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

The Effects of Emotional Competences Training among Unemployed Adults: A Longitudinal Study

BACKGROUND

The present study aimed at analyzing whether training in emotional competences (EC) would increase the level of perceived EC among unemployed adults, whether the unemployment duration would moderate the effects of the training and whether the changes in EC would predict changes in the levels of perceived stress, somatic complaints, mental health, and mood states.

METHODS

Seventy-five participants were randomly allocated to an EC training program, or a control group. Following a controlled experimental design, the participants completed all the measures prior to the intervention (T1), one month later (T2) and six months after the first data collection (T3).

RESULTS

The results showed that change in EC after the training depended on the duration of unemployment. The difference between the experimental and control groups in EC after the training was significant when the participants had been unemployed for less time. In addition, the results indicated that changes in EC were found to be significant predictors of changes in perceived stress, mental health, somatic complaints, and vigor and confusion (mood dimensions) six months after the intervention.

CONCLUSION

The data suggest that unemployment duration plays a crucial role in determining the range and intensity of intervention effects.

Cortisol Response to Stress in Adults with Attention Deficit Hyperactivity Disorder

BACKGROUND

Differences in the cortisol response have been reported between children exhibiting the inattentive and hyperactive/impulsive subtypes of attention deficit hyperactivity disorder. However, there is no such information about adults. The aim of the present study was to determine the possible differences between the combined and inattentive subtypes in the cortisol response to stress.

METHODS

Ninety-six adults with attention deficit hyperactivity disorder, 38 inattentive and 58 combined, without any medical or psychiatric comorbidities and 25 healthy controls were included. The Trier Social Stress Test was used to assess physiological stress responses. Clinical data and subjective stress levels, including the Perceived Stress Scale, were also recorded.

RESULTS

No significant differences in the cortisol response to the Trier Social Stress Test were found between patients and controls. However, albeit there were no basal differences, lower cortisol levels at 15 (P=.015), 30 (P=.015), and 45 minutes (P=.045) were observed in the combined compared with the inattentive subtype after the stress induction; these differences disappeared 60 minutes after the stress. In contrast, the subjective stress responses showed significant differences between attention deficit hyperactivity disorder patients and controls (P<.001), but no differences were seen between attention deficit hyperactivity disorder subtypes. In turn, subjective stress measures, such as the Perceived Stress Scale, positively correlated with the whole cortisol stress response (P<.027).

CONCLUSIONS

Both the combined and inattentive attention deficit hyperactivity disorder adults exhibited a normal cortisol response to stress when challenged. Nevertheless, the inattentive patients displayed a higher level of cortisol after stress compared with the combined patients. Despite the differences in the cortisol response, adults with attention deficit hyperactivity disorder reported high levels of subjective stress in their every-day life.

Caregivers' hair cortisol: a possible biomarker of chronic stress is associated with obesity measures among children with disabilities

BACKGROUND

The stress of caring for a loved one with chronic illness has been associated with childhood obesity. Hair cortisol has been proposed as a novel biomarker of chronic psychological stress. This study aimed to evaluate the associations between caregivers' chronic stress evaluated by hair cortisol concentrations (HCC) and obesity measures among children with disabilities such as autism.

METHODS

Eighty-five dyads of children with disabilities and their primary caregivers participated in the study between April and July 2013 in the Patagonia Region, Chile. Trained research staff conducted anthropometric measurements of children and caregivers. Cortisol concentrations, extracted from hair samples with methanol, were quantified using liquid chromatography tandem mass spectrometry. Pearson's correlation coefficients and linear regression models were used to examine the associations between caregiver HCC (log-transformed) and child obesity measures with adjustment for covariates.

RESULTS

Caregiver HCC were positively and significantly correlated with child weight (child age- and sex-adjusted r =0.23, P = 0.036), body mass index (BMI) (r = 0.23, P = 0.035), circumferences of neck (r = 0.30, P = 0.006), waist (r = 0.27, P = 0.014), and hip (r = 0.22, P = 0.044). After adjustment for children's age and sex, caregiver HCC were significantly related to child weight (kg) (beta = 4.47, standard error (SE) = 2.09), BMI (kg/m(2)) (beta = 1.52, SE = 0.71), neck circumference (cm) (beta = 1.20, SE = 0.43), waist circumference (cm) (beta = 3.75, SE = 1.50), and hip circumference (cm) (beta = 3.02, SE = 1.48). Caregiver HCC were also positively but not statistically significantly associated with child waist-to-hip ratio (beta = 0.01, SE = 0.01; P = 0.191) or body fat percentage (%) (beta = 2.11, SE = 1.28; P = 0.104). Further adjustment for other covariates including child disability diagnosis and caregiver age, sex, education, current smoking, perceived stress, and caregiver BMI did not change the results substantially.

CONCLUSIONS

Chronic stress of caregivers, evaluated by increased cortisol concentrations in hair, was positively associated with obesity measures among children with disabilities.

Mental well-being mediates the relationship between perceived stress and perceived health

The association between stress and health has been well researched in the past; however, comparatively few mediators have been tested to understand the underlying mechanism. With increasing awareness on mental well-being, this study evaluated the relationship between perceived stress and perceived health and examined mental well-being as a mediator. Two-hundred undergraduates aged 21 to 26 years completed the English Perceived Stress Scale, Health Status Questionnaire and Asian Mental Well-Being Scale that assess perceived stress, perceived health and mental well-being, respectively. Factor analysis and structural equation modelling on the Perceived Stress Scale replicated the reported two-factor structure after excluding an insignificant item. Linear multiple regression analyses indicated that perceived stress was negatively associated with perceived health. Results showed that mental well-being partially mediated the relationship between perceived stress and perceived health, although it is acknowledged that this association could be bidirectional. Findings from the present study suggest that future research could focus on reducing stress and improving mental well-being to alleviate the effect of stress on health.

Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago

Abstract Objective: Puerto Rican children suffer disproportionately from asthma. Project CURA tested the efficacy of a community health worker (CHW) intervention to improve use of inhaled corticosteroids (ICS) and reduce home asthma triggers in Puerto Rican youth in Chicago.

METHODS

This study employed a behavioral randomized controlled trial design with a community-based participatory research approach. Medications and technique were visually assessed; adherence was determined using dose counters. Home triggers were assessed via self-report, visual inspection and salivary cotinine. All participants received education on core asthma topics and self-management skills. Participants in the CHW arm were offered home education by the CHW in four visits over four months. The attention control arm received four newsletters covering the same topics.

RESULTS

While most of the participants had uncontrolled persistent asthma, <50% had ICS at baseline. In the CHW arms, 67% of participants received the full four-visit intervention. In the Elementary school cohort (n=51), the CHW arm had lower odds of having an ICS (OR=0.2; p=0.02) at 12-months; no differences were seen in other outcomes between arms at any time point. The only significant treatment arm difference in the high school cohort (n=50) was in inhaler technique where the CHW arm performed 18.0% more steps correct at five months (p<0.01) and 14.2% more steps correct at 12 months (p<0.01).

CONCLUSIONS

While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers, important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers.

Measuring Social Capital Investment: Scale Development and Examination of Links to Social Capital and Perceived Stress

Individuals with greater social capital have better health outcomes. Investment in social capital likely increases one's own social capital, bearing great implications for disease prevention and health promotion. In this study, the authors developed and validated the Social Capital Investment Inventory (SCII). Direct effects of social capital investment on perceived stress, and indirect effects through social capital were examined. 397 Participants from Beijing and Wuhan, China completed surveys. Analyses demonstrated that the SCII has a single factor structure and strong internal consistency. Structural equation modeling showed that individuals who invested more in social capital had greater bonding social capital, and subsequently less perceived stress. Results suggest that disease prevention and health promotion programs should consider approaches to encourage social capital investment; individuals may be able to reduce stress by increasing their investment in social capital. Future research is needed to provide additional empirical support for the SCII and observed structural relationships.

Associations between air pollution and perceived stress: the Veterans Administration Normative Aging Study

BACKGROUND

There is mixed evidence suggesting that air pollution may be associated with increased risk of developing psychiatric disorders. We aimed to investigate the association between air pollution and non-specific perceived stress, often a precursor to development of affective psychiatric disorders.

METHODS

This longitudinal analysis consisted of 987 older men participating in at least one visit for the Veterans Administration Normative Aging Study between 1995 and 2007 (n = 2,244 visits). At each visit, participants were administered the 14-item Perceived Stress Scale (PSS), which quantifies stress experienced in the previous week. Scores ranged from 0-56 with higher scores indicating increased stress. Differences in PSS score per interquartile range increase in moving average (1, 2, and 4-weeks) of air pollution exposures were estimated using linear mixed-effects regression after adjustment for age, race, education, physical activity, anti-depressant medication use, seasonality, meteorology, and day of week. We also evaluated effect modification by season (April-September and March-October for warm and cold season, respectively).

RESULTS

Fine particles (PM2.5), black carbon (BC), nitrogen dioxide, and particle number counts (PNC) at moving averages of 1, 2, and 4-weeks were associated with higher perceived stress ratings. The strongest associations were observed for PNC; for example, a 15,997 counts/cm(3) interquartile range increase in 1-week average PNC was associated with a 3.2 point (95%CI: 2.1-4.3) increase in PSS score. Season modified the associations for specific pollutants; higher PSS scores in association with PM2.5, BC, and sulfate were observed mainly in colder months.

CONCLUSIONS

Air pollution was associated with higher levels of perceived stress in this sample of older men, particularly in colder months for specific pollutants.

Smoking and perceived stress in relation to short salivary telomere length among caregivers of children with disabilities

Telomere length (TL), the length of repeated DNA sequence that forms protective caps at the end of chromosomes, has emerged as a novel biomarker of cell aging and oxidative stress. There is increasing research exploring the associations of smoking and perceived stress with TL, and the results are inconsistent. This study aimed to examine whether smoking and perceived stress were associated with shortened salivary TL among primary caregivers of children with disabilities. Using a quantitative polymerase chain reaction method, salivary TL was assessed among 89 caregivers aged 19-69 years (87% were women) who took care of disabled children in the Patagonia Region, Chile. Interviewer-administered questionnaires were used to collect information on sociodemographic and lifestyle factors. The 14-item Perceived Stress Scale was used to assess perceived stress. Mean relative TL was 0.92 (standard error = 0.03). Smokers had age-adjusted mean TL that was 0.07 units lower (β = -0.07, standard error = 0.03; p = 0.012) than non-smokers. Smokers were 2.17 times more likely to have shorter TL ( < 0.73, the lowest quartile of TL) than non-smokers (odds ratio = 3.17; 95% confidence interval = 1.05-9.52) with adjustment for age and perceived stress. Caregivers with higher perceived stress were 2.13 times more likely to have shorter TL (odds ratio = 3.13; 95% confidence interval = 1.03-9.55) than caregivers with lower perceived stress after adjustment for age and smoking. This study provides the first evidence of strong associations between smoking and perceived stress and shortened salivary TL among caregivers of children with disabilities. Larger studies with detailed information on smoking status are warranted to confirm our findings.

Evaluation of psychometric properties of the malay version perceived stress scale in two occupational settings in malaysia

Background:

The 10-item version of Perceived Stress Scale (PSS-10) is a widely used tool to measure stress. The Malay version of the PSS-10 has been validated among Malaysian Medical Students. However, studies have not been conducted to assess its validity in occupational settings.

Aim:

The aim of this study is to assess the psychometric properties of the Malay version of the PSS-10 in two occupational setting in Malaysia.

Subjects and Methods:

This study was conducted among 191 medical residents and 513 railway workers. An exploratory factor analysis was performed using the principal component method with varimax rotation. Correlation analyses, Kaiser-Meyer-Olkin, Bartlett's test of Sphericity and Cronbach's alpha were obtained. Statistical analysis was carried out using statistical package for the social sciences version 16 (SPSS, Chicago, IL, USA) software.

Results:

Analysis yielded two factor structure of the Malay version of PSS-10 in both occupational groups. The two factors accounted for 59.2% and 64.8% of the variance in the medical residents and the railway workers respectively. Factor loadings were greater than 0.59 in both occupational groups. Cronbach's alpha co-efficient was 0.70 for medical residents and 0.71 for railway workers.

Conclusion:

The Malay version of PSS-10 had adequate psychometric properties and can be used to measure stress among occupational settings in Malaysia.

Psychological stress exerts effects on pathogenesis of hepatitis B via type-1/type-2 cytokines shift toward type-2 cytokine response

BACKGROUND

Psychological and physical stress has been demonstrated to have an impact on health through modulation of immune function. Despite high prevalence of stress among patients with hepatitis B virus (HBV) infection, little is known about whether and how stress exerts an effect on the course of hepatitis B.

METHODS

Eighty patients with chronic hepatitis B(CHB) completed the Perceived Stress Scale-10(PSS-10) and State-Trait Anxiety Inventory(STAI). Fresh whole blood was subject to flow cytometry for lymphocytes count. Plasma samples frozen at -80 °C were thawed for cytokines, alanine aminotransferase (ALT), and virus load. These patients were grouped into high or low perceived stress, state anxiety and trait anxiety groups according to the scale score. Sociodemographic, disease-specific characteristics, lymphocytes count and cytokines were compared.

RESULTS

Firstly, a negative association between ALT and stress (t =  -4.308; p =  .000), state anxiety (t =  -3.085; p =  .003) and trait anxiety (t =  -4.925; p =  .000) were found. As ALT is a surrogate marker of hepatocytes injury, and liver injury is a consequence of immune responses. Next, we tested the relationship between stress/anxiety and lymphocytes. No statistical significance were found with respect to counts of total T cells, CD4+ T cell, CD8+ T cell, NK cell, and B cell count between high and low stress group. Type-2 cytokine interleukin-10 (IL-10) level was significantly higher in high stress group relative to lower counterpart (t = 6.538; p = 0.000), and type-1 cytokine interferon-gamma (IFN-γ) level shown a decreased tendency in high stress group (t =  -1.702; p = 0.093). Finally, INF-γ:IL-10 ratio displayed significant decrease in high perceived stress(t =  -4.606; p = 0.000), state anxiety(t =  -5.126; p = 0.000) and trait anxiety(t =  -4.670; p = 0.000) groups relative to low counterparts.

CONCLUSION

Our data show stress is not related to the lymphocyte cells count in CHB patients, however, stress induces a shift in the type-1/type-2 cytokine balance towards a type-2 response, which implicated a role of psychological stress in the course of HBV related immune-pathogenesis.

The perceived stress scale (PSS): normative data and factor structure for a large-scale sample in Mexico

One of the most widely used scales for the evaluation of stress is the Perceived Stress Scale (PSS), and it has been adapted into different languages. However, few studies have presented normative data from large samples, and there do not appear to be any studies of the PSS that provide normative data based on large samples for Mexico. Thus, the goal of this study was to provide normative data regarding gender and different age groups for a sample of 1990 Mexican subjects to validate the factor structure of the construct for this sample. The analysis of the 10- and 14-item versions of the PSS revealed that the scale had adequate reliability and that the factor structure was consistent with previous studies. With respect to the normative data, the means of the different groups ranged from 20.93 to 25.63 for the PSS14 and from 14.52 to 17.73 for the PSS10. We propose that scores within one standard deviation of these means be used as reference values for each group.

Validation of the Perceived Stress Scale in a community sample of older adults

BACKGROUND

Three versions of Perceived Stress Scale (PSS-14, PSS-10, and PSS-4) are among the most widely used measures of stress. The aim of the current study was to validate this instrument in a sample of nondemented older adults to facilitate studies of the impact of stress on health.

METHODS

Seven hundred sixty-eight nondemented adults over the age of 70 years completed the PSS-14 questionnaire and other neuropsychological tests. Exploratory factor analysis was used to determine the underlying factor structure of all PSS versions, and confirmatory factor analysis was used to test the construct validity of factors. The internal consistency reliability of the scales was assessed using Cronbach's alpha, and concurrent validity was evaluated by examining PSS relation with age, gender, depression, anxiety, and Positive Affect and Negative Affect Schedule.

RESULTS

A two-factor model was the optimal fit for the 14-item and 10-item versions of PSS. For PSS-14, all items' loadings exceeded 0.4 for one of the two factors except item 12. Therefore, we studied a 13-item version of PSS and 10-item and 4-item subsets representing PSS-10 and PSS-4. Internal consistency coefficients were satisfactory for the full scale of PSS-13 and PSS-10 but not for PSS-4. Women reported higher levels of stress than men. Higher levels of total PSS scores showed association with higher levels of depression, anxiety, and negative affect, and lower level of positive affect.

CONCLUSIONS

The 13-item and 10-item versions of PSS may be used to understand the experience of stress among older adults.

Assessing Workplace Bullying: Spanish Validation of a Reduced Version of the Negative Acts Questionnaire

The aim of the present study was to validate a reduced Spanish version of the Negative Acts Questionnaire (NAQ; Einarsen & Raknes, 1997). This instrument, which has been widely used in various studies, was developed to measure workplace bullying. Two samples, the first comprising 352 employees from 11 organizations, and the second comprising victims of bullying who were recruited from 15 Spanish associations against bullying, participated in the study. Exploratory factor analysis conducted with the data from the first sample revealed a two-factor solution that accounted for 63.3% of the total variance. The data from the second sample were used for confirmatory factor analyses to compare three structure models of the NAQ (one factor, two independent factors, and two correlated factors). The results indicate that the correlated two-factor model provided the best fit to the data (χ2/df = 2.1, CFI = .93, GFI = .95, RMR = .04, RMSEA = .06, AIC = 215.4). Reliability analysis showed that this 14-item Spanish version had high internal consistency. Significant correlations between the NAQ and its dimensions and diverse health and perceived stress scales were found, which provided evidence of construct validity. Taken conjointly, the results of this study support the use of the Spanish version of the reduced NAQ in future research.

Evaluation of Amigas Latinas Motivando el Alma (ALMA): a pilot promotora intervention focused on stress and coping among immigrant Latinas

Recent immigrant Latinas are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. This study evaluated Amigas Latinas Motivando el Alma, a promotora intervention to reduce stress and promote health and coping among recent immigrant Latinas. Using a pre- and post-test design, we evaluated mental health outcomes, specifically, in promotoras. Promotoras' knowledge levels related to role of promotora and stress management increased, depressive symptoms and stress levels decreased, and coping responses and perceived social support increased as well. Results suggest that promotora programs may be an effective way to improve mental health in recent immigrant Latinas.

Effectiveness of Mindfulness-Based Cognitive Therapy on the Quality of Life, Emotional Status, and CD4 Cell Count of Patients Aging with HIV Infection

Long-term diagnosed and treated HIV-infected patients have to cope with a wide range of challenges that threaten their ability to age successfully. We report the results of a randomized controlled trial testing the effects of a mindfulness-based cognitive therapy (MBCT) program on quality of life (QoL), emotional status, and immune status over a 3-month period. Forty HIV-infected patients diagnosed prior to 1996 and on cART for a minimum of 5 years were randomized to follow an MBCT program (n = 20) or remain as controls (routine follow-up) (n = 20). A regression analysis was performed, and the measurement of effect size was estimated using Cohen's d. QoL, psychological stress, depressive symptoms, and anxiety symptoms improved in the MBCT group compared with the control group. During follow-up, patients in the MBCT group had a significantly increased CD4 cell count. Effect sizes for MBCT on the variables assessed were large (d = 0.8). The findings suggest that this program may help to promote successful aging in these patients.

Korean versions of the Perceived Stress Scale (PSS-14, 10 and 4): psychometric evaluation in patients with chronic disease

BACKGROUND

The Perceived Stress Scale (PSS) is a representative instrument used to measure stress. The original PSS comprises 14 items (PSS-14) in two subscales, but 10- and 4-item versions are also available (PSS-10 and 4, respectively). The target populations of psychometric studies using the PSS have far mainly comprised college students, and the underlying constructs of the PSS versions are controversial: one factor vs. two factors and first order vs. second order.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the Korean versions of the PSS-14, 10 and 4 (designated KPSS-14, 10 and -4, respectively) in patients with chronic disease.

METHODS

The PSS-14, 10 and 4 were translated into Korean using forward and backward translation. Factorial construct validity was tested using both exploratory and confirmatory factor analyses. Item convergent validity and item discriminant validity were tested. Concurrent validity was examined using the Center for Epidemiologic Studies-Depression scale. Known-groups validity was analysed using t-test and effect size. Reliability was tested using Cronbach's alpha and the intraclass correlation coefficient.

RESULTS

Exploratory factor analysis supported a two-factor model for all Korean versions of the PSS, and confirmatory factor analysis indicated that the model fit the KPSS-10 well and the KPSS-4 only marginally. The testing of item convergent and discriminant validity revealed a 100% scaling success. As expected, all scores in the KPSS-14, 10 and 4 were moderately correlated with depression scores and differed significantly according to gender. The Cronbach's alpha for the KPSS-14 and 10 exceeded the criterion of 0.70. The intraclass correlation coefficient values of all three Korean versions were satisfied.

CONCLUSIONS

The KPSS-10 exhibited a first-order, two-factor construct, and excellent reliability and validity were established for Korean patients with chronic disease. The psychometric properties of the shortest version, KPSS-4, were only marginally acceptable.

Cervical cancer screening adherence among HIV-positive female smokers from a comprehensive HIV clinic

HIV-positive women are at elevated risk for developing cervical cancer. While emerging research suggests that gynecologic health care is underutilized by HIV-positive women, factors associated with adherence to Pap testing, especially among HIV-positive female smokers are not well known. We utilized baseline data from a smoking cessation trial and electronic medical records to assess Pap smear screening prevalence and the associated characteristics among the HIV-positive female participants (n = 138). 46 % of the women had at least 1 Pap test in the year following study enrollment. Multiple logistic regression analysis indicated that younger age, African American race, hazardous drinking, increased number of cigarettes smoked per day, and smoking risk perception were associated with non-adherence to Pap smear screening. Cervical cancer screening was severely underutilized by women in this study. Findings underscore the importance of identifying predictors of non-adherence and addressing multiple risk factors and behavioral patterns among HIV-positive women who smoke.

Correlates of high perceived stress among pregnant Hispanic women in Western Massachusetts

Prenatal psychosocial stress has been associated with adverse pregnancy outcomes, even after controlling for known risk factors. This paper aims to evaluate correlates of high perceived stress among Hispanic women, a group with elevated rates of stress during pregnancy. We conducted this analysis among 1,426 pregnant Hispanic women using data from Proyecto Buena Salud, a prospective cohort study conducted in Western Massachusetts. Cohen's Perceived Stress Scale (PSS-14) validated in English and Spanish was administered in early (mean = 12.4 weeks gestation), mid (mean = 21.3 weeks gestation) and late (mean = 30.8 weeks gestation) pregnancy at which time bilingual interviewers collected data on socio-demographic, acculturation, behavioral, and psychosocial factors. High perceived stress was defined as a PSS score >30. Young maternal age (odds ratio (OR) = 0.6; 95 % confidence interval (CI) 0.4-0.9 for <19 vs. 19-23 years), pre-pregnancy consumption of alcohol (OR = 2.2; 95 % CI 1.4-3.5 for >12 drinks/month vs. none) and smoking (OR = 2.2; 95 % CI 1.3-3.7 for >10 cigarettes/day vs. none) were associated with high perceived stress during early pregnancy. Furthermore, higher annual household income (OR = 0.4; 95 % CI 0.1-0.9 for >$30,000 vs. <$15,000), greater number of adults in the household (OR = 1.8; 95 % CI 1.1-3.0 for ≥3 vs. 1) and language preference (OR = 0.6; 95 % CI 0.4-0.9 for Spanish vs. English) were associated with high stress during mid-pregnancy. Likewise, annual household income was inversely associated with high stress during late pregnancy. Our results have important implications for incorporation of routine screening for psychosocial stress during prenatal visits and implementation of psychosocial counseling services for women at high risk.

Psychometric Evaluation of the Perceived Stress Scale in Multiple Sclerosis

Multiple sclerosis (MS) is a progressive disease characterized by neurological symptoms and sometimes heightened levels of distress. The Perceived Stress Scale (PSS) is often used in MS samples to measure stress but has not been validated in this population. Participants (n=446) completed the PSS as well as measure of depression, anxiety, and mental and physical health. Factor analyses indicated that the general factor of a bifactor model accounted for a large amount of the variance in the 14-item and 10-item versions of the PSS. The 4-item PSS had two factors, the Stress subscale and the Coping subscale, but a one-factor model also fits the data well. Total scores and both subscales had sufficient reliability and validity for all versions of the PSS, although a few items of the 14-item PSS had low item-total correlations. This study supports the use of the total score of the PSS in MS but also suggests that the 10-item PSS had better psychometric properties than the 14-item PSS.

Intestinal recruiting and activation profiles in peripheral blood mononuclear cells in response to pathogen-associated molecular patterns stimulation in patients with IBS

BACKGROUND

Immune activation, increased Toll-like Receptors (TLR) expression, and gut epithelial diffusion of bacterial molecules have been reported in irritable bowel syndrome (IBS). Thus, we sought to relate these factors by analyzing gut homing (integrin α4β7), intestinal recruiting (CCR5) and activation (CD28) phenotypes, and the cytokines and chemokines concentration in peripheral blood T-lymphocytes stimulated with TLR-ligands.

METHODS

Twenty-one IBS-Rome II (1 PI-IBS) patients and 19 controls were studied. Isolated peripheral blood mononuclear cells were cultured with and without Escherichia coli lipopolysaccharide (LPS), Staphylococcus aureus peptidoglycan (PGN), and unmethylated cytosine-phosphate-guanine motifs (CpG). Phenotypes were investigated by flow cytometry and supernatant cytokines and chemokines were also measured.

KEY RESULTS

After LPS, CCR5 expression in CD4⁺ α4β7⁺ cells remained unchanged in IBS, but decreased in controls (p = 0.002), to lower levels than in IBS (Mean fluorescence intensity [MFI]: 1590 ± 126.9 vs 2417 ± 88.4, p < 0.001). There were less CD8(+) α4β7⁺ CCR5⁺ cells (85.7 ± 1.5 vs 90.8 ± 0.9%, p = 0.006) after LPS and CD3⁺ α4β7⁺ CCR5⁺ (40.0 ± 1.7 vs 51.2 ± 4.3%, p = 0.006) after PGN in controls. Also, after LPS, CD28 decreased in CD4⁺ α4β7⁺ CCR5⁺ in IBS (MFI: 2337 ± 47.2 vs 1779 ± 179.2, p < 0.001), but not in controls. Cytokines and chemokines were similar, except for lower IL8/CXCL8 in the unstimulated condition in IBS (4.18, 95% CI: 3.94-4.42 vs 3.77, 3.59-3.95; p = 0.006).

CONCLUSIONS & INFERENCES

Pathogen-associated molecular patterns stimulation of peripheral blood T cells expressing gut homing marker in IBS compared with controls resulted in an unsuccessful down-regulation of the co-expression of intestinal recruiting/residence phenotype and a state of activation. These findings support an interaction between an innate immune predisposition and microbial triggers, which may unleash or exacerbate IBS.

Chronic stress and calcium oxalate stone disease: influence on blood cortisol and urine composition

OBJECTIVE

To evaluate the influence of chronic stress (CS) on urine composition of calcium oxalate (CaOx) stone patients and controls.

METHODS

This case-control study enrolled 128 patients during a period of 20 months. The cases were CaOx stone formers with a recent stone episode. Controls were matched by sex and age. Dimensions of CS were evaluated in cases and controls by validated self-report questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout, and satisfaction with life. Blood and urine samples were collected to determine cortisol levels and urinary composition.

RESULTS

More relations between CS dimensions and blood and urine parameters were observed in cases than in controls. In cases, the blood cortisol level was related positively with the number of stressful life events (P = .03), intensity of these events (P = .04), and anxiety (P = .04). In addition, urinary magnesium (P = .03) and pyrophosphate (P = .05) levels were positively related with satisfaction with life and burnout, respectively. In contrast, urinary magnesium levels were negatively related with perceived stress (P = .01), anxiety (P = .016), and depression (P = .03). In controls, the number of stressful life events and the intensity of stressful life events was related positively with magnesium (P = .06, P = .02) levels and negatively with blood cortisol levels (P = .03, P = .004).

CONCLUSION

Based on the variation between cases and controls in relations between CS dimensions and biochemical parameters, we hypothesize that CS may trigger a differential biological response in CaOx stone formers and controls, which in turn may promote or protect against CaOx stone formation.

Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale

The perceived stress scale (PSS) has been translated to several languages and validated in many cultures. The longer 14-item version (PSS-14), has been translated to Swedish and validated for Swedish use. However, the Swedish version of the shorter 10-item version (PSS-10) has not been validated before. Therefore, the aim of this study was to evaluate the Swedish version of the PSS-10 with regard to reliability and validity, and to provide normative data. Data from 3,406 individuals who took part in the Västerbotten Environmental Health Study in Sweden were used. The respondents constitute a random sample, aged 18 to 79 years, and stratified for age and sex. They responded to the Swedish version of the PSS-10 as well as to the hospital anxiety and depression scale, and the Shirom Melamed burnout questionnaire for assessment of construct validity. The results show that the PSS-10 provides approximately normally distributed data, has good internal reliability (Cronbach's alpha 0.84), and has good construct validity with anxiety (r = 0.68), depression (r = 0.57), and mental/physical exhaustion (r = 0.71). The favorable psychometric properties of the Swedish version of the PSS-10 suggest use of the instrument for assessing perceived stress in Swedish and similar populations.

Predictors of stress of parents of a child with cancer: a Jordanian perspective

BACKGROUND

Most paediatric oncology studies agree that being parents of a child with cancer is an emotionally stressful event. Although an increasing number of studies have investigated psychological stress of parents of a child with cancer, few of these studies have included both parents or investigated the predictors of high stress levels for the mothers and the fathers. Moreover, studies published over the last few decades were limited to Western countries and have shown inconsistent findings about parental perceived stress whose children have cancer. This study explored differences in predictors of perceived stress between Jordanian mothers and fathers of children with cancer.

METHODS

This study involved a survey of 300 couples parenting a child with cancer. Participants answered the Arabic version of the Perceived Stress Scale 10-items, demographic and characteristics check list questionnaires. The main aims were to measure perceived stress levels for mothers and fathers, explore the predictors associated with high perceived stress levels and make a comparison between them.

FINDINGS

Mothers reported significantly higher stress levels than fathers (p<0.001), with a large effect size (0.30). Some of the factors associated with mothers and fathers high stress levels affected both parents whereas employment status affected only fathers' stress levels.

CONCLUSIONS

These findings indicate the need to work with the mothers and the fathers with a child with cancer in Jordan to recognise their psychological needs at the time of diagnosis and followed by on-going psychological support for both parents.

The migration process as a stress factor in pregnant immigrant women in Spain

Spain has seen a significant increase of the immigrant population in the past two decades. There are 5.6 million registered immigrants in this country, and 63% of them range in age between 16 and 41 years; 47% of the immigrant population are women. This situation requires additional health care, particularly as it pertains to the sexual and reproductive health of female immigrants. The objective of our study was to determine if there were differences between women of Spanish origin and immigrant women in terms of obstetric outcomes (obstetric history, gestational age at end of gestation, and at delivery) and various psychological variables during the immediate postpartum period. This was a cross-sectional study-we evaluated 30 women of Spanish origin and 30 immigrant women during the immediate postpartum period. During the 4 months after delivery, we proceeded to gather perinatal data for the study participants from their health records, partograms, and nursing assessment notes. Additionally, and following the immediate postpartum period, participants filled out the Stress Perception and Stress Vulnerability Questionnaires, as well as the Optimism Scale. Immigrant women have greater perception of stress (p = .00) and vulnerability to stress (p = .001) than do Spanish women. However, no group differences were found in obstetric variables.

How do psychological variables influence coping strategies in inflammatory bowel disease?

BACKGROUND

Adjusting to chronic disease is a complex process and one that, in the case of inflammatory bowel disease (IBD), has received very little attention. The objectives of this study were to identify coping strategies used by patients with IBD and to explore how these strategies are related to psychological characteristics.

METHODS

A transversal study was designed in which 875 patients with IBD were prospectively enrolled. Independent variables were evaluated using a sociodemographic questionnaire and a clinical questionnaire-the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS); dependent variables were evaluated using the COPE Inventory (Coping Orientation to Problems Experienced), a multidimensional scale for evaluating general coping styles. Multiple linear regression was used to identify the variables associated with the type of coping used.

RESULTS

The participation rate was 91.3%. The most common coping strategy was emotion-focused coping (X=2.64; 95% CI=2.61-2.69), with no differences in relation to type of disease. The highest scores for anxiety were associated with emotion-focused coping (β=0.164, p=0.001) whereas, for depression, the highest scores were associated with escape-avoidance (β=0.108, p=0.044). No correlation was found between stress levels and type of coping.

CONCLUSIONS

Patients with IBD have a tendency to focus on emotions in their coping process, and this process appears to be related not only to sociodemographic characteristics or features of the disease itself but also to psychological factors-anxiety and depression, primarily.

Perceived Stress and Depressive Symptoms Among Latino Adults

The present study examined whether ethnic identity cluster patterns, using Ethnic Identity Scale (EIS) subscale scores, moderated the relationship between perceived stress and depressive symptoms. Participants were 390 Latino adults from a moderately sized Midwestern city. Four ethnic identity cluster patterns were identified through cluster analysis: Achieved Positive, Diffuse Positive, Foreclosed Positive, and Diffuse Negative. Results from a moderated multiple regression analysis indicated a significant interaction effect of ethnic identity clusters (i.e., Achieved Positive vs. Diffuse Negative) and perceived stress on depressive symptoms. Specifically, at lower levels of stress, no significant difference was found; whereas, at higher levels of stress, individuals with Achieved Positive cluster patterns had significantly lower levels of depressive symptoms than individuals with Diffuse Negative cluster patterns. The findings are discussed within the context of ethnic identity theory and the implications for research and clinical conceptualizations.

[Validity of the Connor-Davidson resilience scale (10 items) in a population of elderly]

AIMS

To examine the psychometric properties of the Spanish version of the CD-RISC 10-items in a sample of the elderly population of Cuenca, Spain; and to assess if the Spanish version preserves the same factorial structure as the original one.

METHODS

A cross sectional study was conducted in five health centres in the province of Cuenca. The study included a random sample of 500 people aged 60-75 years who lived within the community.

MEASUREMENTS

The sociodemographic variables, CD-RISC-10 (resilience), PSS (perceived stress), SF-12v2, Pfeiffer Short Portable Mental Status questionnaire, GDS (geriatric depression), and MOS (social support), were all used to gather data. The number of factors underlying the CD-RISC 10 items was analysed using exploratory factor analysis. Furthermore, this factor structure was tested by confirmatory factor analysis.

RESULTS

A single underlying factor was found in the CD-RISC 10 items. The factor structure was tested using confirmatory factor analysis and it was found that a single factor model showed acceptable goodness of fit values for both men and women. Convergent validity was performed to test whether the mean scores of the variables were significantly associated with resilience. The Cronbach's α coefficient for the CD-RISC 10 items scale was 0.81. The overall scores of the Spanish version of the CD-RISC-10 items correlated directly with MOS and the physical and mental components of SF-12, and inversely with the PSS and GDS.

CONCLUSIONS

The Spanish version of the CD-RISC-10 showed good psychometric properties. Thus, it can be used as a valid and reliable instrument to measure resilience in the non-institutionalized older population.

Validation of a Greek version of PSS-14; a global measure of perceived stress

AIM

To evaluate validity of the Greek version of a global measure of perceived stress PSS-14 (Perceived Stress Scale - 14 item).

MATERIALS AND METHODS

The original PSS-14 (theoretical range 0-56) was translated into Greek and then back-translated. One hundred men and women (39 +/- 10 years old, 40 men) participated in the validation process. Firstly, participants completed the Greek PSS-14 and, then they were interviewed by a psychologist specializing in stress management. Cronbach's alpha (a) evaluated internal consistency of the measurement, whereas Kendall's tau-b and Bland & Altman methods assessed consistency with the clinical evaluation. Exploratory and Confirmatory Factor analyses were conducted to reveal hidden factors within the data and to confirm the two-dimensional character of the scale.

RESULTS

Mean (SD) PSS-14 score was 25(7.9). Strong internal consistency (Cronbach's alpha = 0.847) as well as moderate-to-good concordance between clinical assessment and PSS-14 (Kendall's tau-b = 0.43, p < 0.01) were observed. Two factors were extracted. Factor one explained 34.7% of variability and was heavily laden by positive items, and factor two that explained 10.6% of the variability by negative items. Confirmatory factor analysis revealed that the model with 2 factors had chi-square equal to 241.23 (p < 0.001), absolute fix indexes were good (i.e. GFI = 0.733, AGFI = 0.529), and incremental fix indexes were also adequate (i.e. NFI = 0.89 and CFI = 0.92).

CONCLUSION

The developed Greek version of PSS-14 seems to be a valid instrument for the assessment of perceived stress in the Greek adult population living in urban areas; a finding that supports its local use in research settings as an evaluation tool measuring perceived stress, mainly as a risk factor but without diagnostic properties.

Review of the psychometric evidence of the perceived stress scale

PURPOSE

The purpose of this study was to review articles related to the psychometric properties of the Perceived Stress Scale (PSS).

METHODS

Systematic literature searches of computerized databases were performed to identify articles on psychometric evaluation of the PSS.

RESULTS

The search finally identified 19 articles. Internal consistency reliability, factorial validity, and hypothesis validity of the PSS were well reported. However, the test-retest reliability and criterion validity were relatively rarely evaluated. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst. The psychometric properties of the PSS have been evaluated empirically mostly using populations of college students or workers.

CONCLUSION

Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. However, future studies should evaluate these psychometric properties in greater depth, and validate the scale using diverse populations.

Clinical stress assessment using a visual analogue scale

BACKGROUND

Clinicians increasingly require short, efficient methods for assessing distress, both in applied research and clinical settings. Most of the available questionnaires are unsuitable for busy clinical settings. The visual analogue scale (VAS) is widely but empirically used to assess perceived stress.

AIMS

To provide evidence on two of the psychometric properties of the VAS: its discriminative sensitivity (capacity to highlight a difference between groups) and its interconcept validity (the relationship between VAS stress assessment and the assessment of different, but similar concepts).

METHODS

Employees attending occupational health centres were randomly selected and completed the VAS and also either the Perceived Stress Scale (PSS) or the Hospital Anxiety and Depression Scale (HADS). Analyses of variance were performed to study group effects (age, sex, marital status, parental status, occupational status) on stress scores (PSS and VAS).

RESULTS

In total, 763 employees participated of whom 501 completed the PSS and 262 the HADS. P-values obtained for the effects of sex, age and occupational status were lower with the VAS than with the PSS. Correlations between the VAS and the anxiety subscale, depression subscale and total score of the HADS were 0.66, 0.45 and 0.65, respectively. Other tools used to assess aspects of psychological distress are known to have similar correlations.

CONCLUSIONS

Our findings provide evidence that the VAS is at least as discriminating as a questionnaire when it comes to highlighting differences in stress levels between two groups, and the observed correlations with related constructs support its construct validity.

Time, touch, and compassion: effects on autonomic nervous system and well-being

OBJECTIVE

Compassion is critical for complementary and conventional care, but little is known about its direct physiologic effects. This study tested the feasibility of delivering two lengths of time (10 and 20 minutes) and two strategies (tactile and nontactile) for a practitioner to nonverbally communicate compassion to subjects who were blind to the interventions.

METHODS

Healthy volunteers were informed that we were testing the effects of time and touch on the autonomic nervous system. Each subject underwent five sequential study periods in one study session: (1) warm-up; (2) control-with the practitioner while both read neutral material; (3) rest; (4) intervention-with practitioner meditating on loving-kindness toward the subject; and (5) rest. Subjects were randomized to receive one of four interventions: (1) 10 minutes tactile; (2) 20 minutes tactile; (3) 10 minutes nontactile; or (4) 20 minutes nontactile. During all interventions, the practitioner meditated on loving-kindness toward the subject. For tactile interventions, the practitioner touched subjects on arms, legs, and hands; for nontactile interventions, the practitioner pretended to read. Subjects' autonomic activity, including heart rate, was measured continuously. Subjects completed visual analog scales for well-being, including relaxation and peacefulness, at warm-up; postcontrol; immediately postintervention; and after the postintervention rest and were asked about what they and the practitioner had done during each study period.

RESULTS

The 20 subjects' mean age was 24.3 ± 4 years; 16 were women. The practitioner maintained a meditative state during all interventions as reflected in lower respiratory rate, and subjects remained blind to the practitioner's meditative activity. Overall, interventions significantly decreased heart rate (P < .01), and although other changes did not reach statistical significance, they were in the expected direction, with generally greater effects for the tactile than nontactile strategies and for 20-minute than 10-minute doses.

CONCLUSIONS

Two strategies are feasible for blinding subjects to nonverbal communication of compassion; even with blinding, nonverbal communication of compassion affects subjects' autonomic nervous system. These results should be replicated in larger samples, including patient populations, and mechanisms sought to explain observed effects. Compassion is not only good care; it may also be good medicine.

Recruitment, asthma characteristics, and medication behaviors in Midwestern Puerto Rican youth: data from Project CURA

BACKGROUND

Puerto Rican children have the highest prevalence of asthma, but detailed descriptions of this population have been limited to the island of Puerto Rico and the northeastern United States.

OBJECTIVE

To describe the asthma characteristics of this urban Midwest cohort of Puerto Rican youth, focusing on medication behaviors, and to test whether their asthma outcomes are associated with their demographic and psychosocial variables.

METHODS

Data are from the baseline cohorts of a randomized controlled trial designed to improve medication adherence in Puerto Rican youth. Recruitment used a community-based participatory research approach. Data were collected in the home. Medications and medication technique were visually assessed, and adherence was determined using electronic medication monitors or counters. Data on asthma symptoms and morbidity, demographics, and psychosocial factors were collected.

RESULTS

The recruitment of 101 participants (51 in elementary school and 50 in high school) was completed in 14 months. Despite overall high asthma severity and poor asthma control, 20% of participants had no reliever medicine in their home. Self-report of controller use was higher than actual controller medications visualized in the home. For those who had an inhaled corticosteroid medicine (only 45% of elementary school participants and 12% of high school participants), median adherence was 1.0 doses per day. Rates of depression and stress were very high among both caregivers and children.

CONCLUSION

Puerto Rican youth in the Midwest bear a significant asthma burden in addition to other stressors, including depression. Visual inspection of medications and monitoring of adherence are critical for understanding asthma morbidity in this high-risk population.

Parental stress when caring for a child with cancer in Jordan: a cross-sectional survey

BACKGROUND

Most studies report that being parents of a child with cancer is a stressful experience, but these have tended to focus on mothers and few have included both parents. Moreover, studies have focussed on families in Western countries and none have been published examining the psychological outcomes for parents living in an Arabic country.This research explores the stress levels of Jordanian parents caring for a child with cancer in order to identify the psychological needs of parents in this environment and to explore how mothers and fathers stress levels might differ.

METHODS

The study was carried out in Jordan using the Perceived Stress Scale 10-items (PSS10). The questionnaire was completed by 300 couples with a child who has cancer and a comparison group of 528 couples where the children do not have any serious illness. Multivariate backward regression analysis was carried out.

RESULTS

Analysis adjusting for spousal stress and sociodemographic predictors revealed that stress levels of mothers with a child who had cancer remained significantly higher than mothers whose children did not have any serious illness (p < 0.001). However, having a child with cancer did not show a significant association with the fathers' reported stress scores (p = 0.476) when spousal stress was in the model, but was highly significant once that was removed (p < 0.001).Parental stress was analysed for those with a child who has cancer and in models which included spouse's stress scores, sociodemographic and cancer-related predictors 64 % of the variance was explained for mothers (adjusted R2 = 0.64, p < 0.001) and fathers (adjusted R2 = 0.64, p < 0.001). Models excluding spousal stress scores explained just 26 % of the variance for fathers and 22 % for mothers.

CONCLUSIONS

This is the first study into the psychological outcomes for parents living in an Arabic country who care for a child with cancer. Both mothers and fathers with a child diagnosed with cancer reported higher stress levels than those from the normal Jordanian parent population. Mothers and fathers of children with cancer reported significantly different levels of stress to each other but models reveal significant contributions of the stress score of fathers upon mothers, and vice versa. The findings provide evidence of the need for psychological support to be developed for families caring for a child with cancer in Jordan.

Emotional and symptomatic reactivity to stress in individuals at ultra-high risk of developing psychosis

BACKGROUND

The stress-vulnerability model of psychosis continues to be influential. The aim of this study was to compare emotional and symptomatic responses to stress in individuals at ultra-high risk (UHR) of developing psychosis, in age- and gender-matched healthy controls, and in patients with non-affective psychosis.

METHOD

A total of 27 UHR, 27 psychotic and 27 healthy individuals completed the experience sampling method, an ambulant diary technique, where they were required to fill in self-assessment questions about their emotions, symptoms and perceived stress at semi-random times of the day for 6 days. Quesionnaire and interview assessments were also completed.

RESULTS

Multilevel regression analyses showed that individuals at UHR of developing psychosis reported greater negative emotions in response to stress than the healthy individuals. Against the initial hypotheses, the UHR individuals also experienced greater emotional reactivity to stress when compared with the patient group. No significant differences were observed between the patients and the non-clinical sample. Stress measures significantly predicted the intensity of psychotic symptoms in UHR individuals and patients, but the extent of this did not significantly differ between the groups.

CONCLUSIONS

Individuals at UHR of developing psychosis may be particularly sensitive to everyday stressors. This effect may diminish after transition to psychosis is made and in periods of stability. Subtle increases in psychotic phenomena occur in response to stressful events across the continuum of psychosis.

Psychological stress is associated with high levels of IL-6 in HIV-1 infected individuals on effective combined antiretroviral treatment

This study explores the role of psychological stress in the circulating levels of interleukin-6 (IL-6) in a group of HIV-1 infected individuals on effective cART. We developed a cross-sectional study with 50 individuals with confirmed diagnosis of HIV-1 infection ≥1 and ≤8 years, on continuous cART for >1 and <8 years and with plasma viral load <50 copies/mL for at least 1 year. Clinical, behavioral and psychological variables were collected to control their possible indirect contribution in the relationship between psychological stress and IL-6. Pearson correlation and univariate/multivariate logistic regressions were performed. Eighty-eight percent of the subjects were male: median (IQR) age: 39.0 (32.7-42.2), years since HIV-1 infection: 3.4 (2.1-7.0), years on cART: 2.5 (1.6-5.7), CD4 cell count: 709.0 (573.5-881.0) cell/mm(3), plasma levels of IL-6: 7.0 (0-12.2) pg/ml. A strong correlation between IL-6 and psychological stress was found (r=.81). Psychological stress (coef: 0.49; SD: 0.05), anxiety/depression (0.37; 0.08) and unhealthy diet (2.94; 1.38) were associated with higher levels of IL-6. In the multivariate model psychological stress remained strongly associated with IL-6 (R(2): 59%). In conclusion, individuals with psychological stress presented high levels of IL-6 and psychological stress was the only variable which remained strongly associated with IL-6. This strong relationship suggests evidence for a mechanism through which psychological stress might contribute to the health's impairment of HIV-infected individuals on effective cART.

Psychometric properties of the French versions of the Perceived Stress Scale

OBJECTIVES

This study was conducted to examine the psychometric properties of the French versions of the Perceived Stress Scale (PSS) and to compare the appropriateness of the three versions of this scale (14 items, 10 items, or 4 items) in a sample of workers.

MATERIALS AND METHODS

Five hundred and one workers were randomly selected in several occupational health care centers of the North of France during 2010. Participants completed a questionnaire including demographic variables and the PSS. The psychometric properties of this scale were analyzed: internal consistency, factorial structure, and discriminative sensibility.

RESULTS

For the PSS-14 and PSS-10, the Exploratory Factor Analysis (EFA) provided a two-factor structure, corresponding to the positively and negatively worded items. Those two factors were significantly correlated (r = 0.43 and 0.50, respectively). For the PSS-4, the EFA yielded a one-factor structure. The reliability was high for all three versions of the PSS (Cronbach's α values ranged from 0.73 to 0.84). The results concerning the effects of age, gender, marital, parental and occupational statuses showed that the 10-item version had the best discriminative sensibility.

CONCLUSIONS

The findings confirmed satisfactory psychometric properties of all the three French versions of the PSS. We recommend the use of the PSS-10 in research settings because of its good psychometric properties.

A prospective cohort study of modifiable risk factors for gestational diabetes among Hispanic women: design and baseline characteristics

OBJECTIVES

Women diagnosed with gestational diabetes mellitus (GDM) are at high risk for future diabetes, with rates of GDM consistently higher in Hispanic than non-Hispanic white women. Currently recognized risk factors for GDM are absent in up to half of affected women, and studies addressing modifiable risk factors for GDM in Hispanic women are sparse.

METHODS

Proyecto Buena Salud is an ongoing prospective cohort study of Hispanic women in Massachusetts designed to assess physical activity, psychosocial stress, and GDM risk. Bilingual interviewers recruit prenatal care patients early in pregnancy and assess activity, trait anxiety, perceived stress, and depressive symptoms using validated questionnaires.

RESULTS

Baseline characteristics of the first 632 participants are presented. Women were predominantly young (69% <24 years), were unmarried (87%), and had low levels of education (48% had less than high school). Women with high acculturation were less likely to live with a partner (OR: 0.6, 95% CI 0.4-0.8) than women with low acculturation. Few participants met physical activity guidelines during pregnancy (5.2%). Levels of perceived stress (mean 26.9 +/- 7.1), trait anxiety (mean 41.6 +/- 10.4), and depressive symptoms (33.2%) were high.

CONCLUSIONS

Proyecto Buena Salud represents a high-risk population of pregnant Hispanic women who are predominantly inactive, with higher levels of perceived stress, trait anxiety, and depressive symptoms compared to predominantly non-Hispanic white cohorts studied earlier. Therefore, Proyecto Buena Salud provides a unique opportunity to prospectively evaluate modifiable risk factors for GDM. Findings will inform prenatal behavioral intervention programs designed to address modifiable GDM risk factors.

Risk factors for prenatal depressive symptoms among Hispanic women

Prior studies of risk factors for depressive symptoms during pregnancy are sparse and the majority have focused on non-Hispanic white women. Hispanics are the largest minority group in the US and have the highest birth rates. We examined associations between pre and early pregnancy factors and depressive symptoms in early pregnancy among 921 participants in Proyecto Buena Salud, an ongoing cohort of pregnant Puerto Rican and Dominican women in Western Massachusetts. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (mean=13 weeks gestation) by bilingual interviewers who also collected data on sociodemographic, acculturation, behavioral, and psychosocial factors. A total of 30% of participants were classified as having depressive symptoms (EPDS scores>12) with mean+SD scores of 9.28+5.99. Higher levels of education (college/graduate school vs. <high school: RR=0.60, 95% CI 0.41-0.86), household income (Ptrend=0.02), and living with a spouse/partner (0.80; 95% CI 0.63-1.00) were independently associated with lower risk of depressive symptoms. There was the suggestion that failure to discontinue cigarette smoking with the onset of pregnancy (RR=1.32; 95% CI 0.97-1.71) and English language preference (RR=1.33; 95% CI 0.96-1.70) were associated with higher risk. Single marital status, second generation in the U.S., and higher levels of alcohol consumption were associated with higher risk of depressive symptoms in univariate analyses, but were attenuated after adjustment for other risk factors. Findings in the largest, fastest-growing ethnic minority group can inform intervention studies targeting Hispanic women at risk of depression in pregnancy.

Does alleviating poverty affect mothers' depressive symptoms? A quasi-experimental investigation of Mexico's Oportunidades programme

BACKGROUND

Depression is a major cause of disability, particularly among women; poverty heightens the risk for depression. Beyond its direct effects, maternal depression can harm children's health and development. This study aimed to assess the effects of a large-scale anti-poverty programme in Mexico (Oportunidades) on maternal depressive symptoms.

METHODS

In 2003, 5050 women living in rural communities who had participated in Oportunidades since its inception were assessed and compared with a group of 1293 women from matched communities, whose families had received no exposure to Oportunidades at the time of assessment but were later enrolled. Self-reported depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordinary least squares regressions were used to evaluate the treatment effect of programme participation on depression while adjusting for covariates and clustering at the community level.

RESULTS

Women in the treatment group had lower depressive symptoms than those in the comparison group (unadjusted mean CES-D scores: 16.9 ± 9.8 vs 18.6 ± 10.2). In multivariable analyses, programme participation was associated with lower depression whilst controlling for maternal age, education and household demographic, ethnicity and socio-economic variables [β= -1.7 points, 95% confidence interval (95% CI) -2.46 to -0.96, P < 0.001]. Reductions in perceived stress and increases in perceived control were mediators of programme effects on women.

CONCLUSIONS

Although Oportunidades did not target maternal mental health directly, we found modest but clinically meaningful effects on depressive symptoms. Our design permits stronger causal inference than observational studies that have linked poverty and depressive symptoms. Our results emphasize that the well-being of individuals is responsive to macro-level economic policies and programmes.

Comparative study of the psychosocial risks associated with families with multiple births resulting from assisted reproductive technology (ART) and without ART

OBJECTIVE

To determine whether the psychosocial risks associated with multiple births are increased as a consequence of the use of assisted reproductive technology (ART) in comparison with those not resulting from ART.

DESIGN

Cross-sectional study.

SETTING

Fertility units of a university hospital and a private hospital.

PATIENT(S)

Parents of single children and multiples (twins and triplets) between 6 months and 4 years of age (n = 636) were divided into two groups: those who conceived through ART (n = 265) and those who conceived through non-ART (n = 371).

INTERVENTION(S)

Administration of six scales, in office or by mail.

MAIN OUTCOME MEASURE(S)

Measurement scales of material necessities, social stigma, marital satisfaction, perceived stress, depression, quality of life, and their subscales.

RESULT(S)

The analysis of variance, Student's t-test, and χ(2)-test were applied. No effect was observed based on the use of ART in the psychosocial variables studied. Significant differences were obtained between the groups of single (SB) and multiple births (MB) with respect to material necessities, social stigma, marital satisfaction, depression, and quality of life.

CONCLUSION(S)

Having more than one child per birth, whether resulting from the use of ART or not, increases psychosocial risks for the parents. Assisted reproduction centers should include this information with the obstetric and neonatal risks, stressing the advantages of having one child per birth. Psychosocial risks are not increased as a result of having used ART, but the goal of avoiding the repeated use of ART does influence the desire to transfer the maximum number of embryos possible. Psychological counseling should be included before initiating ART, as well as when a multiple pregnancy is confirmed.

An Arabic version of the perceived stress scale: translation and validation study

BACKGROUND

The Perceived Stress Scale has been designed to measure the degree to which situations in a person's life are perceived as stressful.

OBJECTIVE

The paper describes the development of an Arabic version of the Perceived Stress Scale.

DESIGN

A translation process with cross-cultural considerations was employed to produce an Arabic version of the Perceived Stress Scale.

SETTINGS

Participants were asked to complete the Arabic version Perceived Stress Scale twice in their homes.

PARTICIPANTS

The Jordanian study population for the Arabic version Perceived Stress Scale validation consisted of 126 volunteers (74 male, 52 female). Ninety participants completed the scale twice (55 male, 35 female), of whom 58 were high schools teachers and 32 technical workers. Arabic was the first language of all participants and all gave informed consent.

RESULTS

The Arabic version Perceived Stress Scale reliability and validity were evaluated. Prior to an exploratory factor analysis, the suitability of data for factor analysis was assessed with acceptable results. The exploratory factor analysis showed two factors with eigenvalues greater than 1.0 (45.0% of variance). The Cronbach's alpha coefficients were 0.74 (Factor 1), 0.77 (Factor 2) and 0.80 for the Arabic version Perceived Stress Scale overall. The test-retest reliability had an intra-correlation coefficient of 0.90.

CONCLUSIONS

The Arabic version Perceived Stress Scale showed an adequate reliability and validity. Therefore, the Arabic Perceived Stress Scale is considered a suitable instrument to assess perceived stress in Arabic people.

Perceived Stress Scale: reliability and validity study in Greece

Objective:

To translate the Perceived Stress Scale (versions PSS-4, −10 and −14) and to assess its psychometric properties in a sample of general Greek population.

Methods:

941 individuals completed anonymously questionnaires comprising of PSS, the Depression Anxiety and Stress scale (DASS-21 version), and a list of stress-related symptoms. Psychometric properties of PSS were investigated by confirmatory factor analysis (construct validity), Cronbach’s alpha (reliability), and by investigating relations with the DASS-21 scores and the number of symptoms, across individuals’ characteristics. The two-factor structure of PSS-10 and PSS-14 was confirmed in our analysis. We found satisfactory Cronbach’s alpha values (0.82 for the full scale) for PSS-14 and PSS-10 and marginal satisfactory values for PSS-4 (0.69). PSS score exhibited high correlation coefficients with DASS-21 subscales scores, meaning stress (r = 0.64), depression (r = 0.61), and anxiety (r = 0.54). Women reported significantly more stress compared to men and divorced or widows compared to married or singled only. A strong significant (p < 0.001) positive correlation between the stress score and the number of self-reported symptoms was also noted.

Conclusions:

The Greek versions of the PSS-14 and PSS-10 exhibited satisfactory psychometric properties and their use for research and health care practice is warranted.