Psychometric Properties of a European Spanish Version of the Perceived Stress Scale (PSS)

Health Information Technologies in the Support Systems of Pregnant Women and Their Caregivers: Mixed-Methods Study

Background

The quality and quantity of families’ support systems during pregnancy can affect maternal and fetal outcomes. The support systems of expecting families can include many elements, such as family members, friends, and work or community groups. Emerging health information technologies (eg, social media, internet websites, and mobile apps) provide new resources for pregnant families to augment their support systems and to fill information gaps.

Objective

This study sought to determine the number and nature of the components of the support systems of pregnant women and their caregivers (eg, family members) and the role of health information technologies in these support systems. We examined the differences between pregnant women’s support systems and those of their caregivers and the associations between support system composition and stress levels.

Methods

We enrolled pregnant women and caregivers from advanced maternal-fetal and group prenatal care clinics. Participants completed surveys assessing sociodemographic characteristics, health literacy, numeracy, and stress levels and were asked to draw a picture of their support system. Support system elements were extracted from drawings, categorized by type (ie, individual persons, groups, technologies, and other) and summarized for pregnant women and caregivers. Participant characteristics and support system elements were compared using the Pearson chi-square test for categorical variables and Wilcoxon ranked sum test for continuous variables. Associations between support system characteristics and stress levels were measured with Spearman correlation coefficient.

Results

The study enrolled 100 participants: 71 pregnant women and 29 caregivers. The support systems of pregnant women were significantly larger than those of caregivers—an average of 7.4 components for pregnant women and 5.4 components for caregivers (P=.003). For all participants, the most commonly reported support system elements were individual persons (408/680, 60.0%), followed by people groups (132/680, 19.4%), technologies (112/680, 16.5%), and other resources (28/680, 4.1%). Pregnant women’s and caregivers’ technology preferences within their support systems differed—pregnant women more often identified informational websites, apps, and social media as parts of their support systems, whereas caregivers more frequently reported general internet search engines. The size and components of these support systems were not associated with levels of stress.

Conclusions

This study is one of the first demonstrating that technologies comprise a substantial portion of the support systems of pregnant women and their caregivers. Pregnant women more frequently reported specific medical information websites as part of their support system, whereas caregivers more often reported general internet search engines. Although social support is important for maternal and fetal health outcomes, no associations among stress, support system size, and support system components were found in this study. As health information technologies continue to evolve and their adoption increases, their role in patient and caregiver support systems and their effects should be further explored.

Resilience as a protective factor in pregnancy and puerperium: Its relationship with the psychological state, and with Hair Cortisol Concentrations

PURPOSE

Stress is considered an important risk factor for the physical and psychological health of pregnant women. Hence, it is very important to study those protective factors that attenuate the negative effects of stress, such as resilience. The objective of this study was to verify the role of resilience as a stress-reducing factor during pregnancy.

METHODS

A total of 151 pregnant women were assessed in this study: high resilience (n = 55) and low resilience (n = 96). Assessment consisted on perceived stress, pregnancy-specific stress, psychopathological symptoms, psychological wellbeing and Hair Cortisol Concentrations (HCC) during the third trimester of pregnancy and the puerperium, as well as postpartum depression.

RESULTS

The results show that there were statistically significant differences between women with high and low resilience in: perceived stress [F (1,150) = 8.40; p = .005)], HCC [F (1,150) = 9.70; p = .002], pregnancy-specific stress [F (1,150) = 9.62; p = .002], and various subscales of psychopathological symptoms. Specifically, women with high resilience had lower levels of perceived stress, pregnancy-specific stress, psychopathological symptoms, psychological wellbeing, and Hair Cortisol Concentrations during the third trimester. During the puerperium, women in the high resilience group showed higher psychological wellbeing, lower psychopathological symptoms, and lower postpartum depression scores.

CONCLUSIONS

These results highlight the protective role of resilience when pregnant women are confronted by the negative effects of stress, and therefore the potential utility of resilience to improve the health of pregnant women and their neonates.

Stress beyond coping? A Rasch analysis of the Perceived Stress Scale (PSS-14) in an Aboriginal population

The history of colonization contributed to Aboriginal and Torres Strait Islanders becoming one of the most disadvantaged groups in Australia. The multiple social inequalities, and therefore the constant insecurities for many about low income, poor living conditions, unemployment, and discrimination, generate chronic stress in this population. In the Baby Teeth Talk Study, an oral-health randomized controlled trial, the Perceived Stress Scale (PSS-14) was administered to 367 pregnant Aboriginal women at baseline. The aim of the present study was to evaluate the validity and reliability of the PSS-14 in an Aboriginal population. The study analysed: (a) model fit; (b) dimensionality; (c) local dependence; (d) differential item functioning; (e) threshold ordering and item fit; (f) targeting; (g) reliability; and (h) criterion validity. The dimensionality analysis indicated a two-factor structure, with negatively and positively worded items clustering together and 21.7% (95% Agresti-Coull C.I. [17.8%, 26.2%]) statistically significant t-tests between the persons' estimates. After the creation of composite items, the revised Perceived Distress (χ2 (21) = 11.74, p = 0.946) and Perceived Coping (χ2 (28) = 17.63, p = 0.935) subscales fitted the Rasch model. Reliability was modest (PersonSeparationIndexdistress = 0.72; PersonSeparationIndexcoping = 0.76). The latent correlation between the Perceived Distress and Perceived Coping subscales was r = 0.14. It is hypothesized that the social inequalities experienced by the Aboriginal population are so pronounced that even Aboriginal pregnant women that perceived themselves as coping well with life challenges ended up endorsing items regarding high levels of stress. The present research showed that a revised PSS-14 is a culturally valid and modestly reliable psychological instrument to measure stress in a population of pregnant Aboriginal women in Australia.

Acculturation stress and allostatic load among Mexican immigrant women

OBJECTIVES

this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US ( n =19) and Mexico ( n = 40).

METHOD

measures of stress included the Perceived Stress Scale (PSS) and the Hispanic Women's Social Stressor Scale (HWSSS). A composite measure of 8 indicators of AL (systolic and diastolic blood pressure, body mass index (BMI), waist-to-hip ratio, total cholesterol, glycated hemoglobin (hemoglobin A1C), triglycerides and C-reactive protein) was calculated.

RESULTS

there were no significant group differences in AL between Mexican and Mexican immigrant women ( t = 1.55, p = .126). A principal component factor analysis was conducted on the 8 AL indicators; a 2-factor solution explained 57% of the variance. Group differences in the two AL factors were analyzed using MANOVA. BMI and waist-to-hip ratios were lower, but blood pressure and triglycerides were higher in the US group and were mediated by time in the US. Greater acculturation stress was significantly related to increased waist-to-hip ratio ( r = .57, p = .02).

FINAL REMARKS

findings suggest some measures of AL increased with time in the US, and acculturation stress may be a significant factor.

Motivational Climate in Sport Is Associated with Life Stress Levels, Academic Performance and Physical Activity Engagement of Adolescents

The present study sought to define and contrast an explanatory model incorporating motivational climate towards sport, life stress, academic performance, and engagement in physical activity, and to analyze the existing relationships between these variables as a function of sex. A total of 2452 adolescents of both sexes (42.7% males and 57.3% females) participated in the present study, with self-reported ages between 13 and 16 years (M = 14.43; SD = 1.15). Participants were from Granada (Spain) and perceived motivational climate towards sport (PMCSQ-2), life stress (PSS), academic performance, and engagement in physical activity (PAQ-A) were analyzed. A multi-group structural equation model was constructed, which demonstrated excellent fit to the observed data (χ² = 309.402; DF = 40; p < 0.001; CFI = 0.973; NFI = 0.970; IFI = 0.973; and RMSEA = 0.052). A negative and direct association exists between ego climate and task climate. A positive association was found between motivational climate, task climate (males r = 0.336/females r = 0.238), and ego climate (males r = 0.198/ females r = 0.089) and engagement in physical activity. A task climate was associated with better academic performance and lower levels of life stress. The main conclusions of this study highlight that a task-involving climate and engagement in physical activity are both associated with lower levels of life stress and higher levels of academic performance.

Rationale and design of the SI! Program for health promotion in elementary students aged 6 to 11 years: A cluster randomized trial

Unhealthy habits in children are increasing at an alarming rate. The school provides a promising setting for effective preventive strategies to improve children's lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based educational intervention aimed at all stages of compulsory education in Spain. Here, we present the design of the SI! Program for Elementary School cluster-randomized controlled trial, targeting children aged 6 to 11 years. This trial aims to study the impact of different timings and intensities of exposure to SI! Program activities on elementary school children and their immediate environment (parents/caregivers, teachers, and school). The trial includes 1770 children from 48 public elementary schools in Madrid (Spain), together with their parents and teachers. Schools and their children were randomly assigned to the intervention group (the SI! curriculum-based educational program over 3 or 6 academic years) or to the control group (standard curriculum). The primary outcomes are the change from baseline at 3-year and 6-year follow-up in children's scores for knowledge, attitudes, and habits (KAH) and health factors (blood pressure, height, weight, waist circumference, and skinfold thickness). Secondary outcomes include 3-year and 6-year changes from baseline in lifestyle questionnaire scores for parents/caregivers and teachers, and in the school environment questionnaire. The overarching goal of the SI! Program is to provide an effective and sustainable health promotion program for the adoption of healthy behaviors in children. The present trial will address the impact and the optimal timing and duration of this educational intervention in the elementary school setting.

Reliability and validity of the Perceived Stress Scale-10 in Hispanic Americans with English or Spanish language preference

This study examined the psychometric properties of the Perceived Stress Scale-10 among 436 community-dwelling Hispanic Americans with English or Spanish language preference. Multigroup confirmatory factor analysis examined the factorial invariance of the Perceived Stress Scale-10 across language groups. Results supported a two-factor model (negative, positive) with equivalent response patterns and item intercepts but different factor covariances across languages. Internal consistency reliability of the Perceived Stress Scale-10 total and subscale scores was good in both language groups. Convergent validity was supported by expected relationships of Perceived Stress Scale-10 scores to measures of anxiety and depression. These results support the use of the Perceived Stress Scale-10 among Hispanic Americans.

Psychological distress and resilience of mothers and fathers with respect to the neurobehavioral performance of small-for-gestational-age newborns

Background

The existence of psychological distress (PD) during pregnancy is well established. Nevertheless, few studies have analyzed the PD and resilience of mothers and fathers during high-risk pregnancy. This study analyzes the differences between parents’ PD and resilience and the relation between them and the neurobehavioral performance of their SGA newborns.

Methods

This prospective study compares two groups of parents and newborns: case group (52 parents and 26 SGA fetuses) and comparison group (68 parents and 34 appropriate-for-gestational-age, AGA, fetuses). In each group, the parents were evaluated during the last trimester of pregnancy, to obtain standardized measures of depression, stress, anxiety, and resilience. At 40 ± 1 weeks corrected gestational age, psychologists evaluated the state of neonatal neuromaturity achieved.

Results

Multivariate analysis of variance showed, in gender comparisons, that mothers obtained higher scores than fathers for psychological distress but lower ones for resilience. Similar differences were obtained in the comparison of parents’ distress to intrauterine growth by SGA vs. AGA newborns. Mothers of SGA newborns were more distressed than the other groups. However, there were no differences between the fathers of SGA vs. AGA newborns. Regarding neurobehavioral performance, the profiles of SGA newborns reflected a lower degree of maturity than those of AGA newborns. Hierarchical regression analyses showed that high stress and low resilience among mothers partially predict low neurobehavioral performance in SGA newborns.

Conclusions

These findings indicate that mothers of SGA newborns may need psychological support to relieve stress and improve their resilience. Furthermore, attention should be paid to the neurobehavioral performance of their babies in case early attention is needed.

Mental health and worries of pregnant women living through disaster recovery

The health and well-being of pregnant women during and after natural disasters remains an international concern. In this mixed methods study we described pregnant women's mental health, psychosocial concerns and sources of stress living in New Orleans during long term recovery from Hurricane Katrina. Our survey of 402 pregnant women indicated poor social support was associated with higher levels of depression symptomology, post-traumatic stress disorder, anxiety, and stress. Women were interviewed and described seven common areas of worry. We concluded that pregnant women living in post-disaster communities have stressful lives years after the event, needing innovative models of care to build resilience.

Psychophysiological Stress Response of a Paralympic Athlete During an Ultra-Endurance Event. A Case Study

Psychophysiological response of athletes with spinal cord injurie has not been reported yet in scientific literature. The aim of this study is to examine the psychophysiological stress response of Paralympic athlete during competitive activities. We collected the following psychophysiological measurements: anxiety-trait, anxiety-state, locus of control, perceived psychological stress, stress-copying style, rate of perceived exertion, perceived muscle pain, body temperature, forced vital capacity, blood oxygen saturation, blood glucose and lactate concentrations, isometric hand strength, cortical arousal, heart rate variability, heart rate and velocities of a female Paralympic spinal cord injured athlete in a 11 h and 44 min ultraendurance mountain event. An ultraendurance mountain even produced an increase in the sympathetic autonomous modulation, heart rate, lactate, muscular pain and rated of perceived exertion and a decrease in cortical arousal, hand strength and respiratory muscle in a spinal cord injurie female athlete during. The Paralympic athletes presented a low psychological inflexibility, high life engagement, strong internal locus of control, a low trait and state anxiety and medium perceived psychological stress. These results are consistent with the expected response during a highly stressful situation and consistent with previous findings in athletes without spinal cord injurie.

Relationship between resilience and stress: Perceived stress, stressful life events, HPA axis response during a stressful task and hair cortisol

BACKGROUND

There is no consensus about how resilience is related to the different types of stress such as daily or chronic stress and psychopathology. The main objective of this study is to evaluate the relationship between resilience and the different measures of stress such as perceived stress, chronic stress, life events, HPA axis response during a stressful task and psychopathology.

MATERIAL AND METHODS

The design was cross-sectional. Resilience, perceived stress, stressful life events, hair cortisol and HPA axis response during Trier Social Stress Test measured by salivary cortisol samples and psychopathological symptoms were assessed in a sample of 80 University students.

RESULTS

Participants with low resilience showed higher scores in perceived stress level (p < .001), the number of current life events (p < .02), the intensity of stressful events (p < .025) as well as Obsession and Compulsion (p = .006), Interpersonal Sensitivity (p = .028), Phobic Anxiety (p = .044) and psychopathological severity (p = .033). Resilience was associated with chronic stress by perceived stress (p < .001), hair cortisol concentration (p = .022), obsessions and compulsions (p = .016), interpersonal sensitivity (p = .022), and depression symptoms (p = .039).

CONCLUSION

Resilience seems to be determinant in perceived stress, the number of current life events, the intensity of stressful events, chronic stress, obsession and compulsions, interpersonal sensitivity, phobic anxiety and depression symptoms, and psychopathological severity index.

Adaptación, validación y propiedades psicométricas de la “Escala de Evaluación del Estado de Crisis” (EEEC), en una muestra de estudiantes técnicos y universitarios en Colombia

El objetivo del presente estudio instrumental fue adaptar y analizar la validez y la fiabilidad de la “Escala de Evaluación del Estado de Crisis” (Crisis State Assessment Scale, CSAS; Lewis, 2005) en una muestra de 648 estudiantes colombianos en formación técnica o universitaria. La traducción y adaptación de la escala se realizó mediante la técnica de doble traducción, la versión en español resultante fue sometida a un estudio instrumental exploratorio con 129 participantes. Se obtuvo un alfa Cronbach total de 0,84 indicando una buena consistencia interna del instrumento adaptado, por lo que se procedió a la fase de validación factorial. El instrumento evalúa los siguientes tres constructos psicológicos: la intensidad del estado de crisis psicológica, la percepción del evento estresante y la percepción de los problemas de afrontamiento. El coeficiente alfa de Cronbach en la muestra de validación fue de .88 (n = 648), indicando una adecuada exactitud en la medida instrumental. El análisis factorial exploratorio de ejes principales con rotación promax arrojó una estructura bifactorial bien definida que explica el 60% de la varianza común. En el análisis factorial confirmatorio, los mejores índices de ajuste entre los datos empíricos y los modelos teóricos probados, corresponde al modelo que postula que existen dos factores de primer orden, Percepción del Evento Estresante “PEE” y Problemas Percibidos de Afrontamiento “PPA”, y que están explicados por un factor emergente de segundo orden que correspondería al constructo del Estado de Crisis “EEEC”. Los datos anteriores soportan una validez de constructo congruente con la teoría transaccional del estrés de Lazarus y Folkman (1984). Las correlaciones de Pearson entre el puntaje total y la “Escala de Estrés Percibido” fue de .70, apoyando la validez concurrente. En conclusión, estos resultados sugieren que la versión adaptada al español de la “Escala de Evaluación del Estado de Crisis” (EEEC) posee propiedades psicométricas satisfactorias para ser utilizada en la población colombiana y que los ítems que la componen son comprendidos sin problemas de adecuación cultural.

Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study

Background

A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity.

Methods

This case–control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR).

Results

A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02–70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24–5.74, p = 0.012).

Conclusion

A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity.

Electronic supplementary material

The online version of this article (10.1186/s13075-019-1808-z) contains supplementary material, which is available to authorized users.

Pain Expressions and Inhibitory Control in Patients With Fibromyalgia: Behavioral and Neural Correlates

Fibromyalgia (FM) is a generalized chronic pain condition associated with a variety of symptoms, including altered cognitive and emotional processing. It has been proposed that FM patients show a preferential allocation of attention to information related to the symptoms of the disease, particularly to pain cues. However, the existing literature does not provide conclusive evidence on the presence of this attentional bias, and its effect on cognitive functions such as inhibitory control. To clarify this issue, we recorded the electroencephalographic activity of 31 women diagnosed with FM and 28 healthy women, while performing an emotional Go/NoGo task with micro-videos of pain, happy, and neutral facial expressions. We analyzed behavioral data, performed EEG time-frequency analyses, and obtained the event-related potentials (ERPs) N2 and P3 components in NoGo trials. A series of self-reports was also administered to evaluate catastrophic thinking and the main symptoms of fibromyalgia. Pain expressions were associated with longer reaction times and more errors, as well as with higher theta and delta power, and P3 amplitude to NoGo stimuli. Thus, behavioral and psychophysiological data suggest that increased attention to pain expressions impairs the performance of an inhibitory task, although this effect was similar in FM patients and healthy controls. N2 amplitude was modulated by type of facial expression (larger to pain faces), but only for the control group. This finding suggests that the presentation of pain faces might represent a smaller conflict for the patients, more used to encounter pain stimuli. No main group effects were found significant for N2 or P3 amplitudes, nor for time-frequency data. Using stimuli with greater ecological validity than in previous studies, we could not confirm a greater effect of attentional bias toward negative stimuli over inhibitory performance in patients with FM. Studying these effects allow us to better understand the mechanisms that maintain pain and develop intervention strategies to modify them.

An Explanatory Model of Emotional Intelligence and Its Association with Stress, Burnout Syndrome, and Non-Verbal Communication in the University Teachers

The present study set out to define and contrast an explanatory model of perception of stress, the dimensions of burnout syndrome, emotional intelligence, and non-verbal communication in a sample of university teachers. A total of 1316 teachers from Spain, aged between 24 and 70 years (M = 45.64, SD = 10.33) and evenly distributed between both sexes, participated. The measurement instruments employed were the Perceived Stress Scale (PSS), the Maslach Burnout Inventory (MBI), the Trait Meta-Mood Scale (TMMS-24), and the Nonverbal Immediacy Scale (NIS) A structural equation model was produced that demonstrated adequate fit to the empirical data (130,259; df = 9; p < 0.001; CFI = 0.907; NIF = 0.914; IFI = 0.923; RMSEA = 0.077). Results revealed that stress relates positively with emotional exhaustion and negatively with personal fulfilment. Emotional exhaustion was associated directly with emotional attention and inversely with emotional clarity and emotional repair, with these being linked to personal fulfilment. Both emotional clarity and repair related positively with non-verbal communication. Conclusions from the present study are that emotional intelligence and body language are two relevant factors in the prevention of burnout syndrome, and as a result can help to ensure the mental wellbeing of university teachers.

Clinical effects of mindfulness meditation and cognitive behavioral therapy standardized for insomnia: A protocol for a systematic review and meta-analysis

INTRODUCTION

This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of mindfulness meditation and cognitive behavioral therapy programs as a psychological intervention for insomnia disorders.

METHODS AND ANALYSIS

We will search the following 11 electronic databases without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. Furthermore, we will also search 5 Korean-language databases (Oriental Medicine Advanced Searching Integrated System, Korean studies Information Service System, Research Information Service System, Korean Medical Database, and Korea Citation Index). The study selection and data extraction will be performed independently by 2 authors. The study quality assessment and evaluation of the quality of evidence for the main findings will be performed independently by 2 authors using the Cochrane tool for assessing risk of bias and predefined criteria (the Grading of Recommendations Assessment, Development, and Evaluation approach). Data synthesis and analysis will be performed using RevMan Version 5.3. Data will be synthesized by either a fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. If any plan for documenting important protocol amendments changes, the researchers will have a revision agreement and then register the modification in the International Prospective Register of Systematic Reviews (PROSPERO).

ETHICS AND DISSEMINATION

Ethical approval will not be required because individual patient data are not included and because this protocol is for a systematic review. The findings of this systematic review will be disseminated through conference presentations.PROSPERO registration number: CRD42018111217.

Spanish adaptation of the Gambling Motives Questionnaire (GMQ): Validation in adult pathological gamblers and relationship with anxious-depressive symptomatology and perceived stress

Gambling has been found to be related to different motives, such as enhancement, social, and behavioral and emotional coping. The most used instrument in this field is the Gambling Motives Questionnaire (GMQ; Stewart & Zack, 2008), which has not been validated in clinical samples. This study aimed to validate a Spanish version of the GMQ in a sample of adult pathological gamblers and to analyze its relationship with pathological gambling, anxiety, depression, and perceived stress. A sample of 164 gamblers was recruited from centers for the treatment of pathological gambling. The three-factor structure (enhancement, social, and coping motives) of the GMQ was validated through exploratory and confirmatory factorial analyses, and its convergent validity was proven. Gambling motives correlated with pathological gambling, anxiety, depression, and perceived stress. Enhancement motives predicted pathological gambling, while controlling for the effect of anxiety, depression, and perceived stress. These results are relevant for clinical evaluation and intervention with adult pathological gamblers.

Aspectos psicosociales de la calidad de vida en supervivientes pediátricos de tumores en el sistema nervioso central

Introducción: Los supervivientes de tumores del sistema nervioso central (TSNC) presentan peor calidad de vida en relación a la salud (CVRS) que los supervivientes de otras neoplasias y la población normativa. El tipo y gravedad de las secuelas no parecen tener un impacto claro en la CVRS, pero la afectación del cociente intelectual (CI) sí podría modular la CVRS. Además, las estrategias de afrontamiento del paciente y de los progenitores y el malestar emocional parental podrían también actuar sobre la CVRS. Objetivo: Determinar si las estrategias de afrontamiento del adolescente y su CI, y las estrategias de afrontamiento, el estrés general y el malestar emocional parental, modulan las dimensiones psicosociales de la CVRS del superviviente. Método: Estudio transversal descriptivo-correlacional. Se reclutaron 37 adolescentes (12-19 años) que llevaban ≥1 año fuera de tratamiento oncológico y 44 progenitores. Resultados: En la CVRS valorada por los adolescentes, las dimensiones Relación con los Padres y Vida Familiar, Amigos y Apoyo Social, y Entorno Escolar dependen de la estrategia de afrontamiento de resolución del problema usada por el adolescente. La dimensión Aceptación Social depende del estilo de afrontamiento improductivo del adolescente y del estilo de búsqueda de ayuda social de los padres. La CVRS valorada por los padres depende de las secuelas, el CI del adolescente y, el tipo de tratamiento oncológico recibido. Discusión y conclusiones: Las estrategias de afrontamiento centradas en la resolución del problema, deben ser consideradas para valorar e intervenir en la mejora de la CVRS de los supervivientes TSNC.

Physical and Mental Health Impacts of Household Gardens in an Urban Slum in Lima, Peru

Rural poverty and lack of access to education has led to urban migration and fed the constant growth of urban slums in Lima, Peru. Inhabitants of these informal settlements lack land rights and access to a public water supply, resulting in poor sanitation, an inability to grow food, and suboptimal health outcomes. A repeated measures longitudinal pilot study utilizing participatory design methods was conducted in Lima between September 2013 and September 2014 to determine the feasibility of implementing household gardens and the subsequent impact of increased green space on well-being. Anthropometric data and a composite of five validated mental health surveys were collected at the baseline, 6-months, and 12-months after garden construction. Significant increases from the baseline in all domains of quality of life, including: physical (p < 0.01), psychological (p = 0.05), social (p = 0.02), environmental (p = 0.02), and overall social capital (p < 0.01) were identified 12 months after garden construction. Life-threatening experiences decreased significantly compared to the baseline (p = 0.02). There were no significant changes in parent or partner empathy (p = 0.21), BMI (p = 0.95), waist circumference (p = 0.18), or blood pressure (p = 0.66) at 6 or 12 months. Improved access to green space in the form of a household garden can significantly improve mental health in an urban slum setting.

Depressed as Freshmen, Stressed as Seniors: The Relationship between Depression, Perceived Stress and Academic Results among Medical Students

Research in the field has identified the presence of stress and depression among medical students. However, no other study has pointed out the differences between years of study. The objectives of the study are to identify the levels of stress and depression among medical students and to point out the relationship between these two variables. Methods: The cross-sectional study gathered data regarding socio-demographic characteristics, depression, self-identified psychological and physical symptoms during stressful periods and perceived stress among medical students in a university in Romania. Statistical analysis was performed using IBM SPSS Statistics v23. For comparative analysis the t-test for independent samples and one-way ANOVA was used and for correlational analysis, Pearson and Spearman correlations was used. Results: Freshmen are the most depressed and graduating students are the most stressed medical students. Statistical analysis reveals an average score of perceived stress (M = 17.31 ± 6.79) and mild-moderate depression (M = 10.11 ± 7.69). Women are more prone to symptoms of depression. Students enrolled in the third year of study are the least depressed and the least stressed. Perceived stress is significantly positive correlated with depression and negative in strong correlation with the number of course credits received. More than half of students experience an increased rate of anxiety and consumption of alcohol, coffee, sweets or cigarettes during stressful academic periods. Over 60% declare themselves satisfied with their academic results. Conclusions: Strategies to diminish the level of stress and depression among medical students are necessary. Psychological support and educational counseling should start from admission, since freshmen experience the highest rate of depression.

Stress, anger and Mediterranean diet as predictors of metabolic syndrome

BACKGROUND AND OBJECTIVE

Metabolic syndrome (MetS) is a cluster of metabolic conditions that include abdominal obesity, reduction in cholesterol concentrations linked to high density lipoproteins (HLDc), elevated triglycerides, increased blood pressure and hyperglycaemia. Given that this is a multicausal disease, the aim of this study is to identify the psychological, emotional and lifestyle variables that can have an influence on the different MetS components.

PATIENTS AND METHODS

A cross-sectional study with 103 patients with diagnostic criteria for MetS (47 male and 56 female). Anthropometric, clinical and analytical measurements were collected to assess the variables associated with MetS. The main psychological and emotional variables were also assessed.

RESULTS

Different multiple linear regression tests were performed to identify which variables were predictive of MetS. The dependent variables were body mass index (BMI), abdominal circumference, HDLc, and quality of life, and the predictive variables were psychological stress, anger and adherence to a Mediterranean diet. The results showed that psychological stress was a predictor of quality of life (β=-0.55, P≤0). Similarly, anger was a predictor of BMI (β=0.23, P=.047) and abdominal circumference (β=0.27, P=.021). As expected, adherence to a Mediterranean diet was a predictor of HDLc (β=0.2, P=.045) and of quality of life (β=-0.18, P=.031).

CONCLUSIONS

The results confirm a link between adherence to certain dietary habits and lifestyle, however they go one step further and show the importance of psychological and emotional factors like psychological stress and anger in some MetS components.

Newborn infants' hair cortisol levels reflect chronic maternal stress during pregnancy

Cortisol obtained from hair samples represents a retrospective biomarker of chronic stress experienced by the subject in previous months. Although hair cortisol levels have been used to study the relationship between maternal and neonatal stress levels in primates, this has not yet been performed in humans using a longitudinal design and focusing specifically on this association. Therefore, the objective of this study was to determine whether a relationship existed between maternal psychological stress and hair cortisol levels during pregnancy and postpartum, and neonatal hair cortisol levels. The sample consisted of 80 pregnant women and their 80 newborn infants. We conducted a longitudinal assessment of hair cortisol levels, psychological stress, anxiety, and depression in the three trimesters of pregnancy and postpartum. After childbirth, neonatal hair cortisol levels were also measured. We found that maternal hair cortisol levels in the first trimester negatively predicted neonatal hair cortisol levels. Perceived stress in the third trimester of pregnancy also predicted lower neonatal cortisol, whereas pregnancy-specific stress in the same trimester had a positive relation with neonatal cortisol. Cortisol is essential for embryonic and fetal development; consequently, if fetal synthesis of cortisol is affected by high maternal cortisol levels, such development could be impaired.

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.

Association between stress pathway gene (CRHR1⧹CRHBP) polymorphisms and heroin dependence

Stress could increase risk of heroin addiction and relapse. Genetic factors that associated with stress may be involved in this process. To explore the relationship between stress pathway gene (CRHR1⧹CRHBP) polymorphisms and heroin dependence, nine tag single nucleotide polymorphisms (CRHR1 rs12953076, rs4458044, rs242924, rs17689966; CRHBP rs1715751, rs3792738, rs32897, rs10062367, rs1875999) of stress related genes were genotyped by TaqMan SNP genotyping assay for 524 heroin-dependent patients who were abstinent and 489 normal controls. The patients were followed up for 5 years to determine whether relapse or not. Life stress was assessed by Perceived Stress Scale (PSS) at baseline and within 12 months just discharged. No differences were found in the frequencies of genotypes and alleles in nine loci of stress pathway genes between case and control groups (p > 0.05), but there were significant discrepancy in perceived stress scores in genotype distributions. Multivariate regression analysis revealed that CRHBP gene polymorphism rs3792738 had interactions with life stress during predicting the risk of heroin relapse. It was concluded that the predictive value of a genetic interaction with the stress axis for the risk of heroin relapse may be useful for future preventive and individualized therapeutic strategies.

Perinatal depression prevention through home visitation: a cluster randomized trial of mothers and babies 1-on-1

Postpartum depression is highly prevalent in low-income women and has significant health effects on mother and child. This pilot study tested the effectiveness of the newly adapted Mothers and Babies (MB) 1-on-1 intervention. A cluster randomized trial was conducted with 8 programs using trained home visitors to deliver MB 1-on-1 and 6 delivering usual home visiting. One hundred twenty pregnant women not experiencing major depression were enrolled. Outcomes were assessed at baseline and 3- and 6-months postpartum. The rate of change in depressive and anxiety symptoms between groups was significant at 6 months, but not 3 months. No statistically significant differences between groups were found on secondary outcomes except perceptions of social support at 6 months. There was variability in use of MB skills, with fewer women using cognitive restructuring techniques. Although larger studies should be conducted, MB 1-on-1 appears promising in using home visitors to deliver a cognitive behavioral intervention to women at risk for postpartum depression.

Development of a Self Report Stress Scale Using Item Response Theory-I: Item Selection, Formation of Factor Structure and Examination of Its Psychometric Properties

INTRODUCTION

Due to the absence of Turkish psychometric devices assessing stress, in the present study it was aimed to develop a stress scale, and examine its basic psychometric properties.

METHODS

Current study included two processes, formation of item pool and examination of psychometric properties of the selected items through three studies. In the first study, 611 individuals aged between 18 and 77 responded to 130 selected items. In the second study, 2223 individuals aged between 18 and 68 responded to 80 items. In the third study, 1969 individuals aged between 18 and 79 responded to the final form of 36 items. Further, in study 3 for criterion related validity 163 individuals completed the Coopersmith Self-Esteem Inventory, 113 individuals completed the Beck Anxiety Inventory, 104 individuals completed the Hospital Anxiety and Depression Scale, 107 individuals completed the Beck Depression Inventory, and 265 individuals completed the Perceived Stress Scale. Moreover, in the investigation of test-retest reliability, 119 individuals took the final form of the test after 2 weeks, and 111 individuals took the final form of the test after 3 weeks.

RESULTS

In the first study, out of 130 items, 54 that showed item-total score correlations below 0.30 were excluded from the scale. Fifty-seven items were preserved exactly, and 19 items' sentence structures were changed. Furthermore, by adding 4 new items, 80 were prepared for the second study. In the second study, two factors structure namely "Physiological Reactions/Strain" and "Psychological/Cognitive Appraisals" sub-dimensions were identified, and 36 items were selected via Item Response Theory representing these sub-dimensions. In study 3, exploratory factor analysis provided strong support for our hypothesized two factors structure. Confirmatory factor analysis indicated hypothesized model had a better fit to the data. Internal consistency coefficients were 0.94 for the entire scale, 0.90 for Physiological Reactions/Strain sub-dimension, and 0.91 for Psychological/Cognitive Appraisals sub-dimension. Correlation coefficients between the entire scale and other criterion scales ranged from 0.22 to 0.63. Test-retest correlation coefficients between the first administration of the scale, and the administrations at two and three week intervals were 0.88.

CONCLUSION

Results showed that the scale has basic psychometric requirements provided that the scale will be supported by validity studies.

Prenatal Perceived Stress and Adverse Birth Outcomes Among Puerto Rican Women

BACKGROUND

Preterm birth and low birthweight contribute substantially to the disproportionately high infant mortality rates experienced by Puerto Ricans in the United States. The purpose of this study was to examine whether the timing and pattern of prenatal psychosocial stress increased risk of adverse birth outcomes in this high-risk population.

MATERIALS AND METHODS

Proyecto Buena Salud was a prospective cohort study conducted from 2006 to 2011 among predominantly Puerto Rican women. Participants (n = 1,267) were interviewed in early, mid-, and late pregnancy. We evaluated associations between early and mid-pregnancy stress (Perceived Stress Scale) and preterm birth and low birthweight, and stress at each pregnancy time point and small for gestational age (SGA).

RESULTS

Elevated levels of perceived stress in mid-pregnancy increased risk for preterm birth and low birthweight in adjusted analyses, with a linear trend observed for each increasing quartile of stress (ptrend = 0.01). Women in the highest quartile of stress experienced three times the risk for preterm birth (odds ratio [OR] = 3.50, confidence interval [95% CI]: 1.38-8.87) and low birthweight (OR = 3.53, 95% CI = 1.27-9.86) compared with women in the lowest quartile. Early pregnancy stress was not associated with preterm birth or low birthweight. Increase in stress from early to late pregnancy increased risk for SGA (OR = 1.90, 95% CI = 1.01-3.59); no associations were found between stress at any timepoint and SGA.

CONCLUSION

Elevated levels of mid-pregnancy perceived stress increased risk for preterm birth and low birthweight, and an increase in stress over the course of pregnancy increased risk for SGA in a population of predominantly Puerto Rican women.

Athletic identity and self-esteem among active and retired Paralympic athletes

Athletic identity (AI) has been suggested as a variable that can have an impact on the psychological health of the athletes upon retirement. The aim of this study was to provide more insight on the transition out of elite sport by assessing and comparing the extent of AI and self-esteem in an active group (AG) and a retired group (RG) of Paralympic athletes. Perceived stress and depressive symptoms were additionally assessed in the AG and RG, respectively. A non-probability sampling method was used to recruit active and retired Paralympic athletes (AG, n = 43; RG, n = 41, where 35 retired voluntarily and 6 retired involuntarily) with visual or physical impairments, from Dutch-, English-, Portuguese- and Spanish-speaking countries. Participants completed an electronic survey with questionnaires to assess the study variables mentioned above. Descriptive analysis, comparisons (Mann-Whitney U test and t-test) and Spearman's correlation coefficient were performed for the statistical analysis. Scores of AI were significantly lower in the RG (44.6 ± 9.6) compared to the AG (49.4 ± 8.9); t(82) = 2.36, p = .021, d = 0.51. No differences in self-esteem were found between RG and AG; however, within the RG, athletes who involuntarily retired (21 ± 7.1) had significantly lower self-esteem scores than those who retired voluntarily (25.2 ± 4.2); t(39) = 2.04, p = .049, d = 0.73. In conclusion, free choice upon retirement can positively influence the athletes' self-esteem, whereas a strong AI may negatively influence the retirement process, as it was positively correlated with depressive symptoms (ρ = .409, p = .008). These findings can have practical implications for sport psychologists to better support their athletes.

MTHFR gene methylation is associated with perceived stress in healthy young adults

BACKGROUND

Epigenetic factors have been identified in the past years as interesting candidates for psychiatric disorders and related endophenotypes. It has been found that the methylenetetrahydrofolate reductase (MTHFR) gene is associated with major depressive disorder, and the aim of the current study was to examine the possible association between perceived stress and MTHFR methylation, taking into account depressive symptoms as a covariate.

PARTICIPANTS AND METHODS

Seventy-eight healthy Colombian participants (mean age=20.9 years; SD=3.0) were evaluated with the Perceived Stress Scale and with the Patient Health Questionnaire-9 for depressive symptomatology. MTHFR methylation levels were measured with a methylation-sensitive high-resolution melting method. A multiple regression analysis (adjusting for age, sex, and depressive symptoms) was carried out to assess the association between MTHFR methylation and perceived stress scores.

RESULTS

We found a significant inverse correlation between MTHFR methylation levels and perceived stress scores (r=-0.502; P=5.9×10(-5)), which remained significant after being adjusted for age, sex, and depressive symptomatology.

CONCLUSION

To our knowledge, this is the first study that reports an association between perceived stress and MTHFR methylation levels. This report adds evidence to the emerging role of epigenetic changes in endophenotypes related to affective disorders.

Perceived stress and high fat intake: A study in a sample of undergraduate students

Objectives

Different studies have reported the association between perceived stress and unhealthy diet choices. We aimed to determine whether there is a relationship between perceived stress and fat intake among undergraduate medical students.

Methods/Principal findings

A cross-sectional study was performed including first-year medical students. The outcome of interest was the self-report of fat intake assessed using the Block Screening Questionnaire for Fat Intake (high vs. low intake), whereas the exposure was perceived stress (low/normal vs. high levels). The prevalence of high fat intake was estimated and the association of interest was determined using prevalence ratios (PR) and 95% confidence intervals (95%CI). Models were created utilizing Poisson regression with robust standard errors.

Data from 523 students were analyzed, 52.0% female, mean age 19.0 (SD 1.7) years. The prevalence of high fat intake was 42.4% (CI: 38.2%–46.7%). In multivariate model and compared with those with lowest levels of stress, those in the middle (PR = 1.59; 95%CI: 1.20–2.12) and highest (PR = 1.92; 95%CI: 1.46–2.53) categories of perceived stress had greater prevalence of fat intake. Gender was an effect modifier of this association (p = 0.008).

Conclusions

Greater levels of perceived stress were associated with higher fat intake, and this association was stronger among males. More than 40% of students reported having high fat consumption. Our results suggest the need to implement strategies that promote decreased fat intake.

Estresse e Coping de Árbitros de Futebol no Teste Físico FIFA

Resumo Árbitros de futebol parecem sofrer o impacto do estresse em sua atuação, especialmente em situações definidoras de seu sucesso profissional, como a Avaliação Física FIFA, que determina a aptidão física para atuação em campeonatos estaduais e nacionais. Estratégias de coping determinam a percepção de situações estressoras, e consequentemente, a forma de enfrentamento das mesmas. Este estudo teve por objetivo avaliar o impacto do teste físico FIFA nos níveis de estresse e coping de árbitros de futebol atuantes em campeonatos estaduais e nacionais (Federação Mineira de Futebol – FMF e Confederação Brasileira de Futebol – CBF, respectivamente). Responderam a Escala de Estresse Percebido, que avalia estresse negativo (distress) e coping, 42 árbitros da FMF e 17 da CBF, antes e após o teste físico FIFA. Na avaliação pré-teste, verificou-se que os árbitros da CBF apresentaram histórico de mais testes físicos, treinos por semana, anos de experiência, além de escores mais altos em coping (p<0,05). Quando controladas as diferenças iniciais, árbitros CBF e FMF não diferiram significativamente em coping e distress no pós-teste físico. Diante da confirmação parcial das hipóteses, sugere-se a condução de novas pesquisas na área que incluam a avaliação do tipo de estratégia de coping utilizado e características de personalidade dos árbitros.

The Role of Ethnicity and Acculturation in Preoperative Distress in Parents of Children Undergoing Surgery

This study examined the effects of acculturation on anxiety and stress in Latino and non-Latino white parents of children undergoing outpatient surgery. Participants included 686 parent-child dyads from four major children's hospitals in the United States. Latino parents who grew up in the U.S. reported higher levels of anxiety (p = 0.009) and stress (p < 0.001) compared to parents who grew up in a Latin American country. Additionally, English-speaking Latino parents reported higher anxiety and stress compared to both Spanish-speaking Latino and non-Latino white parents (p's < 0.05), whereas Spanish-speaking Latino and non-Latino white parents reported similar levels of stress and anxiety. Results of the current study were consistent with the immigrant health paradox in that more acculturated Latino parents reported higher levels of anxiety and stress than less acculturated Latino and non-Latino white parents, supporting the need for culturally tailored interventions in the perioperative environment.

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study

OBJECTIVES

Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity.

DESIGN

Population-based cohort study.

SETTING

Primary healthcare in Denmark.

PARTICIPANTS

118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.

OUTCOME MEASURES

General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.

RESULTS

Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.

CONCLUSION

Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.

Prediction of parental posttraumatic stress, anxiety and depression after a child's critical hospitalization

OBJECTIVE

To study the role of parental resilience, emotions accessed during admission and perceived stress in predicting the degree of parental posttraumatic stress disorder (PTSD), anxiety and depression symptoms after a child's treatment in intensive care.

METHODS

This was prospective longitudinal cohort study. A total of 196 parents of pediatric intensive care survivors completed questionnaires assessing resilience, perceived stress, emotions experienced during admission, 48h post-discharge (T0). Sociodemographic and medical data were also collected. Main outcomes were anxiety, depression and PTSD, three (T1) and six (T2) months later.

RESULTS

At T2, 23% of parents reported clinically significant levels of symptoms of PTSD, 21% reported moderate-severe anxiety, and 9% reported moderate-severe depression. These rates were not statistically different to rates at T1. Path analyses indicated that 47% of the variance in psychopathology symptoms at T2 could be predicted from the variables assessed at T0. Resilience was a strong negative predictor of psychopathology symptoms, but this effect was mostly indirect, mediated by the stress that parents perceive during their child's critical hospitalization.

CONCLUSIONS

Mobilizing coping in order to maintain resilience and to decrease their perceived stress levels could improve parents' mental health outcomes following their child's intensive care treatment.

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.

Network analysis of multiple risk factors for mental health in young Colombian adults

BACKGROUND

A considerable proportion of young adults are affected by psychological distress at any time and an important fraction of them may develop mental disorders. Use of novel approaches for the analysis of data from multiple psychological scales might facilitate the identification of key indicators of mental health.

AIMS

The aim of current study was to examine the relationship between multiple risk factors for mental illness, using a network analysis perspective.

METHODS

A sample of 334 young Colombian adults (mean age = 21.7) were evaluated with validated scales measuring several psychosocial factors previously associated with mental health (e.g. worry, sleep problems, suicidal ideation, childhood abuse, alcohol related-problems and personality traits). A total of 24 nodes were included in the network analysis and topology, centrality, and stability of the networks were studied.

RESULTS

Specific nodes that occupied critical positions in the network were identified, with worry, perceived distress and low energy being the most central nodes.

CONCLUSIONS

Our explorative findings suggest that a network analysis might identify risk factors that have a central role in the multiple dimensions of emotional health in young adults. These novel analyses could have important applications for the understanding of the psychological functioning affecting mental health.

Chinese version of the Perceived Stress Scale-10: A psychometric study in Chinese university students

Chinese university students often suffer from acute stress, which can affect their mental health. We measured and evaluated perceived stress in this population using the Simplified Chinese version of the 10-item Perceived Stress Scale (SCPSS-10). The SCPSS-10, Patient Health Questionnaire (PHQ), and Generalized Anxiety Disorder 7-item scale (GAD-7) were conducted in 1096 university students. Two weeks later, 129 participants were re-tested using the SCPSS-10. Exploratory factor analysis yielded two factors with Eigen values of 4.76 and 1.48, accounting for 62.41% of the variance. Confirmatory factor analysis demonstrated good fit of this two-factor model. The internal consistency reliability, as measured by Cronbach's α, was 0.85. The test-retest reliability coefficient was 0.7. The SCPSS-10 exhibited high correlation with the PHQ-9 and GAD-7, indicating an acceptable concurrent validity. The SCPSS-10 exhibited satisfactory psychometric properties in Chinese university students.