Evaluation of the Reliability, Validity, and Predictive Validity of the Subscales of the Perceived Stress Scale in Older Adults

Abstract

Background The Perceived Stress Scale (PSS) is made up of two subscales but is typically used as a single summary measure. However, research has shown that the two subscales may have differential properties in older adults. Objective To evaluate the internal consistency, test-retest reliability, and the concurrent and predictive validity for development of aMCI of the positively-worded (PSS-PW) and negatively-worded (PSS-NW) subscale scores of the PSS in older adults. Methods We recruited community residing older adults free of dementia from the Einstein Aging Study. Reliability of the PSS-PW and PSS-NW was assessed using Cronbach’s alpha for internal consistency and intraclass correlation for one year test-retest reliability. Concurrent validity was evaluated by examining the relationship between the PSS subscales and depression, anxiety, neuroticism, and positive and negative affect. Predictive validity was assessed using multivariate Cox regression analyses to examine the relationship between baseline PSS-PW and PSS-NW score and subsequent onset of aMCI. Results Both PSS-PW and PSS-NW showed adequate internal consistency and retest reliabilities. Both the PSS-PW and PSS-NW were associated with depression, neuroticism, and negative affect. The PSS-NW was uniquely associated with anxiety while the PSS-PW was uniquely associated with positive affect. Only the PSS-PW was associated with a statistically significant increased risk of incident aMCI (HR=1.27; 95% CI: 1.06–1.51 for every 5 point increase in PSS-PW). Conclusions Evaluating the separate effects of the two PSS subscales may reveal more information than simply using a single summation score. Future research should investigate the PSS-PW and PSS-NW as separate subscales.

Positively Worded Subscale Score of the Perceived Stress Scale Is Associated with Cognitive Domain Function

“…Various measures related to stress, including life events, neuroticism, and cortisol, have been linked to cognitive decline, particularly memory decline [ 6 – 9 ]. Perceived stress has been shown to predict the transition from normal cognition to amnestic mild cognitive impairment (aMCI) and from aMCI to dementia [ 10 , 11 ]. However, little research has examined the relationship between perceived stress and domains of cognitive function in nondemented older adults.…”

“…These two factors are poorly correlated in older adults (r = −0.28) [ 13 ]. We have validated and investigated the properties of these subscales [ 11 ]. Using data from the Einstein Aging Study (EAS), we found that only the PSS-PW subscale predicts the transition from normal cognition to amnestic mild cognitive impairment (aMCI) and from aMCI to dementia [ 11 , 16 ].…”

“…We have validated and investigated the properties of these subscales [ 11 ]. Using data from the Einstein Aging Study (EAS), we found that only the PSS-PW subscale predicts the transition from normal cognition to amnestic mild cognitive impairment (aMCI) and from aMCI to dementia [ 11 , 16 ]. Some researchers have hypothesized that the PSS-PW subscale measures perceived coping ability and the PSS-NW subscale measures perceived helplessness [ 12 , 15 ].…”

Evaluation of the measurement properties of the Perceived Stress Scale (PSS) in Hispanic caregivers to patients with Alzheimer’s disease and related disorders

“…No items were flagged for salient DIF with either the primary or sensitivity analyses. The study by Jiang et al (2017) observed that the positive subscale was more predictive of amnestic mild cognitive impairment (MCI) than the negatively worded item subscale. It could be argued that the positive items may be more reflective of coping and resilience.…”

“…They found that the negative subscale items correlated positively, while the positive item subscale correlated negatively with measures of depression and anxiety. Jiang et al (2017) examined the 14-item PSS in a sample (n = 663) of White (65%), Black (28%), and other (7%) older people in the Einstein Aging Project; they found that the positive subscale was uniquely predictive of development of amnestic mild cognitive impairment.…”