A Global Measure of Perceived Stress Author(s): Sheldon Cohen, Tom Kamarck and Robin Mermelstein Reviewed work(s): 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 . Accessed: 24/10/2012 13:12 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp . JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. American Sociological Association is collaborating with JSTOR to digitize, preserve and extend access to Journal of Health and Social Behavior. http://www.jstor.org A GLOBAL MEASURE OF PERCEIVED STRESS 385 Richardson,Jean, and JulieSolis Wiggins,Jerry S. 1982 "Place ofdeath of Hispanic cancer patients 1973 Personalityand Prediction:Principles of in Los Angeles County." Unpublished PersonalityAssessment. Reading, MA: manuscript. Addison-WesleyPublishing Co. Stoddard,Sandol WilderFoundation 1978 The HospiceMovement. Briarcliff Manor, 1981 Carefor the Dying: A Studyof the Need for New York: Steinand Publishers. Hospice in RamseyCounty, Minnesota. A Valle, R., and L. Mendoza reportto the NorthwestArea Foundation 1978 The Elder Latino. San Diego, CA: Cam- fromthe AmherstH. WilderFoundation, panilePress. 355 WashingtonSt., St. Paul, MN. A GlobalMeasure of PerceivedStress SHELDON COHEN Carnegie-Mellon University TOM KAMARCK Universityof Oregon ROBIN MERMELSTEIN Universityof Oregon Journalof Healthand Social Behavior1983, Vol. 24 (December):385-396 This paper presents evidencefrom threesamples, two of college studentsand one of partici- pants in a communitysmoking-cessation program, 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 betterpredictor of theoutcome in question thanwere life-event scores. When compared to a depressive symptomatologyscale, the PSS was found to measure a differentand independentlypredictive construct. Additionaldata indicateadequate reliability and validityof a four-itemversion of thePSS for telephoneinterviews. The PSS is suggestedfor examiningthe role of nonspecificappraised stress in the etiologyof disease and behavioral disorders and 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, stressfulevents is, to some degree,determined thistheoretical perspective has not been ac- companiedby developmentof psychometri- callyvalid measures of perceivedstress. This Researchreported in thispaper was supportedby grantsfrom the National Science Foundation (BNS articlediscusses the limitationsof objective 7923453)and the Heart,Lung and Blood Institute and subjectivemeasures of stressused in the (HL 29547). The authorsare indebtedto Edward assessmentof bothglobal and event-specific Lichtensteinand Karen McIntyrefor their collab- stresslevels. It arguesthat a psychometrically orationon thesmoking cessation project; the staff of soundglobal measure of perceived stress could Universityof Oregondormitory housing for their cooperationin securing Student Sample I; PamBirell providevaluable additional information about forher cooperation in obtaining class participantsfor therelationship between stress and pathology. SampleII; and to Susan Fiske,Lew Goldberg,Ed- Data are presented on the psychometric ward Lichtenstein,Karen Matthews, Michael propertiesof the Perceived Stress Scale (PSS), Scheier,and Tom Wills for commentson earlier draftsof thismanuscript. an instrumentdeveloped in responseto these Addresscommunications to: SheldonCohen, De- issues.The PSS measuresthe degree to which partmentof Psychology,Carnegie-Mellon Univer- situations in one's life are appraised as sity,Pittsburgh, PA 15206. stressful. 386 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR Researchon the role of psychosocialand "event"is thecognitively mediated emotional environmentalstressors as riskfactors in both responseto theobjective event, not the objec- physicaland psychological illness has typically tiveevent itself (Lazarus, 1977;Mason, 1971). employedrelatively objective stressor mea- An importantpart of thisview is thatthis re- sures.This work includes studies of the effects sponseis notbased solelyon theintensity or of specificstressful events, such as unem- any otherinherent quality of the event,but ployment(Cobb and Kasl, 1977;Dooley and ratheris dependenton personaland contextual Catalano, 1980; Gore, 1978), bereavement factorsas well. (Stroebeet al., 1982),and exposureto intense The assumedcentrality of thecognitive ap- levels of noise (Cohen and Weinstein,1981) praisal process suggeststhe desirabilityof and high levels of population density measuringperceived stress as opposed or in (Sundstrom,1978). In addition,there is an additionto objective stress. For example, abundantliterature on thecumulative effect of comparisonof the predictivevalidities of ob- objective stressfullife events (Dohrenwend jectiveand subjectivemeasures could help to andDohrenwend, 1974, 1981). In thesestudies, clarifythe role of theappraisal process in the variousversions of life-eventscales (original relationshipbetween objective stressors and scale developedby Holmes and Rahe, 1967) illness.Perceived stress scales could also be are used to producea cumulativestress score. used in conjunctionwith objective scales in an These scores are usuallybased on eitherthe effortto determinewhether factors such as numberof events that have occurred within the social support(Pearlin et al., 1981),hardiness specifiedtemporal framework (in mostcases, (Kobasa, 1979),and locus of control(Johnson six to 12months) or on a sumof event weights and Sarason, 1979) protectpeople fromthe thatare based on judges' ratingsof thediffi- pathogeniceffects of stressfulevents by alter- cultyof adjustingto theseevents. ingstressor appraisal or by altering the process Thereare some clear advantages to objective or processesby whichappraised stress results measuresof stressfulevents. First, such mea- in physiologicalor behavioraldisorders (Gore, surespermit an estimateof theincreased risk 1981).Finally, perceived stress can be viewed fordisease associatedwith the occurrenceof as an outcomevariable-measuring the experi- easily identifiableevents. Second, the mea- encedlevel of stressas a functionof objective surementprocedure is oftensimple, e.g., did stressfulevents, coping processes, personality thisevent occur duringthe last six months?, factors,etc. and in manycases, personsexperiencing a Previouswork has employeda numberof particularevent can be identifiedwithout the approachesto assess bothglobal and event- necessityof asking them about the occurrence specificlevels of perceivedstress. For exam- of the event, e.g., personsliving in noise- ple, severalinvestigators have modifiedlife- impactedcommunities. Third, these measure- eventscales in an attemptto measureglobal menttechniques minimize the chance of vari- perceivedstress. The modificationinvolved ous subjectivebiases in the perceptionsand askingrespondents to ratethe stressfulness or reportingof events. impactof each experiencedevent. In general, On theother hand, the use ofobjective mea- life-stressscores based on self-ratingsofevent suresof stress implies that events are, in and of stressfulnessare betterpredictors of health- themselves,the precipitatingcause of pathol- relatedoutcomes than are scoresderived from ogy and illnessbehavior. This implicationis either a simple countingof events (unit- counterto theview that persons actively inter- weighting)or normativeadjustment ratings act withtheir environments, appraising poten- (Sarason et al., 1978; Vinokurand Selzer, tiallythreatening or challengingevents in the 1975).However, the increases in predictability lightof availablecoping resources (Lazarus, providedby these ratingsare small. It is 1966, 1977). From this latterperspective, noteworthythat any increasein predictability stressoreffects are assumed to occur only ofa weightedevent score over a simplecount when both (a) the situationis appraisedas of eventsis likelyto be smallsince alternative threateningor otherwisedemanding and (b) in- weightingschemes yield composite scores that sufficientresources are availableto cope with are substantiallycorrelated with the event the situation.The argumentis thatthe causal count(Lei and Skinner,1980). In short,cal- A GLOBAL MEASURE OF PERCEIVED STRESS 387 culatingglobal perceived stress levels on the ical scalethat can be administeredinonly a few basis ofreactions to individualevents assumes minutesand is easyto score.Because levels of thatperceived stress levels are very highly cor- appraisedstress should be influencedby daily relatedwith the numberof reportedevents. hassles,major events, and changesin coping Otherweaknesses of global perceivedstress