Development of the brief inventory of perceived stress

Assessment of psychometric performance for the Chinese version of the Brief Inventory of Perceived Stress integrating exploratory graph analysis and confirmatory factor analysis

OBJECTIVE

This study was to evaluate measurement properties of the Chinese version of the Brief Inventory of Perceived Stress (BIPS-C) and confirm possible solutions for measuring the constructs underlying perceived stress.

METHODS

A total of 1356 community residents enrolled and were randomly split into two halves. The first half was used to explore the underlying constructs of the BIPS-C by exploratory graph analysis (EGA) and the second half was used to compare and confirm the constructs by confirmatory factor analysis (CFA).

RESULTS

The EGA identified a one-factor model of the BIPS-C with an accuracy of 99.3%. One-factor, three-factor, second-order, and bifactor models were compared by CFAs. The bifactor model with one general and three specific factors was found to be the most adequate [comparative fit index (CFI) = 0.990; Tucker-Lewis index (TLI) = 0.979; root mean square error of approximation (RMSEA) = 0.058] and was superior to the other models. The related bifactor indices showed a stronger existence of the general factor. The bifactor model of the BIPS-C also showed adequate internal consistency with McDonald's omega and omega subscales ranging from moderate to strong (0.677-0.869).

CONCLUSION

The BIPS-C demonstrates sufficient measurement properties for assessing general perceived stress.

A single-arm, open-label pilot study of neuroimaging, behavioral, and peripheral inflammatory correlates of mindfulness-based stress reduction in multiple sclerosis

Multiple sclerosis (MS) is a chronic neurological disease frequently associated with significant fatigue, anxiety, depression, and stress. These symptoms are difficult to treat, and prominently contribute to the decreases in quality of life observed with MS. The underlying mechanisms of these "silent" symptoms are not well understood and include not just the psychological responses to a chronic disease, but also biological contributions from bidirectional psycho-neuro-immune (dys)regulation of systemic inflammatory biology. To address these issues, we conducted a prospective, observational pilot study to investigate the psychological, biological, and neuroarchitecture changes associated with a mindfulness-based stress reduction (MBSR) program in MS. The overarching hypothesis was that MBSR modulates systemic and central nervous system inflammation via top-down neurocognitive control over forebrain limbic areas responsible for the neurobiological stress response. 23 patients were enrolled in MBSR and assessed pre/post-program with structural 3 T MRI, behavioral measures, hair cortisol, and blood measures of peripheral inflammation, as indexed by the Conserved Transcriptional Response to Adversity (CTRA) profile. MBSR was associated with improvements across a variety of behavioral outcomes, as well as on-study enlargement of the head of the right hippocampus. The CTRA analyses revealed that greater inflammatory gene expression was related to worse patient-reported anxiety, depression, stress, and loneliness, in addition to lower eudaimonic well-being. Hair cortisol did not significantly change from pre- to post-MBSR. These results support the use of MBSR in MS and elucidate inflammatory mechanisms related to key patient-reported outcomes in this population.

Psychometric and next day electrodermal activity data from an experiment involving midazolam, ketamine, and painful stimulation

This is a report of unpublished data obtained from a randomized, single-blind, within-subject crossover design, neuroimaging trial comparing the effects of midazolam and ketamine on memory and pain. An experimental auditory paradigm paired with the periodic pain was used to examine auditory encoding and subsequent recognition. Psychometric surveys assessed stress, anxiety, depression, and pain behaviors. These data were collected to potentially characterize inter-subject variation during analysis. Electrodermal activity was measured to examine the association between previous pain-pairing of experimental items and autonomic responses during next day recognition memory testing, with exposure to the same auditory word items. Electrodermal responses were determined using an event-related analysis approach. These data may help shape future experiments using psychometric data to characterize individual responses or using next day electrodermal activity to determine conditioned responses to previously-experienced aversive stimuli.

Childhood maltreatment and leukocyte telomere length in men and women with chronic illness: an evaluation of moderating and mediating influences

BACKGROUND

Childhood maltreatment can result in lifelong psychological and physical sequelae, including coronary artery disease (CAD). Mechanisms leading to increased risk of illness may involve emotional dysregulation and shortened leukocyte telomere length (LTL).

METHODS

To evaluate whether (1) childhood maltreatment is associated with shorter LTL among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status influence these results; and (3) symptoms of anxiety, depression, and stress moderate or mediate the association between childhood maltreatment and LTL, men and women (N = 1247; aged 65 ± 7.2 years) with and without CAD completed validated questionnaires on childhood maltreatment, symptoms of depression, anxiety, and perceived stress. LTL was measured using quantitative polymerase chain reaction. Analyses included bivariate correlations, hierarchical regressions, and moderation/mediation analyses, controlling for sociodemographic and lifestyle variables.

RESULTS

Childhood maltreatment was associated with significantly shorter LTL (r = -0.059, p = 0.038, b = -0.016, p = 0.005). This relation was not moderated by depression, anxiety, nor perceived stress, though there was mitigated evidence for absence of a maltreatment-LTL relation in men with CAD. Stress perception (but not anxiety or depression) partially mediated the relation between childhood maltreatment and LTL [Indirect effect, b = -0.0041, s.e. = 0.002, 95% CI (-0.0085 to -0.0002)].

CONCLUSIONS

Childhood maltreatment was associated with accelerated biological aging independently of patient characteristics. Emotional dysregulation resulting in chronic stress may contribute to this process. Whether stress management or other interventions may help prevent or slow premature aging in those who have suffered maltreatment requires study.

The Perceived Stress Scale as a Measure of Stress: Decomposing Score Variance in Longitudinal Behavioral Medicine Studies

BACKGROUND

The Perceived Stress Scale (PSS) is a widely used measure designed to assess perceptions of recent stress. However, it is unclear to what extent the construct assessed by the PSS represents factors that are stable versus variable within individuals, and how these components might vary over time.

PURPOSE

Determine the degree to which variability in repeated PSS assessments is attributable to between-person versus within-person variance in two different studies and populations.

METHODS

Secondary analyses utilized data from two studies with up to 13 PSS assessments: An observational study of 127 patients with heart failure followed over 39 months (Study 1), and an experimental study of 73 younger, healthy adults followed over 12 months (Study 2). Multilevel linear mixed modeling was used to estimate sources of variance in the PSS total and subscale scores across assessments.

RESULTS

Between-person variance accounted for a large proportion of the total variance in PSS total scores in Study 1 (42.3%) and Study 2 (51.1%); within-person variance comprised the remainder. Between-person variance was higher for shorter assessment periods (e.g., 1 week), and was comparable when examining only the first 12 months of assessments in each study (52.9% vs. 51.1%).

CONCLUSIONS

Within two samples differing in age and health status, between-person variance accounted for approximately half of the total variation in PSS scores over time. While within-person variance was observed, the construct assessed by the PSS may substantially reflect a more stable characteristic of how an individual perceives stressful life circumstances than previously appreciated.

Validation of the Chinese version of the Perceived Stress Scale-10 integrating exploratory graph analysis and confirmatory factor analysis

OBJECTIVE

The study aimed to initially assess the measurement properties of the 10-item simplified Chinese version of the Perceived Stress Scale (PSS-C-10) and as a first, assess a longitudinal measurement invariance (LMI).

METHODS

A longitudinal survey was conducted with a convenient sample of healthcare students using the PSS-C-10. We assessed the PSS-C-10 mainly using composite analytical approaches, including exploratory graph analysis (EGA) and confirmatory factor analysis (CFA) to suggest the best-fit factor structure and assess measurement invariance.

RESULTS

The EGA identified a two-factor structural solution with an accuracy of 98.6% at baseline and 100% at a 7-day follow-up. The CFA subsequently confirmed this structure, with a comparative fit index of 0.963 at baseline and 0.987 at follow-up, Tucker-Lewis index of 0.951 at baseline and 0.982 at follow-up, and root mean square error of approximation of 0.111 at baseline and 0.089 at follow-up. The LMI was supported by the goodness-of-fit indices, and their changes fell within the recommended cut-off range. Additionally, Cronbach's alpha (0.885 at baseline and 0.904 at follow-up), McDonald's omega (0.885 at baseline and 0.902 at follow-up), and an ICC value of 0.816 for 7 days demonstrated the robust reliability of the PSS-C-10.

CONCLUSION

The PSS-C-10 exhibited a stable two-factor structure with promising LMI and measurement properties.

Medical School Faculty and Staff Well-being in Fall 2020 during the COVID-19 Pandemic

The COVID-19 pandemic increased stress and worry among faculty and staff members at universities across the US. To assess the well-being of university faculty and staff, a survey was administered at a medical school in the state of Hawai'i during early fall 2020. The purpose of the exploratory study was to assess and gauge faculty and staff members' well-being regarding the school's response to COVID-19. Participants in this study represented a convenience sample of compensated teaching, research, and administrative faculty and staff members. A total of 80 faculty and 73 staff members participated. Overall, faculty and staff reported relatively low levels of worries and stress. Staff members reported greater levels of worry and stress than faculty members in 8 of the 11 questions. Statistical differences were detected in 3 questions, with staff reporting higher levels of worry and stress in their health and well-being of themselves (P < .001), paying bills (P < .001), and losing their jobs (P < .001). Both faculty and staff reported good overall satisfaction on the timeliness and clarity of messages that they received, support from leadership and the school, and support to adjust to changes in response to COVID-19. For both faculty and staff, the greatest worry or concern for the open-ended question on worry and stress was related to financial and economic issues. Data from this survey and can contribute to an understanding of medical school employee well-being during a major operational disruption and may help develop policies and programs to assist employees in different employment categories during future disruptions.

Effects of the MINDSTRONG© CBT-based program on depression, anxiety and healthy lifestyle behaviors in graduate health sciences students

ObjectiveTo evaluate effects of the MINDSTRONG^© cognitive-behavioral skills building program versus an attention control program on mental health outcomes and lifestyle behaviors of graduate health professional students. Participants: 201 entering graduate students from seven health sciences colleges at a public land grant University in the U.S. Midwest. Methods: A randomized controlled trial was conducted with three-month follow-up. Valid and reliable instruments measured depression, anxiety, stress, healthy lifestyle beliefs and healthy lifestyle behaviors. Results: Students receiving MINDSTRONG^© reported less depression/anxiety and healthier lifestyle behaviors than those receiving the control program. Students with elevated levels of depression/anxiety at baseline demonstrated greater benefits from the program. Conclusions: MINDSTRONG^© can be used as a preventive and early intervention for improving mental health outcomes and lifestyle behaviors in graduate students. Because the program can be delivered by trained non-mental health professionals, it has the potential to be widely scaled on campuses throughout the U.S.

The COVID-19 infodemic at your fingertips. Reciprocal relationships between COVID-19 information FOMO, bedtime smartphone news engagement, and daytime tiredness over time

Considering that insufficient sleep has long been regarded as a significant public health challenge, the COVID-19 pandemic and its co-evolving infodemic have further aggravated many people's sleep health. People's engagement with pandemic-related news, particularly given that many people are now permanently online via smartphones, has been identified as a critical factor for sleep health, such that public health authorities have recommended limited news exposure. This two-wave panel survey, conducted with a representative sample in Austria during its first COVID-19 lockdown, examines (a) how fear of missing out on pandemic-related news (i.e., COVID-19 information FOMO) is reciprocally related to smartphone-based bedtime news engagement, as well as (b) how both bedtime news engagement and COVID-19 information FOMO predict daytime tiredness. Partial metric measurement invariant structural equation modeling revealed that COVID-19 information FOMO and bedtime news engagement are reciprocally associated over time, indicating a potentially harmful reinforcing loop. However, results further suggested that COVID-19 information FOMO may be the primary driver of daytime tiredness, not smartphone-based bedtime news engagement. These findings suggest that a perceived loss of (informational) control over the pandemic outbreak more strongly than poor sleep habits accounts for depleted energy resources during lockdown. However, given the initial evidence for a reinforcing loop, this effect pattern may change in the long term.

Severity of psychological distress over five years differs as a function of sex and presence of coronary artery disease

BACKGROUND

Psychological distress is more prevalent and severe among patients with coronary artery disease (CAD) compared to healthy individuals. Little is known regarding its time course, and whether these differences extend to individuals with non-cardiovascular (CV) illnesses. This study examined the presence, severity, and time course of psychological distress in men and women with CAD and those of similarly aged individuals suffering from non-CV conditions.

METHODS

1229 individuals (61% men; mean_age = 60.4 ± 7.0 years) with stable CAD or non-CV illnesses reported on social support, hostility, stress, anxiety and depression at baseline as well as 4.8 ± 0.8 years later. Analyses involved mixed (Sex*CAD status*Time) repeated measures analyses (controlling for relevant covariates), as well as Chi-square and McNemar analyses.

RESULTS

Women with CAD reported more symptoms of depression compared to other participants at both evaluations (p's < 0.01), and reported more symptoms of anxiety and stress compared to others at T1 (p's < 0.05). At T2, perceived stress remained significantly greater among women with CAD compared to men (p's < 0.01), though differences in anxiety were no longer significant. Men reported more hostility than women (p = 0.001). CAD women fell within the clinical range for depression (p < 0.001), anxiety (p = 0.001), and stress (p = 0.030) more frequently compared to others at T1, and for depression (p = 0.009) and stress (p = 0.002) at T2.

CONCLUSIONS

The evolution of patient distress differed as a function of the measure examined, their sex, and/or CV status. While psychological distress was prevalent among these patients with diverse health conditions, women with CAD were particularly and chronically vulnerable.

Effects of a cognitive-behavioral skills building program on the mental health outcomes and healthy lifestyle behaviors of veterinary medicine students

OBJECTIVE

To evaluate the effects of a cognitive-behavioral skills building program (ie, MINDSTRONG; The Ohio State University) on the mental health outcomes and healthy lifestyle beliefs and behaviors of Doctor of Veterinary Medicine (DVM) students.

Sample

DVM students (n = 62) before beginning their program at a large public Midwest land-grant university.

Procedures

All 171 incoming DVM students (class of 2024) were required to take the cognitive-behavioral skills building program (7 weeks in length) before starting their 2020 school year. Students were given the option to consent to the study portion of the program. Consenting participants completed a pre- and postsurvey containing demographic questions and 5 valid and reliable scales, including the Patient Health Questionnaire-9 that assesses depressive symptoms, the Generalized Anxiety Disorder-7 that evaluates anxiety, the Brief Inventory of Perceived Stress that measures stress, and the Healthy Lifestyle Beliefs and Healthy Lifestyle Behaviors scales. Descriptive statistics described sample characteristics, paired t tests assessed changes over time in the outcomes Personal Wellness Assessment, and Cohen's d determined effect sizes.

Results

62 DVM students completed both surveys. Postintervention, students had significant improvements in depressive symptoms, anxiety, and healthy lifestyle beliefs and behaviors.

Clinical Relevance

Although this study used a small convenience sample of DVM students from a single university, a cognitive-behavioral skills building program demonstrated the ability to decrease rates of depression, anxiety, and suicidal ideation and improve healthy lifestyle beliefs and behaviors. Requiring DVM students to participate in such programming could provide benefit during their professional education and throughout their careers.

The Chinese version of the Perceived Stress Questionnaire: development and validation amongst medical students and workers

BACKGROUND

A valid and efficient stress measure is important for clinical and community settings. The objectives of this study were to translate the English version of the Perceived Stress Questionnaire (PSQ) into Chinese and to assess the psychometric properties of the Chinese version of the PSQ (C-PSQ). The C-PSQ evaluates subjective experiences of stress instead of a specific and objective status.

METHODS

Forward translations and back translations were used to translate the PSQ into Chinese. We used the C-PSQ to survey 2798 medical students and workers at three study sites in China from 2015 to 2017. Applying Rasch analysis (RA) and factor analysis (FA), we examined the measurement properties of the C-PSQ. Data were analyzed using the Rasch model for item fit, local dependence (LD), differential item functioning (DIF), unidimensionality, separation and reliability, response forms and person-item map. We first optimized the item selection in the Chinese version to maximize its psychometric quality. Second, we used cross-validation, by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), to determine the best fitting model in comparison to the different variants. Measurement invariance (MI) was tested using multi-group CFA across subgroups (medical students vs. medical workers). We evaluated validity of the C-PSQ using the criterion instruments, such as the Chinese version of the Perceived Stress Scale (PSS-10), the Short Form-8 Health Survey (SF-8) and the Goldberg Anxiety and Depression Scale (GADS). Reliability was assessed using internal consistency (Cronbach's alpha, Guttman's lambda-2, and McDonald's omegas) and reproducibility (test-retest correlation and intraclass correlation coefficient, [ICC]).

RESULTS

Infit and/or outfit values indicated that all items fitted the Rasch model. Three item pairs presented local dependency (residual correlations > 0.30). Ten items showed DIF. Dimensionality instruction suggested that eight items should be deleted. One item showed low discrimination. Thirteen items from the original PSQ were retained in the C-PSQ adaptation (i.e. C-PSQ-13). We tested and verified four feasible models to perform EFA. Built on the EFA models, the optimal CFA model included two first-order factors (i.e. constraint and imbalance) and a second-order factor (i.e., perceived stress). The first-order model had acceptable goodness of fit (Normed Chi-square = 8.489, TLI = 0.957, CFI = 0.965, WRMR = 1.637, RMSEA [90% CI] = 0.078 [0.072, 0.084]). The second-order model showed identical model fit. Person separation index (PSI) and person reliability (PR) were 2.42 and 0.85, respectively. Response forms were adequate, item difficulty matched respondents' ability levels, and unidimensionality was found in the two factors. Multi-group CFA showed validity of the optimal model. Concurrent validity of the C-PSQ-13 was 0.777, - 0.595 and 0.584 (Spearman correlation, P < 0.001, the same hereinafter) for the Chinese version of the PSS-10, SF-8, and GADS. For reliability analyses, internal consistency of the C-PSQ-13 was 0.878 (Cronbach's alpha), 0.880 (Guttman's lambda-2), and 0.880 (McDonald's omegas); test-retest correlation and ICC were 0.782 and 0.805 in a 2-day interval, respectively.

CONCLUSION

The C-PSQ-13 shows good metric characteristics for most indicators, which could contribute to stress research given its validity and economy. This study also contributes to the evidence based regarding between-group factorial structure analysis.

Prevalence and Correlates of Depression, Anxiety, Stress, Healthy Beliefs, and Lifestyle Behaviors in First-Year Graduate Health Sciences Students

BACKGROUND

Graduate and professional students are reported to have higher than average rates of depression compared to age- and gender-matched populations. Further, more than half of student health visits are due to anxiety, yet little is known about the relationships among depression, anxiety, and healthy lifestyle behaviors in this population as well as what factors predict depression and anxiety.

AIMS

The purposes of this study were as follows: (a) to examine the prevalence of depression, anxiety, stress, physical health, healthy beliefs, and lifestyle behaviors in incoming first-year health sciences professional students; (b) to describe the relationships among these variables; and (c) to determine predictors of depression and anxiety.

METHODS

A descriptive correlational study design was used with baseline data collected from first-year graduate health sciences students from seven health professions colleges who were participating in a wellness onboarding intervention program, including Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine.

RESULTS

Seventeen percent of incoming students reported moderate-to-severe depressive symptoms with 6% reporting suicidal ideation. In addition, 14% of the participating students reported moderate-to-severe anxiety. Factors that predicted depression and anxiety included having less than 7 hr of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control.

LINKING EVIDENCE TO ACTION

These findings highlight the need to routinely screen incoming health sciences students for depression and anxiety upon entrance into their academic programs so that evidence-based interventions can be delivered and students who report severe depression or suicidal ideation can be immediately triaged for further evaluation and treatment. Providing cultures of well-being and emphasizing self-care throughout academic programs also are essential for students to engage in healthy lifestyles.

Childhood Trauma, Perceived Stress, and Hair Cortisol in Adults With and Without Cardiovascular Disease

OBJECTIVE

Childhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing cardiovascular disease (CVD). This may partially reflect trauma-induced disturbances in how stress is later perceived and regulated. This study evaluated the associations of childhood trauma with perceived stress and hair cortisol concentrations (HCC) in a large sample of adults with coronary artery disease (CAD) and in non-CVD patients experiencing other nonfatal illnesses. Whether sex, age, or CVD status influenced these associations was also examined.

METHODS

A total of 1124 men and women (aged 65.2 [6.9] years) recruited from a hospital cohort completed the Childhood Trauma and Perceived Stress Questionnaires, whereas hair samples were obtained from 598 participants. Health status was confirmed via medical records.

RESULTS

Moderate to severe childhood trauma was experienced by 359 participants. Childhood trauma was associated with greater perceived stress levels for the past 2 years (r = .308, p = .01; β = 0.263, p < .001), but not 3-month cortisol secretion in hair. Perceived stress correlated negatively with age (r = -.241, p < .001). In secondary analyses, age moderated the relation between sexual abuse and perceived stress (β = -0.067, p = .016). Although sexual abuse was associated with greater levels of perceived stress among all participants, this relation was strongest in younger individuals.

CONCLUSIONS

Participants who experienced trauma in their youth reported greater levels of perceived stress, but not HCC, in late adulthood. Whether this suggests intact hypothalamic-pituitary-adrenal regulation in those exposed to childhood trauma or whether this reflects the characteristics of our sample requires further investigation.

The influence of a learning to forgive programme on negative affect among mentally disordered offenders

BACKGROUND

Clinical trials and meta-analyses provide some evidence for effectiveness of forgiveness therapy delivered individually or in groups. To date, however, forgiveness therapy has not been evaluated with mentally disordered offenders. Given the high prevalence of experienced and perpetrated trauma among such people, this population may particularly benefit from such an intervention.

AIM

The aim of this study is to test the feasibility and impact of a 'learn to forgive' group programme among mentally disordered offenders on a specialist secure hospital setting.

METHODS

We conducted a non-randomised trial with 36 offenders with mental disorders and 29 comparison patients. The intervention group engaged in a six-week manual-based 'learn to forgive' treatment programme, while the comparison group watched a 90-minute video on forgiveness. Both groups completed measures of anger, depression, stress, forgiveness and satisfaction with life at baseline and then 6 and 18 weeks later. A repeated measures mixed-effects model was used to investigate the association between affective outcomes and type of intervention received, after adjusting for baseline characteristics.

RESULTS

The group completion rate was over 90%. The treatment and comparison groups were similar on baseline demographic and criminological measures, but the treatment group had higher baseline anger and depression scores. While both groups showed improved capacity to forgive and reduced negative affect over time, those in the 'learn to forgive' programme showed significantly more improvement in forgiveness and on anger measures.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Forgiveness training can be delivered effectively to offenders with mental disorders in clinical settings. Its range of benefits, including reduction I in anger as well as improved capacity to forgive, suggest that it may have longer term implications for personal safety and reintegration into mainstream societal settings. Copyright © 2016 John Wiley & Sons, Ltd.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Effects of an energy balance educational intervention and the COPE cognitive behavioral therapy intervention for Division I U.S. Air Force Academy female athletes

BACKGROUND AND PURPOSE

Female athletes struggle harder than male athletes to lose body fat and maintain a leaner physique. The purpose of this study was to determine the effects of an educational and cognitive behavioral therapy (CBT)-based intervention on knowledge, body composition, anxiety, stress, and nutritional intake.

METHODS

A randomized controlled trial was conducted with 153 female athletes from the U.S. Air Force Academy (USAFA). Participants were assigned to one of three groups: (a) a combined energy balance and CBT-based intervention (E1); (b) a CBT-based intervention alone (E2); and (c) a control group (C). Main outcomes included a DXA scan for body composition, a knowledge test, the GAD-7 for anxiety, the brief inventory of perceived stress (BIPS) for stress, and a 24-h food recall.

FINDINGS

Significant improvement on knowledge of energy balance occurred in all three groups E1 (p < .001), E2, and C (p < .05). Significant reductions in percentage of body fat occurred in E1 (p < .001) and E2 (p < .05). There also were significant reductions in the percent of fat consumed by E1 (p < .05) and saturated fat consumed by both E1 and E2 (p < .05). The control group only demonstrated a significant increase in stress as measured by the BIPS (p < .05).

CONCLUSIONS

A combined energy balance and CBT-based intervention improves knowledge and body fat.

IMPLICATIONS

The importance to assess knowledge, anxiety, stress, nutrition intake, and percentage of body fat in female athletes and to deliver evidence-based interventions to improve their health outcomes.

Physical health, lifestyle beliefs and behaviors, and mental health of entering graduate health professional students: Evidence to support screening and early intervention

BACKGROUND AND PURPOSE

Little is known about the physical health, lifestyle beliefs and behaviors, and mental health among first-year health professional graduate students. Therefore, the purpose of this study was to describe these attributes as well as to explore the relationships among them.

METHODS

A descriptive correlational study was conducted on the baseline data from a wellness onboarding intervention study with 93 health sciences students from seven different colleges within a large public land grant university in the Midwest United States.

FINDINGS

Nearly 40% of the sample was overweight/obese, and 19% of students had elevated total cholesterol levels. Only 44% met the recommended 30 min of exercise 5 days per week. Forty-one percent reported elevated depressive symptoms and 28% had elevated anxiety. Four students reported suicidal ideation. Inverse relationships existed among depression/anxiety and healthy lifestyle beliefs/behaviors.

CONCLUSIONS

Students entering health professional schools are at high risk for depression, anxiety, and unhealthy behaviors, which could be averted through screening and early evidence-based interventions.

IMPLICATIONS FOR PRACTICE

Assessing the physical health, lifestyle behaviors, and mental health of first-year health sciences professional students is important to identify health problems and modifiable at-risk behaviors so that early interventions can be implemented to improve outcomes.

The Effect of CardioWaves Interval Training on Resting Blood Pressure, Resting Heart Rate, and Mind-Body Wellness

An experimental study to examine the effects of CardioWaves interval training (CWIT) and continuous training (CT) on resting blood pressure, resting heart rate, and mind-body wellness. Fifty-two normotensive (blood pressure <120/80 mmHg), pre-hypertensive (120-139/80-89 mmHg), and hypertensive (>140/90 mmHg) participants were randomly assigned and equally divided between the CWIT and CT groups. Both groups participated in the assigned exercise protocol 30 minutes per day, four days per week for eight weeks. Resting blood pressure, resting heart rate, and mind-body wellness were measured pre- and post-intervention. A total of 47 participants (15 females and 32 males) were included in the analysis. The CWIT group had a non-significant trend of reduced systolic blood pressure (SBP) and increased diastolic blood pressure (DBP) while the CT group had a statistically significant decrease in awake SBP (p = 0.01) and total SBP (p = 0.01) and a non-significant decrease in DBP. With both groups combined, the female participants had a statistically significant decrease in awake SBP (p = 0.002), asleep SBP (p = 0.01), total SBP (p = 0.003), awake DBP (p = 0.02), and total DBP (p = 0.05). The male participants had an increase in SBP and DBP with total DBP showing a statistically significant increase (p = 0.05). Neither group had a consistent change in resting heart rate. Both groups showed improved mind-body wellness. CWIT and CT reduced resting blood pressure, with CT having a greater effect. Resting heart rate did not change in either group. Additionally, both CWIT and CT improved mind-body wellness.

Development of the Perceived Stress Inventory: A New Questionnaire for Korean Population Surveys

Background

Given emerging evidence of the association between stress and disease, practitioners need a tool for measuring stress. Several instruments exist to measure perceived stress; however, none of them are applicable for population surveys because stress conceptualization can differ by population. The aim of this study was to develop and validate the Perceived Stress Inventory (PSI) and its short version for use in population surveys and clinical practice in Korea.

Methods

From a pool of perceived stress items collected from three widely used instruments, 20 items were selected for the new measurement tool. Nine of these items were selected for the short version. We evaluated the validity of the items using exploratory factor analysis of the preliminary data. To evaluate the convergent validity of the PSI, 387 healthy people were recruited and stratified on the basis of age and sex. Confirmatory analyses and examination of structural stability were also carried out. To evaluate discriminatory validity, the PSI score of a group with depressive symptoms was compared with that of a healthy group. A similar comparison was also done for persons with anxious mood.

Results

Exploratory factor analysis supported a three-factor construct (tension, depression, and anger) for the PSI. Reliability values were satisfactory, ranging from 0.67 to 0.87. Convergent validity was confirmed through correlation with the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. People with depressive or anxious mood had higher scores than the healthy group on the total PSI, all three dimensions, and the short version.

Conclusion

The long and short versions of the PSI are valid and reliable tools for measuring perceived stress. These instruments offer benefits for stress research using population-based surveys.

Predictors of outcome for telephone and face-to-face administered cognitive behavioral therapy for depression

BACKGROUND

Cognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression.

METHOD

A total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18).

RESULTS

The demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome.

CONCLUSIONS

Findings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment.

Do positive or negative stressful events predict the development of new brain lesions in people with multiple sclerosis?

BACKGROUND

Stressful life events have long been suspected to contribute to multiple sclerosis (MS) disease activity. The few studies examining the relationship between stressful events and neuroimaging markers have been small and inconsistent. This study examined whether different types of stressful events and perceived stress could predict the development of brain lesions.

METHOD

This was a secondary analysis of 121 patients with MS followed for 48 weeks during a randomized controlled trial comparing stress management therapy for MS (SMT-MS) to a waitlist control (WLC). Patients underwent magnetic resonance imaging (MRI) scans every 8 weeks. Every month, patients completed an interview measure assessing stressful life events and self-report measures of perceived stress, anxiety and depressive symptoms, which were used to predict the presence of gadolinium-enhancing (Gd+) and T2 lesions on MRI scans 29-62 days later. Participants classified stressful events as positive or negative. Negative events were considered 'major' if they involved physical threat or threat to the patient's family structure, and 'moderate' otherwise.

RESULTS

Positive stressful events predicted decreased risk for subsequent Gd+ lesions in the control group [odds ratio (OR) 0.53 for each additional positive stressful event, 95% confidence interval (CI) 0.30-0.91] and less risk for new or enlarging T2 lesions regardless of group assignment (OR 0.74, 95% CI 0.55-0.99). Across groups, major negative stressful events predicted Gd+ lesions (OR 1.77, 95% CI 1.18-2.64) and new or enlarging T2 lesions (OR 1.57, 95% CI 1.11-2.23) whereas moderate negative stressful events, perceived stress, anxiety and depressive symptoms did not.

CONCLUSIONS

Major negative stressful events predict increased risk for Gd+ and T2 lesions whereas positive stressful events predict decreased risk.

A randomized trial of stress management for the prevention of new brain lesions in MS

OBJECTIVES

This trial examined the efficacy of a stress management program in reducing neuroimaging markers of multiple sclerosis (MS) disease activity.

METHODS

A total of 121 patients with relapsing forms of MS were randomized to receive stress management therapy for MS (SMT-MS) or a wait-list control condition. SMT-MS provided 16 individual treatment sessions over 24 weeks, followed by a 24-week post-treatment follow-up. The primary outcome was the cumulative number of new gadolinium-enhancing (Gd+) brain lesions on MRI at weeks 8, 16, and 24. Secondary outcomes included new or enlarging T2 MRI lesions, brain volume change, clinical exacerbation, and stress.

RESULTS

SMT-MS resulted in a reduction in cumulative Gd+ lesions (p = 0.04) and greater numbers of participants remained free of Gd+ lesions during the treatment (76.8% vs 54.7%, p = 0.02), compared to participants receiving the control treatment. SMT-MS also resulted in significantly reduced numbers of cumulative new T2 lesions (p = 0.005) and a greater number of participants remaining free of new T2 lesions (69.5% vs 42.7%, p = 0.006). These effects were no longer detectable during the 24-week post-treatment follow-up period.

CONCLUSIONS

This trial indicates that SMT-MS may be useful in reducing the development of new MRI brain lesions while patients are in treatment.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that SMT-MS, a manualized stress management therapy program, reduced the number of Gd+ lesions in patients with MS during a 24-week treatment period. This benefit was not sustained beyond 24 weeks, and there were no clinical benefits.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT00147446.