Stress is a multi-dimensional construct that comprises of exposure to stressors (events), perceptions of psychological stress, and biobehavioral responses to stress. A more nuanced understanding of stress-health linkages requires assessment of each of these components. Here, we suggest measures that have been specifically developed to assess perceptions of stress – each with their own strengths and limitations.
Perceived Stress Scale (PSS)
The Perceived Stress Scale (PSS) is one of the most common measures for assessing global stress perceptions. It measures the degree to which an individual perceives his/her life as uncontrollable, unpredictable, and overloading within the past month (Cohen et al., 1983). The PSS is closely linked with measures of psychological stress and self-reported health (depressive and physical symptomatology; Cohen et al., 1988); it is also correlated with biological markers of stress and disease (reviewed in Cohen, & Janicki‐Deverts, 2012). The Perceived Stress Scale (4-, 10-, and 14-item versions), its psychometric properties, and its translations into different languages can be found here.
Stress Overload Scale (SOS)
The Stress Overload Scale (SOS) is comprised of 30 items and is designed to measure “stress overload”, a state described in stress theories as occurring when demands overwhelm resources. The respondent uses a 5‐point Likert scale (1= not at all, 5= a lot) to indicate subjective feelings and thoughts experienced over the prior week. There are two factors underlying overload: Personal Vulnerability (PV) and Event Load (EL), which are measured by two distinct but correlated subscales. Even-numbered items on the SOS comprise the Event Load, and the odd-numbered items (item 5 is reversed scored) comprise the Personal Vulnerability scale; there are also 6 filler items used to discourage negative response sets that are not scored. The scales can be summed to obtain a continuous total score, with higher scores indicating higher levels of stress overload. Or, the subscales can be split at their means to form a four-category diagnostic matrix; those scoring in the High EL-High PV category have been shown to be at the greatest risk for subsequent pathology. The SOS was constructed through a sequenced series of factor analytic and psychometric studies, all using community samples matched to US Census demographic proportions. It differs from other measures of stress in that it is (1) psychometrically strong; (2) appropriate to community research, due to its brevity and fit to a broad demographic spectrum; (3) unique in its ability to cross-section individuals into risk categories. The internal consistency of the SOS is excellent (with Cronbach’s alphas > .94 for both subscales and the measure as a whole). Test-retest reliability is good (with coefficients averaging .75 over one week). Construct validity has been demonstrated in significant correlations with other measures of stress and illness (Amirkhan, 2012; Amirkhan et al., 2015); Criterion validity has been shown in the SOS’ ability to predict illness and abnormal cortisol responses following a stressful event (Amirkhan et al., 2015). A 10-item scale (SOS-S) has recently been developed (Amirkhan, 2016). See cited articles for the full-scale items.
Summary provided by James Amirkhan.
New Development: Stress in Context (SIC) Questionnaire
Global stress measures, such as the Perceived Stress Scale, are relative measures, which is a strength, in that this measure can be used in any population and context. However, it also presents a limitation for assessing how stress perceptions may be linked to specific contexts that are typically creating demand. For example, individuals facing chronic social adversity like living in a low socioeconomic neighborhood rife with danger, do not have as elevated stress scores as one might predict, suggesting there is habituation or social comparison that leads to normalizing the environment and thus lower stress scores. This may obscure links with health outcomes in chronic stress exposed populations. The Stress in Context (SIC) questionnaire has been developed to address this limitation. The SIC assesses stress perceptions in specific contexts, such as at home, neighborhood, in social relationships, at work, and during childhood. Weighting stress perceptions to each of these contexts may help remind people of the many potential sources of perceived stress from their environment, and thus get a more accurate summative measure. The SIC may be more relevant for lower-income populations or samples exposed to chronic adversity. Currently, the SIC is being validated by the Stress Measurement Network, led by Wendy Berry Mendes. So far, it is equivalent to the PSS in self-report measures of psychological distress, well-being, and self-reported health, but shows a unique relationship to resting sympathetic state. To obtain the most current version, please contact us (Stefanie.Mayer@ucsf.edu).
Author and Reviewer(s):
This summary was prepared by Stefanie Mayer, PhD, and reviewed by the Stress Network leadership team, Sheldon Cohen, PhD, and James Amirkhan, PhD. If you have any comments on these measures, email Stefanie.Mayer@ucsf.edu. Version date: December 2017.
Amirkhan, J. H. (2012). Stress overload: A new approach to the assessment of stress. American Journal of Community Psychology, 49(1-2), 55-71.
Amirkhan, J. H. (2016). A brief stress diagnostic tool: The short Stress Overload Scale. Assessment, 1073191116673173.
Amirkhan, J. H., Urizar Jr, G. G., & Clark, S. (2015). Criterion validation of a stress measure: The Stress Overload Scale. Psychological Assessment, 27(3), 985.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385-396.
Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on Applied Social Psychology (pp. 31–67). Newbury Park, CA: Sage
Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. Journal of the American Medical Association, 298(14), 1685-1687.
Cohen, S., & Janicki‐Deverts, D. (2012). Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of applied social psychology, 42(6), 1320-1334.