A Japanese version of the perceived stress scale: translation and preliminary test
Introduction
This paper describes the development of a Japanese version of a stress measure for use in a cross-cultural study of antecedents of work-related stress amongst nurses. There are a number of models for conceptualising stress which broadly fall into one of the following three categories: those looking at external stressors; those focusing on responses to stress; and those emphasising the interaction between individual appraisals of the demand imposed and of his/her capability (Cox, 1986). However, there is a growing consensus that stress develops from an imbalance between the individual’s perception of situational demand and of his/her own ability to cope with the demand. That is to say the experience of stress is dependent upon the interaction between the individual and the external stressor.
There is a diversity of scales for quantifying the level of stress, and each scale’s conceptual and operational definition of stress can also be classified according to the above categorisation. Many attempt to measure the frequency of specific stressful events that the respondent has experienced within a particular environment. One such example is the Nursing Stress Scale (Gray-Toft and Anderson, 1981). Others assess the intensity of stress induced by particular events, such as the Life Event Scale (Holmes and Rahe, 1967) and the Occupational Stress Indicator (Cooper et al., 1988). However, both these stress measurements measure stress purely in terms of external stressors thereby requiring that there is a common perception of that which is potentially stressful. Also, stress caused by specific events cannot be simply separated from stress emanating from other sources, for example, personal stress may increase work-related stress (Lewis et al., 1994) because perceived ability to cope may be diminished. Furthermore, a scale that measures stress in relation to specific events runs the risk of being inherently culture bound since that which is perceived as stressful to one group may not be to another.
An ideal stress measurement for a cross-cultural study should, therefore, assess the individual’s global perception of stress rather than stress related to specific events. The Perceived Stress Scale (PSS) created by Cohen et al. (1983) is one of the few instruments to measure a global level of perceived stress, dealing with the degree to which situations in one’s life are appraised as stressful. It is a 14-item scale that assesses perceived stressful experience or stress responses over the previous month. Each item is on a five-point Likert format which requires scoring of 4=never, 3=almost never, 2=sometimes, 1=fairly often and 0=very often for items stating positive experiences or response. Reverse scoring is required for items stating negative experiences or response. Total possible scores are from 0 to 56. Higher scores represent high stress levels.
There is an abundant literature reporting reliability and validity. The creators reported convergent validity indicated by relationships with depressive (r=0.76, n=332) and physical (r=0.70, n=64) symptomatology scales. Internal consistency reliability was high with Cronbach’s alpha coefficient ranging from 0.84 (n=332) to 0.86 (n=64) (Cohen et al., 1983).
The PSS has subsequently been used in a range of settings and has been shown to relate to a number of physiological and psychological responses. Scores on the PSS are associated with depressive symptoms (Chang, 1998; Otto et al., 1997), measures of depression (Band et al., 1998; Treadgold, 1999) and anxiety and psychosomatic complaints (van Eck and Nicolson, 1994). The PSS scores are also related to biochemical responses such as anti-inflammatory response (Song et al., 1999), antibody status (Burns et al., 2002), and use of antidepressant (Fava et al., 1996). The PSS has been utilised not only for measuring levels of stress, but also for evaluating the effect of interventions to reduce stress (Chen et al., 2000) and has been used as a reference standard for examining validity of new stress measures (Levenstein et al., 1993).
A major present gap in cross-cultural research on health outcomes is that most measurements have been developed in English-speaking countries and there are relatively few measurements which have been properly constructed or appropriately translated and evaluated in non-English-speaking cultural settings (Hutchinson et al., 1996). The PSS has been translated into several languages including Spanish (Department of Psychology, 2002), Swedish (Eskin and Parr, 1996) and Chinese (Lee and Crockett, 1994). Thus it has particular value in cross-cultural studies since it has been used in a wider range of cultures than most measures. Nevertheless there is no evaluated Japanese version. This paper reports the development of a translated Japanese version of the PSS and preliminary testing for reliability and validity. Permission to translate the PSS into Japanese was granted by the developer, Professor Sheldon Cohen. The study was conducted under the aegis of a wider study which had been ethically scrutinised and approved by the author’s institutional ethical committee.
Section snippets
Translation
The repeated forward–backward translation procedure was adopted as it is most commonly quoted in the adaptation and translation process (Meadows et al., 1996) and was considered to be the best within the strategies which were pragmatically possible. In this procedure a forward translation is made from the source original language to the target new language. The target language version is then translated back into the source language and compared to the original version. Errors in the target
Method
A small-scale investigation was conducted to examine reliability and validity for the PSS Japanese version (PSSJ). The original PSS was administered on native English speakers in London and the PSSJ on native Japanese speakers in a suburb of Tokyo. The data collected were statistically analysed using SPSS 10.1 for Windows in terms of internal consistency reliability and construct validity. This allows the technical performance of scores on the translated measure to be tested and its conceptual
Internal consistency
In order to examine the extent to which all the items in the PSS and PSSJ represent the same phenomena within the sample, Cronbach’s alpha coefficient was calculated. The analysis showed 0.88 for the PSS and 0.81 for the PSSJ, both are acceptable and very close to the figures identified for the original version which was from 0.84 to 0.86 (Cohen et al., 1983) and 0.80 (Hewitt et al., 1992).
Construct validity
An exploratory factor analysis was deployed to compare the relationships among the items between the PSS
Discussion
Discussion on meanings of words among an intimate couple of a native English speaker and a Japanese native speaker is, as far as we are aware, novel in the formal cross-cultural translation of psychometric scales and may greatly contribute to the equivalence between the original and target language versions. However such couples are likely to differ from the population in general. The translation might, therefore, be biased although professional translators and those who generate the original
Conclusion
This study has confirmed the internal consistency of scores on the original PSS and identified similar reliability in scores on the translated PSSJ. However reliability is a necessary but not sufficient indicator of successful translation. The equivalence between the PSS and PSSJ is further supported through a near identical factor structure and factor loadings on items. We conclude that the PSSJ is a suitable tool for the study of perceived stress among native Japanese speakers and that there
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