Perceived Stress Scale

1. Background and references

The Perceived Stress Scale is a 10-item self report questionnaire that measures persons
evaluation of the stressfulness of the situations in the past month of their lives. The citation for
the 10-item scale is Cohen, S., & Williamson, . !1"##$. Perceived stress in a pro%a%ilit& sample
of the 'nited States. (n S. Spacapan & S. )s*amp !+ds.$, The social ps&cholo,& of health-
Claremont S&mposium on applied social ps&cholo,&. .e/%ur& Par*, C0- Sa,e. The PSS /as
desi,ned for use /ith communit& samples /ith at least a 1unior hi,h school education. The items
are eas& to understand and the response alternatives are simple to ,rasp. 2oreover, the questions
are quite ,eneral in nature and hence relativel& free of content specific to an& su%-population
,roup. There are also 13- and 3-item versions of the scale, /hich /ere not used in the C)450
stud&.
There are man& different aspects of stress, includin, !a$ actual environmental e6periences, !%$
su%1ective evaluations of the stressfulness of a situation, and !c$ the affective, %ehavioral, or
%iolo,ical responses to environmental e6periences or their su%1ective evaluations. The Perceived
Stress Scale measures su%1ective evaluations of the stressfulness of a situation. These are
referred to as appraisals or perceptions of stress. 78This9 ps&cholo,ical perspective on stress
places emphasis on the or,anisms perception and evaluation of the potential harm posed %&
stimuli !stressors or events$. The perception of threat arises /hen the demands imposed upon an
individual are perceived to e6ceed his or her felt a%ilit& to cope /ith those demands. This
im%alance ,ives rise to la%elin, oneself as %ein, stressed and to a concomitant ne,ative
emotional response. (t is important to emphasi:e that ps&cholo,ical stress is defined not solel&
in terms of the stimulus condition or the response varia%les, %ut rather in terms of the transaction
%et/een the person and the environment. Ps&cholo,ical stress involves interpretation of the
meanin, of an event and the interpretation of the adequac& of copin, resources. (n short, the
ps&cholo,ical perspective on stress assumes that stress arises totall& out of persons perceptions
!/hether accurate or inaccurate$ of their relationship to their environment; !Cohen, <essler, and
ordon, 1""=$.
The Perceived Stress Scale is the onl& empiricall& esta%lished inde6 of ,eneral stress appraisal.
7The PSS measures the de,ree to /hich situations in ones life are appraised as stressful;
!Cohen, et al., 1"#>? p. >#@$. The ori,inal 13-item scale /as desi,ned 7to tap the de,ree to
/hich respondents found their lives unpredicta%le, uncontrolla%le, and overloadin,; !p. >#=$.
2. Summary statistic
PSS-10 scores are o%tained %& reversin, the scores on the four positive items, e.,., 0A3, 1A>,
BAB, etc. and then summin, across all 10 items. (tems 3,@, =, and # are the positivel& stated
items. Scores can ran,e from 0 to 30, /ith hi,her scores indicatin, ,reater stress.
The PSS is not a dia,nostic instrument, so there are no cut-offs. There are onl& comparisons
%et/een people in a ,iven sample. There are some normative data on the PSS %ased on a 1"#>
4arris Poll of a representative '.S. sample. These data ma& %e helpful in providin,
comparisons, %ut the& are over B0 &ears old. See- Cohen, S., & Williamson, . !1"##$.
Perceived stress in a pro%a%ilit& sample of the 'nited States. (n S. Spacapan & S. )s*amp
!+ds.$, The social ps&cholo,& of health- Claremont S&mposium on applied social ps&cholo,&.
.e/%ur& Par*, C0- Sa,e.
Cor more information a%out PSS scorin, !cut-offs and dia,noses$, refer to the article-
Cohen, S. !1"#D$. Contrastin, the hassle scale and the perceived stress scale. 0merican
Ps&cholo,ist, 31, =1D-=1" !comment$.
3. Reliability and validity
(nternal relia%ilit&. Crom Cohen and Williamson, 1"##, p. @@, Coefficient alpha of .=#.
Test-retest relia%ilit&. ( didnt find an&thin,. The items on the scale are anchored to appraisals in
the past month, so one /ould not necessaril& e6pect hi,h test-retest relia%ilit& for measurements
that did not overlap in time.
Construct validit&- Crom Cohen and Williamson, 1"##, p. @@- 7E PSS scores /ere moderatel&
related to responses on other measures of appraised stress, as /ell as to measures of potential
sources of stress as assessed %& event frequenc&.;
Predictive validit&. o to
http-FF///.macses.ucsf.eduFresearchFps&chosocialFnote%oo*Fpssref.html to see a list of studies
that e6amine the relationship %et/een the Perceived Stress Scale !PSS$ and %iolo,ical or verified
disease outcomes.
Giscriminant validit&. (n a stud& e6aminin, the relationship of the common cold to ne,ative life
events, ne,ative affect, and perceived stress, havin, more ne,ative life events /as associated
/ith more severe clinical illness !i.e., more severe s&mptoms$ /hereas ,reater ne,ative affect
and perceived stress /ere associated /ith a hi,her pro%a%ilit& of %ecomin, infected !Cohen, et
al., 1"">$. This demonstrates that perceived stress is not the same as ne,ative life events
themselves, even thou,h it ma& have %een the ne,ative life events that contri%uted to the
perceived stress.
4. Selected abstracts
Cohen, Sheldon. Perceived stress in a pro%a%ilit& sample of the 'nited States. (n Spacapan,
Shirl&nn !+d$? )s*amp, Stuart !+d$. !1"##$. The social ps&cholo,& of health. !pp. >1-D=$. B@1
pp. Thousand )a*s, C0, 'S- Sa,e Pu%lications, (nc.
0%stract!from the chapter$ the purpose of this chapter is to present ps&chometric and descriptive
data on a scale desi,ned to measure stress perceptions, and to esta%lish that such a scale can
predict the ran,e of health-related outcomes presumed to %e associated /ith appraised stress FFF
/e discuss the advanta,es of a scale measurin, ,enerali:ed perceptions of stress, descri%e the
Perceived Stress Scale !PSS$, and address the controvers& surroundin, the use of a scale
assessin, stress perceptions FFF /e report ne/ and e6citin, PSS data from a lar,e !B,>#=
respondents$ pro%a%ilit& sample of the 'nited States collected %& Houis 4arris and 0ssociates,
(nc. in 1"#> FFF data are presented on the ps&chometric qualities of the scale, and on the relation
of the PSS to other stress, health, and satisfaction measures.
Cohen, Sheldon? <amarc*, Tom? 2ermelstein, 5o%in. 0 ,lo%al measure of perceived stress.
Iournal of 4ealth and Social Jehavior. Kol B3!3$ Gec 1"#>, >#@->"D.
Presents data on the Perceived Stress Scale !PSS$, a 13-item measure of the de,ree to /hich
situations in oneLs life are appraised as stressful. Concurrent and predictive validities and internal
and test-retest relia%ilities of the ne/ scale /ere determined usin, scores from 33D
under,raduates and from D3 Ss !mean a,e >#.3 &rs$ participatin, in a smo*in,-cessation pro,ram
offered %& the universit&. 5esults sho/ that the PSS had adequate relia%ilit& and /as a %etter
predictor of the outcome in question !depressive and ph&sical s&mptomatolo,&, utili:ation of
health services, social an6iet&, and smo*in,-reduction maintenance$ than /ere life-event scores.
When compared to a depressive s&mptomatolo,& scale, the PSS /as found to measure a different
and independent predictive construct. 0dditional data indicated adequate relia%ilit& and validit&
of a 3-item version of the PSS for telephone intervie/s. (t is su,,ested that the PSS, /hich is
appended, %e used to e6amine the role of nonspecific appraised stress in the etiolo,& of disease
and %ehavioral disorders and as an outcome measure of e6perienced levels of stress.
Cohen, Sheldon. Contrastin, the 4assles Scale and the Perceived Stress Scale- WhoLs reall&
measurin, appraised stressM 0merican Ps&cholo,ist. Kol 31!D$ Iun 1"#D, =1D-=1#.
5esponds to the criticism of the perceived stress scale !PSS$ developed %& the present author and
collea,ues !see record 1"#3-B3##@-001$ %& 5. S. Ha:arus et al !see record 1"#D-10=D@-001$ in
their defense of the hassles scale the& developed. (t is contended that the PSS predicts
ps&cholo,ic and ph&sical s&mptoms and health %ehaviors after controllin, for an& redundanc&
/ith ps&cholo,ical s&mptom measures.
Cohen, Sheldon? T&rrell, Gavid 0? Smith, 0ndre/ P. Ps&cholo,ical stress and suscepti%ilit& to
the common cold. .e/ +n,land Iournal of 2edicine. Kol >B@!"$ 0u, 1""1, D0D-D1B.
+6amined the association %et/een ps&cholo,ical stress and suscepti%ilit& to the common cold.
>"3 health& Ss !a,ed 1#-@3 &rs$ /ere assessed for de,ree of stress and then e6perimentall&
e6posed to 1 of @ cold viruses, /hile BD control Ss /ere e6posed to a place%o. Ps&cholo,ical
stress /as associated /ith increased ris* of acute infectious respirator& illness in a dose-response
manner? this ris* /as attri%uta%le to increased rates of infection. The stress inde6 /as associated
/ith host resistance and not /ith differential e6posure to virus. The relation %et/een stress and
colds /as independent of a variet& of health practices, %ut there /as a limited association
%et/een stress and clinical illness.
Cohen, Sheldon? T&rrell, Gavid 0? Smith, 0ndre/ P. .e,ative life events, perceived stress,
ne,ative affect, and suscepti%ilit& to the common cold. Iournal of Personalit& and Social
Ps&cholo,&. Kol D3!1$ Ian 1"">, 1>1-130.
0fter completin, questionnaires assessin, stressful life events, perceived stress, and ne,ative
affect, >"3 health& Ss /ere intentionall& e6posed to a common cold virus, quarantined, and
monitored for the development of %iolo,icall& verified clinical illness. Consistent /ith the
h&pothesis that ps&cholo,ical stress increases suscepti%ilit& to infectious a,ents, hi,her scores on
each of the > stress scales /ere associated /ith ,reater ris* of developin, a cold. 4o/ever, the
relation %et/een stressful life events and illness /as mediated %& a different %iolo,ic process
than /ere relations %et/een perceived stress and illness and ne,ative affect and illness. That
these scales have independent relations /ith illness and that these relations are mediated %&
different processes challen,es the assumption that perceptions of stress and ne,ative affect are
necessar& for stressful life events to influence disease ris*.