Perceived Stress Scale (PSS)
The Perceived Stress Scale (PSS) is a widely recognized tool designed to assess an individual’s stress levels and their perception of stressors in their lives. Developed in 1983 by Sheldon Cohen and colleagues, the PSS evaluates how individuals perceive their ability to cope with stress by asking them to reflect on their feelings and thoughts over the past month. Respondents rate their experiences on a scale that ranges from "never" to "very often," allowing practitioners to gauge stress levels effectively. The PSS highlights that stress is subjective; different individuals may perceive the same situations differently, leading to varying stress levels even in similar circumstances.
The scale includes three versions: PSS-14, PSS-10, and PSS-4, which contain 14, 10, and 4 items respectively, each focusing on the timeframe of the past month. Scoring involves reversing the values of specific questions and summing the total to categorize stress levels as low, moderate, or high. Understanding perceived stress is vital as chronic stress can negatively impact mental and physical health, potentially leading to issues such as anxiety, depression, and cardiovascular diseases. Thus, the PSS serves as an important instrument for both individuals and health practitioners in recognizing and addressing stress.
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Perceived Stress Scale (PSS)
The Perceived Stress Scale (PSS) is a measure used to help determine an individual’s stress level. It is one of several instruments that have been developed for this purpose. The PSS was created in 1983 and remained the instrument of choice for many practitioners.
Stress can have a negative effect on health. Prolonged or severe stress can lead to disease or impact life expectancy. For these reasons, practitioners require a way to measure stress levels in their patients.
The PSS surveys an individual’s feelings and thoughts over the last month. It includes similar questions to help get an accurate measure of stress. The individual chooses answers that best fit each question: 0 never, 1 almost never, 2 sometimes, 3 fairly often, and 4 very often.
Background
Humans respond to stress in ways that developed to protect them from danger. In early human history, predators and outside threats such as marauders were common, and an individual who responded quickly to danger was more likely to survive. The threat response originates in the hypothalamus at the base of the brain. It consists of the fight or flight response, which includes nerve signals and hormone triggers. The adrenal glands release a flood of adrenaline, cortisol, and other hormones. Adrenaline increases heart rate and blood pressure, which increase energy supplies to the body. Cortisol boosts sugars in the bloodstream, which feeds the brain and increases the body’s ability to repair tissue damage. Cortisol also produces responses that aid the body in a fight or flight response but could cause harm to the body as well. It slows systems that are not necessary in an immediate response to a threat, including the immune, digestive, and reproductive systems and growth processes. When a temporary threat has passed, levels of hormones return to normal and systems function at normal levels again. When an individual is in a constant state of stress, however, long-term boosts in stress hormones can affect the body’s systems and functions and increase chances of mental and physical health problems. Anxiety, depression, and memory problems are among the mental problems, while physical health problems include heart disease and weight gain.
Hans Selye (1907–1982), who is called the father of stress research, first applied the word stress in the medical field. It was previously a term used in physics, referring to the interaction of a force and resistance to it. Selye’s use of the word refers to the body’s response to a demand. Selye became interested in biological stress as a second-year student at the University of Prague medical school. While making rounds with his teachers, he took note of the diagnoses that had been made based on history and physical findings. Selye also noted that many patients had symptoms in common that were not considered when the diagnoses were made. These included feelings of lethargy and lack of appetite. A decade later, as assistant professor of biochemistry at McGill University in Montreal, Canada, he was identifying female sex hormones using cow ovaries and female rats. He noted physical changes to rats exposed to stresses. These included atrophy of the lymphatic system, enlarged adrenal glands, and peptic ulcers. His work led him to differentiate between acute stress and the body’s response to chronic stressors. The latter became known as Selye’s Syndrome or general adaptation syndrome.
Selye introduced his response model of stress in 1956 with his book The Stress of Life. He also developed a general adaptation syndrome (GAS) model, which has three concepts of stress: stress is a defensive mechanism; it follows three stages: alarm, resistance, and exhaustion; and sustained or extreme stress may lead to diseases or death. By the 1980s, Selye had further developed his theories about stress. He concluded that it could be positive, or eustress, or negative, or dystress.
Researchers who did look at stress were studying events and experiences that caused stress. They did not take into account the individual’s perception of the stressor, specifically how well the person felt that he or she could cope with it. Richard S. Lazarus developed a transactional model of stress.
Overview
The PSS measures the psychological stress associated with many demographics. These include age, education, employment status, gender, and income. It was developed by Sheldon Cohen, Tom Kamarch, and Robin Mermelstein. The PSS was administered to 446 undergraduates and 64 subjects participating in a program, with the results used to establish reliability.
The Cohen PSS includes items, or questions, that the individual must answer based on how stressful the subject regards each situation. The items were developed to determine how overloaded, uncontrollable, and unpredictable subjects found their lives. The PSS was created for use with subjects with at least a junior-year high school education. Three versions of the PSS have been developed: the PSS-14, which includes fourteen items; the PSS-10, comprised of ten items; and the PSS-4, with four questions.
Each item specifies the one-month timeframe for the response. For example, an item might ask, “In the last month, how often did you feel you could not handle a situation?”
To score the PSS results, the practitioner must reverse the scores of specific questions. The 0s become 4s, 1s become 3s, 2s remain the same, 3s become 1s, and 4s become 0s. Then the scores for each item are added. Low stress is indicated by a total score from 0 to 13. Moderate stress scores range from 14 to 26. High perceived stress is indicated by scores ranging from 27 to 40.
Perceived stress is an indicator for subjects because perception varies a great deal. For example, a husband and wife could experience the same events, but weigh their importance very differently. One might be upset that household chores are not completed, while the other shrugs it off. One might be easily irritated by small hiccups in a plan because it leaves him or her feeling helpless, while the other simply attacks the problem and finds ways around obstacles. The same events and experiences may result in wildly different levels of perceived stress among individuals.
Bibliography
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Lazarus, Richard S., and Susan Folkman. Stress, Appraisal, and Coping. Springer Publishing Company, Inc. 1984.
Manzar, Md Dilshad, et. al. “Psychometric Properties of the Perceived Stress Scale in Ethiopian University Students.” BMC Public Health, vol. 19, no. 41, 2019, doi.org/10.1186/s12889-018-6310-z. Accessed 2 Mar. 2020.
“Perceived Stress Scale—10 Item.” University of California, San Francisco, macses.ucsf.edu/research/psychosocial/pss10.php. Accessed 2 Mar. 2020.
Perera, Marisa J., et. al. “Factor Structure of the Perceived Stress Scale-10 (PSS) Across English and Spanish Language Responders in the HCHS/SOL Sociocultural Ancillary Study.” Psychological Assessment, vol. 29, no. 3, 2017, pp. 320 – 328, doi: YPERLINK "https://dx.doi.org/10.1037%2Fpas0000336" \t "pmc‗ext" 10.1037/pas0000336. Accessed 2 Mar. 2020.
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Vallejo, Miguel A., et. al. “Determining Factors for Stress Perception Assessed with the Perceived Stress Scale (PSS-4) in Spanish and Other European Samples.” Frontiers in Psychology, 26 Jan. 2018, HYPERLINK "https://doi.org/10.3389/fpsyg.2018.00037" https://doi.org/10.3389/fpsyg.2018.00037. Accessed 2 Mar. 2020.
Walinga, Jennifer, and Charles Stangor. “Health, Stress, and Coping.” Introduction to Psychology—1st Canadian Edition. BCcampus Open Education, 2014. Available online at opentextbc.ca/introductiontopsychology/front-matter/about-bccampus/. Pp. 743 – 758. Accessed 2 Mar. 2020.
Wulsin, Lawson, MD. "Measuring Stress: So Simple, So Complex." Reviewed by Devon Frye. Psychology Today, 19 Jan. 2024, www.psychologytoday.com/us/blog/deep-dives/202401/measuring-stress-so-simple-so-complex. Accessed 6 Sept. 2024.