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1.  Reliability and Validity of the Multidimensional Scale of Perceived Social Support (MSPSS): Thai Version 
This study examines the Thai version of the Multidimensional Scale of Perceived Social Support (MSPSS) for its psychometric properties.
In total 462 participants were recruited - 310 medical students from Chiang Mai University and 152 psychiatric patients, and they completed the Thai version of the MSPSS, the State Trait Anxiety Inventory (STAI), the Rosenberg Self-Esteem Scale (RSES) and the Thai Depression Inventory (TDI). Test-retest reliability was conducted over a four week period.
Factor analysis produced three-factor solutions for both patient (PG) and student groups (SG), and overall the model demonstrated adequate fit indices. The mean total score and the sub-scale score for the SG were statistically higher than those in the PG, except for ‘Significant Others’. The internal consistency of the scale was good, with a Cronbach’s alpha of 0.91 for the SG and 0.87 for the PG. After a four week retest for reliability exercise, the intra-class correlation coefficient (ICC) was found to be 0.84. The Thai-MSPSS was found to have a negative correlation with the STAI and the TDI, but was positively correlated with the RSES.
The Thai MSPSS is a reliable and valid instrument to use.
PMCID: PMC3219878  PMID: 22114620
Social support; MSPSS; Reliability; Validity; Factor analysis; Confirmatory Factor analysis; Thai.
2.  Teacher Stress Inventory: validation of the Greek version and perceived stress levels among 3,447 educators 
The Teacher Stress Inventory (TSI) is an instrument for measuring occupational stress in teachers. This study aimed to translate and adapt it for use in Greece, and then assess its reliability and validity.
The Greek versions of the TSI and the 14-item Perceived Stress Scale (PSS-14) were posted on all Greek educators’ official sites during May 2012. A nationwide sample of 3,447 teachers of all levels and specialties completed the questionnaires via the Internet. Reliability was determined by the calculation of Cronbach’s alpha coefficient. Confirmatory factor analysis was conducted and validity was further examined by investigating the correlation of the TSI with the PSS-14 and their association with demographics and work-related factors.
Satisfactory Cronbach’s alpha values (above 0.70) were found for all TSI dimensions. Confirmatory factor analysis confirmed the two-factor construct of TSI (root mean square error of approximation, comparative fit index, and goodness-of-fit index values were 0.079, 0.956, and 0.951, respectively), confirming the pre-established theory for the two latent variables, Stress Sources and Stress Manifestations. Significant correlations were found between TSI subscales, PSS-14 sex, age, lack of support, and students’ difficulties.
The Greek version of the TSI was found to have satisfactory psychometric properties, and its use for assessing stress in Greek teachers is warranted.
PMCID: PMC4358647  PMID: 25834469
TSI; reliability; validity; Greek educators; occupational stress; psychosocial factors
3.  Psychometric Properties of the Chinese Version of the Perceived Stress Scale in Policewomen 
PLoS ONE  2011;6(12):e28610.
The 10-item Perceived Stress Scale (PSS-10) is one of most widely used instruments to measure a global level of perceived stress in a range of clinical and research settings. This study was conducted to examine the psychometric properties of the Simplified Chinese version of the PSS-10 in policewomen.
A total of 240 policewomen were recruited in this study. The Simplified Chinese versions of the PSS-10, the Beck Depression Inventory Revised (BDI-II), and the Beck Anxiety Inventory (BAI) were administered to all participants, and 36 of the participants were re-tested two weeks after the initial testing.
Principal Findings
The overall Cronbach's alpha was 0.86, and the test–retest reliability coefficient was 0.68. Exploratory Factor Analysis (EFA) yielded 2 factors with eigenvalues of 4.76 and 1.48, accounting for 62.41% of variance. Factor 1 consisted of 6 items representing “negative feelings”; whereas Factor 2 consisted of 4 items representing “positive feelings”. The item loadings ranged from 0.72 to 0.83. The Confirmatory factor analysis (CFA) indicated a very good fit of this two-factor model to this sample. The PSS-10 significantly correlated with both BDI-II and BAI, indicating an acceptable concurrent validity.
The Simplified Chinese version of the PSS-10 demonstrated adequate psychometric properties for evaluating stress levels. The results support its use among the Chinese population.
PMCID: PMC3229602  PMID: 22164311
4.  A Short Version of the Revised ‘Experience of Close Relationships Questionnaire’: Investigating Non-Clinical and Clinical Samples 
This study seeks to investigate the psychometric properties of the short version of the revised ‘Experience of Close Relationships’ questionnaire, comparing non-clinical and clinical samples.
In total 702 subjects participated in this study, of whom 531 were non-clinical participants and 171 were psychiatric patients. They completed the short version of the revised ‘Experience of Close Relationships’ questionnaire (ECR-R-18), the Perceived Stress Scale-10(PSS-10), the Rosenberg Self-Esteem Scale (RSES) and the UCLA Loneliness scale. A retest of the ECR-R-18 was then performed at four-week intervals. Then, confirmatory factor analyses were performed to test the validity of the new scale.
The ECR-R-18 showed a fair to good internal consistency (α 0.77 to 0.87) for both samples, and the test-retest reliability was found to be satisfactory (ICC = 0.75). The anxiety sub-scale demonstrated concurrent validity with PSS-10 and RSES, while the avoidance sub-scale showed concurrent validity with the UCLA Loneliness Scale. Confirmatory factor analysis using method factors yielded two factors with an acceptable model fit for both groups. An invariance test revealed that the ECR-R-18 when used on the clinical group differed from when used with the non-clinical group.
The ECR-R-18 questionnaire revealed an overall better level of fit than the original 36 item questionnaire, indicating its suitability for use with a broader group of samples, including clinical samples. The reliability of the ECR-R- 18 might be increased if a modified scoring system is used and if our suggestions with regard to future studies are followed up.
PMCID: PMC3367387  PMID: 22675397
ECR-R-18; short; the Experiences of Close Relationships; Confirmatory factor analysis.
5.  Validation of the Perceived Stress Scale in a Community Sample of Older Adults 
Three versions of Perceived Stress Scale (PSS-14, PSS-10, and PSS-4) are among the most widely used measures of stress. The aim of current study was to validate this instrument in a sample of non-demented elderly adults to facilitate studies of the impact of stress on health.
768 nondemented adults over the age of 70 years completed the PSS-14 questionnaire and other neuropsychological tests. Exploratory Factor Analysis (EFA) was used to determine the underlying factor structure of all PSS versions and Confirmatory Factor Analysis (CFA) was used to test the construct validity of factors. The internal consistency reliability of the scales was assessed using Cronbach's alpha, and concurrent validity was evaluated by examining PSS relation with age, gender, depression, anxiety, and Positive Affect and Negative Affect Schedule (PANAS).
A two-factor model was the optimal fit for the 14- and 10-item versions of PSS. For the PSS-14, all items’ loadings exceeded 0.4 for one of the two factors except item 12. Therefore, we studied a 13-item version of PSS as well as 10- and 4-item subsets representing PSS-10 and PSS-4. Internal consistency coefficients were satisfactory for the full scale of PSS-13 and PSS-10, but not for PSS-4. Women reported higher levels of stress than men. Higher levels of total PSS scores showed association with higher levels of depression, anxiety, and negative affect, and lower level of positive affect.
The 13- and 10-item versions of PSS may be used to understand the experience of stress among older adults.
PMCID: PMC4013212  PMID: 24302253
Perceived Stress Scale; older adults; Coping; Distress; Psychometric Properties
6.  Perceived Stress Scale: Reliability and Validity Study in Greece 
To translate the Perceived Stress Scale (versions PSS-4, −10 and −14) and to assess its psychometric properties in a sample of general Greek population.
941 individuals completed anonymously questionnaires comprising of PSS, the Depression Anxiety and Stress scale (DASS-21 version), and a list of stress-related symptoms. Psychometric properties of PSS were investigated by confirmatory factor analysis (construct validity), Cronbach’s alpha (reliability), and by investigating relations with the DASS-21 scores and the number of symptoms, across individuals’ characteristics. The two-factor structure of PSS-10 and PSS-14 was confirmed in our analysis. We found satisfactory Cronbach’s alpha values (0.82 for the full scale) for PSS-14 and PSS-10 and marginal satisfactory values for PSS-4 (0.69). PSS score exhibited high correlation coefficients with DASS-21 subscales scores, meaning stress (r = 0.64), depression (r = 0.61), and anxiety (r = 0.54). Women reported significantly more stress compared to men and divorced or widows compared to married or singled only. A strong significant (p < 0.001) positive correlation between the stress score and the number of self-reported symptoms was also noted.
The Greek versions of the PSS-14 and PSS-10 exhibited satisfactory psychometric properties and their use for research and health care practice is warranted.
PMCID: PMC3166743  PMID: 21909307
Perceived Stress Scale; translation; psychometric properties; validation; Greece
7.  Assessing Perceived Stress in Medical Personnel: In Search of an Appropriate Scale for the Bengali Population 
The occurrence of stress and stress related anxiety and depression in medical personnel are being increasingly reported in literature. The perceived stress scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is needed to assess perceived stress in our population using appropriately translated version of PSS. The objectives of study were to prepare a Bengali version of PSS-10 and to establish its psychometric properties in the study population.
Materials and Methods:
The study was conducted in a teaching hospital among medical students and interns (N=37). The translated Bengali version and the original English version of PSS-10 were separately handed over to the individual subjects. The scores were compared across different subgroups and psychometric properties of the translated version were assessed using SPSS 16.
Internal consistency of PSS English (α=0.79) and Bengali (α=0.80) was satisfactory. Intra-rater reliability was adequate (κ>0.5) for most of the items, but showed an inadequate value (κ<0.5) for four items on the scale. After deleting these four items from the Bengali version, a new six-item PSS in Bengali was derived that showed good internal consistency (α=0.699).
This new version needs to be validated in a larger study population. Perceived stress score using PSS-10 was considerably high in our study population, although there was no significant difference between the subgroups (male/female, intern/student).
PMCID: PMC3701356  PMID: 23833339
Perceived stress scale; psychometric property; translation
8.  Reliability and Validity of the Korean Version of the Connor-Davidson Resilience Scale 
Psychiatry Investigation  2010;7(2):109-115.
The Connor-Davidson Resilience Scale (CD-RISC) measures various aspects of psychological resilience in patients with posttraumatic stress disorder (PTSD) and other psychiatric ailments. This study sought to assess the reliability and validity of the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC).
In total, 576 participants were enrolled (497 females and 79 males), including hospital nurses, university students, and firefighters. Subjects were evaluated using the K-CD-RISC, the Beck Depression Inventory (BDI), the Impact of Event Scale-Revised (IES-R), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale (PSS). Test-retest reliability and internal consistency were examined as a measure of reliability, and convergent validity and factor analysis were also performed to evaluate validity.
Cronbach's α coefficient and test-retest reliability were 0.93 and 0.93, respectively. The total score on the K-CD-RISC was positively correlated with the RSES (r=0.56, p<0.01). Conversely, BDI (r=-0.46, p<0.01), PSS (r=-0.32, p<0.01), and IES-R scores (r=-0.26, p<0.01) were negatively correlated with the K-CD-RISC. The K-CD-RISC showed a five-factor structure that explained 57.2% of the variance.
The K-CD-RISC showed good reliability and validity for measurement of resilience among Korean subjects.
PMCID: PMC2890864  PMID: 20577619
Connor-Davidson Resilience Scale; Posttraumatic stress disorder; Resilience; Reliability; Validity; Trauma
9.  A Comparison of Reliability and Construct Validity between the Original and Revised Versions of the Rosenberg Self-Esteem Scale 
Psychiatry Investigation  2012;9(1):54-58.
The Rosenberg Self-Esteem Scale (RSES) is a widely used instrument that has been tested for reliability and validity in many settings; however, some negative-worded items appear to have caused it to reveal low reliability in a number of studies. In this study, we revised one negative item that had previously (from the previous studies) produced the worst outcome in terms of the structure of the scale, then re-analyzed the new version for its reliability and construct validity, comparing it to the original version with respect to fit indices.
In total, 851 students from Chiang Mai University (mean age: 19.51±1.7, 57% of whom were female), participated in this study. Of these, 664 students completed the Thai version of the original RSES - containing five positively worded and five negatively worded items, while 187 students used the revised version containing six positively worded and four negatively worded items. Confirmatory factor analysis was applied, using a uni-dimensional model with method effects and a correlated uniqueness approach.
The revised version showed the same level of reliability (good) as the original, but yielded a better model fit. The revised RSES demonstrated excellent fit statistics, with χ2=29.19 (df=19, n=187, p=0.063), GFI=0.970, TFI=0.969, NFI=0.964, CFI=0.987, SRMR=0.040 and RMSEA=0.054.
The revised version of the Thai RSES demonstrated an equivalent level of reliability but a better construct validity when compared to the original.
PMCID: PMC3285741  PMID: 22396685
Rosenberg Self Esteem Scale; Revised; Reliability; Validity
10.  Reliability and validity of the Japanese version of the Resilience Scale and its short version 
BMC Research Notes  2010;3:310.
The clinical relevance of resilience has received considerable attention in recent years. The aim of this study is to demonstrate the reliability and validity of the Japanese version of the Resilience Scale (RS) and short version of the RS (RS-14).
The original English version of RS was translated to Japanese and the Japanese version was confirmed by back-translation. Participants were 430 nursing and university psychology students. The RS, Center for Epidemiologic Studies Depression Scale (CES-D), Rosenberg Self-Esteem Scale (RSES), Social Support Questionnaire (SSQ), Perceived Stress Scale (PSS), and Sheehan Disability Scale (SDS) were administered. Internal consistency, convergent validity and factor loadings were assessed at initial assessment. Test-retest reliability was assessed using data collected from 107 students at 3 months after baseline. Mean score on the RS was 111.19. Cronbach's alpha coefficients for the RS and RS-14 were 0.90 and 0.88, respectively. The test-retest correlation coefficients for the RS and RS-14 were 0.83 and 0.84, respectively. Both the RS and RS-14 were negatively correlated with the CES-D and SDS, and positively correlated with the RSES, SSQ and PSS (all p < 0.05), although the correlation between the RS and CES-D was somewhat lower than that in previous studies. Factor analyses indicated a one-factor solution for RS-14, but as for RS, the result was not consistent with previous studies.
This study demonstrates that the Japanese version of RS has psychometric properties with high degrees of internal consistency, high test-retest reliability, and relatively low concurrent validity. RS-14 was equivalent to the RS in internal consistency, test-retest reliability, and concurrent validity. Low scores on the RS, a positive correlation between the RS and perceived stress, and a relatively low correlation between the RS and depressive symptoms in this study suggest that validity of the Japanese version of the RS might be relatively low compared with the original English version.
PMCID: PMC2993730  PMID: 21083895
11.  Reliability, Validity and Preliminary Hypothesis Tests for the English Version of the Psychological Strain Scales (PSS)1 
The original Psychological Strain Scales (PSS) was published with data from a sample of a Chinese population, which consisted of four strain scales: value strain, aspiration strain, deprivation strain, coping strain. This study aims to validate and develop the English version of the PSS instrument.
Together with the PSS, Moos’s Coping Response Inventory (CRI), Spielberger Trait-Anxiety scale, CES-D depression scale, and the NCS suicidal behavior scales were administered in a survey to a sample (N=280) of American college students. Item-total statistics, Cronbach’s Alpha, Guttman Split-Half coefficient, factor analyses, correlation analysis and t tests were applied to test the reliability and validity of the English version of the PSS. Univariate and multivariable regression analyses were operated to know how extent the PSS predicts psychopathology such as anxiety, depression and suicidal behaviors.
Cronbach’s Alpha coefficient of PSS was 0.936. The Split-Half Coefficient of PSS was 0.839. The reliability of the PSS was excellent. The factor analysis results demonstrated strong construct validity of each scale. The criterion validity and the discriminant validity were both excellent for the English version of PSS instrument.
With the excellent scores on both reliability and validity, the English version of the PSS scales can be an excellent measurement for estimating the psychological strain levels of American college students as well as predicting their psychopathology. The PSS can be applicable for research to evaluate and predict suicidal behaviors and mental disorders.
PMCID: PMC4077777  PMID: 24856556
Psychological Strain Scales (PSS); Reliability; Validity; Mental Disorder; Suicide
12.  Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke 
BMC Public Health  2010;10:513.
Smoking causes heart disease, the major cause of death in China and Hong Kong. Stress is one major trigger of smoking and relapse, and understanding stress among smoking cardiac patients can therefore help in designing effective interventions to motivate them to quit. The objective of this study was to examine the psychometric properties of the Perceived Stress Scale (PSS), and to compare the appropriateness of the three versions of the scale (PSS-14, PSS-10, and PSS-4) among Chinese cardiac patients who were also smokers.
From March 2002 to December 2004, 1860 cardiac patients who smoked were recruited at the cardiac outpatient clinics of ten acute hospitals in Hong Kong, and 1800 questionnaires were analysed. Participants completed a questionnaire including the PSS, nicotine dependence and certain demographic variables. The psychometric properties of the PSS were investigated: construct validity using confirmatory factor analysis, reliability using Cronbach's alpha and concurrent validity by examining the relationship with smoking- and health-related variables.
For all the three versions of the PSS, confirmatory factor analyses corroborated the 2-factor structure of the scale, with the positive and negative factors correlating significantly and negatively to a moderate extent (r < -0.5), and high Cronbach's alpha values for the two subscales (alpha > 0.5). All the correlations of the two subscales and the smoking- and health-related variables were statistically significant and in the expected directions although of small magnitudes, except daily cigarette consumption.
The findings confirmed the satisfactory psychometric properties of all three Chinese versions of PSS. We recommend the use of PSS-10 for research which focuses on the two components of perceived stress, as it shows a higher reliability; and the use of PSS-4 if such partition is not essential and space for multiple measures is limited.
PMCID: PMC2939644  PMID: 20735860
13.  The 27-item Coping Strategies Questionnaire – Revised: Confirmatory factor analysis, reliability and validity in Italian-speaking subjects with chronic pain 
The Coping Strategies Questionnaire – Revised was developed as a tool to assess cognitive factors contributing to adaptive functioning in the presence of chronic pain. The English-language version of the questionnaire is well validated; however, translation of such questionnaires may affect their validity, among other factors. Accordingly, the authors of this study translated the Coping Strategies Questionnaire – Revised into Italian and conducted an extensive evaluation of the psychometric properties of the translated version of the questionnaire.
Increasing attention is being devoted to cognitive-behavioural measures to improve interventions for chronic pain.
To develop an Italian version of the Coping Strategies Questionnaire – Revised (CSQ-R), and to validate it in a study involving 345 Italian subjects with chronic pain.
The questionnaire was developed following international recommendations. The psychometric analyses included confirmatory factor analysis; reliability, assessed by internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficients); and construct validity, assessed by calculating the correlations between the subscales of the CSQ-R and measures of pain (numerical rating scale), disability (Sickness Impact Profile – Roland Scale), depression (Center for Epidemiological Studies – Depression Scale) and coping (Chronic Pain Coping Inventory) (Pearson’s correlation).
Confirmatory factor analysis revealed that the CSQ-R model had an acceptable data-model fit (comparative fit index and normed fit index ≤0.90, root mean square error of approximation ≥0.08). Cronbach’s alpha was satisfactory (CSQ-R 0.914 to 0.961), and the intraclass correlation coefficients were good/excellent (CSQ-R 0.850 to 0.918). As expected, the correlations with the numerical rating scale, Sickness Impact Profile – Roland Scale, Center for Epidemiological Studies – Depression Scale and Chronic Pain Coping Inventory highlighted the adaptive and maladaptive properties of most of the CSQ-R subscales.
The CSQ-R was successfully translated into Italian. The translation proved to have good factorial structure, and its psychometric properties are similar to those of the original and other adapted versions. Its use is recommended for clinical and research purposes in Italy and abroad.
PMCID: PMC4158961  PMID: 24761430
Confirmatory factor analysis; Coping Strategies Questionnaire; Cross-cultural adaptation; Reliability; Validity
14.  Assessing Stress in Cancer Patients 
Assessment  2004;11(3):216-223.
Using the Perceived Stress Scale (PSS), perceptions of global stress were assessed in 111 women following breast cancer surgery and at 12 and 24 months later. This is the first study to factor analyze the PSS. The PSS data were factor analyzed each time using exploratory factor analysis with oblique direct quartimin rotation. Goodness-of-fit indices (root mean square error of approximation [RMSEA]), magnitude and pattern of factor loadings, and confidence interval data revealed a two-factor solution of positive versus negative stress items. The findings, replicated across time, also indicate factor stability. Hierarchical factor analyses supported a second-order factor of “perceived stress.” This alternative factor model of the PSS is presented along with observations regarding the measure's use in cancer research.
PMCID: PMC2746492  PMID: 15358877
perceived stress; factor analysis; breast cancer
15.  Dialectal influence on chronic pulmonary disease assessment test: the reliability and validity study 
Chronic obstructive pulmonary disease (COPD) patients living in many countries are familiar with local dialects rather than the official language. We, therefore, compare the reliability and validity of the COPD Assessment Test (CAT) in Thai and northern Thai dialect versions, in stable COPD patients living in the northern part of Thailand.
A total of 160 COPD patients were randomly selected for the evaluation of each dialect version of CAT (n=80). The internal consistency of all eight items and test–retest reliability were investigated by using Cronbach’s alpha coefficient and intraclass correlation coefficient (ICCC), respectively. The validity was evaluated by the degree of correlation with St George’s Respiratory Questionnaire (SGRQ) using Pearson’s correlation. The correlations of CAT with clinical parameters such as forced expiratory volume in the first second (FEV1), modified Medical Research Council scale (mMRC) dyspnea score, and 6-minute walk distance (6-MWD) were also evaluated.
The two versions of CAT showed high internal consistency reliability (Cronbach’s alpha coefficient of 0.82 and 0.76) as well as a high test–retest reliability (ICCC of 0.82 and 0.84) for Thai and northern Thai dialect versions, respectively. The test results revealed that the northern Thai dialect version had good correlation with SGRQ whereas the Thai version correlated only moderately.
The two Thai versions of CAT were proven to be good clinical tools with high reliability and acceptable validity for assessing the quality of life of Thai COPD patients. However, the northern Thai dialect version is more suitable for evaluating COPD patients living in the northern part of Thailand.
PMCID: PMC4362659  PMID: 25792822
chronic obstructive pulmonary disease; COPD assessment test; quality of life; validation; reliability
16.  Development of the Brief Inventory of Perceived Stress 
Journal of clinical psychology  2012;68(6):631-644.
To provide a measure of perceived stress that is psychometrically superior to existing instruments and novel in dimensionality.
At 4-week intervals over 48 weeks, patients with multiple sclerosis (N = 138) completed 26 items from the Perceived Stress Scale (PSS) and the Perceived Stress Questionnaire (PSQ).
Extant factor analytic models of the PSS fit poorly. A new measure using nine PSS and PSQ items, the Brief Inventory of Perceived Stress (BIPS), demonstrated good fit, construct validity, and stability with 3 factors: Lack of Control, Pushed, and Conflict and Imposition.
Items commonly used to measure perceived stress may have a more sophisticated underlying structure than previously thought. The BIPS's multidimensionality and longitudinal stability offer potential benefits in conceptualization and outcome prediction.
PMCID: PMC3689206  PMID: 22467381
perceived stress; factor analysis; psychometric properties; stress appraisal; factorial invariance; measurement
17.  Factor Structure and Reliability of the Malay Version of the Perceived Stress Scale among Malaysian Medical Students 
The Perceived Stress Scale 10 (PSS-10) is a validated and reliable instrument to measure global levels of perceived stress. This study aims to assess the internal consistency, reliability, and factor structure of the Malay version of the PSS-10 for use among medical students.
The original English version of the PSS-10 was translated and back-translated into Malay language. The Malay version was distributed to 242 Bachelor of Medical Science students in a private university in Malaysia. Test–retest reliability was assessed in 70 students. An exploratory principal component factor analysis with varimax rotation was performed. Reliability was tested using the intraclass correlation coefficient (ICC).
All 242 students participated in the initial questionnaire study (validity and factor structure), and 70 students participated in the test–retest reliability of the study. Exploratory factor analysis yielded 2 factors that accounted for 57.8% of the variance. Cronbach’s alpha coefficients for the 2 factors were 0.85 and 0.70, respectively. The reliability test showed an ICC of 0.82 (95% CI: 0.70, 0.89).
The Malay version of the PSS-10 showed adequate psychometric properties. It is a useful instrument for measuring stress among medical students in Malaysia.
PMCID: PMC3684234  PMID: 23785249
Malaysia; medical; psychological; reliability and validity; stress; students
18.  Internet Addiction Test (IAT): Which is the Best Factorial Solution? 
The Internet Addiction Test (IAT) by Kimberly Young is one of the most utilized diagnostic instruments for Internet addiction. Although many studies have documented psychometric properties of the IAT, consensus on the optimal overall structure of the instrument has yet to emerge since previous analyses yielded markedly different factor analytic results.
The objective of this study was to evaluate the psychometric properties of the Italian version of the IAT, specifically testing the factor structure stability across cultures.
In order to determine the dimensional structure underlying the questionnaire, both exploratory and confirmatory factor analyses were performed. The reliability of the questionnaire was computed by the Cronbach alpha coefficient.
Data analyses were conducted on a sample of 485 college students (32.3%, 157/485 males and 67.7%, 328/485 females) with a mean age of 24.05 years (SD 7.3, range 17-47). Results showed 176/485 (36.3%) participants with IAT score from 40 to 69, revealing excessive Internet use, and 11/485 (1.9%) participants with IAT score from 70 to 100, suggesting significant problems because of Internet use. The IAT Italian version showed good psychometric properties, in terms of internal consistency and factorial validity. Alpha values were satisfactory for both the one-factor solution (Cronbach alpha=.91), and the two-factor solution (Cronbach alpha=.88 and Cronbach alpha=.79). The one-factor solution comprised 20 items, explaining 36.18% of the variance. The two-factor solution, accounting for 42.15% of the variance, showed 11 items loading on Factor 1 (Emotional and Cognitive Preoccupation with the Internet) and 7 items on Factor 2 (Loss of Control and Interference with Daily Life). Goodness-of-fit indexes (NNFI: Non-Normed Fit Index; CFI: Comparative Fit Index; RMSEA: Root Mean Square Error of Approximation; SRMR: Standardized Root Mean Square Residual) from confirmatory factor analyses conducted on a random half subsample of participants (n=243) were satisfactory in both factorial solutions: two-factor model (χ2 132= 354.17, P<.001, χ2/df=2.68, NNFI=.99, CFI=.99, RMSEA=.02 [90% CI 0.000-0.038], and SRMR=.07), and one-factor model (χ2 169=483.79, P<.001, χ2/df=2.86, NNFI=.98, CFI=.99, RMSEA=.02 [90% CI 0.000-0.039], and SRMR=.07).
Our study was aimed at determining the most parsimonious and veridical representation of the structure of Internet addiction as measured by the IAT. Based on our findings, support was provided for both single and two-factor models, with slightly strong support for the bidimensionality of the instrument. Given the inconsistency of the factor analytic literature of the IAT, researchers should exercise caution when using the instrument, dividing the scale into factors or subscales. Additional research examining the cross-cultural stability of factor solutions is still needed.
PMCID: PMC3806548  PMID: 24184961
IAT; Internet; addiction; factorial structure; psychometric properties; structural validity
19.  Translation and validation of the Chinese version of the quality of life radiation therapy instrument and the head & neck module (QOL-RTI/H&N) 
To translate and validate the Chinese version of the Quality Of Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N), a disease-specific scale to measure quality of life (QOL) for patients with head and neck cancer (HNC) who received radiotherapy.
The QOL-RTI/H&N was translated and validated according to the standard process: a translation and back-translation procedure, pilot testing and a validation study. HNC patients were enrolled from the Cancer Center of Sun Yat-sen University and assessed using the QOL-RTI/H&N, QLQ-C30 and QLQ-H&N35. Reliability (internal consistency reliability, split-half reliability and test-retest reliability), validity (content validity, construct validity, criterion validity and discriminant validity), and responsiveness analysis were performed to evaluate the psychometric characteristics of the QOL-RTI/H&N.
A total of 238 patients (99.2%) completed the questionnaire. Item RTI23 had 16.0% missing data. Other items had low percentages of missing data (0.4% or 0.8%) or no missing data. The average time to finish the scale was 9.8 minutes. Cronbach's alpha of the domains ranged from 0.41 to 0.77. The split-half reliability coefficients ranged from 0.43 to 0.77. All of the intra-class correlation coefficients were equal to or greater than 0.8. All of the item-own domain correlation coefficients were greater than those of the item-other domain. Confirmatory factor analysis showed that Comparative Fit Index, Normed Fit Index and Non-Normed Fit Index were equal to 1.00. Root Mean Square Error of Approximation was 0.01, with 90% CI (0.00, 0.10). The domain scores of the QOL-RTI/H&N were significantly correlated with those of the QLQ-C30 or QLQ-H&N3. All domain scores of patients in different radiotherapy stages were statistically significant (P < 0.05), apart from the speech domain.
The Chinese version of the QOL-RTI/H&N is a valid, reliable and responsive scale to measure QOL in HNC patients and can be used to assess the effects of radiotherapy treatment on these patients.
PMCID: PMC4022371  PMID: 24731442
Head and neck cancer; Quality of Life; QOL-RTI/H&N; Translation; Validation
20.  Comprehensibility, reliability, validity, and responsiveness of the Thai version of the Health Assessment Questionnaire in Thai patients with rheumatoid arthritis 
Arthritis Research & Therapy  2009;11(4):R129.
The Health Assessment Questionnaire Disability Index (HAQ-DI) is a commonly used instrument to assess functional status of patients with rheumatoid arthritis (RA). Translations and adaptations of the HAQ-DI have been carried out for use with RA patients in several countries. The objective of this study was to evaluate the psychometric properties of the Thai version of the HAQ-DI (Thai HAQ) in Thai patients with RA.
Comprehensibility of the Thai HAQ was assessed by 126 patients with RA from 6 medical centers in Thailand. Another group of 115 patients with active RA was enrolled to test the reliability (internal reliability and 1-week test-retest reliability), construct validity (correlations with other measures of RA disease activity), floor and ceiling effects, and sensitivity to change of the Thai HAQ at 3 months of treatment with disease-modifying antirheumatic drugs.
More than 98% of the patients regarded the Thai HAQ as comprehensible. The internal consistency of the Thai HAQ was satisfactory with the overall Cronbach alpha of 0.91. The test-retest reliability of the Thai HAQ was acceptable with the intraclass correlation coefficient of 0.89. Moderate correlations between the Thai HAQ and other outcomes of RA disease activity were observed, except erythrocyte sedimentation rate, with the Spearman correlation coefficients ranging from 0.42 to 0.57. The responsiveness of the Thai HAQ was moderate, with a standardized response mean of 0.75 (95% confidence interval 0.56 to 0.94).
The Thai HAQ is comprehensible, reliable, valid and sensitive to change in the evaluation of functional status of Thai patients with RA. The Thai HAQ is an essential tool to measure treatment effects and progression of disability in RA patients and should be applied in both clinical trials and routine clinical care settings.
PMCID: PMC2745813  PMID: 19709443
21.  The Chinese version of the world health organization quality of life instrument-older adults module (WHOQOL-OLD): psychometric evaluation 
Under the circumstance of global population aging, the issue on how to facilitate the quality of life (QOL) for older people brings us grand challenge. On the way to solve this problem, it is inextricable to measure QOL for older people accurately at onset. This study is aimed at evaluating the reliability and validity of the Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD).
We received 1005 valid WHOQOL-OLD questionnaires from 1050 respondents who were 60 and older by quota sampling method. To calculate the test-retest correlation coefficient we re-interviewed 101 participants from the community. Psychometric properties were evaluated from the aspect of feasibility, internal consistency reliability, test-retest reliability, content validity, construct validity and discriminant validity.
Missing item responses took up 0.0%-2.7% in the scale. The WHOQOL-OLD showed satisfactory reliability with Cronbach’s Alpha coefficients ranging from 0.711 (Social participation) to 0.842 (Sensory ability) for each domain. The intra-class correlation coefficients (ICC) presenting test-retest reliability were all over 0.7. In Confirmatory Factor Analysis (CFA), Root Mean Square Error of Approximation (RMSEA) was 0.084 (a little more than 0.08) and comparative fit index (CFI) 0.95 (>0.90) which meant acceptable construct validity. There were higher correlation coefficients between items and their hypothesized domains than other domains (P < 0.001), indicating good content validity. The results of t-test showed good discriminant validity of the WHOQOL-OLD between the healthy group and the unhealthy group (P < 0.0083).
The Chinese version of WHOQOL-OLD showed good feasibility, reliability and validity in this study. However, before it can be used national-widely, further research should be conducted in other areas of China.
PMCID: PMC3847352  PMID: 24034698
Elderly; Quality of life; Reliability; Validity; WHOQOL-OLD
22.  Validation of the Thai Version of a Work-related Quality of Life Scale in the Nursing Profession 
Safety and Health at Work  2014;5(2):80-85.
Currently available questionnaires for evaluating the quality of worklife do not fully examine every factor related to worklife in all cultures. A tool in Thai is therefore needed for the direct evaluation of the quality of worklife. Our aim was to translate the Work-related Quality of Life Scale-2 (WRQLS-2) into Thai, to assess the validity and reliability of the Thai-translated version, and to examine the tool's accuracy vis-à-vis nursing in Thailand.
This was a descriptive correlation study. Forward and backward translations were performed to develop a Thai version of the WRQLS. Six nursing experts participated in assessing content validity and 374 registered nurses (RNs) participated in its testing. After a 2-week interval, 67 RNs were retested. Structural validity was examined using principal components analysis. The Cronbach's alpha values were calculated. The respective independent sample t test and intraclass correlation coefficient were used to analyze known-group validity and test–retest reliability. Multistate sampling was used to select 374 RNs from the In- and Outpatient Department of Srinagarind Hospital of the Khon Kaen University (Khon Kaen, Thailand).
The content validity index of the scale was 0.97. Principal components analysis resulted in a seven-factor model, which explains 59% of the total variance. The overall Cronbach's alpha value was 0.925, whereas the subscales ranged between 0.67 and 0.82. In the assessment results, the known-group validity was established for the difference between civil servants and university employees [F (7.982, 0.005) and t (3.351; p < 0.05)]. Civil servants apparently had a better quality worklife, compared to university employees. Good test–retest reliability was observed (r = 0.892, p < 0.05).
The Thai version of a WRQLS appears to be well validated and practicable for determining the quality of the work-life among nurses in Thailand.
PMCID: PMC4147237  PMID: 25180138
quality of worklife; registered nurses; Thai version; validity and reliability; Work-Related Quality of Life Scale-2
23.  Level of agreement between self-rated and clinician-rated instruments when measuring major depressive disorder in the Thai elderly: a 1-year assessment as part of the THAISAD study 
Whether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found.
Patients and methods
This was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months.
Among the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet’s AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD.
The level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances.
PMCID: PMC3940641  PMID: 24596457
late-life depression; measurement; correlation
24.  Brief Chinese version of the Family Experience Interview Schedule to assess caregiver burden of family members of individuals with mental disorders 
Caregiver burden is an important issue that needs to be addressed when developing management programs for persons with chronic mental illnesses, but there is, as yet, no reliable way for assessing this in China.
Assess the validity and reliability of a brief adapted Chinese version of the Family Experience Interview Schedule (FEIS) among caregivers of inpatients with mental disorders in China.
We first translated and back-translated the original 114-item FEIS and administered it to 606 primary caregivers of psychiatric inpatients. After excluding 9 items about sociodemographic variables and 9 items that over 15% of respondents were unable to answer, we conducted an exploratory factor analysis using a random half of the sample on the remaining 96 items and, based on the results of the factor analysis, selected the items to be included in the final shortened scale. Correlation analysis, confirmatory factor analysis, and internal consistency measures were used to assess the reliability and validity of the final scale using data from the second half of the sample.
The final scale included 28 items that loaded on five dimensions: (a) patients’ violent behavior; (b) patients’ suicidal tendency; (c) caregivers’ depression and anxiety; (d) disruption of caregivers’ daily routines; and (e) caregivers’ satisfaction with health services. These five dimensions explained 50.5% of the total variance. Confirmatory factor analysis found reasonable fit of this 5-factor model (χ2 /df=2.94, p<0.001, goodness-of-fit index [GFI]=0.85, comparative fit index [CFI]=0.85, root-mean-square error of approximation [RMSEA]=0.08). The correlation coefficients between each item and the corresponding factor were all above 0.5. The Cronbach α coefficient of the entire scale was 0.76 and that for the five dimensions varied between 0.71 and 0.84.
The five dimensions of family burden assessed by the 28-item brief Chinese version of FEIS have good internal consistency and, thus, appear to assess valid dimensions of family burden in Chinese caregivers of persons with serious mental illnesses. Further work is needed to assess the test-retest reliability of this scale and its sensitivity to change over time.
PMCID: PMC4372764  PMID: 25852259
family burden; mental disorders; reliability; validity; Family Experience Interview Schedule; China
25.  Development and psychometric testing of the active aging scale for Thai adults 
Active aging is central to enhancing the quality of life for older adults, but its conceptualization is not often made explicit for Asian elderly people. Little is known about active aging in older Thai adults, and there has been no development of scales to measure the expression of active aging attributes.
The aim of this study was to develop a culturally relevant composite scale of active aging for Thai adults (AAS-Thai) and to evaluate its reliability and validity.
Eight steps of scale development were followed: 1) using focus groups and in-depth interviews, 2) gathering input from existing studies, 3) developing preliminary quantitative measures, 4) reviewing for content validity by an expert panel, 5) conducting cognitive interviews, 6) pilot testing, 7) performing a nationwide survey, and 8) testing psychometric properties. In a nationwide survey, 500 subjects were randomly recruited using a stratified sampling technique. Statistical analyses included exploratory factor analysis, item analysis, and measures of internal consistency, concurrent validity, and test–retest reliability.
Principal component factor analysis with varimax rotation resulted in a final 36-item scale consisting of seven factors of active aging: 1) being self-reliant, 2) being actively engaged with society, 3) developing spiritual wisdom, 4) building up financial security, 5) maintaining a healthy lifestyle, 6) engaging in active learning, and 7) strengthening family ties to ensure care in later life. These factors explained 69% of the total variance. Cronbach’s alpha coefficient for the overall AAS-Thai was 0.95 and varied between 0.81 and 0.91 for the seven subscales. Concurrent validity and test–retest reliability were confirmed.
The AAS-Thai demonstrated acceptable overall validity and reliability for measuring the multidimensional attributes of active aging in a Thai context. This newly developed instrument is ready for use as a screening tool to assess active aging levels among older Thai adults in both community and clinical practice settings.
PMCID: PMC4116362  PMID: 25092971
active aging; scale development; psychometric evaluation; culturally sensitive measure; Thai elderly

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