Department of Epidemiology and Environmental Health, University at Buffalo (State University of New York), New York, USA.
Global and Community Mental Health Research Group, Faculty of Social Sciences (E21-3040), University of Macau, Avenida da Universidade, Taipa, Macao (SAR), People's Republic of China.
Br J Health Psychol. 2020 Sep;25(3):728-753. doi: 10.1111/bjhp.12448. Epub 2020 Jul 7.
Poverty is linked to poor mental health, and stress is a key pathway. Most existing stress scales were developed in high-income settings. We use primary data collected from three large population-based studies in Ghana and Tanzania to examine the performance and psychometric properties of a new measure of self-perceived stress, the Enhanced Life Distress Inventory (ELDI).
Development of the ELDI was informed by an exploratory qualitative study implemented among youth and adolescents in Ghana, Malawi, and Tanzania and structured following the Life Distress Inventory (LDI). We implemented the ELDI in three ongoing longitudinal impact evaluations involving quantitative household surveys in two studies in Tanzania and in one in Ghana to evaluate its performance and psychometric properties.
Sample sizes ranged from N = 608 to N = 2,458, with variation in gender, age, and geographic location. Exploratory factor analysis uncovered three underlying factors of the ELDI, which justified the use of three sub-scales: economic and health-related well-being, risk/security, and social relations. Further analysis demonstrated that the ELDI has adequate psychometric properties, including internal consistency, and construct validity.
A major contribution of the ELDI is its development in and for LMIC settings and its ability to assess different areas (life domains) of distress. This multi-sectoral lens gives the scale the potential to examine not only programmes targeting stress, but also those targeting sources of stress, and to examine whether they improve stress and mental health via those pathways. More testing of the ELDI's performance and psychometric properties is needed in additional settings.
贫困与心理健康不良有关，而压力是一个关键途径。大多数现有的压力量表都是在高收入环境中开发的。我们利用在加纳和坦桑尼亚的三项大型基于人群的研究中收集的原始数据，检验一种新的自我感知压力量表——增强型生活压力量表（ELDI）的性能和心理计量特性。
ELDI 的开发是基于在加纳、马拉维和坦桑尼亚的青年和青少年中进行的探索性定性研究，其结构遵循生活压力量表（LDI）。我们在坦桑尼亚的两项纵向影响评估研究和加纳的一项研究中实施了 ELDI，对其性能和心理计量特性进行了评估。
样本量范围从 N=608 到 N=2458，性别、年龄和地理位置存在差异。探索性因子分析揭示了 ELDI 的三个潜在因素，这证明了使用三个子量表的合理性：经济和健康相关福祉、风险/安全和社会关系。进一步的分析表明，ELDI 具有足够的心理计量特性，包括内部一致性和结构有效性。
ELDI 的一个主要贡献是它在中低收入国家环境中开发和应用的能力，以及它评估不同领域（生活领域）压力的能力。这种多部门视角使该量表有可能不仅能够评估针对压力的方案，还能够评估针对压力源的方案，并检验它们是否通过这些途径改善压力和心理健康。需要在更多的环境中进一步测试 ELDI 的性能和心理计量特性。
