 60.0–90.0). Problems in the dimension of anxiety/depression were reported by 82.8%.

Conclusion

The results of the study support the notion that the prevalence of COPD among inmates of Greek correctional institutions may increase in the following years. The findings underscore the importance of taking actions to limit COPD prevalence and its risk factors in the Greek correctional system.

Pathways Between Discrimination and Quality of Life in Patients with Type 2 Diabetes

BACKGROUND

Discrimination is a social determinant that has been linked to poor physical and mental health outcomes. This study aimed to examine the pathway whereby discrimination influences quality of life in patients with type 2 diabetes.

SUBJECTS AND METHODS

Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Measures included perceived discrimination, perceived stress, social support, and social cohesion and were based on a theoretical model for the pathways by which perceived discrimination influences mental and physical health. Quality of life was measured using the SF-12 questionnaire.

RESULTS

The final model [χ(2)(106) = 157.35, P = 0.009, R(2) = 0.99, root mean square error of approximation = 0.03, comparative fit index = 0.99] indicates direct effects of higher perceived stress (r = -1.02, P < 0.05) and lower social support (r = 0.36, P < 0.001) significantly related to decreased mental health component score (MCS) of quality of life. Discrimination and social cohesion were not significantly directly related to MCS. However, higher discrimination (r = 0.47, P < 0.001), higher social cohesion (r = 0.14, P < 0.05), and lower social support (r = -0.43, P < 0.001) were significantly directly related to increased stress. No significant paths were found for the physical component score of quality of life.

CONCLUSIONS

Perceived discrimination was significantly associated with stress and served as a pathway to influence the mental health component of quality of life (MCS). Social support had a direct and an indirect effect on MCS through a negative association with stress. These results suggest that future interventions should be developed to decrease stress and increase social support surrounding discrimination to improve the MCS of quality of life in patients with diabetes.

Validation of the World Health Organization Disability Assessment Schedule (WHO-DAS II) in Greek and its added value to the Short Form 36 (SF-36) in a sample of people with or without disabilities

BACKGROUND

There is controversy and ongoing interest on the measurement of functionality in the personal and social level.

OBJECTIVES

(1) to validate the Greek version of the World Health Organization Disability Assessment Schedule (WHO DAS II) and (2) to determine its added value to the physical and psychological health subscales of the Short Form 36 (SF-36).

METHODS

In a cross-sectional design, data were collected between December 2014 and March 2015 by using three questionnaires (WHO DAS II, SF-36, PSS-14) in a sample of people with disabilities (n = 101) and without disabilities (n = 109) in Athens, Greece. WHO DAS II internal consistency, construct and criterion-related validity were assessed by Cronbach alpha, exploratory factor analysis and correlations; its added value by multivariable linear regression.

RESULTS

Cronbach Alpha's were satisfactory for the WHO DAS II, PSS-14 and SF-36 (0.85, 0.88 and 0.96 respectively). Exploratory factor analysis confirmed the existence of one or two factors in people with or without disabilities, respectively. WHO DAS II score showed significant negative correlation with the physical and mental health scale of SF-36 score, especially strong for physical health while was positively related to PSS-14 score. In multivariate analysis mental health appraisal was related to perceived stress in both groups.

CONCLUSIONS

This study support the validity of the Greek version of WHO DAS II and warranted its use in assessment and follow up of people with disabilities, contributing to the development of suitable policies to cover their needs and providing comparable data with other surveys using the same instrument.

Different perceptions of stress, coping styles, and general well-being among pregnant Chinese women: a structural equation modeling approach

Few studies have examined different perceptions of stress or explored the positive aspects of well-being among pregnant Chinese women, so there is a need to explore these phenomena in order to fill the research gap. The aim of this study was to examine the relationships among the different perceptions of stress, coping styles, and general well-being using a structural equation modeling approach. We examined a hypothetical model among 755 pregnant Chinese women based on the integration of theoretical models. The Perceived Stress Scale (PSS), the Trait Coping Styles Questionnaire (TCSQ), and the General Well-Being Schedule (GWB) were used to measure perceived stress, coping styles, and general well-being, respectively. A structural equation model showed that positive and negative perceptions of stress significantly influenced positive and negative coping styles, respectively. Different perceptions of stress were significantly associated with general well-being, but different coping styles had no significant effects on general well-being. The model had a good fit to the data (IFI = 0.910, TLI = 0.904, CFI = 0.910, and RMSEA = 0.038). Different perception of stress was able to predict significant differences in coping styles and general well-being.