RESEARCH ARTICLE

Chinese version of the Perceived Stress Scale-

10: A psychometric study in Chinese university
students
Wei Lu1, Qian Bian1, Wenzheng Wang1, Xiaoling Wu2, Zhen Wang1*, Min Zhao1*

1 Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China,
2 Academic Affairs Office, Shanghai Jiao Tong University, Shanghai, P.R. China

* [email protected] (MZ); [email protected] (ZW)

a1111111111
a1111111111
a1111111111 Abstract
a1111111111
a1111111111 Chinese university students often suffer from acute stress, which can affect their mental
health. We measured and evaluated perceived stress in this population using the Simplified
Chinese version of the 10-item Perceived Stress Scale (SCPSS-10). The SCPSS-10,
Patient Health Questionnaire (PHQ), and Generalized Anxiety Disorder 7-item scale (GAD-
OPEN ACCESS 7) were conducted in 1096 university students. Two weeks later, 129 participants were re-
Citation: Lu W, Bian Q, Wang W, Wu X, Wang Z, tested using the SCPSS-10. Exploratory factor analysis yielded two factors with Eigen val-
Zhao M (2017) Chinese version of the Perceived ues of 4.76 and 1.48, accounting for 62.41% of the variance. Confirmatory factor analysis
Stress Scale-10: A psychometric study in Chinese
demonstrated good fit of this two-factor model. The internal consistency reliability, as mea-
university students. PLoS ONE 12(12): e0189543.
https://doi.org/10.1371/journal.pone.0189543 sured by Cronbach’s α, was 0.85. The test-retest reliability coefficient was 0.7. The SCPSS-
10 exhibited high correlation with the PHQ-9 and GAD-7, indicating an acceptable concur-
Editor: Yong-hui Dang, Xi0 an Jiaotong University
School of Medicine, CHINA rent validity. The SCPSS-10 exhibited satisfactory psychometric properties in Chinese uni-
versity students.
Received: July 24, 2017

Accepted: November 27, 2017

Published: December 18, 2017

Copyright: © 2017 Lu et al. This is an open access

article distributed under the terms of the Creative Introduction
Commons Attribution License, which permits Psychological stress arises from an imbalance between individual’s perception and the external
unrestricted use, distribution, and reproduction in
environmental demands. Studies have demonstrated that psychological stress is closely corre-
any medium, provided the original author and
source are credited. lated with anxiety, depression, and physical conditions such as cardiovascular diseases and
cancer [1–4]. Psychological stress reflects the subjective evaluation of one’s ability to cope with
Data Availability Statement: All relevant data are
demands. People experience stress when they perceive that their resources are insufficient to
within the paper and its Supporting Information
files. cope with a situation [5].
University students encounter many sources of stress such as variable environment, lifestyle
Funding: This study was supported by the Ministry
changes, academic burdens, and interpersonal relationships, all of which can lead to significant
of Science and Technology Project
(2009BAI77B08), Shanghai One Hundred Talent
psychological dysfunctions. In particular, most university students in China are sensitive to
Project in health division (XBR2011015), and the stress since they tend to be the only child in their family. Indeed, studies have shown high lev-
National Natural Science Foundation of China els of stress and depression in Chinese university students [6, 7].
(81371486). The Perceived Stress Scale (PSS), one of the most widely used psychological scales, was
Competing interests: The authors have declared developed by Cohen in 1983 and it has shown sufficient reliability and validity [8, 9]. The PSS
that no competing interests exist. has a number of advantages over other tools: 1) it only takes a few minutes and is easy to score;

PLOS ONE | https://doi.org/10.1371/journal.pone.0189543 December 18, 2017 1/8

 Chinese version of PSS-10 in university students

2) the items are easily understandable; 3) it is not limited to a specific situation and can be
used for past or ongoing events; 4) it can be used to examine changes over time in response to
stress-inducing events; and 5) the PSS can be used as an outcome variable [9–11]. The PSS has
been translated into many languages including Portuguese, Japanese, Arabic, Thai, and Chi-
nese, as well as across several populations including pregnant and postpartum women, cardiac
patients, and medical students [12–17]. The PSS was translated in Traditional Chinese, tested
in Taiwan and Hong Kong, and found to be reliable [14, 18]. Nevertheless, there has only been
one study on the validity of 10-item PSS in simplified Chinese (SCPSS-10), the primary lan-
guage used in mainland China; this study was conducted in Chinese policewomen [17]. Thus,
we analyzed the generalizability of the SCPSS-10 to other Chinese speaking populations.
Therefore, we assessed the perceived stress levels to evaluate the mental health status of Chi-
nese university students. Perceived stress has not been measured and validated in this popula-
tion. Thus, this study is the first to evaluate the reliability and validity of the SCPSS-10 in
Chinese university students.

Methods
Subjects
Undergraduate students were recruited from Shanghai Jiao Tong University between January
1, 2011 and December 31, 2011. A total of 10 departments were selected from 22 faculties
based on convenience sampling; 2191 students from the 10 departments were invited to partic-
ipate in the study, of whom 1096 (50.0%) agreed to participate and completed the scales. Out
of those students, 129 students (11.8%) were randomly selected for reassessment 2 weeks later
using the SCPSS-10.
All the procedures were reviewed and approved by the Institutional Review Board of Shang-
hai Mental Health Center. Written informed consent was obtained from every subject before
participation.

Instruments
All the participants were asked to complete the following self-administered questionnaires in a
classroom within 30 minutes. No more than 50 students completed the test simultaneously in
the same classroom.

Perceived Stress Scale-10

The Perceived Stress Scale (PSS) is a self-reported scale with three versions: 14-item scale,
10-item scale, and four-item scale. The 10-item version (PSS-10) has demonstrated good reli-
ability and validity with a Cronbach’s α of 0.78–0.91 and test-retest reliability coefficients of
0.55–0.80 [8, 9, 19], i.e. with better reliability and validity than the other two versions [8]. The
SCPSS-10, the Chinese version of the PSS-10, has shown good reliability and validity with a
Cronbach’s α of 0.86 [14]. The version used in this study is the same as the one used in police-
women [14] and consists of all 10 original PSS items, six of which are negative (items 1, 2, 3, 6,
9, and 10) while the others are positive (items 4, 5, 7, and 8). The participants were required to
answer each question using a five-point Likert scale score ranging from 0 (never) to 4 (very
often) and report the event frequency correlated with the PSS items in the last month. Total
scores ranged from 0 to 40, and participants with higher scores had higher perceived stress
levels.

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 Chinese version of PSS-10 in university students

Patient Health Questionnaire (PHQ-9)

The PHQ-9 is a self-reported version of the Primary Care Evaluation of Mental Disorders
(PRIME-MD) diagnostic instrument for mental disorders in primary care settings, but not in
psychiatric settings [20]. The PHQ-9 covers nine dimensions listed in the Diagnostic and Sta-
tistical Manual of Mental Disorders, 4th Edition, and consists of nine items for measuring the
frequency of depressive symptoms within 2 weeks [21, 22]. Each item ranges from 0 (not at all)
to 3 (nearly every day). Total score represents the severity of depressive symptoms ranging
from 0 to 27, and a score of 27 represents the most severe symptoms. Scores of 5, 10, 15, and
20 represent the threshold for mild, moderate, moderately severe, and severe depression. Pre-
vious studies demonstrated that the PHQ-9 is a reliable and robust instrument for screening
depressive symptoms in adults [22, 23]. Studies have shown that perceived stress can result in
the development of depression, and that the PSS-10 has a good reliability for estimating the
level of stress perception [13]. The PHQ-9 has been translated into various languages (includ-
ing Chinese) and yields robust reliability, with Cronbach’s α values of 0.73–0.95 [24–28].

Generalized Anxiety Disorder 7-item scale (GAD-7)

The GAD-7 questionnaire [21] is a one-dimensional self-reported scale designed to assess the
symptoms of anxiety. The GAD-7 has good reliability as well as criterion, construct, factorial,
and procedural validity [21, 26, 29–31]. It consists of seven items for detecting the frequency of
anxiety symptoms during the previous two weeks. Each item ranges from 0 (not at all) to 3
(nearly every day). The total scores range 0–21, and scores of 5, 10, and 15 represent the
thresholds for mild, moderate, and serious depressive symptoms [21, 22, 24–28]. Although
anxiety is a normal reaction to stress, in excessive or chronic cases anxiety disorders may
develop. Previous studies found a high correlation between anxiety measures and the PSS-10,
indicating concurrent validity of the scales [32]. The Chinese version of the GAD-7 has dem-
onstrated good psychometric properties [33].

Statistical analysis
Continuous variables were presented as mean and standard deviation. The internal consis-
tency reliability of the SCPSS-10 was evaluated using the Cronbach’s α coefficient. A Cron-
bach’s α coefficient value of 0.7–0.8 indicated sufficient reliability, whereas a value of 0.8–0.9
indicated very good reliability. Pearson correlation analysis was applied to assess the test-retest
reliability and evaluate the concurrent validity of SCPSS-10 on the depressive and anxious
symptoms measured by the PHQ-9 and GAD-7.
The samples were randomly split into two halves for the construct structure analysis. The
sample data were screened to confirm that no assumptions were violated prior to the EFA
using the Kaiser-Meyer-Olkin test and Bartlett’s test of sphericity. Exploratory factor analysis
(EFA) was conducted with the first half using the principle component analysis with varimax
rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy was applied to assess sample
adequacy. Confirmatory factor analysis (CFA) was applied to determine the fitness of the pre-
viously identified two-factor and one-factor models [19]. The covariance matrix was tested by
the maximum-likelihood estimation method to determine how well the model fitted the sam-
ple data. Goodness-of-fit index (GFI), normalized fit index (NFI), comparative fit index (CFI),
root mean square residual (RMSR), and root mean square error of approximation (RMSEA)
were used to evaluate the models.
SPSS version 20.0 (IBM, Armonk, NY, USA) was used for analysis. The CFA analysis was
conducted using AMOS 7.0 (SPSS Inc., Chicago, IL, USA). p < 0.05 was considered statisti-
cally significant.

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 Chinese version of PSS-10 in university students

Results
Participant characteristics
The mean age of the 1096 participants (395 women, 701 men) was 18.3 ± 0.7 years. The mean
SCPSS-10 score was 13.7 ± 5.6 for the whole student sample, and there were no significant dif-
ferences between females (13.9 ± 5.5) and males (13.5 ± 5.5).
For the whole study sample, the SCPSS-10, PHQ, and GAD scores were 13.7±5.6, 4.3±3.1,
and 2.8±2.9, respectively. For the retest sample, the SCPSS-10, PHQ, and GAD scores were
18.6±4.7, 4.9±3.2, and 3.6±3.3, respectively.

Reliability of the SCPSS-10

The internal consistency of the SCPSS-10 was reliable (Cronbach’s α = 0.85) for the whole
sample set. At the end of the second week, the test-retest reliability of the SCPSS-10 was 0.70.

EFA
Sampling adequacy was good (Kaiser-Meyer-Olkin = 0.86) and Bartlett’s test of sphericity was
statistically significant (p < 0.001). The principal component analysis with the varimax rotation
of the SCPSS-10 scores obtained two factors with Eigen values > 1.0 accounting for 62.49% of
the variance (Table 1). Factor loading ranged from 0.67 to 0.80 for SCPSS items, which entered
into factor 1, and from 0.73 to 0.87 for SCPSS items, which entered into factor 2.

CFA
In this sample, the two-factor solution was demonstrated to be adequate: GFI = 0.940,
NFI = 0.925, CFI = 0.939, RMSR = 0.039, and RMSEA = 0.049. In contrast, the one-factor

Table 1. Exploratory factor analysis and reliability coefficients of the SCPSS-10 (n = 548).
SCPSS-10 Item Factor loading
Factor 1 Factor 2
1. In the last month, how often have you been upset because of something that 0.777 0.040
happened unexpectedly?
2. In the last month, how often have you been unable to control the important things in 0.755 0.188
your life?
3. In the last month, how often have you felt nervous and “stressed”? 0.793 0.070
4. In the last month, how often have you felt confident about your ability to handle your 0.146 0.844
personal problems?
5. In the last month, how often have you felt that things were going your way? 0.349 0.732
6. In the last month, how often have you found that you could not cope with all of the 0.723 0.211
things that you had to do?
7. In the last month, how often have you been able to control irritations in your life? 0.014 0.738
8. In the last month, how often have you felt that you were in control of things? 0.214 0.869
9. In the last month, how often have you been angered because of things that were 0.667 0.165
outside of your control?
10. In the last month, how often have you felt difficulties were piling up so high that you 0.756 0.237
could not overcome them?
Eigen value 4.43 1.81
% variance 44.34 18.14
Cronbach’s α coefficient 0.86 0.83

SCPSS-10, Simplified Chinese version of the 10-item Perceived Stress Scale.

https://doi.org/10.1371/journal.pone.0189543.t001

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 Chinese version of PSS-10 in university students

Table 2. Goodness-of-fit indices of two CFA models of the SCPSS-10 (n = 548).

Model GFI NFI CFI RMR RMSEA
One-factor model 0.676 0.596 0.628 0.093 0.122
Two-factor model 0.940 0.925 0.939 0.039 0.049
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model showed a poor data fit: GFI = 0.676, NFI = 0.596, CFI = 0.628, RMR = 0.093, and
RMSEA = 0.122. None of the fit indices matched the cut-off criterion (Table 2). The CFA indi-
cated that the SCPSS-10 two-factor model was a reasonable approximation to the population.

Concurrent validity
We analyzed the association between the SCPSS-10, GAD-7, and PHQ-9 (Table 3). GAD-7
and PHQ-9 were positively correlated with SCPSS-10. The factors associated with the SCPSS-
10 total score and the other two scales had correlation coefficients of 0.37–0.87 (Table 3).

Discussion
Our study assessed for the first time perceived stress in Chinese university students. The psy-
chometric data yielded good validity and reliability for SCPSS-10. Overall, the Cronbach’s α of
the SCPSS-10 was 0.85, which is better than the standard of psychological measurement
(Cronbach’s α > 0.7) [34]. In addition, the 2-week test-retest reliability of the SCPSS-10 was
0.70, which is acceptable and demonstrated good cross-temporal constancy, similar to our pre-
viously published studies on policewomen (r = 0.68). These results are consistent with previous
studies of the PSS in other languages [2, 13–16, 19] as well as previous study from our group
conducted in Chinese policewomen, in which we obtained a Cronbach’s α value of 0.86 [17].
SCPSS-10 revealed high levels of perceived stress in Chinese university students, which also
correlated with anxiety and depression.
Regarding the SCPSS-10 structure, the construct validity analysis showed that the two com-
mon factors extracted from the principal component analysis with varimax rotation repre-
sented positive (Factor 1) and negative (Factor 2) feelings. This was consistent with other
language versions [8, 12, 13]. In this study, the Eigen values of the SCPSS-10 were 4.43 and
1.81, accounting for 44.34% and 18.14% of the variance. The loadings were 0.667–0.793 for
Factor 1 and 0.732–0.869 for Factor 2. The CFA demonstrated a relatively better goodness-of-
fit for the two-factor model for SCPSS-10 compared with the previous studies [17]. This may
be due to higher homogeneity of the sample, as undergraduate students tend to have similar
economic, social, and cultural backgrounds compared to policewomen. Although some
researchers have suggested one-factor model solution for the PSS-10, CFA revealed a poor fit
using this model. These results were consistent with a previous report based on Chinese

Table 3. Correlations between SCPSS-10, depression (PHQ-9), and anxiety (GAD-7) screening tools.
SCPSS-10 Factor 1 Factor 2 GAD-7
Factor 1 0.87
Factor 2 0.77 0.37
GAD-7 0.59 0.56 0.39
PHQ-9 0.57 0.53 0.40 0.72

SCPSS-10, Simplified Chinese version of the 10-item Perceived Stress Scale; PHQ-9, Patient Health Questionnaire; GAD-7, Generalized Anxiety Disorder
7-item scale.

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 Chinese version of PSS-10 in university students

speaking population [35]. Furthermore, the correlation coefficients between the two extracted
common factors and the total SCPSS-10 scores were 0.87 and 0.77, and the correlation coeffi-
cient between Factors 1 and 2 was 0.37, indicating good internal homogeneity. Nevertheless,
“positive feelings” and “negative feelings” both reflect perceived stress, and it has been sug-
gested that any distinction between these factors is irrelevant and reflects the sentence struc-
ture of the scale [8]. Thus, although the two-factor model solution of PSS-10 is better, we
suggest not using two separate subscales in the clinical setting.
Wang et al. demonstrated that the SCPSS-10 was significantly and moderately positively
correlated with anxiety and depression in policewomen [17]. Other studies have showed that
the PSS-10 has concurrent validity with other measures, including the State Trait Anxiety
Inventory and the Beck Depression Inventory [13, 36]. We found that SCPSS-10 is moderately
positively correlated with PHQ-9 (rs = 0.59, p < 0.001) and GAD-7 (rs = 0.57, p < 0.001).
For the satisfactory psychometric results in Chinese university students, we propose that
SCPSS-10 should be widely applied in Chinese speaking university students, even outside
China mainland. Nevertheless, because of differences in university levels, and of social, eco-
nomic, and cultural differences among Chinese-speaking regions, additional studies should be
performed in those regions in order to confirm the generalizability of our results. Although
the participants recruited in our study were all freshmen university students, those in higher
grades may have different levels and kinds of stress, which may require different evaluation.
For example, junior, senior, or graduate-level students may encounter higher psychological
stress because of the accumulated study burden and job-hunting pressures. University students
may also have different perceived psychological pressures depending on their educational lev-
els, although both groups in the present study received similar education at similar ages after
high school. Second, construct validity was limited to self-reported measure comparisons.
Third, we did not evaluate discriminant validity of the SCPSS-10 in this present study. Thus,
further studies should address these questions in diverse populations, and more objective mea-
sures should be applied to improve the psychometric quality of the SCPSS-10.

Conclusion
In conclusion, we find that SCPSS-10 is a reliable and valid instrument for estimating the stress
levels in university students within a Chinese cultural context. We also found high perceived
stress levels in university students, which was also correlated with anxiety and depression.

Supporting information
S1 Table. Stress scale retest list and results.
(XLSX)
S2 Table. Stress test list and results.
(XLSX)

Acknowledgments
This study was supported by the Ministry of Science and Technology Project (2009BAI77B08),
Shanghai One Hundred Talent Project in health division (XBR2011015), and the National
Natural Science Foundation of China (81371486).

Author Contributions
Conceptualization: Wei Lu, Qian Bian, Zhen Wang, Min Zhao.

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 Chinese version of PSS-10 in university students

Data curation: Wei Lu, Qian Bian, Xiaoling Wu.

Formal analysis: Wei Lu, Qian Bian, Wenzheng Wang, Xiaoling Wu, Min Zhao.
Investigation: Wei Lu, Qian Bian, Xiaoling Wu.
Methodology: Wei Lu, Qian Bian, Xiaoling Wu.
Project administration: Qian Bian, Xiaoling Wu, Min Zhao.
Resources: Wenzheng Wang, Xiaoling Wu, Zhen Wang.
Validation: Qian Bian, Xiaoling Wu.
Visualization: Wenzheng Wang, Xiaoling Wu, Min Zhao.
Writing – original draft: Wei Lu, Zhen Wang, Min Zhao.
Writing – review & editing: Wei Lu, Zhen Wang, Min Zhao.

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