A Global Measure of Perceived Stress

Author(s): Sheldon Cohen, Tom Kamarck and Robin Mermelstein

Source: Journal of Health and Social Behavior, Vol. 24, No. 4 (Dec., 1983), pp. 385-396
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2136404 .
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A GLOBAL MEASURE OF PERCEIVED STRESS 385

Richardson, Jean,andJulieSolis Wiggins,

JerryS.
1982 "Place ofdeathofHispaniccancerpatients 1973 Personality and Prediction:Principlesof
in Los Angeles County." Unpublished PersonalityAssessment.Reading, MA:
manuscript. Addison-Wesley Publishing Co.
Stoddard,Sandol WilderFoundation
1978 The HospiceMovement.Briarcliff Manor, 1981 CarefortheDying:A StudyoftheNeedfor
New York:Steinand Publishers. Hospicein RamseyCounty,Minnesota.A
Valle, R., and L. Mendoza reportto the Northwest Area Foundation
1978 The Elder Latino. San Diego, CA: Cam- fromthe AmherstH. WilderFoundation,
panilePress. 355 Washington St., St. Paul, MN.

A GlobalMeasureofPerceivedStress
SHELDON COHEN
Carnegie-Mellon University

TOM KAMARCK
Universityof Oregon

ROBIN MERMELSTEIN
Universityof Oregon

of Healthand Social Behavior1983,Vol. 24 (December):385-396

Journal

This paper presents evidencefrom threesamples, two of college studentsand one of partici-
pants in a communitysmoking-cessationprogram,for the reliabilityand validityof a 14-item
instrument,the Perceived Stress Scale (PSS), designed to measure the degree to which
situationsin one's lifeare appraised as stressful.The PSS showed adequate reliabilityand, as
predicted, was correlated with life-eventscores, depressive and physical symptomatology,
utilizationof health services, social anxiety,and smoking-reductionmaintenance.In all com-
parisons, thePSS was a betterpredictorof theoutcome in question thanwerelife-event scores.
When compared to a depressive symptomatologyscale, the PSS was found to measure a
different and independently predictiveconstruct. Additionaldata indicateadequate reliability
and validityof a four-itemversionof thePSS for telephoneinterviews.The PSS is suggestedfor
examiningthe role of nonspecificappraised stress in the etiologyof disease and behavioral
disordersand as an outcome measure of experiencedlevels of stress.

It is a common assumption among health -byone's perceptionsof theirstressfulness,

researchers that the impact of "objectively" e.g., see Lazarus (1966, 1977). Surprisingly,
perspectivehas not been ac-
stressfulevents is, to some degree,determined thistheoretical
Researchreported inthispaperwas supported by
grantsfromtheNationalScienceFoundation (BNS
7923453)and the Heart,Lung and Blood Institute
(HL 29547).The authorsare indebtedto Edward
Lichtenstein and KarenMcIntyrefortheircollab-
orationon thesmoking cessationproject;thestaff
of
University of Oregondormitory housingfortheir
cooperation insecuringStudent SampleI; PamBirell
forhercooperation inobtaining classparticipants
for
SampleII; and to Susan Fiske,Lew Goldberg, Ed-
ward Lichtenstein,Karen Matthews,Michael
Scheier,and Tom Wills forcommentson earlier
draftsof thismanuscript.
Addresscommunications to: SheldonCohen,De-
partment of Psychology, Carnegie-Mellon Univer-
sity,Pittsburgh,PA 15206.
companiedby development of psychometri-
callyvalidmeasuresof perceivedstress.This
articlediscussesthe limitations of objective
and subjectivemeasuresof stressused in the
assessmentof bothglobaland event-specific
stresslevels.It arguesthata psychometrically
soundglobalmeasureofperceivedstresscould
providevaluableadditionalinformation about
therelationship betweenstressandpathology.
Data are presentedon the psychometric
propertiesofthePerceivedStressScale (PSS),
an instrument developedin responseto these
issues.The PSS measuresthedegreeto which
situations in one's life are appraised as
stressful.

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386 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

Researchon the role of psychosocialand "event"is thecognitively mediatedemotional

environmental stressorsas riskfactorsin both responseto theobjectiveevent,nottheobjec-
physicalandpsychological illnesshastypically tiveeventitself(Lazarus,1977;Mason,1971).
employedrelativelyobjectivestressormea- An important partof thisviewis thatthisre-
sures.Thisworkincludesstudiesoftheeffects sponseis notbased solelyon theintensity or
of specificstressfulevents,such as unem- any otherinherent qualityof the event,but
ployment (Cobb and Kasl, 1977;Dooley and rather is dependent on personalandcontextual
Catalano, 1980; Gore, 1978), bereavement factorsas well.
(Stroebeet al., 1982),and exposureto intense The assumedcentrality of thecognitiveap-
levels of noise (Cohen and Weinstein,1981) praisal process suggeststhe desirability of
and high levels of population density measuring perceivedstressas opposedor in
(Sundstrom,1978). In addition,thereis an additionto objective stress. For example,
abundant literatureon thecumulative effectof comparisonof thepredictive validitiesof ob-
objectivestressfullife events (Dohrenwend jectiveand subjectivemeasurescouldhelpto
andDohrenwend, 1974,1981).In thesestudies, clarify theroleof theappraisalprocessin the
variousversionsof life-event scales (original relationshipbetweenobjectivestressorsand
scale developedby Holmesand Rahe, 1967) illness.Perceivedstressscales could also be
are usedto producea cumulative stressscore. usedinconjunction withobjectivescalesinan
These scoresare usuallybased on eitherthe effortto determine whetherfactorssuch as
number ofeventsthathaveoccurredwithin the social support(Pearlinet al., 1981),hardiness
specifiedtemporalframework (in mostcases, (Kobasa, 1979),and locusofcontrol(Johnson
sixto 12months)or on a sumofeventweights and Sarason, 1979)protectpeople fromthe
thatare based on judges' ratingsof thediffi- pathogenic effectsof stressful
eventsbyalter-
cultyof adjustingto theseevents. ingstressorappraisalorbyaltering theprocess
Therearesomeclearadvantages toobjective or processesbywhichappraisedstressresults
measuresof stressful events.First,suchmea- inphysiological or behavioral disorders(Gore,
surespermitan estimateof theincreasedrisk 1981).Finally,perceivedstresscan be viewed
fordisease associatedwiththeoccurrenceof as an outcomevariable-measuring theexperi-
easily identifiable events. Second, the mea- encedlevelofstressas a function ofobjective
surement procedureis oftensimple,e.g., did stressful events,copingprocesses,personality
thiseventoccurduringthe last six months?, factors,etc.
and in manycases, personsexperiencing a Previousworkhas employeda numberof
particular eventcan be identified withoutthe approachesto assess bothglobaland event-
necessityofaskingthemabouttheoccurrence specificlevelsof perceivedstress.For exam-
of the event,e.g., personslivingin noise- ple, severalinvestigators have modifiedlife-
impactedcommunities. Third,thesemeasure- eventscales in an attemptto measureglobal
menttechniquesminimize thechanceof vari- perceivedstress.The modification involved
ous subjectivebiases in the perceptions and askingrespondents to ratethestressfulness or
reporting of events. impactof each experienced event.In general,
On theotherhand,theuse ofobjectivemea- life-stress scoresbasedon self-ratings ofevent
suresofstressimpliesthateventsare,inandof stressfulness are betterpredictors of health-
themselves, theprecipitating cause of pathol- relatedoutcomesthanare scoresderivedfrom
ogy and illnessbehavior.This implication is either a simple countingof events (unit-
counterto theviewthatpersonsactivelyinter- weighting)or normativeadjustmentratings
act withtheirenvironments, appraising poten- (Sarason et al., 1978; Vinokurand Selzer,
tiallythreatening or challenging eventsin the 1975).However,theincreasesinpredictability
lightof availablecopingresources(Lazarus, providedby these ratingsare small. It is
1966, 1977). From this latterperspective, noteworthy thatanyincreasein predictability
stressoreffectsare assumed to occur only ofa weighted eventscoreovera simplecount
whenboth (a) the situationis appraisedas ofeventsis likelyto be smallsincealternative
threatening or otherwise demanding and(b) in- weighting schemesyieldcompositescoresthat
sufficientresourcesare availableto cope with are substantially correlatedwith the event
thesituation. The argument is thatthecausal count(Lei and Skinner,1980).In short,cal-

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A GLOBAL MEASURE OF PERCEIVED STRESS 387

culatingglobalperceivedstresslevelson the icalscalethatcanbe administered inonlya few

basisofreactionsto individual eventsassumes minutes andis easyto score.Becauselevelsof
thatperceivedstresslevelsareveryhighly cor- appraisedstressshouldbe influenced bydaily
relatedwiththe numberof reportedevents. hassles,majorevents,and changesin coping
Otherweaknessesof global perceivedstress resources,thepredictive validityofthePSS is
scalesthatarebasedon a specificlistofevents expectedto falloffrapidlyafterfourto eight
includean insensitivityto chronicstressfrom weeks.
ongoinglife circumstances, to stress from Evidence is presented from three
eventsoccurring in the lives of close friends samples-twoofcollegestudents andone ofa
and family,fromexpectations concerning fu- more heterogeneouscommunity group-for
tureevents,and fromeventsnotlistedon the theconcurrent andpredictive validities
andthe
scale. internaland test-retestreliabilities
of thenew
Subjectivemeasuresofresponseto specific scale. The paper also examinesthe relative
stressorshave also been widelyused, e.g., predictivevalidityof the PSS and two life-
measures of perceivedoccupationalstress eventinstruments. Ourpremiseis thatthePSS
(Kahnet al., 1964).Thereare,however,some shouldprovidea betterpredictor ofhealthout-
practicaland,theoreticallimitations of mea- comesthandoes a globalmeasureofobjective
suresofspecificstressors. Practically,itis dif- stressors,
suchas life-event scales.Thisshould
ficultand time-consuming to adequatelyde- occur because a perceivedstressinstrument
velop and psychometrically validatean indi- providesa moredirectmeasureofthelevelof
vidualmeasureeverytimea new stressoris stressexperienced bytherespondent. Presum-
studied.Theoretically, thereis an issue of ably,itis thislevelofappraisedstress,notthe
whethermeasuresof perceivedresponseto a objectiveoccurrence oftheevents,thatdeter-
specificstressorreallyassess a person'sevalu- minesone's responseto a stressor(s) (Lazarus,
ationsof thatstressor.Thereis, in fact,evi- 1966,1977).Also, the new measureis more
dence that people oftenmisattribute their globalthanlife-event scales. Thatis, it is sen-
feelingsof stressto a particular sourcewhen sitiveto chronicstressderiving fromongoing
thatstressis actuallydue to anothersource lifecircumstances, to stressfromexpectations
(Gochman, 1979; Keating, 1979; Worchel, concerning future events,tostressfromevents
1978; Worcheland Teddlie, 1976). Another notlistedon a particular life-eventsscale,and
problemwithmeasuresofresponseto specific to reactionsto thespecificeventsincludedon
stressorsis thatsuchmeasuresimplytheinde- any scale.
pendenceof thateventin theprecipitation of
disease. However,it is likelythattheillness
processis affected by a person'sglobalstress METHODS
level,notjust byhis/her responseto a particu-
lar event. Validationdatawerecollectedinthreesam-
ples - twoconsisting of collegestudents and
The above discussion indicates the de-
of developing
sirability an instrument to mea- one consistingofa more heterogeneous group
sure a globallevel of perceivedstress.This enrolledin a smoking-cessation program. The
articlepresentsdata on the PerceivedStress samples and assessment procedures are de-
Scale, a 14-itemmeasureof the degreeto scribedbelow.
whichsituations in one's lifeare appraisedas
stressful.PSS itemsweredesignedto tap the Perceived Stress Scale (PSS)
degreeto whichrespondents foundtheirlives
unpredictable, uncontrollable, and overload- The 14 itemsof the PSS are presentedin
ing.These threeissues have been repeatedly AppendixA. PSS scoresare obtainedby re-
foundto be centralcomponents oftheexperi- versing thescoreson thesevenpositiveitems,
ence of stress(Averill,1973; Cohen, 1978; e.g., 0=4, 1=3, 2=2, etc., and thensumming
Glass and Singer,1972;Lazarus, 1966,1977; acrossall 14 items.Items4, 5, 6, 7, 9, 10,and
Seligman,1975). The scale also includesa 13 are thepositively stateditems.
numberof directqueriesaboutcurrent levels The PSS was designedforuse withcommu-
ofexperienced stress.The PSS is an econom- nitysampleswithat leasta juniorhighschool

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388 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

education.The itemsare easy to understand thathad occurredon a scale ranging from-3

and the responsealternatives are simpleto (extremely negative)to +3 (extremely posi-
grasp.Moreover,as notedabove, the ques- tive),theformat usedby Sarasonet al. (1978).
tionsare quite generalin natureand hence Separatescoresweregenerated based on self-
relativelyfreeof contentspecificto any sub- ratedimpactand unweighted events.The un-
populationgroup. weightedscore was the totalnumberof life
The data reportedin thisarticleare from eventschecked.The score based on impact
somewhatrestricted samples,in thattheyare ratingswas the summedimpactof checked
younger,more educated,and containfewer events.Theimpactscoreis nota puremeasure
minority members thanthegeneralpopulation. of the occurrenceof objectiveevents,but
In lightof thegenerality of scale contentand rather takesintoaccounttherespondents' per-
simplicity of languageand responsealterna- ceptionsof theevents.
tives,we feel thatdata fromrepresentative The CenterforEpidemiologic StudiesDe-
samplesof the generalpopulationwouldnot pressionScale (CES-D) was employedas a
differsignificantlyfromthosereported below. measureof current level of depressivesymp-
tomatology(Radloff,1977). Twentyitems,
each representinga statecharacteristic or not
College Student Sample I ofa depressedperson,are rated
characteristic
scale to indicatethefrequency
on a four-point
The respondents were 332 (121 male, 209 of theiroccurrenceduringthelast week. Re-
female,two withsex not specified)freshman sponseoptionsrangefrom"rarelyor noneof
college studentslivingin dormitories at the thetime"to "mostor all of thetime."
University of Oregon.The mean age of the Physicalsymptomatology was measuredby
samplewas 19.01witha standard deviationof the Cohen-Hoberman Inventoryof Physical
2.75. All respondentsgave writtenconsent Symptoms (CHIPS). The CHIPS is a listof39
allowingaccess to theirstudenthealthcenter common physical symptoms(Cohen and
records. Hoberman, 1983). Items were carefully
Measures. Respondentscompleted five selectedto excludesymptoms ofan obviously
scales: one measuredlifeevents;anotherso- psychological nature,e.g., feltnervousor de-
cial anxiety; a third depressive symp- pressed.Thescale,however,is primarily made
tomatology, fourth,physicalsymptomatology; up ofsymptoms, suchas headache,backache,
and finallyperceivedstress(thePSS). All in- acid stomach,that have been traditionally
struments were completedduringa one and viewedas psychosomatic. Each itemis rated
one-half hoursession. forthedegreeto whichthatproblembothered
A modifiedversionof the CollegeStudent ordistressed theindividual during thepasttwo
Life-Event Scale (CSLES) was usedas a mea- weeks.Itemsareratedonfive-point scalefrom
sureof stressful lifeevents;theoriginalscale "not at all" to "extremely." The CHIPS has
was developedby Levineand Perkins(1980). beenfoundto haveadequatereliability and to
Thisscale is composedof99 itemsthatrepre- predictuse of studenthealthservicesin the
senteventsthatfallinto14different categories seven-week periodfollowing completion ofthe
characterizing theadjustment demandsofcol- scale(r = .29and.22inindependent samples).
lege students,e.g., academic affairs,male- The Social Avoidanceand DistressScale
femalerelationships, andfamily matters. Nine (SADS) was used to measuresocial anxiety
itemsdealingwithhealth-related issues were (Watson and Friend, 1969). This 28-item
not used in calculatinglife-stress scores be- true-falsescale taps boththe desireto avoid
cause of thepossibility thattheseitemswere others(socialavoidance)andtheexperience of
measuringthe same thingas items in the distressin socialinteractions (socialdistress).
symptomchecklists.Analysesincludingthe of thestudenthealthcenterwas
Utilization
unuseditemsindicated thattheirexclusion did also monitored.All university studentsare re-
-
notaffecttheresultsreported below. quiredto paya feethatprovidesforoutpatient
Respondents wereaskedto indicatewhether medicalcare. The physiciansat the student
each eventhad occurredduringthelastyear. healthcenterroutinely fillout a standardized
Theywereasked to ratetheimpactof events formdescribing theproblem(s)forwhichthe

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A GLOBAL MEASURE OF PERCEIVED STRESS 389

studentwas treatedat each visit.The formis weresolic-

Program.Participants
ing-Control
and radio
newspaper,television,
based on the International Classification of itedthrough
in
To qualifyforparticipation
Diseases, 9thRevision (Commissionon Profes- advertisements.
sionalandHospitalActivities, 1980)andallows theprogram, subjectseitherhadto be married
each visit to be classifiedas illness-relatedor livingwitha partner.The meanage of the
(codes 001-779),injury- and poisoning-relatedsubjects was 38.4 years (s = 11.57). Thirty-
(codes 800-999),or "other"(V codes), e.g., sevenpercentofthesamplemadeover$25,000
receiveprophylactic vaccination. peryear,and 74 percenthadformaleducation
For each student,the numberof visitsin beyondhighschool.Theyhad been smoking
each ofthethreecategorieswas recorded.Up foran averageof20.9 years(s = 11.82).Only
to three symptomsor problemscould be threeof theparticipants werestudents;all of
checkedforany individualvisit.If theprob- theseweregraduatestudents, 25 to 31 years
lemswereall in thesame category,onlyone old. Themeanself-monitored baselinesmoking
visitwas recordedforthatcategory.If the ratewas 25.6 cigaretsa day.
problemswerein different categories,a sepa- Treatment.Treatmentgroupsmet for six
ratevisitwas recorded foreachofthepertinent consecutiveweeklysessionslastingapprox-
categories.Whentotalvisits(collapsingover imatelytwo hourseach. The targetquitting
categories)were calculated,each visit was dateoccurredon thefourth session.Interven-
countedas one, irrespective of whether there tion strategies included behavioral self-
was a singleproblemor a number ofproblems management techniques, nicotine-fading,anda
in differentcategories.Boththenumber ofill- cognitive-behavioral relapse preventionpro-
ness visitsand thenumberof totalvisitsare gram.Overall,64 percent(N = 41) ofthesub-
analyzedin thisreport. jects wereabstinent at theend of treatment.
The number ofvisitswas calculatedforeach Measures. Duringa pretreatment testing
of two independent timeblocks:the44 days session,subjectscompleteda life-event scale,
precedingthetestingsessionand the46 days a physical-symptom checklist(CHIPS), and
following thetestingsession.The initial44-day thePSS. The life-event scale consistedof 71
periodwas usedas an indicator ofthebase-rate normatively negativeeventschosenfromthe
of visits. UnpleasantEventsSchedule(Lewinsohnand
Talkington,1979).This scale replacedtheone
College Student Sample II used withstudent samplesbecauseitprovided
an itempool appropriate to the community
Respondents inthesecondsamplewere114 population.Subjectsidentify the eventsthat
members ofa class in introductory personality have happenedto themin thelast six months
psychology (53females, 60males,andonewith and ratetheimpactofeach eventon a seven-
sex notspecified) whoreceivedclass creditfor pointscale,ranging fromextremely to
negative
participatinginthestudy.The meanage ofthe extremely positive.As in thecollegestudent
samplewas 20.75witha standarddeviationof samples,boththe numberof eventsand the
4.41. These studentscompletedthesamefive event-impact scoreswereanalyzed.
questionnaires as thosein thepreviousstudy SubjectscompletedthePSS and theCHIPS
duringa one and one-half hoursessionduring priorto thefirsttreatment sessionand at the
the secondweek of the SpringQuarter.For endofthesix-weektreatment. Bothtestswere
thissample,thedataon healthservicesutiliza- administered in the same manner as withthe
tionwere dividedintothe 90 days preceding collegestudentsamples,exceptthatwiththe
the testingsessionand the46 days following groupof smokers,a one-weektimeframewas
thetesting session.The90-dayperiodwasused used fortheCHIPS.
as an indicatorof thebase-rateof visits.
RESULTS
Smoking-CessationSample
Means, Variance and ReliabilityEstimates
Subjects.Subjectswere27 malesand 37 fe-
ina smoking-cessation
malesparticipating pro- Mean scores on the PSS forthe complete
gramrunby theUniversity of OregonSmok- samples(males and femalescombined)were

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390 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

23.18and23.67inthestudent samplesand25.0 andfemalesin each sample.The relativemag-

inthesmoking-cessation sample.Standardde- nitudesof the correlations formales and fe-
viationswere7.31,7.79,and 8.00,and ranges maleswitheach ofthecriteria werecompared
were6 to 50, 5 to 44, and 7 to 47. Mean PSS by transforming the correlations to z scores
scoresforfemaleswere23.57and 25.71inthe (Fisher'stransformation) and dividingthedif-
studentsamplesand 25.6 in the communityferencebetweenthez scoresby thestandard
sample.Standarddeviationswere7.55, 6.20, errorof the difference betweenthe z coeffi-
and 8.24. Mean PSS scores formales were cients(cf.Guilford, 1965).None oftheresult-
22.38and21.73inthestudent samplesand24.0 ingz scoresweresignificantly differentfrom0
inthecommunity sample.Standarddeviations at thep < .05 level. Since therewereno dif-
were 6.79, 8.42, and 7.80, respectively. Al- ferences betweenmalesandfemales,onlydata
thoughthe meanPSS score forfemaleswas fortheentiresampleare reported below.
slightlyhigher thanthemeanscoreformalesin Separatecorrelations betweenthePSS and
all threesamples,thisdifference did not ap- validitycriteriawerealso calculatedforthose
proachstatistical significancein any sample. below and above medianage in the smoking
Age was unrelated to PSS in all threesam- cessationsample.These analysesseemedun-
ples. Since theage distribution in thecollege ncessaryin thestudentsamples,since98 per-
studentsampleswas severelyskewed,a cor- centof the studentswerebetween16 and 25
relationbetweenthePSS andagewas unlikely. years old. The 31 personsin the "young"
Thecorrelations betweenageandPSS were.04 community grouprangedfrom22 to 35. The 33
and -.08 in thecollege samples and -.02 in the personsin the"old" grouprangedfrom36 to
smoking-cessation sample. 70. Correlationsforyoungand old werecom-
Coefficient alphareliabilityforthePSS was paredwiththesameprocedure described inthe
.84, .85, and .86 in each of thethreesamples. foregoing. Onlyone ofthesecomparisons indi-
For a state measure,test-retest correlations cateda statistically difference
significant at the
shouldbe muchhigher forshortretestintervals p < .05 - actuallyp < .01 - level. Data on
thanforlongerones. For thePSS, twointer- thiscomparison arepresented in theappropri-
valsareavailable,twodaysandsixweeks.The atesectioninthefollowing andaddressedinthe
PSS was administered, on twooccasionssepa- discussionsection.
ratedby two days,to 82 collegestudentsen- Correlations between PSS and Life-Event
rolledin coursesat theUniversity ofOregon; Scores. Since perceivedstressshouldgener-
when respondingto the retest,the subjects ally increase with increases in objective
wereasked to striveforaccuracyratherthan cumulativestresslevels, the PSS shouldbe
for consistencyacross time.The test-retestrelatedtothenumber oflifeevents.Moreover,
correlation inthissamplewas .85,whereasthe thesecorrelations shouldbe higherwhenthe
correlation was only.55 forthe64 subjectsin life-event scores are based on the self-rated
thesmoking studywhowereretestedaftersix impactof theevents,sinceimpactscoresre-
weeks. flectsomeofthesamestressorappraisalmea-
suredby thePSS. As apparentfromTable 1,
Evidence for Concurrentand thereis a smallto moderatecorrelation be-
Predictive Validity tweennumber oflifeeventsand thePSS in all
threesamples.Moreover,in all butone case,
Separatecorrelations betweenthePSS and thatcorrelation increaseswhenthescale score
thevaliditycriteriawerecalculatedformales takesintoaccounttherespondent's perception

TABLE 1. CorrelationsbetweenLife-EventScores and PSS

Smoking-CessationStudy
College Student College Student Beginningof End of
Sample I Sample II Treatment Treatment
Number of Life Events .20* .17 .38* .39*
Impact of Life Events .35* .24* .49* .33*
*p<.Ol.

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A GLOBAL MEASURE OF PERCEIVED STRESS 391

TABLE 2. Correlations ofStressMeasureswithDe- than that the stress caused the symp-
pressiveSymptomatology tomatology.
In regard to establishingthe validityof the
CollegeStudentCollegeStudent PSS, it is importantto note the substantialcor-
SampleI SampleII
relations between the scale and both symp-
Numberof
LifeEvents .18* .14 tomatologymeasures. There is probablysome
Impactof overlap between what is measured by the de-
LifeEvents .29* .33* pressive symptomatologyscale and what is
Perceived measured by the PSS, since the perceptionof
StressScale .76* .65* stress may be a symptomof depression. This
*p<.001. may, to some degree, account for the mag-
nitude of that correlation.In lightof the very
of the events. Hotelling t-tests, testing the high correlation between the PSS and the
statisticalsignificanceof differencesbetween CES-D (depressive symptomscale), it is desir-
correlations,indicate that this increase is sig- able to demonstratethat these scales are not
nificant(p < .05) forStudentSample I and for measuringthe same thing.Hence, partialcor-
the smoking-cessationsample at the beginning relationswere calculated; in these, depressive
of treatment. symptomatology was partialledout of the cor-
There was a differencein the correlation relations between the PSS and physical symp-
between PSS and numberof negative events tomatology, and the PSS was partialledout of
for young and old participantsin the smoking the correlation between depressive symp-
cessation sample. For the young, the correla- tomatologyand physical symptomatology.In
tion was .65 (p < .05); forthe old, it was .19. the case of PSS and physicalsymptomatology,
PSS Versus Life Events as a Predictor of the correlationwas .16, p < .01, for sample I
Symptomatology. As noted earlier, we ex- and .17, p < .07, for sample II. In the case of
pected thatthe PSS would be a betterpredictor the CES-D and physical symptomatology, the
of the various health outcomes than would correlation was .31, p < .01, in sample I and
stressfullife-eventscores. The data presented .38,p < .01, in sample II. Hence, even withthe
in Tables 2 and 3 supportthispredictionin the very high correlation between the PSS and
case of both depressive and physical symp- CES-D, both scales still independentlypre-
tomatology.Hotellingt-test(p < .05) provide dicted physical symptomatology.
statisticalsupport for these differencesin all PSS Versus Life Events as a Predictor of
cases. Since these are cross-sectionalcorrela- Utilization of Health Services. Table 4 pre-
tions, no causal inferencesare implied. For sents the correlations between the PSS and
example, it is possible that increased symp- utilization of health services, both beforeand
tomatology caused increased stress, rather afteradministrationof the scale. In Sample I,
the PSS significantly predictedutilizationdur-
ing the five-weekperiod aftercompletingthe
TABLE 3. Correlations* of StressMeasureswith
PhysicalSymptomatology
TABLE 4. Correlations of PSS and HealthCenter
College College Smoking- Beforeand AfterCompleting
Utilization
Student Student Cessation Scale
SampleI SampleII Studya
Numberof Student Student
Life Events .31 .36 .40 Sample I SampleII
Impactof BeforeScale Administration
Life Events .23 .32 .51 PhysicalIllnessVisits .08 -.06
Perceived All Visits .11* -.05
Stress Scale .52 .65 .70 AfterScale Administration
a Sincethelife-events was adminis- Physical Illness Visits .17** .04
questionnaire
tered only at beginning of treatment,only All Visits .20*** .12
beginning-of-treatment data are presentedso that *p<.05.
PSS and life-event correlationsare equivalent. **p<.0l.
* p <.001 forall correlations. ***p <.001.

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392 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

scale. In SampleII, therewas a nonsignificantcoefficient alpha reliability estimatefor the

correlation betweenthePSS andall visitsafter four-item PSS was .72. The test-retest reliabil-
administration of the scale. Correlationbe- ityof the four-item scale over a two-month
tweenthePSS and physicalillnessvisitsafter intervalwas .55.
administration of the scale, withbefore-ad- The four-item scaleat one monthwas corre-
ministration visitspartialledout,was .15,p < lated(.31,p < .01)withtheaveragenumber of
.007, for Sample I and -.02 for Sample II. cigarettes smokedper day at one month;the
Similarpartialcorrelation forthePSS and all latterinformation was froma self-report con-
visitsafteradministration, withall preadmin- firmedwith a carbon monoxidemeasure.
istration visitspartialledout,was .16,p < .01, Similarly, thefour-item scale at threemonths
forSampleI and .13forSampleII. Thesecor- was correlated(.37, p < .001) withsmoking
relationssuggestthatthePSS is predictive of rate at threemonths.Finally,the shortPSS
changesin healthcenterutilization. Correla- scale at one monthaftertreatment predicted
tionsoflife-event scoreswithutilization were smoking ratethreemonths aftertreatment (.39,
notsignificant in bothsamplesforbothphysi- p < .001). In all cases, the greaterthe PSS
cal illness and all visits; these correlations score,themorecigarettes smoked.A number
rangedfrom-.04 to +.03. ofpartialcorrelationswerecalculatedtoclarify
PSS Versus Life Events as a Predictor of the natureof the relationship betweenthe
Social Anxiety.Levels of perceivedstressin abridgedversionofthePSS and smoking rate.
collegestudents,especiallyfreshmen, should In the firstpartialcorrelation,the end-of-
be relatedto theirabilityto becomeintegrated treatment PSS score and smokingrate were
intotheuniversity community. We wouldex- partialledout of the correlation betweenthe
pectthatthepoorertheintegration, thegreater four-item PSS and smoking rateat one month
theperceivedstress.The social anxietyscale followingtreatment. The partialcorrelation
providesa traitmeasurethatpresumably taps was .29,p < .01.In thesecondcorrelation, the
difficultyinmaking friendsandsocialcontacts, four-item PSS and smoking rateat one month
i.e., theabilitytointegrateintothecommunity.following treatment werepartialled out of the
In bothstudentsamples,increasesin social correlation betweenthe four-item scale and
anxietywereassociatedwithincreasesin per- smoking rateat threemonths.The partialcor-
ceivedstress(.37 and .48,p < .001forboth). relationwas .34,p < .01. Theseanalysesindi-
Although numberoflifeeventswas unrelated cate thatchanges-in perceivedstressas mea-
to social anxietyin bothsamples,therewere suredby thePSS are predictive ofchangesin
smallcorrelations betweeneventimpactand smoking rate.Another partialcorrelation indi-
social anxiety(-.13, p < .02, -.26, p < .01). catedthattheabridged PSS predicted changes
Again,theseare cross-sectional data and no insmoking rateovera two-month period.Spe-
causal inferences are implied. cifically,a correlation of .26 (p < .05) was
PSS and Smoking-ReductionMaintenance: foundwhen smokingrate at the one-month
The Four-Item Scale. To examine the role of follow-up was partialled outofthecorrelation
the PSS as a predictorof maintenanceof betweenthefour-item PSS at one monthand
smoking-rate reduction, perceivedstresslevel smoking rateat threemonths.Thesedatasug-
was also assessed one and threemonthsfol- gestthatthefour-item scale providesa useful
lowingtreatment. Since posttreatment data measureof perceivedstressforuse in tele-
werecollectedbytelephone interview,a short phoneinterviews and othersituations wherea
versionof the scale, consistingof the four veryshortscale is required.
items(numbers2, 6, 7, and 14)thatwerecor-
relatedmosthighly withthe14-item scale,was
employed.The mean score on the four-itemDISCUSSION
scale was 5.6 at one monthand 5.9 at three
months.Standarddeviations were3.6 and4.0, The PSS has adequate internaland test-
andthescoresrangedfrom0 to 15and0 to 14. retestreliability and is correlatedin the ex-
Mean PSS scoresformaleswere4.8 at one pectedmannerwitha rangeof self-report and
monthand 5.9 at three,whilemeanscoresfor behavioralcriteria. Moreover,thePSS is more
femaleswere 6.2 and 5.9, respectively. The closely relatedto a life-event impactscore,

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A GLOBAL MEASURE OF PERCEIVED STRESS 393

whichis to somedegreebased on therespon- eventscales willbe predictive overfairly long

dent'sappraisalof theevent,thanto themore periods,such as severalmonthsto several
objectivemeasureofthenumber ofeventsoc- years.2 We have examined the predictive
curring withina particular timespan.The PSS abilityofthePSS overfourto 12weekperiods
also provedto be a betterpredictor of health afteradministration. These data suggestthat
and health-related outcomesthaneitherofthe the best predictions occur withina one- or
two life-eventscales. Finally,the PSS, al- two-month period.It is ourfeelingthatas this
though highlycorrelatedwith depressive periodis lengthened, thepredictive validity of
symptomatology, was foundto measurea dif- thescale willfall.Afterall,perceivedlevelsof
ferent and independently predictive construct. stressshouldbe influenced by dailyhassles,
It is noteworthy thatthelevelofcorrelation major-events, andchangesintheavailability of
betweenthe life-event scales and the symp- copingresources,all of whichare quitevari-
tomatological outcomes(.18 to .36 range)is able over a shortperiod.In fact,test-retest
equivalentto,'ifnotbetterthan,similarcorre- reliability analysesindicatethattest-retests in-
lationsreportedin the literature (cf. Rabkin volvinga veryshorttime(twodays) resultin
andStruening, 1976;Tausig,1982).Hence,the fairlysubstantial correlations,whereasadmin-
superior predictabilityofthePSS is notattrib- istrations sixweekslaterproducemoremoder-
utableto psychometric weaknessesinthelife- ate test-retest correlations.
eventscales thatwereemployedor to idiosyn- As mentioned earlier,thePSS canbe usedto
craticaspects of the samplesunder study. determinewhether"appraised" stressis an
Moreover,froman absoluteperspective, the etiological(or risk)factorin behavioraldis-
PSS correlations withsymptomatological mea- ordersor disease. It can also be used to look
suresare quitehigh(.52 to .76). However,in morecloselyat theprocessby whichvarious
the case of depressivesymptomatology, the moderators oftheobjectivestressor/pathology
correlation maybe somewhatinflated by the relationship operate.For example,we could
overlapin the operationaldefinitions of per- determine whether socialsupportprotects one
ceived stress and of depressive symp- fromthepathogenic effectsof stressful
events
tomatology (cf.Dohrenwend etal., 1978;Gore, by altering theappraisalof thoseeventsor by
1981). theprocessbywhichappraisedstress
altering
In general,the relationships betweenPSS causesan illnessoutcome.Thissecondkindof
andthevalidity wereunaffected
criteria bysex analysis,however,is limited to thedegreethat
or age. The one exceptionwas thestrongre- thePSS reflects responsesto eventsoutsideof
lationship betweenthePSS andnumber oflife thosemeasuredby theobjectiveeventinstru-
eventsforthe youngand the lack of such a ment.Thatis, itis limitedto thedegreethatit
relationship fortheold.Thesedatamayreflect is moreglobalthantheobjectivestressor mea-
a difference in theroleof lifeeventsin deter- sure.Finally,thePSS can be used as an out-
mining stresslevelsforthesetwoage groups. come variable, measuringpeople's experi-
Thatis, otherchronicstressors, expectations, encedlevelsofstressas a function ofobjective
etc. maybe moreimportant fortheolderre- stressful events,copingresources,personality
spondents. factors,etc.
The PSS differs fromlife-event scales in a The four-item versionofthePSS providesa
numberof ways. First,thePSS asks abouta usefultool whendata mustbe collectedover
shorterperiod,one monthas opposedto the the phone. This scale makes repeatedmea-
usualsix to 12monthscoveredby typicallife- sures of perceivedstress in large samples
eventscales.1It is worthnotingthatwitha feasible.It shouldbe noted,however,thatbe-
subjectivescale, theshorter periodshouldbe cause of the limitednumberof items,the
sufficient sinceperceivedstressduring thelast abridgedscale suffers ininternal and
reliability
monthshouldreflect anyobjectiveeventsthat thusprovidesa lessadequateapproximation of
are stillaffecting respondents' stresslevels. perceivedstresslevelsthantheentirescale.
A seconddifference betweenthePSS and a Althoughnottestedin thisstudy,thePSS
life-event scale is theperiodof timeafterad- mayalso providean economicaltool foras-
ministration thatthescaleprovidespredictions sessing chronic stress level. Either the
of health-related outcomes.Presumably, life- abridgedversionof the PSS or thecomplete

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394 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

14-item scale couldbe used. Monthly adminis- independent predictivevaliditiesof the PSS
trations ofthescale couldbe summedor aver- and a depressive symptomatology scale.
aged,providing a reliable,i.e., basedon more Hence,thePSS can be viewedas assessinga
samples,measureofchronicstress,as wellas a statethatplaces peopleat riskof,i.e., is an-
predictor thatrepresents a longertermthanthe tecedentto, clinicalpsychiatric disordereven
one-month periodcoveredby the scale. though thatstateis also partofa diversesetof
Two commonly used measures of feelingsand statesthatare characteristic of
nonspecificpsychologicaldistress,the nine- disorder.
scale, 54-itemPERI Demoralization Measure In sum, the PSS is a briefand easy-to-
(Dohrenwendet al., 1980) and the 28-item administer measureof the degreeto which
General Health Questionnaire(Goldberg, situations in one's lifeare appraisedas stress-
1972),includea number ofitemsthatare simi- ful.It has been provento possess substantial
lartothoseinthePSS. Thesescales,however, reliability and validity;thus, it providesa
are muchbroaderin scope.Theyaredesigned potentialtool forexamining issues aboutthe
as epidemiological measures of symp- roleofappraisedstresslevelsintheetiology of
tomatology, andbothincludea broadrangeof disease and behavioraldisorders.
itemstappingcommonpsychiatric symptoms,
such as hostility, diminished self-esteem, de- NOTES
pression,and anxiety,as well as psychoso-
maticcomplaints.Althoughappraisedstress 1. There are two recentlydevelopedlife-event
scales thatassess eventsovera one-month pe-
maybe symptomatic of psychological disorder riod,theHassle Scale (Kanneret al., 1981)and
when viewed in combinationwithelevated the UnpleasantEventsScale (Lewinsohnand
scoreson otherpsychiatric symptoms, itis our Talkington, 1979).
contention thattheperception of stressitself, 2. Pearlinetal. (1981)havepointedoutthatthereis
no singletimeframethatis optionalforobserv-
as assessed by the PSS, is not a measureof ingtheeffects ofdiverselifeevents.However,
psychologicalsymptomatology. This conten- existingworks,includingthe Pearlinet al.
tionis, infact,supported bythedataindicating study,examineratherlongperiods.

APPENDIX A:
Items and Instructionsfor PerceivedStressScale

The questionsinthisscale ask youaboutyourfeelings andthoughts duringthelastmonth.In each case,

youwillbe askedtoindicate howoftenyoufeltorthought a certainway.Although someofthequestionsare
similar, betweenthemandyoushouldtreateach one as a separatequestion.The best
thereare differences
approachis toanswereachquestionfairly quickly.Thatis,don'ttrytocountup thenumber oftimesyoufelt
a particular thatseemslikea reasonableestimate.
way,butratherindicatethealternative
For each questionchoosefromthefollowing alternatives:
0. never
1. almostnever
2. sometimes
3. fairlyoften
4. veryoften
1. In thelastmonth, howoftenhaveyoubeenupsetbecauseofsomething thathappenedunexpectedly?
2. In thelast month,howoftenhave youfeltthatyou wereunableto controltheimportant thingsin
yourlife?
3. In thelast month,howoftenhave youfeltnervousand "stressed"?
4*a In thelast month, howoftenhaveyoudealtsuccessfully withirritating
lifehassles?
5.a In thelastmonth, howoftenhaveyoufeltthatyouwereeffectively copingwithimportant changesthat
wereoccurring in yourlife?
6.a In the last month,how oftenhave you feltconfident aboutyourabilityto handleyourpersonal
problems?
7.a In thelast month,howoftenhave youfeltthatthingsweregoingyourway?
8. In thelastmonth, howoftenhaveyoufoundthatyoucouldnotcope withall thethingsthatyouhad
to do?
9.a In thelast month, howoftenhave youbeenable to controlirritationsin yourlife?
10.a In thelastmonth, howoftenhave youfeltthatyouwereon top of things?

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A GLOBAL MEASURE OF PERCEIVED STRESS 395

APPENDIX A (Continued)

11. In thelast month,how oftenhave you been angeredbecause of thingsthathappenedthatwere outsideof

your control?
12. In thelast month,how oftenhave you foundyourselfthinking about thingsthatyou have to accomplish?
13. aIn the last month,how oftenhave you been able to controlthe way you spend your time?
14. In thelast month,how oftenhave you feltdifficulties
were pilingup so highthatyou could notovercome
them?
a Scored in the reverse direction.

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