Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, No. 67 Wenhua Road, Shunqing, Nanchong, 637000, Sichuan, China.
Department of Nursing, Affiliated Hospital of North Sichuan Medical College, No. 67 Wenhua Road, Shunqing, Nanchong, 637000, Sichuan, China.
BMC Gastroenterol. 2023 Mar 29;23(1):97. doi: 10.1186/s12876-023-02728-0.
To develop the modified 4-item version of Perceived Stress Scale (PSS) with a better reliability and validity than the 4-item version of PSS (PSS-4) in evaluating psychological stress in patients with functional dyspepsia (FD). The present study also aimed to explore the correlation between dyspepsia symptoms severity (DSS), anxiety, depression, somatization, quality of life (QoL), and psychological stress assessed by two approaches in FD.
A total of 389 FD patients who met the Roman IV criteria completed the 10-item version of the PSS (PSS-10), and 4/10 items were selected by five methods, such as Cronbach's coefficient, exploratory factor analysis (EFA), correlation coefficient, discrete degree, and item analysis, to develop the modified PSS-4. The reliability and validity of the modified PSS-4 and the PSS-4 were compared by internal consistency, EFA, and confirmatory factor analysis (CFA). The correlation between psychological stress assessed by two approaches and DSS, anxiety, depression, somatization, and QoL was explored by Pearson's correlation coefficient and multiple linear regression analysis.
Cronbach's α coefficient of the modified PSS-4 and the PSS-4 was 0.855 and 0.848, respectively, and a common factor was extracted. The cumulative contribution rate of one factor to the overall variance for the modified PSS-4 and the PSS-4 was 70.194% and 68.698%, respectively. The model used for the modified PSS-4 showed that the values of the goodness-of-fit index (GFI) and the adjusted GFI (AGFI) were 0.987 and 0.933, respectively, indicating that the model fitted well. Psychological stress was correlated to DSS, anxiety, depression, somatization, and QoL as assessed by the modified PSS-4 and PSS-4. Multiple linear regression analysis revealed that psychological stress was correlated to somatization, as assessed by the modified PSS-4 (β = 0.251, P < 0.001) and PSS-4 (β = 0.247, P < 0.001). Psychological stress, DSS, and somatization were correlated to QoL, as assessed by the modified PSS-4 (β = 0.173, P < 0.001) and the PSS-4 (β = 0.167, P < 0.001).
The modified PSS-4 showed better reliability and validity, and psychological stress had a greater effect on the somatization and QoL of FD patients assessed by the modified PSS-4 than PSS-4. These findings were helpful for further investigation of the clinical application of the modified PSS-4 in FD.
为了开发一种改良的 4 项感知压力量表（PSS）版本，使其在评估功能性消化不良（FD）患者的心理压力方面比 PSS-4 具有更好的信度和效度。本研究还旨在探讨两种方法评估的消化不良症状严重程度（DSS）、焦虑、抑郁、躯体化、生活质量（QoL）和心理压力之间的相关性。
共有 389 名符合罗马 IV 标准的 FD 患者完成了 10 项 PSS（PSS-10），通过 Cronbach 系数、探索性因子分析（EFA）、相关系数、离散度和项目分析等 5 种方法，选择 4/10 项，以开发改良的 PSS-4。通过内部一致性、EFA 和验证性因素分析（CFA）比较改良 PSS-4 和 PSS-4 的信度和效度。通过 Pearson 相关系数和多元线性回归分析探讨两种方法评估的心理压力与 DSS、焦虑、抑郁、躯体化和 QoL 的相关性。
改良 PSS-4 和 PSS-4 的 Cronbach'α系数分别为 0.855 和 0.848，均提取出一个共同因子。改良 PSS-4 和 PSS-4 对总方差的累积贡献率分别为 70.194%和 68.698%。改良 PSS-4 模型的拟合优度指数（GFI）和调整后的 GFI（AGFI）分别为 0.987 和 0.933，表明模型拟合良好。心理压力与改良 PSS-4 和 PSS-4 评估的 DSS、焦虑、抑郁和躯体化呈正相关。多元线性回归分析显示，改良 PSS-4 评估的心理压力与躯体化呈正相关（β=0.251，P<0.001）和 PSS-4（β=0.247，P<0.001）。改良 PSS-4 和 PSS-4 评估的心理压力、DSS 和躯体化与 QoL 呈正相关（β=0.173，P<0.001）和 PSS-4（β=0.167，P<0.001）。
改良 PSS-4 具有更好的信度和效度，与改良 PSS-4 相比，心理压力对 FD 患者的躯体化和 QoL 的影响更大。这些发现有助于进一步探讨改良 PSS-4 在 FD 中的临床应用。
