title: The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples.
abstract: OBJECTIVE
  The aim was to translate, revise, and standardize the Perceived Stress Questionnaire (PSQ) by Levenstein et al. (1993) in German. The instrument assesses subjectively experienced stress independent of a specific and objective occasion.
  
  
  METHODS
  Exploratory factor analyses and a revision of the scale content were carried out on a sample of 650 subjects (Psychosomatic Medicine patients, women after delivery, women after miscarriage, and students). Confirmatory analyses and examination of structural stability across subgroups were carried out on a second sample of 1,808 subjects (psychosomatic, tinnitus, inflammatory bowel disease patients, pregnant women, healthy adults) using linear structural equation modeling and multisample analyses. External validation included immunological measures in women who had suffered a miscarriage.
  
  
  RESULTS
  Four factors (worries, tension, joy, demands) emerged, with 5 items each, as compared with the 30 items of the original PSQ. The factor structure was confirmed on the second sample. Multisample analyses yielded a fair structural stability across groups. Reliability values were satisfactory. Findings suggest that three scales represent internal stress reactions, whereas the scale "demands" relates to perceived external stressors. Significant and meaningful differences between groups indicate differential validity. A higher degree of certain immunological imbalances after miscarriage (presumably linked to pregnancy loss) was found in those women who had a higher stress score. Sensitivity to change was demonstrated in two different treatment samples.
  
  
  CONCLUSIONS
  We propose the revised PSQ as a valid and economic tool for stress research. The overall score permits comparison with results from earlier studies using the original instrument.
authors.affiliation: Department of Psychosomatic Medicine, Charité-University Hospital Berlin, Luisenstrasse 13 a, D-10117 Berlin, Germany. herbert.fliege@charite.de
authors.forename: Herbert
authors.initials: H
authors.lastname: Fliege
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.forename: Petra
authors.initials: P
authors.lastname: Arck
authors.forename: Otto B
authors.initials: OB
authors.lastname: Walter
authors.forename: Rueya-Daniela
authors.initials: RD
authors.lastname: Kocalevent
authors.forename: Cora
authors.initials: C
authors.lastname: Weber
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
mesh_terms: D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000276:immunology / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000523:psychology; D011594:Psychometrics; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology; D012016:Reference Values; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D013334:Students / Q000523:psychology; D011795:Surveys and Questionnaires