Marie Germund Nielsen1, Eva Ørnbøl2, Mogens Vestergaard3, Per Bech4, Finn Breinholt Larsen5, Mathias Lasgaard6, Kaj Sparle Christensen7. 1. Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark. Electronic address: mm@ph.au.dk. 2. Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark. 3. Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark; Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark. 4. Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Denmark. 5. Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark. 6. Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark; Department of Psychology, Southern University of Denmark, Odense, Denmark. 7. Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
Abstract
OBJECTIVE: Stress impacts the quality of life and is associated with increased risk of mental and physical disorders. The Perceived Stress Scale (PSS) is widely used for measuring psychological distress. Although the instrument was originally defined as a single construct, several studies based on classical test theory suggest that a two-dimensional structure is more dominant. We aimed to explore the construct validity and dimensionality of the PSS-10 using modern test theory to determine if the scale is predominantly for a one- or a two-dimensional model. METHODS: The study population consisted of 32,374 citizens who completed the PSS-10 as part of the Danish National Health Survey in 2010. We investigated the construct validity of the PSS-10 by CFA. We examined the scalability by investigating the fit of the data distribution in a unidimensional Rasch model and performing modification of response categories, persons and items. The scale dimensionality was additionally assessed by Mokken and Rasch analysis. RESULTS: The PSS-10 did not fit the Rasch model. Item four indicated the largest misfit, and items four and seven displayed disordered thresholds. Unidimensionality could not be established although the data showed improved fit to the Rasch model for the two dimensions respectively with the positive and negative items. Mokken analysis revealed fit to the unidimensional model, but disordered thresholds were shown for item four. CONCLUSION: Our large population-based study indicated scalability problems in the current version of the PSS-10. The conducted analysis overall revealed better statistical fit for a two-dimensional than a unidimensional model.
OBJECTIVE: Stress impacts the quality of life and is associated with increased risk of mental and physical disorders. The Perceived Stress Scale (PSS) is widely used for measuring psychological distress. Although the instrument was originally defined as a single construct, several studies based on classical test theory suggest that a two-dimensional structure is more dominant. We aimed to explore the construct validity and dimensionality of the PSS-10 using modern test theory to determine if the scale is predominantly for a one- or a two-dimensional model. METHODS: The study population consisted of 32,374 citizens who completed the PSS-10 as part of the Danish National Health Survey in 2010. We investigated the construct validity of the PSS-10 by CFA. We examined the scalability by investigating the fit of the data distribution in a unidimensional Rasch model and performing modification of response categories, persons and items. The scale dimensionality was additionally assessed by Mokken and Rasch analysis. RESULTS: The PSS-10 did not fit the Rasch model. Item four indicated the largest misfit, and items four and seven displayed disordered thresholds. Unidimensionality could not be established although the data showed improved fit to the Rasch model for the two dimensions respectively with the positive and negative items. Mokken analysis revealed fit to the unidimensional model, but disordered thresholds were shown for item four. CONCLUSION: Our large population-based study indicated scalability problems in the current version of the PSS-10. The conducted analysis overall revealed better statistical fit for a two-dimensional than a unidimensional model.
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