Criterion validation of a stress measure: the Stress Overload Scale

The Role of Dominant Spiritual and Religious Coping Modality on Psychological Predictors Among Nursing Students

Purpose: The current study aimed to examine the role of the dominant spiritual and religious coping modality on health-related variables and determinants, including stress overload, mindfulness, and impulsivity, among nursing students. Methods: A cross-sectional design was used to achieve the study goal. The authors recruited 1199 nursing students. The results showed that the mean for positive spiritual and religious coping was higher compared to negative spiritual and religious coping. Results: In the current study, 73.3% of nursing students predominantly used positive spiritual and religious coping compared to 17.6% in the neutral group and 9.1% in the negative spiritual and religious coping group. Positive spiritual and religious coping was positively correlated with mindfulness and stress overload and negatively correlated with impulsivity. According to the ANOVA results, students with positive spiritual and religious coping tended to have a significantly higher stress overload, higher mindfulness, and lower impulsivity compared to the neutral and negative spiritual and coping groups. Negative spiritual and religious coping group significantly differed from the neutral groups only in terms of impulsivity. Conclusion: The current study's findings help nursing students by determining dominant spiritual and religious coping modalities and provide valuable information in directing counseling efforts. Results and implications were discussed.

Validity of mental and physical stress models

Different stress models are employed to enhance our understanding of the underlying mechanisms and explore potential interventions. However, the utility of these models remains a critical concern, as their validities may be limited by the complexity of stress processes. Literature review revealed that both mental and physical stress models possess reasonable construct and criterion validities, respectively reflected in psychometrically assessed stress ratings and in activation of the sympathoadrenal system and the hypothalamic-pituitary-adrenal axis. The findings are less robust, though, in the pharmacological perturbations' domain, including such agents as adenosine or dobutamine. Likewise, stress models' convergent- and discriminant validity vary depending on the stressors' nature. Stress models share similarities, but also have important differences regarding their validities. Specific traits defined by the nature of the stressor stimulus should be taken into consideration when selecting stress models. Doing so can personalize prevention and treatment of stress-related antecedents, its acute processing, and chronic sequelae. Further work is warranted to refine stress models' validity and customize them so they commensurate diverse populations and circumstances.

A Literature Review to Identify Effective Web- and App-Based mHealth Interventions for Stress Management at Work

BACKGROUND

Persistent job-related stress can be harmful to physical and mental health and has a sizable financial burden on society. Face-to-face interventions are effective in reducing stress but have the disadvantage of high costs and time requirements. mHealth solutions may be an effective alternative to provide stress management interventions at work. Occupational health professionals need information on which mHealth apps are effective for employees to manage job-related stress. The aim of this review is to provide an overview of effective web- and app-based interventions for reduction of job-related stress and stress-related symptoms.

METHOD

A literature review was conducted in the databases PubMed, PsycINFO, CINAHL Complete, and IEEEXplore.

FINDINGS

A total of 24 articles describing 19 products were found. All products showed effectiveness in trials in improving mental and/or physical health and reducing stress. Most products have a course-like structure with a duration from 1 to 8 weeks. The products use various methods such as psychoeducation and education on stress, cognitive restructuring, emotional regulation, problem-solving, goal setting, gratitude, breathing, or mindfulness techniques. Most products use more than one method and most mixed material such as text on web pages, text messages, videos, reading and audio material, and games.

CONCLUSION/APPLICATION TO PRACTICE

Overall, effective mHealth products were identified for the intervention of acute and chronic stress. Occupational health practitioners can use these 19 evidence-based mHealth products when advising organizations on health promotion of employees to reduce stress symptoms and promote health and well-being.

Breath-centered virtual mind-body medicine reduces COVID-related stress in women healthcare workers of the Regional Integrated Support for Education in Northern Ireland: a single group study

Background

During the COVID-19 pandemic, healthcare workers endured prolonged stress affecting their psychological well-being. Objectives: (1) Evaluate the effects of the Breath-Body-Mind Introductory Course (BBMIC) on COVID-related stress among employees of the Regional Integrated Support for Education, Northern Ireland, (2) Reduce the risk of adverse effects from COVID-related stress, and (3) Evaluate the effects of BBMIC on indicators of psychophysiological states and the consistency with hypothesized mechanisms of action.

Methods

In this single group study, a convenience sample of 39 female healthcare workers completed informed consent and baseline measures: Perceived Stress Scale (PSS), Stress Overload Scale-Short (SOS-S), and Exercise-Induced Feelings Inventory (EFI). Following the online BBMIC 4 h/day for 3 days and the 6 week solo (20 min/day) and group practice (45 min weekly), repeat testing plus the Indicators of Psychophysiological State (IPSS) and Program Evaluation were obtained.

Results

Baseline (T1) mean PSS score was significantly elevated compared to a normative sample: PSS = 18.2 vs. 13.7 (p < 0.001) and improved significantly 11 weeks post-BBMIC (T4). SOS-S mean score declined from 10.7(T1) to 9.7 at 6 week post-test (T3). The SOS-S proportion of High Risk scores found in 22/29 participants (T1), dropped to 7/29 (T3). EFI mean subscale scores improved significantly from T1 to T2 and T3 for Revitalization (p < 0.001); Exhaustion (p < 0.002); and Tranquility (p < 0.001); but not Engagement (p < 0.289).

Conclusion

Among RISE NI healthcare workers affected by COVID-related stress, participation in the BBMIC significantly reduced scores for Perceived Stress, Stress Overload, and Exhaustion. EFI Revitalization and Tranquility scores significantly improved. More than 60% of participants reported moderate to very strong improvements in 22 indicators of psychophysiological state, e.g., tension, mood, sleep, mental focus, anger, connectedness, awareness, hopefulness, and empathy. These results are consistent with the hypothesized mechanisms of action whereby voluntarily regulated breathing exercises change interoceptive messaging to brain regulatory networks that shift psychophysiological states of distress and defense to states of calmness and connection. These positive findings warrant validation in larger, controlled studies to extend the understanding of how breath-centered Mind-body Medicine practices could mitigate adverse effects of stress.

Marriage and health: exploring the role of stress overload

BACKGROUND AND OBJECTIVES

The association between marital status and health is well-established, but its causes remain unclear. This study was the first to examine stress overload, the pathogenic form of stress, as a possible explanation.

DESIGN

The study employed a cross-sectional design and convenience sample to explore relationships among stress overload, marital status, social support, and illness.

METHODS

A diverse sample (n = 455), recruited from community and social media sites, completed an anonymous online survey. Included were standardized measures of stress overload (SOS-S), perceived social support (MSPSS), and somatic symptoms (PHQ-15).

RESULTS

Married participants reported lower stress overload levels than those in any other type of relationship (single, in-a-relationship, or cohabiting). They did not differ from the unmarried in overall level of social support, nor did statistically controlling social support or income levels erase the stress overload differential. They also reported lower levels of symptomology than the unmarried. SEM analyses yielded a best-fitting model showing stress overload to partially mediate the link between marital status and symptoms.

CONCLUSIONS

Stress overload is one mechanism that explains the marital health disparity, albeit not the only one. This holds implications for future research and practice focused on personal relationships and well-being.

Music to decrease anxiety in college students during the COVID-19 pandemic

The COVID-19 pandemic impacted the world in a multiplicity of ways. For college students, considered emerging adults in a time of transition between adolescence and adulthood, the stressors were multiplied by severe disruptions in education, social activities, family distress, and job losses. Significant impact on mental health in college students has been reported during this period. We investigated the effect of a previously researched music experience on the anxiety levels of 36 performing arts college students. Results showed a high level of anxiety pre-intervention, but a significant decrease and normative levels at posttest. Although a small sample size warrants caution in generalization, these results show the feasibility of theoretically sound, brief music experiences to address significant distress in vulnerable populations.

The adaption of the Chinese version of the COVID Stress Scales as a screening instrument of stress: Psychometric properties during the COVID-19 pandemic

The COVID Stress Scales (CSS) was used to access related distress concerning Corona Virus Disease 2019 (COVID-19). Based on China's epidemic prevention and control policies during the COVID-19 pandemic, the adaption of the Chinese version of the CSS was developed. Our study evaluated the reliability and validity of the Chinese adapted version of the CSS during the COVID-19 pandemic. An online survey was employed to construct a national sample of 2,116 participants in Chinese mainland. We examined the factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity. The results demonstrated that the six-factor solution for the Chinese adaptation of the CSS proved a good fit with the data after comparing the factor structure with the five-factor model. The six-factor model had good reliability and supported good convergent, discriminant, and concurrent validity of the CSS Chinese adaption. Overall, our findings supported the Chinese adapted version of the CSS as a psychometrically sound measure of stress during the COVID-19 pandemic in China.

Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population

PURPOSE

To develop and validate a short version of the Beirut Distress Scale (BDS-22), the BDS-10, in the Lebanese population, and evaluate the association between psychological distress and other mental disorders.

METHODS

A total of 2260 participants was enrolled in this cross-sectional study (January-July 2019).

RESULTS

Items converged over a solution of two factors (Factor 1 = Mood, affect and cognitive symptoms; Factor 2 = Physical symptoms; total variance explained = 64.51%). A significantly high correlation was found between BDS-10 and BDS-22 (r = 0.963, p < 0.001). Higher depression, anxiety, and insomnia were significantly associated with higher stress (higher BDS-10 and BDS-22 scores).

PRACTICE IMPLICATIONS

This new short tool is valid and reliable to screen for psychological distress, influencing mood and affect, and physical and cognitive functions.

Self-Report Stress Measures to Assess Stress in Adults With Mild Intellectual Disabilities-A Scoping Review

Stress has a major negative impact on the development of psychopathology and contributes to the onset of adverse physical conditions. Timely recognition and monitoring of stress-related problems are therefore important, especially in client populations that are more vulnerable to stress, such as people with mild intellectual disabilities (MID). Recent research on the use of physiological measures to assess stress levels emphasize that, in addition to these measures, self-report instruments are necessary to gain insight into the individual perception and impact of stress on daily life. However, there is no current overview of self-report stress measures that focus on the experience of stress in the present moment or in daily life. To provide an overview of the existing self-report stress measures for clinicians and researchers, a scoping review was conducted. In addition, to advise clinical professionals on the use of self-report measures of stress for people with MID, the results of an expert consultation were used to refine the preliminary findings. A systematic scoping literature search resulted in a total of 13 self-reported stress measures that met the final inclusion criteria, of which three were developed specifically for assessing stress in adults with MID (GAS-ID, LI, and SAS-ID). For each included self-report stress measure, the psychometric quality, assessment procedure, and suitability for adults with MID were reported. These were supplemented by the findings from the expert consultation. Implications for clinical practice on the use of self-report stress measures, particularly for people with MID, are discussed. Recommendations for future research and development are given.

The Acute Readiness Monitoring Scale: Assessing Predictive and Concurrent Validation

To complement and enhance readiness-monitoring capability, the Acute Readiness Monitoring Scale (ARMS) was developed: a widely applicable, simple psychometric measure of perceived readiness. While this tool may have widespread utility in sport and military settings, it remains unknown if the ARMS demonstrates predictive and concurrent validity. Here, we investigated whether the ARMS is: (1) responsive to an acute manipulation of readiness using sleep deprivation, (2) relates to biological markers of readiness [cortisol/heart-rate variability (HRV)], and (3) predicts performance on a cognitive task. Thirty young adults (aged 23 ± 4 years; 18 females) participated. All participants engaged in a 24-h sleep deprivation protocol. Participants completed the ARMS, biological measures of readiness (salivary cortisol, HRV), and cognitive performance measures (psychomotor vigilance task) before, immediately after, 24-, and 48-h post-sleep deprivation. All six of the ARMS subscales changed in response to sleep deprivation: scores on each subscale worsened (indicating reductions in perceived readiness) immediately after sleep deprivation, returning to baseline 24/48 h post. Lower perceived readiness was associated with reduced awakening responses in cortisol and predicted worse cognitive performance (slower reaction time). No relationship was observed between the ARMS and HRV, nor between any biological markers of readiness (cortisol/HRV) and cognitive performance. These data suggest that the ARMS may hold practical utility in detecting, or screening for, the wide range of deleterious effects caused by sleep deprivation; may constitute a quick, cheap, and easily interpreted alternative to biological measures of readiness; and may be used to monitor or mitigate potential underperformance on tasks requiring attention and vigilance.

Identifying Profiles of Anxiety in Late Childhood and Exploring Their Relationship with School-Based Distress

Failure in dealing with anxiety-provoking situations and stressors in the school setting may have negative consequences not only on children’s performance, but also on their well-being in the future. This research aimed to examine the relationship of forms of anxiety (anticipatory anxiety, school-based performance anxiety, and generalized anxiety) with sources (teacher interactions, academic stress, peer interactions, and academic self-concept) and manifestations (emotional, behavioral, and physiological) of school-based distress. Specifically, our objectives were to examine the correlations between anxiety and school-based distress and, using a person-centered approach, to verify whether different anxiety profiles differed in their levels of distress. The Visual Analogue Scale for Anxiety-Revised (VAA-R) and the School Situation Survey (SSS) were administered to 756 Spanish students (M_age = 9.6, SD = 1.12); 50.3% were girls. Pearson’s correlation coefficients revealed a positive and significant association between each form of anxiety and each source and manifestation of distress. The latent profile analysis identified three anxiety profiles: High Anxiety, High School-based performance Anxiety, and Low Anxiety. The High Anxiety profile scored significantly higher in all sources and manifestations of distress than the Low Anxiety profile. The High Anxiety profile showed significantly higher scores in peer interactions and emotional and behavioral manifestations of distress than the group High School-based performance Anxiety. Suggestions for intervention strategies according to the risk profile are discussed.

Inverse Correlation Between Distress and Performance in the Medical Rescuers Against COVID-19 in Wuhan

Background: During the COVID-19 pandemic, the Chinese government had transferred many medical rescuers to Wuhan, which provided effective support in disease control. The high-intensity working and mental stress during rescue could induce distress and negatively impact the performance of rescuer afterward. Materials and Methods: To identify the characteristics of stress load and its possible effects on performance, the study surveyed 90 medical rescuers in Wuhan using a mobile phone-based self-rated questionnaire. Results: The results showed an existence of universal but mostly mild distress in rescuers. About 95.6% of the participants reported that they had at least one symptom of distress, whereas, the median scores were <30 (100 as max). Compared with civilian rescuers, a higher proportion of working with immediate virus contact was found in military medical rescuers (P = 0.008); however, no statistical differences of stress load were found between civilians and militaries. The rescuers with positive cognition or good psychological preparation were found having lower stress loads than other rescuers. An inverse correlation between the stress load and performance (R = -0.24, P = 0.023) and a positive correlation between social support and working performance (R = 0.349, P = 0.001) were found in our survey, suggesting the possible negative effects of stress and the beneficial effects of social support on performance. Conclusion: Our study indicated that more attention should be paid to the distress of medical rescuers against COVID-19. Positive cognitions, good psychological preparations, and sufficient social support would be necessary to reduce the distress and improve the performance in COVID-19 rescue.

Stress overload and the new nightmare for Dreamers

To determine if, following threats to DACA policies, Dreamer college students experienced greater stress overload, more symptoms, and worse grades than their classmates. Participants: Students (n = 424) from a large public university, including Dreamers (n = 64), participated between March 2017 and June 2018. Methods: Students completed an anonymous online survey containing self-report measures of stress overload, symptoms, grades, and background characteristics. Results: Dreamers reported significantly higher levels of stress overload than did other students, including minorities and immigrants. Dreamers reported more somatic symptoms but not lower grades than other students-outcomes mediated, wholly or partially, by stress overload. Conclusion: Findings document the health toll of current politics on Dreamers, and indicate disproportionate stress overload as a reason. They also attest to Dreamer "grit" in maintaining grades nevertheless. Implications include the need for proactive support by universities and broader social policy change to restore well-being to these students.

Development and Psychometric Properties of the Self-Acceptance Scales for Pregnant and Postpartum Women

Self-acceptance, that is, a person's acceptance of their own psychological and physical attributes, is considered critical for mental wellbeing. A lack of self-acceptance may contribute to the development of psychopathology. In the peripartum period, self-acceptance has particular relevance, as major psychological and body changes are normative during this time. This research presents the development and validation of the Self-Acceptance Scale for Pregnant Women (SAS-PW) and the Self-Acceptance Scale for Postpartum Women (SAS-PPW). Participants were aged 18-52. In Study 1, we developed 77 items for the SAS-PW and 74 items the SAS-PPW, based on literature review, previous scales, and qualitative study. In Study 2, nine experts and 60 representatives of the target population evaluated the instruments' content validity, leading some items to be excluded and others to be modified. Studies 3 and 4 analyzed the instruments' psychometric qualities among respondents to the instruments, 1254 pregnant women and 607 postpartum women from across Brazil. We conducted exploratory and confirmatory factor analyses with independent samples. The final SAS-PW (10 items and two-factors) and SAS-PPW (14 items and three-factors) demonstrated adequate psychometric quality for use with Brazilian pregnant and postpartum women, respectively.

Stress overload in the spread of coronavirus

Background and Objectives: The incidence of novel coronavirus infection across the globe has been uneven, hitting some population subgroups harder than others. Media coverage has proffered explanations for this differential vulnerability, but psychosocial risk factors have been largely ignored. In contrast, multiple theories, medical and psychological, point to one psychosocial factor - stress - as important to the etiology of disease. They also agree that pathogenic stress arises from the particular circumstance in which adaptational demands overwhelm a person's resources, creating "stress overload" that deregulates normal functioning and increases susceptibility to illness. Assessment of stress overload is proposed as essential to understanding viral spread in the current pandemic.Methods: Studies are reviewed explicating (1) stress overload theories and relevant empirical evidence, (2) construction of a stress overload measure and related validity evidence.Results: Findings support the role of stress overload in illness and the accuracy of the measure in predicting illness.Conclusion: It is concluded that assessment of stress overload may help to explain the observed coronavirus disparities, and to identify populations at risk for imminent infection. The 10-item Stress Overload Scale-Short is offered as a potentially useful tool for researchers and clinicians working to map, and stem, the proliferation of coronavirus.

The impact of SARS-CoV-2 on the mental health of healthcare workers in a hospital setting-A Systematic Review

OBJECTIVES

The SARS-CoV-2 global pandemic has subjected healthcare workers (HCWs) to high risk of infection through direct workplace exposure, coupled with increased workload and psychological stress. This review aims to determine the impact of SARS-CoV-2 on mental health outcomes of hospital-based HCWs and formulate recommendations for future action.

METHODS

A systematic review was performed between 31st December 2019 and 17th June 2020 through Ovid Medline and Embase databases (PROSPERO ID CRD42020181204). Studies were included for review if they investigated the impact of SARS-CoV-2 on mental health outcomes of hospital-based HCWs and used validated psychiatric scoring tools. Prevalence of ICD-10 classified psychiatric disorders was the primary outcome measure.

RESULTS

The initial search returned 436 articles. Forty-four studies were included in final analysis, with a total of 69,499 subjects. Prevalence ranges of six mental health outcomes were identified: depression 13.5%-44.7%; anxiety 12.3%-35.6%; acute stress reaction 5.2%-32.9%; post-traumatic stress disorder 7.4%-37.4%; insomnia 33.8%-36.1%; and occupational burnout 3.1%-43.0%. Direct exposure to SARS-CoV-2 patients was the most common risk factor identified for all mental health outcomes except occupational burnout. Nurses, frontline HCWs, and HCWs with low social support and fewer years of working experience reported the worst outcomes.

CONCLUSION

The SARS-CoV-2 pandemic has significantly impacted the mental health of HCWs. Frontline staff demonstrate worse mental health outcomes. Hospitals should be staffed to meet service provision requirements and to mitigate the impact onmental health. This can be improved with access to rapid-response psychiatric teams and should be continually monitored throughout the pandemic and beyond its conclusion.

A Pilot Study Exploring the Use of an Online Pre-Composed Receptive Music Experience for Students Coping with Stress and Anxiety

College/university students face many stressors as they balance their studies, work, personal relationships, and personal/family expectations. Music therapy students have additional stressors related to academic, musical, and clinical development. College/university students have increased mental health needs compared to previous generations, with volume impacting institutions. The objective of this study was to investigate the use of an online receptive music experience for music therapy students' stress and anxiety levels, and also to examine if a particular musical element was perceived as more beneficial in decreasing stress and anxiety. Twenty-three participants (undergraduate and graduate-equivalency music therapy students) engaged in a study offered online. Measures included the Spielberger State Trait Anxiety Inventory (STAI), the Stress Overload Scale (SOS), and a post-experience survey about musical element effectiveness. Results indicated that the receptive music experience elicited a significant decrease in students' stress and anxiety levels. A subscale analysis of the SOS indicated that participants had a significant decrease in personal vulnerability, and an overall decrease in event load, though this decrease was not significant. Participants' reflections about the musical elements indicated that melody was most effective and instrumentation was least effective, with groups of elements also indicated. Pilot study results support further research investigating the use of an online receptive music experience for students, professionals, and music therapy clients as a way to manage acute stress.

Improvements in Stress, Affect, and Irritability Following Brief Use of a Mindfulness-based Smartphone App: A Randomized Controlled Trial

Mindfulness training, which involves observing thoughts and feelings without judgment or reaction, has been shown to improve aspects of psychosocial well-being when delivered via in-person training programs such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Less is known about the efficacy of digital training mediums, such as smartphone apps, which are rapidly rising in popularity. In this study, novice meditators were randomly allocated to an introductory mindfulness meditation program or to a psychoeducational audiobook control featuring an introduction to the concepts of mindfulness and meditation. The interventions were delivered via the same mindfulness app, were matched across a range of criteria, and were presented to participants as well-being programs. Affect, irritability, and two distinct components of stress were measured immediately before and after each intervention in a cohort of healthy adults. While both interventions were effective at reducing stress associated with personal vulnerability, only the mindfulness intervention had a significant positive impact on irritability, affect, and stress resulting from external pressure (between group Cohen's d = 0.44, 0.47, 0.45, respectively). These results suggest that brief mindfulness training has a beneficial impact on several aspects of psychosocial well-being, and that smartphone apps are an effective delivery medium for mindfulness training.

Prenatal Exposure to Stressful Life Events and Infant Breastfeeding

BACKGROUND

Of the various barriers to breastfeeding, limited information is available on the relationship between prenatal stress and breastfeeding. This study investigates the association between prenatal stressful life event (SLE) exposure and breastfeeding initiation postpartum.

MATERIALS AND METHODS

Using Rhode Island Pregnancy Risk Assessment Monitoring System data from 2012 to 2014, SLE was defined as self-report of prenatal exposure to 14 predefined life events such as job loss or illness. Exposure to SLE was categorized by number and type of events. Multivariable logistic regression was performed to assess the relationship between SLE and breastfeeding initiation. Results accounted for complex survey design and were adjusted for maternal and infant characteristics (age, race, ethnicity, insurance, delivery type, parity, gestational age, birth weight for gestational age, and neonatal intensive care unit admission).

RESULTS

Among 3,353 respondents, 86% reported breastfeeding initiation, 74% reported exposure to ≥1 SLE, and 17% reported exposure to ≥4 SLE. Decreased odds of breastfeeding initiation were associated with prenatal exposure to ≥4 SLE (adjusted odds ratio [aOR] 0.67; 95% confidence interval [CI]: 0.48-0.95), emotional stressors (aOR 0.77; 95% CI: 0.61-0.98), and traumatic stressors (aOR 0.68; 95% CI: 0.50-0.91).

CONCLUSION

This study underscores the impact of exposure to prenatal SLE on breastfeeding initiation among postpartum women. Findings may assist providers in identifying at-risk women for anticipatory guidance to improve breastfeeding rates.

Chronic and Daily Stressors Along With Negative Affect Interact to Predict Daily Tiredness

The present study examines the within-person relationship of daily stressors and tiredness and whether this depends on daily negative affect and individual differences in chronic stress. One hundred sixteen older adult participants were recruited via Amazon’s Mechanical Turk for a 9-day daily diary study. Daily tiredness, daily stressors, and negative affect were measured each day, and chronic stress was measured at baseline. Daily stressors, daily negative affect, and chronic stress interacted to predict daily tiredness. People with high chronic stress who experienced an increase in daily negative affect were the most reactive to daily stressors in terms of experiencing an increase in daily tiredness. We also found that people with low levels of chronic stress were the most reactive to daily stressors when they experienced low levels of daily negative affect. Our results highlight the need for individualized and contextualized approaches to combating daily tiredness in older adults.

Evaluating the construct validity of Stress Overload Scale-Short using exploratory structural equation modeling

This study used exploratory structural equation modeling and confirmatory factor analysis to examine the construct validity of the Chinese version of Stress Overload Scale-Short, which included personal vulnerability and event load. The participants included 629 community residents and 495 university students. The results indicated a better goodness-of-fit using exploratory structural equation modeling compared with confirmatory factor analysis. The Stress Overload Scale-Short performed well in distinguishing individuals with more negative emotion symptoms from the general population. A moderation analysis demonstrated that social support moderates the effect of personal vulnerability on negative emotion symptoms. These results facilitated the application of Stress Overload Scale-Short in the current population.

Validation of a Chinese version of the stress overload scale-short and its use as a screening tool for mental health status

PURPOSE

Although stress emerges when environmental demands exceed personal resources, existing measurement methods for stress focus only on one aspect. The newly-developed Short Stress Overload Scale (SOS-S) assesses the extent of stress by assessing both event load (i.e., environmental demands) and personal vulnerability (i.e., personal resources). The present study was designed to evaluate the psychometric properties of the Chinese version of Stress Overload Scale-Short (SOS-SC), and further examine its roles in screening mental health status.

METHODS

A total of 1364 participants were recruited from communities and colleges for scale validation.

RESULTS

Reliabilities were good throughout the subsamples (ω > 0.80). Confirmatory factor analysis indicated the acceptable goodness-of-fit for the two-factor correlated model (Sample 1: 560 community residents). Multi-group confirmatory factor analysis confirmed measurement invariance across community residents (Sample 1) and college students (Sample 2 and Sample 3). Criterion validity and convergent validity were established (Sample 2: 554 college students). Latent moderated structural equations demonstrated that the relationship between SOS-SC and depression is moderated by social support (Sample 2), further validating the SOS-SC. In addition, the SOS-SC effectively screened individuals in a population at different levels of mental health status (i.e., "at risk" vs. "at low risk" for depression symptoms and/or wellbeing).

CONCLUSION

The SOS-SC exhibits acceptable psychometric properties in the Chinese context. That said, the two aspects of stress can be differentiated by the Chinese context, therefore, the SOS-SC can be used to measure stress and screen mental health status among the Chinese population, and monitor and evaluate health-promoting interventions.

Validation of the Stress Overload Scale and Stress Overload Scale–Short Form among a Setswana-speaking community in South Africa

Although there has been extensive research on the phenomenon of stress, there is still a lack of assessment tools, especially in the South African context, that have strong theoretical underpinnings, tapping into both internal depletion of resources and the excessive external demands from the environment in the measurement of stress. The aim of this study was to validate the Setswana version of the original 30-item long form of the Stress Overload Scale as well as the 10-item short form (Stress Overload Scale–Short Form), both evaluating experienced personal vulnerability and external event load. A sample of N = 376 adults living in a rural community in the Northern Cape Province of South Africa were randomly selected to partake in the study. Emerging model fit indices of confirmatory factor analysis testing the hypothesized two-factor structure of the original Stress Overload Scale were not convincingly good. However, we found a remarkable improvement in model fit indices in the case of the Stress Overload Scale–Short Form. Concurrent validity was shown for the Stress Overload Scale–Short Form in significant correlations with depression and emotional well-being. We conclude that the Setswana version of the Stress Overload Scale–Short Form is a psychometrically sound instrument for measuring stress in the present context; however, further validation of the original Stress Overload Scale in diverse samples is necessary to provide stronger support for the hypothesized two-factor structure.

A Brief Stress Diagnostic Tool: The Short Stress Overload Scale

The Stress Overload Scale (SOS) has demonstrated validity in predicting pathological stress reactions; however, at 30 items, it is lengthy for some clinical applications. Here, two studies tested a 10-item SOS-Short (SOS-S). First, the SOS-S was compared with the SOS in a longitudinal community study ( n = 391), using indices of pathology as criterion measures. Results showed the SOS-S to be equivalent to the SOS in reliability and concurrent and predictive validity, although not quite as sensitive to somatic symptoms. Second, the SOS-S was compared to the 10-item Perceived Stress Scale in a cross-sectional community study ( n = 249), in which symptoms and response biases were also assessed. Results showed both measures to be susceptible to biasing, and the SOS-S to demonstrate superior validity when biases were controlled. The SOS-S appears a viable alternative to the SOS and the 10-item Perceived Stress Scale for assessing stress, and risk for sequelae, across a broad demographic spectrum.

Process for massage therapy practice and essential assessment

BACKGROUND

Little evidence exists about processes in massage therapy practice. Investigating current frameworks is warranted. This qualitative study is a secondary data analysis using grounded theory to understand how massage therapy experts describe massage therapy practice.

METHODS

31 massage therapy experts were invited to a 2-day symposium to discuss best practices for the profession. Through qualitative analysis, memoing, and discussion, the data were summarized into themes.

RESULTS

Three themes were identified around massage therapy practice: 1) client centered, 2) structure for practice, and 3) influencing factors. Each theme is clarified and expanded.

DISCUSSION

Conceptual models were developed for research and clinical practice and a definition for massage therapy practice was identified. Challenges and limitations are discussed.

CONCLUSION

The goal of providing these models is to give massage therapists tools to deliver the best possible care. The models need testing to see if they help advance the profession.