Research in Gerontological Nursing

Instrument Development 

Reliability and Validity of the Korean Version of the Perceived Stress Scale-10 (K-PSS-10) in Older Adults

Gwi-Ryung Son Hong, PhD, RN; Hye-Kyung Kang, PhD, RN; Eunmi Oh, PhD, RN, GNP; YoungOk Park, RN, MSN; Haesook Kim, PhD, RN, GNP-BC

Abstract

The purpose of the current study was to examine the reliability and validity of the Korean version of the Perceived Stress Scale-10 (K-PSS-10). After translation and back-translation of the original PSS-10, a convenience sample of 342 community-dwelling older adults was recruited from senior community centers. Data were analyzed using factor analysis, Pearson's correlation coefficient, and Cronbach's alpha. Using factor analysis with principal axis factoring with oblimin rotation, two factors were extracted. The two-factor solution explained 49.71% of the total variance. Internal consistency values for negative and positive subdomains were 0.87 and 0.71, respectively. Moderate relationships were found between a negative response to stress and depression (r = 0.42, p < 0.001) and quality of life (r = −0.45, p < 0.001). A positive response to stress had moderate significant correlations with depression (r = 0.30, p < 0.001) and quality of life (r = −0.36, p < 0.001). Overall, the K-PSS-10 had good reliability, with a Cronbach's alpha of 0.75. The K-PSS-10 demonstrated the desired psychometric properties and was easy to use to assess the stress of community-dwelling older adults in Korea.

[Res Gerontol Nurs. 2016; 9(1):45–51.]

Abstract

The purpose of the current study was to examine the reliability and validity of the Korean version of the Perceived Stress Scale-10 (K-PSS-10). After translation and back-translation of the original PSS-10, a convenience sample of 342 community-dwelling older adults was recruited from senior community centers. Data were analyzed using factor analysis, Pearson's correlation coefficient, and Cronbach's alpha. Using factor analysis with principal axis factoring with oblimin rotation, two factors were extracted. The two-factor solution explained 49.71% of the total variance. Internal consistency values for negative and positive subdomains were 0.87 and 0.71, respectively. Moderate relationships were found between a negative response to stress and depression (r = 0.42, p < 0.001) and quality of life (r = −0.45, p < 0.001). A positive response to stress had moderate significant correlations with depression (r = 0.30, p < 0.001) and quality of life (r = −0.36, p < 0.001). Overall, the K-PSS-10 had good reliability, with a Cronbach's alpha of 0.75. The K-PSS-10 demonstrated the desired psychometric properties and was easy to use to assess the stress of community-dwelling older adults in Korea.

[Res Gerontol Nurs. 2016; 9(1):45–51.]

Stress influences quality of life and mental and physical health (Chiriboga, Black, Aranda, & Markides, 2002). According to the stress and coping appraisal model (Lazarus & Folkman, 1984), each individual perceives stress in his or her own way, and the subjective interpretation of a stressful event varies depending on internal and external stimuli. The process of personal perception includes recognizing the demands of a specific situation while perceiving stress, and assessing the extent of situational demands relative to one's personal abilities and resources. Because excessive, chronic, and repetitive stressors are related to increased risk of illness, it is essential to understand individual perceptions of stressful situations.

During the past four decades, mental health concerns have become a prominent issue among Korean older adults due to the rapid changes in Korean society. The prevalence of depression is reported to be as high as 63% in community-dwelling older adults (Kim, Chae, & Chae, 2009). Furthermore, the suicide rate among Korean older adults has increased by approximately five times between 1990 and 2010 (approximately 70 per 100,000 individuals)—the highest suicide rate among Organization for Economic Cooperation and Development (OECD; 2014) countries. Because perceived stress is a risk factor for depression (Kim & Lee, 2010; Lincoln, 2007) and is related to a reduced quality of life in older adults (Kim, 2009), it is critical to appropriately assess perceived stress to prevent further mental health problems.

The Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983) is a simple instrument to measure stress, focusing on the subjective experience of stressful situations. The PSS has been widely used to assess stress as it relates to health for various ages and groups, including different clinical settings, cultures, and ethnic groups. The PSS has evolved into three versions (i.e., the PSS-14, PSS-10, and PSS-4), based on the number of measured items. Reliability and validity of these versions have been well-established in more than 17 language versions, including Chinese, Japanese, Thai, Spanish, and Portuguese. In Korea, although attention to mental health issues has increased and health professionals agree on the importance of appropriate measurement of stress, few instruments are available to easily measure stress among Korean older adults. Recently, two studies (Lee, Chung, Suh, & Jung, 2014; Park & Seo, 2010) have demonstrated the validity of the Korean version of the PSS. However, neither study evaluated the Korean version of the PSS specifically among Korean older adults residing in the community. Because the PSS-14 is excessively long and the PSS-10 showed better psychometric properties (Cohen & Williamson, 1988; Leung, Lam, & Chan, 2010), the PSS-10 was selected and translated into Korean (K-PSS-10) for the current study.

The purpose of the current study was to develop a translated Korean version of the PSS-10 and verify the reliability and validity among Korean older adults residing in the community. Two specific aims were identified to achieve this purpose:

  • explore the validity of the K-PSS-10 in Korean older adults using factor analysis and convergent validity; and
  • determine the reliability of K-PSS-10 dimensions in Korean older adults.

The current findings might help health professionals and researchers more easily measure and better understand perceived stress in Korean older adults. The appropriate assessment of perceived stress with a reliable and valid instrument will ultimately identify and prevent further mental health problems and improve the quality of life in Korean older adults.

Method

Participants

After receiving institutional review board approval from a university in Seoul, South Korea, the authors contacted the chairperson of a senior community center to obtain permission to contact potential study participants. A convenience sample of 342 community-dwelling older adults was recruited. All participants were 60 or older, able to communicate, and agreed to participate in the study. The current study used a methodological study design.

Procedure

Researchers interviewed participants using a questionnaire. If participants could not read, researchers read and explained each measure item. If participants were able to complete the questionnaire by themselves, researchers provided instructions regarding how to answer each item and left the participant to answer the questions independently. Completion of the questionnaire took approximately 15 minutes. After the interview or self-report was completed, a small gift was given to all participants to thank them for their time.

Measurement

Perceived Stress. The PSS is a 10-item tool that includes two subdomains: positive (items 4, 5, 7, and 8) and negative (items 1, 2, 3, 6, 9, and 10). Items are rated on a 5-point Likert scale ranging from 0 = not at all to 4 = very often. Possible total scores range from 0 to 40, with higher scores representing higher stress levels. Internal consistency of Cronbach's alpha for this instrument in a sample of women with breast cancer was 0.86 (Cohen et al., 1983). In the current study, the Cronbach's alpha of the negative and positive subdomain was 0.87 and 0.71, respectively.

After permission to use the PSS-10 (Cohen & Williamson, 1988) was obtained, the English version of the original PSS was translated into Korean using a translation procedure to establish content and semantic equivalence (Flaherty, Gaviria, & Pathak, 1988). First, two bilingual nursing scholars (G.-R.S.H., E.O.) evaluated the 10 items for relevance to Korean older adults to establish content equivalence; all 10 items were included in the translated version. In this process, asymmetrical translation was performed using different words while maintaining the meaning of the original instrument. Second, for semantic equivalence, a blind back-translation from the Korean version of the PSS-10 to the English version was completed. A native English speaker (i.e., a professor in the English department) then reviewed and evaluated each item of the original English version of the PSS-10 and the back-translated version and rated each item on a 3-point scale where 3 = exactly the same meaning in both instruments, 2 = almost the same meaning, and 1 = different meanings in each version. All 10 items were rated either 2 or 3 and items rated as 2 were revised until the two versions were equivalent.

Depression. Depression was assessed with the 15-item Short Geriatric Depression Scale (SGDS; Sheikh & Yesavage, 1986), which has been translated into Korean (Cho et al., 1999). Possible total scores range from 0 to 15, with depression indicated by a score ≥8 (Cho et al., 1999). A higher score represents a higher level of depression. Concurrent validity of the SGDS was established with the Center for Epidemiologic Studies Depression Scale (CESD; Eaton, Muntaner, Smith, Tien, & Ybarra, 2004) (r = 0.69). Cronbach's alpha was 0.89 in the study by Cho et al. (1999) and 0.87 in the current study.

Perceived Health. Perceived health was assessed with a single item regarding overall health from the survey of the Korea Institute for Health and Social Affairs (2009), with response options ranging from 1 = very good to 5 = very poor. Possible total scores ranged from 1 to 5, with higher scores representing greater negative perceptions of overall health.

Quality of Life. Quality of life was measured using the 25-item Quality of Life Scale for older adults (Lee et al., 2003), in which each item is rated on a 4-point scale from 1 = not satisfied to 4 = very satisfied. Possible total scores range from 25 to 100, with higher scores indicating higher quality of life. The tool comprises four subdomains: six items focusing on physical health, nine items regarding psychological health, five items dealing with social relationships and income level, and five items assessing physical environment. Concurrent validity of this instrument has been well-established among Korean older adults (Lee et al., 2003). Cronbach's alpha values of the subdomains ranged from 0.84 (physical environment) to 0.90 (physical health). Overall Cronbach's alpha was reported to be 0.95 in the current study.

Data Analysis

Data were managed and analyzed using SPSS 17.0 for Windows®. The alpha was set at 0.05 for relevant analyses. Descriptive statistics included the mean and standard deviation of each variable. First, principal axis factoring (PAF) with oblimin rotation was used to extract factors. Convergent validity was examined with the concepts of depression, perceived health, and quality of life using Pearson's correlation coefficient. Internal consistency reliability was measured using Cronbach's alpha for each subdomain of the K-PSS-10.

Results

Demographic Characteristics of Participants

The mean age of participants was 72.8 (SD = 6.11 years, range = 60 to 93 years). Most participants were female (65.2%), living with their spouse (53.5%), Christian (49.1%), and elementary school graduates (26.6%) (Table 1). Approximately 31% of participants perceived their health to be fair. There were no significant differences in perceived stress according to age, gender, marital status, religion, or education. However, perceived stress varied significantly according to level of perceived health (F = 5.19, p < 0.01).

Demographic Characteristics (N = 342)

Table 1:

Demographic Characteristics (N = 342)

Construct Validity

Factor Analysis. Preliminary PAF analysis with oblimin rotation was performed to estimate the optimal number of factors to extract in the final analysis and identify weak items (i.e., no factor loading >0.40). The scree test and eigen-values suggested that the optimal solution has two factors: negative and positive responses to stress. The two-factor PAF solution for the 10 total items explained 49.71% of the variance. Bartlett's test (chi-square = 1,327.239, p < 0.001) and a Kaiser–Meyer–Olkin measure of sampling adequacy of 0.83, or meritorious, indicated the suitability of the analysis. Negative and positive responses to perceived stress were measured using six items (i.e., items 1, 2, 3, 6, 9, and 10) and four items (i.e., items 4, 5, 7, and 8), respectively (Table 2).

Factor Loadings and Reliability of the Korean Version of the Perceived Stress Scale-10

Table 2:

Factor Loadings and Reliability of the Korean Version of the Perceived Stress Scale-10

Convergent Validity. Correlations among the K-PSS-10, depression, perceived health, and quality of life were examined. Moderate relationships between negative response to stress and depression (r = 0.42, p < 0.001) and quality of life (r = −0.45, p < 0.001) were reported. The relationship between negative response to stress and perceived health was weak but significant (r = 0.24, p < 0.001). However, positive response to stress had a moderately significant correlation with depression (r = 0.30, p < 0.001) and quality of life (r = −0.36, p < 0.001). The relationship between positive response to stress and perceived health was not statistically significant (r = 0.08, p > 0.05) (Table 3).

Pearson Correlations Between Korean Version of the Perceived Stress Scale-10 Factors and Construct Validity Variables

Table 3:

Pearson Correlations Between Korean Version of the Perceived Stress Scale-10 Factors and Construct Validity Variables

Reliability. Cronbach's alphas were calculated for the K-PSS-10 and its factors, which were constructed from the items loading on each factor. Overall, the alpha of the K-PSS-10 was acceptable (0.75), indicating that the scale shows a high degree of internal consistency reliability (Nunnally, 1978). Alpha values of the negative and positive responses to stress were 0.87 and 0.71, respectively.

Discussion

The current study investigated the reliability and validity of the K-PSS-10, which was translated and back-translated from the original English version into Korean. Results demonstrated that the K-PSS-10 had acceptable psychometric properties to measure perceived stress in Korean older adults.

Exploratory factor analysis to examine construct validity showed two factors: negative and positive responses. Each factor corresponded to a set of items (six items for the negative response to stress and four items for the positive response). In other words, items from the PSS showed a positive correlation with negative emotions and a negative correlation with positive emotions. This result was consistent with the original study (Cohen & Williamson, 1988) and has been shown to not vary, even among participants ranging from college students to older adults, or across cultures (Cohen & Williamson, 1988; Lee et al., 2014; Mimura & Griffiths, 2004; Wongpakaran & Wongpakaran, 2010; Yu & Ho, 2010).

In the current study, the total explained percentage of variance was 49.71%. This result was slightly higher than that of the original English PSS-10 version, in which 48.9% of variance was explained (Cohen & Williamson, 1988), but lower than that reported in a recent study of Korean adults with chronic disease (51.11%) (Lee et al., 2014). Because this result was similar to studies conducted among other ethnic groups, the explanatory power of 49.71% in the current study was acceptable and established construct validity.

Convergent validity, another method to assess construct validity, was established in the evaluation of the relationships of the underlying factors (i.e., negative and positive responses to stress) and depression, perceived health, and quality of life. As expected, the negative and positive factors were significantly related to depression and quality of life. This finding is consistent with findings of other studies, where depression was high when perceived stress was also high among college students, the general public, and older adults (Andreou et al., 2011; Park & Seo, 2010; Ramírez & Hernández, 2007; Wongpakaran & Wongpakaran, 2010; Yu & Ho, 2010). Similar to other studies (Lau & Yin, 2011; Marshall, Allison, Nykamp, & Lanke, 2008), the current study also indicates that quality of life is low when perceived stress level is high.

However, the relationship between perceived stress and perceived health differed from the current authors' expectations. This surprising finding was also observed in previous studies. In a Brazilian study (Reis, Hino, & Rodriquez-Añez, 2010) and a Chinese study (Leung et al., 2010), perceived health was related to negative and positive responses to stress. Leung et al. (2010) found that the correlations between perceived health and negative and positive responses to stress were weak but still significant in older adults.

Reliability analysis showed good internal consistency reliability, with an overall Cronbach's alpha of 0.75. This finding was similar to previous studies conducted using the PSS-10, with reported Cronbach's alphas ranging from 0.74 to 0.85 (Cohen & Williamson, 1988; Lee et al., 2014; Wongpakanan & Wongpakaran, 2010). When reliability was reexamined after splitting the measure into two factors, Cronbach's alpha of positive response to stress (0.71) was lower than that of negative response to stress (0.87), consistent with studies of the translated versions of the PSS-10 in Japan (Reis et al., 2010) and Thailand (Wongpakaran & Wongpakaran, 2010).

Recommendations

Continued assessment with larger samples in various settings is needed. Because participants were a convenience sample recruited from senior community centers in Seoul, the capital of Korea, the findings of the current study have limitations regarding generalization to the overall population of Korea. Compared to national survey data gathered in 2008 (Korea Institute for Health and Social Affairs, 2009), participants in the current study were older, had a higher education level, and were better able to accurately assess their health status. In addition, participants in the current study regularly attended senior recreation programs at a community center, meaning they were more physically independent and able to transport themselves from their homes to the senior center.

Further psychometric evaluation needs to be conducted to increase the robustness of the K-PSS-10. Because the current study only examined exploratory factor analysis (EFA), future studies examining EFA and confirmatory factor analysis will strengthen the validity of the measure. For the reliability analysis, the current study tested one method. Additional evaluation, such as test–retest reliability, will increase reliability, providing stability of the K-PSS-10 over time.

The K-PSS-10 could be tested in clinical research, exploring the relationship between sociodemographic information and perceived stress to better identify and understand stressors in Korean older adults. This instrument can also be used in comparative studies of older adults from different cultural backgrounds.

Conclusion

As a preliminary study, the reliability and validity of the K-PSS-10 were acceptable to assess perceived stress in older adults in Korea. Considering that the number of older adults continues to increase in Korea, the K-PSS-10 is a tool with potential use in a wide range of future studies of stress in older adults. A replication study with a larger sample size and additional psychometric evaluation will confirm the use of the K-PSS-10 for application in clinical research and practice.

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Demographic Characteristics (N = 342)

Demographicn (%)Mean (SD) of the K-PSS-10Fp Value
Age (years)
  60 to 6431 (9.1)17.45 (4.36)0.690.598
  65 to 6971 (20.8)16.39 (5.03)
  70 to 74108 (31.6)16.02 (5.07)
  75 to 7977 (22.5)16.97 (5.82)
  >8051 (14.9)16.71 (5.09)
  Missing4 (1.1)
Gender
  Female223 (65.2)16.49 (5.45)−0.310.758
  Male117 (34.2)16.68 (4.62)
  Missing2 (0.6)
Marital status
  With spouse183 (53.5)16.48 (4.88)−0.310.757
  Without spouse157 (45.9)16.65 (5.51)
  Missing2 (0.6)
Religion
  Christian168 (49.1)16.85 (4.82)0.440.781
  Buddhism105 (30.7)16.17 (4.93)
  None59 (17.2)16.24 (6.40)
  Others5 (1.5)15.40 (6.27)
  Missing5 (1.5)
Education
  No education42 (12.3)18.07 (5.72)2.250.063
  Elementary graduate91 (26.6)16.11 (5.54)
  Middle school graduate69 (20.2)17.46 (4.57)
  High school graduate86 (25.1)16.14 (4.49)
  > College graduate51 (14.9)15.55 (5.64)
  Missing3 (0.9)
Perceived health*
  Very gooda24 (7)14.29 (4.41)5.19<0.01
  Goodb103 (30.1)15.54 (5.10)
  Fair107 (31.3)16.61 (5.17)
  Poor83 (24.3)17.71 (4.93)
  Very poorc21 (6.2)19.57 (5.14)
  Missing4 (1.1)

Factor Loadings and Reliability of the Korean Version of the Perceived Stress Scale-10

ItemFactor 1Factor 2
9. In the last month, how often have you been angered because of things that were outside of your control?0.830.03
3. In the last month, how often have you felt nervous and stressed?0.820.01
10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?0.810
1. In the last month, how often have you been upset because of something that happened unexpectedly?0.76−0.08
2. In the last month, how often have you felt that you were unable to control the important things in your life?0.68−0.04
6. In the last month, how often have you found that you could not cope with all the things that you had to do?0.49−0.08
*4. In the last month, how often have you felt confident about your ability to handle your personal problems?0.030.72
*8. In the last month, how often have you felt that you were on top of things?0.120.71
*5. In the last month, how often have you felt that things were going your way?0.130.60
*7. In the last month, how often have you been able to control irritations in your life?−0.190.48
Eigenvalue3.361.62
Percent explained variance (49.71%)33.5516.16
Mean (SD)1.48 (0.83)1.91 (0.97)
Cronbach's alpha0.870.71

Pearson Correlations Between Korean Version of the Perceived Stress Scale-10 Factors and Construct Validity Variables

FactorDepressionPerceived HealthQuality of Life
Positive stress0.30*0.08−0.36*
Negative stress0.42*0.24*−0.45*
Authors

Dr. Son Hong is Professor, Dr. Oh is Lecturer, and Ms. Park is Lecturer, College of Nursing, Hanyang University, Seoul, and Dr. Kang is Assistant Professor, Department of Nursing, Chungcheong University, Cheongju, South Korea; and Dr. Kim is Adjunct Professor, School of Nursing, University of San Francisco, San Francisco, California.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This study was supported by the Institute of Aging Society at Hanyang University, Seoul, South Korea, for Dr. Hong (2011–2012).

Address correspondence to Gwi-Ryung Son Hong, PhD, RN, Professor, College of Nursing, Hanyang University, #222 Wangsimrilo, Sungdong-gu, Seoul, South Korea; e-mail: grson@hanyang.ac.kr.

Received: November 19, 2014
Accepted: July 20, 2015
Posted Online: September 01, 2015

10.3928/19404921-20150806-72

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