Assessment of stress and self-efficacy for the NIH toolbox for neurological and behavioral function

Kupst, Mary Jo; Butt, Zeeshan; Stoney, Catherine M.; Griffith, James W.; Salsman, John M.; Folkman, Susan; Cella, David

doi:10.1080/10615806.2014.994204

Cited by 133Psychometric Methodologies and TestingAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesHealth Education and Validation

Assessment of stress and self-efficacy for the NIH toolbox for neurological and behavioral function

Open access

Kupst, Mary Jo, Butt, Zeeshan, Stoney, Catherine M., Griffith, James W., Salsman, John M., Folkman, Susan, Cella, David·2015·Anxiety, Stress, & Coping

DOI 10.1080/10615806.2014.994204PMC PMC4515370

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Abstract

BACKGROUND AND OBJECTIVES: The NIH Toolbox for Neurological and Behavioral Function assessment battery contains measures in the domains of cognitive function, motor function, sensory function, and emotional health. It was designed for use in epidemiological and clinical trials health-related research. DESIGN: This paper describes the first phase of instrument development for the stress and self-efficacy subdomain of emotional health. Based on an extensive literature review and expert consultation, 127 measures were initially considered for inclusion in this subdomain, including measures of stress, self-efficacy, emotion regulation, and coping. RESULTS: Several measures, including emotion regulation and measures of coping strategies, did not meet criteria that were a priori established for inclusion. Psychometric properties of the remaining candidate measures were evaluated using data from five independent samples (combined N = 3175). Confirmatory and exploratory factor analyses indicated the Perceived Stress Scale and the General Self-Efficacy Scale each assessed single dimensions. CONCLUSIONS: Based on their psychometric performance, these two instruments were selected for inclusion and subsequent national norming for the NIH Toolbox.

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Claims the paper makes

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Findingown data
One General Self-Efficacy Scale item had a low corrected item-total correlation of .16 in children aged 8-12.
“One item had a low corrected item-total correlation (.16) in 8–12 year-olds: “If someone tries to keep me from getting what I want, I can find a way to get what I want.””
Quote in the paperNot a substantial claim
Findingown data
The General Self-Efficacy Scale model also had good fit indices for adolescents, children aged 8-12 in self- and proxy-report, and ages 13-17.
“This model also had good fit indices for adolescents, ages 8–12 years (self- and proxy report) and 13–17 years of age.”
Quote in the paperSubstantial claim
Findingown data
Perceived Stress Scale item #12 had low corrected item-total correlations across all groups.
“One item (item #12) had low corrected item-total correlations across all groups: “In the last month, how often have you found yourself thinking about things that you have to accomplish?””
Quote in the paperNot a substantial claim
Findingown data
Perceived Stress Scale item #12 had a low item-total correlation in all three pediatric samples.
“Item #12 had a low item-total correlation in all three pediatric samples.”
Quote in the paperSubstantial claim
Findingown data
Across all age groups, internal consistency reliability was good for the Perceived Stress Scale according to Cronbach's alpha.
“Across all age groups, internal consistency reliability was good for the Perceived Stress Scale (PSS) as indicated by Cronbach’s alpha (see Table 2).”
Quote in the paperSubstantial claim

Findingown data
Model fit analyses for emotion regulation and general coping measures were less successful than those for stress and self-efficacy.
“Model fit analyses of emotion regulation and general coping measures were less successful than those for stress and self-efficacy.”
Quote in the paperSubstantial claim
Findingown data
For the remaining General Self-Efficacy Scale items, corrected item-total correlations were greater than .33 across all samples.
“For the rest of the items, corrected item-total correlations were greater than .33 across all of the samples.”
Quote in the paperNot a substantial claim
Findingown data
The General Self-Efficacy Scale had high internal consistency for ages 8-12 in self- and proxy-report, ages 13-17, and ages 18 and older.
“As shown in Table 3, the General Self Efficacy Scale (GSES) had high internal consistency for ages 8–12 years (for both self- and proxy-report), 13–17 years, and 18 years and older.”
Quote in the paperSubstantial claim
Findingown data
Adding the residual dependency resulted in a good-fitting one-factor model for the General Self-Efficacy Scale.
“This addition to the model resulted in a good-fitting one-factor model (see Table 4).”
Quote in the paperSubstantial claim
Findingown data
A bi-factor model with one group factor for positively keyed items and another for reverse-keyed items achieved good fit for the Perceived Stress Scale.
“For the PSS, we included one group factor for all positively keyed items and another group factor for reverse-keyed items; this model achieved good fit for the PSS (see Table 2).”
Quote in the paperSubstantial claim
Findingown data
In the adult sample, a one-factor model did not fit the Perceived Stress Scale well, with CFI = 0.88 and RMSEA = .19.
“In the adult sample, a one-factor model did not fit the PSS well, CFI = 0.88, RMSEA = .19.”
Quote in the paperSubstantial claim
Findingown data
The bi-factor model using scoring factors fit well in all three pediatric samples.
“Otherwise, the bi-factor model using scoring factors fit well in all three samples (see Table 3).”
Quote in the paperSubstantial claim
Findingnone given
Consistent with past research, the Perceived Stress Scale and General Self-Efficacy Scale had good psychometric properties in dimensionality and precision of scores.
“Consistent with past research, the Perceived Stress Scale and the General Self-Efficacy Scale had good psychometric properties in terms of dimensionality and the precision of scores.”
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Premisereasoning
Among healthy individuals, stress can directly affect health through physiological and behavioral pathways.
“Among individuals who are well, stress can have a direct impact on health through its effects on physiological and behavioral functioning.”
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Premisecitation
§ Assessing Stress and Self-Efficacy for the NIH Toolbox for Neurological and Behavioral Function
Many existing measures of neurological and behavioral health are not used in large-scale epidemiological studies and clinical trials because they are costly, lengthy, restricted to particular age groups or populations, or hard to administer.
“Typically, however, such measures are not incorporated into large-scale epidemiological studies and clinical trials because they are expensive, lengthy, limited to certain age groups or populations, or not easily administered (Gershon et al., 2013).”
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- cites Gershon et al., 2013
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Interpretationreasoning
Stress and self-efficacy were not assessed for children aged 3-7 because of limited cognitive and emotional development and the difficulty for caregivers to speculate about children's perceptions.
“However, given the limited development of cognitive and emotional abilities for children ages 3–7 years and the inherent difficulty for parents or other caregivers to speculate on their children’s perceptions of stress and self-efficacy, we did not assess these concepts for this age group.”
Quote in the paperSubstantial claim
Interpretationreasoning
It is not conceptually feasible to derive a single summary score that adequately assesses the broad domain of coping.
“For example, unlike other emotional health concepts like social support or life satisfaction, it is not conceptually feasible to derive a single summary score that adequately assesses the broad domain of coping.”
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Interpretationown data
None of the emotion regulation or coping scales were included as Toolbox measures.
“Given the criteria for NIH Toolbox selection, as well the results of these analyses, none of these scales were able to be included as Toolbox measures.”
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Study design and conductreasoning
The study was limited by its participant selection process.
“In addition to these methodological issues, the study was limited by the participant selection process.”
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Premisecitation
Recent work has shown that data collected from the Internet are comparable to data from probability-based general population samples.
“Recent work, however, has shown that data collected from the Internet are comparable to data from probability-based general population samples (Liu et al., 2010).”
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- cites Liu et al., 2010
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Premisecitation
The scientific team has found that recruiting samples from Internet panels can be a cost-effective, efficient, and valid means of data collection, based on experience with two other large-scale NIH-funded efforts.
“In addition, our scientific team has found that recruiting samples from Internet panels can be a cost-effective, efficient, and valid means of data collection as evidenced by our experience with two other large-scale NIH-funded efforts (Cella et al., 2010; Gershon, R. et al., 2012).”
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- cites Cella et al., 2010
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- cites Gershon, R. et al., 2012
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Findingown data
For the entire NIH Toolbox Emotional Health domain, 554 measures were identified, and 127 were classified as potential measures of stress, self-efficacy, emotion regulation, or coping.
“For the entire NIH Toolbox Emotional Health domain, 554 measures were identified, and of these, 127 were classified as potential measures of stress, self-efficacy, emotion regulation or coping.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown data
Permission was granted to use 36 of the candidate measures.
“We were granted permission to use 36 of those measures.”
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Findingnone given
Based on the described procedures, perceived stress, self-efficacy, emotion regulation, and coping were initially considered the most important subdomains for building a Toolbox measurement strategy.
“Based on the procedures described below, perceived stress, self-efficacy, emotion regulation and coping were initially considered to be the most important subdomains upon which to build a Toolbox measurement strategy.”
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Findingreasoning
After review by project staff and emotion domain consultants, 44 measures were selected for further consideration.
“After review by project staff and emotion domain consultants, 44 measures were selected for further consideration based on criteria described earlier.”
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Findingreasoning
Consensus was reached that the four relevant constructs in the Stress and Self-Efficacy domain were Perceived Stress, Self-Efficacy, Emotion Regulation, and Coping.
“In the Stress and Self-Efficacy domain, consensus was reached that the four relevant constructs identified were Perceived Stress, Self-Efficacy, Emotion Regulation, and Coping.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingreasoning
The short list included six measures of stressful events or perceived stress, three of self-efficacy, four of emotion regulation, and 31 of coping.
“The resulting short list included six measures that assessed stressful events or perceived stress, 3 that assessed self-efficacy, 4 that assessed emotion regulation and 31 that assessed coping.”
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Findingreasoning
On the basis of a comprehensive literature review and extensive discussions, the NIH Toolbox emotional health team selected perceived stress, self-efficacy, emotion regulation, and coping as important constructs to evaluate for possible inclusion.
“On the basis of a comprehensive literature review and extensive discussions, the NIH Toolbox emotional health team selected perceived stress, self-efficacy, emotion regulation and coping as important constructs to be evaluated for possible inclusion in the NIH Toolbox.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Recruiting from an online research panel yielded samples that were predominantly White and had more years of education than population-based samples.
“First, by recruiting participants from an online research panel, we obtained samples that were predominantly White with more years of education relative to population-based samples.”
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May combine two claims.
Findingown data
Preliminary analyses of the Perceived Stress Scale suggested it measures a single dimension, although some variance was accounted for by item direction.
“The preliminary analyses of the Perceived Stress Scale suggested that it measures a single dimension, although there was some variance accounted for by the direction of the items (positively- versus negatively-keyed).”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
The first attempt to fit a one-factor model for the General Self-Efficacy Scale was unsuccessful, with acceptable CFI = .97 but RMSEA > .10.
“Our first attempt to fit a one-factor model was unsuccessful; CFI = .97 was acceptable, but RMSEA was >.10.”
Quote in the paperNot a substantial claim
May combine two claims.
Findingown data
A modification index indicated residual dependency between two General Self-Efficacy Scale items with similar content, so the model was refit.
“A modification index indicated a residual dependency between two items with similar content (see Table 3), so the model was refit to account for it.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim. May combine two claims.
Findingown data
The five samples included adults aged 18+ (N=1111), adolescents aged 13-17 (N=512), children aged 8-12 for self-report (N=513), children aged 8-12 for proxy report (N=539), and children aged 3-7 for proxy report (N=500).
“These five samples were recruited based on age and consisted of adults aged 18 years and above (N= 1111), adolescents aged 13–17 years (N=512), and children aged 8–12 years (N= 513) for self-report forms; and children aged 8–12 years (N= 539) and children aged 3–7 years (N= 500) for parent/guardian proxy forms.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data
Five community-dwelling internet panel samples were recruited for the initial testing wave, with a total N of 3,175.
“Five community-dwelling internet panel samples were recruited for the initial wave of testing (Total N=3,175).”
Quote in the paperNot a substantial claim
May combine two claims.
Findingown data
For children, Cronbach's alpha for the Perceived Stress Scale was .89 for ages 13-17, .87 for ages 8-12, and .87 for the proxy-report version for ages 8-12.
“Cronbach’s alpha was .89 for 13–17 year-olds, .87 for 8–12 year-olds, and 0.87 for a proxy-report version of the PSS for 8–12 year-olds.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
The Kidcope, CSCY, How I Feel-EC, Ways of Coping, Brief COPE, and CBQ had good reliability and validity by classic psychometric analyses but could not be fitted to a unidimensional confirmatory factor analysis model.
“The Kidcope, CSCY, How I Feel-EC, Ways of Coping, Brief COPE, and CBQ had good reliability and validity according to classic psychometric analyses, but could not be fitted to a unidimensional CFA model.”
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Premisecitation
Stress is associated with risk of cardiovascular disease, immune dysfunction, and certain cancers through autonomic, vagal, cortisol, and immune mechanisms.
“It is related to risk of developing cardiovascular diseases, immune dysfunction, and certain cancers, through increased autonomic nervous system activity, poor vagal tone, chronically elevated blood cortisol levels, and decreased immunocompetence (Antoni et al., 2006; Cohen & Williamson, 1988; Raposa, Hammen, Brennan, O'Callaghan, & Najman, 2014; Steptoe & Kivimaki, 2012).”
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- cites Antoni et al., 2006
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- cites Cohen & Williamson, 1988
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- cites Raposa, Hammen, Brennan, O'Callaghan, & Najman, 2014
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Premisecitation
§ Assessing Stress and Self-Efficacy for the NIH Toolbox for Neurological and Behavioral Function
The NIH Toolbox initiative was created to identify, develop when needed, and validate measures in cognitive, emotional, motor, and sensory domains for large-scale epidemiological studies.
“The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIH Toolbox; nihtoolbox.org) initiative was developed to identify, create when necessary, and validate measures in the broad domains of cognitive function, emotional health, motor function, and sensory function for use large-scale epidemiological studies (Gershon, et al., 2010; Gershon, et al. 2013; Salsman, et al., 2013).”
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- cites Gershon, et al., 2010
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- cites Gershon, et al. 2013
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- cites Salsman, et al., 2013
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Premisecitation
The subjective experience of psychological stress is shaped by appraisal of an event's personal significance in relation to values, goals, and coping resources.
“The subjective experience of psychological stress is influenced by the individual’s appraisal of the personal significance of a given event in relation to his or her values and goals and options and resources for controlling the outcome (Folkman, 1984).”
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- cites Folkman, 1984
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Premisecitation
Psychological stress occurs when a person perceives environmental or internal demands as personally threatening and beyond their perceived adaptive capacity.
“Psychological stress is experienced when an individual perceives environmental or internal demands that are personally threatening and exceed his or her perceived adaptive capacity (Cohen, Kessler, & Gordon, 1997; Folkman, 2010; Lazarus & Folkman, 1984).”
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- cites Cohen, Kessler, & Gordon, 1997
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- cites Folkman, 2010
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- cites Lazarus & Folkman, 1984
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Premisecitation
Stress is relevant to disease and health, as shown in human and animal models.
“The relevance of stress to disease and health has been demonstrated in both human and animal models (Cohen, Janicki-Deverts, & Miller, 2007; Segerstrom and Miller, 2004).”
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- cites Cohen, Janicki-Deverts, & Miller, 2007
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Interpretationreasoning
§ Assessing Stress and Self-Efficacy for the NIH Toolbox for Neurological and Behavioral Function
Adding neurological and behavioral function measures to large epidemiological studies could enhance understanding of how these factors relate to varied outcomes while being cost-effective and adding little participant burden.
“Including neurological and behavioral function measures in these large and expensive epidemiological studies could improve understanding of how neurological and behavioral health factors are related to diverse outcomes and do so cost-effectively and with minimal additional participant burden.”
Quote in the paperSubstantial claim
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Premisecitation
§ Assessing Stress and Self-Efficacy for the NIH Toolbox for Neurological and Behavioral Function
The emotional health domain of the NIH Toolbox included four subdomains: Negative Affect, Positive Affect, Social Relationships, and Stress and Self-Efficacy.
“For example, the emotional health domain was comprised of four subdomains: Negative Affect, Positive Affect, Social Relationships, and Stress and Self-Efficacy subdomains, the latter of which is the focus of this paper.”
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- cites Nowinski, Victorson, Debb, & Gershon, 2013
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Premisecitation
Stress can reduce adherence to medication and medical recommendations and can increase health-damaging behavior.
“For example, stress can hamper adherence to medication and other medical recommendations, and it can lead to increases in health-damaging behavior.”
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- cites Cohen, Janicki-Deverts, & Miller, 2007
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Premisecitation
The Ways of Coping Questionnaire is arguably the most widely used coping-strategy scale for adolescents and adults and is a 50-item Likert scale with eight empirically derived factors.
“The Ways of Coping Questionnaire (Folkman & Lazarus, 1988) is arguably the most widely used scale of coping strategies for adolescents and adults. It is a 50-item Likert scale with 8 empirically derived factors.”
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- cites Folkman & Lazarus, 1988
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Premisecitation
Among people with acute or chronic disease, coping is a key factor in how well they manage their health condition, and coping styles can influence whether they cope in healthy or health-destructive ways.
“Among individuals with acute or chronic diseases, coping is a key factor that can determine how well an individual conceptualizes and behaviorally manages a health condition, and ways of coping with stress can influence whether individuals cope in healthy or health-destructive ways (Carver & Vargas, 2011; Folkman, 2010).”
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Premisecitation
Difficulties in regulating emotions are related to problems in psychological and physical functioning.
“Difficulties in regulating emotions have been related to problems in psychological and physical functioning (Appleton, Buka, Loucks, Gilman, & Kubzansky, 2013; Gross & Munoz, 1995; DeSteno, Gross & Kubzansky, 2013).”
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- cites Appleton, Buka, Loucks, Gilman, & Kubzansky, 2013
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- cites Gross & Munoz, 1995
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Premisecitation
The General Self-Efficacy Scale measures personal competence to deal effectively with a variety of stressful situations.
“It measures personal competence to deal effectively with a variety of stressful situations (Schwarzer & Luszczynska, 2008).”
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- cites Schwarzer & Luszczynska, 2008
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Premisecitation
Coping is defined as cognitive and behavioral efforts to manage specific external or internal demands that are appraised as taxing or exceeding one's resources.
“The most comprehensive and frequently-cited definition of coping was formulated by Lazarus and Folkman (1984): “cognitive and behavioral efforts to manage specific external or internal demands (and conflicts between them) that are appraised as taxing or exceeding the resources of the person.””
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Premisecitation
Secondary appraisal involves the degree to which one believes one can influence internal states, behavior, the environment, or desired outcomes.
“Secondary appraisal involves the extent to which one believes they can influence or affect their own internal states, their behavior, the environment, and/or desired outcomes (perceived control) (Lazarus & Folkman, 1984; Wallston, Wallston, Smith & Dobbins, 1987).”
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Premisecitation
The Brief Cope is a widely used coping scale with 28 items forming 14 two-item subscales and good psychometrics.
“Another widely used scale of coping strategies is the Brief Cope (Carver, 1997), a 28 item scale with 14 2-item subscales with good psychometrics.”
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Premisecitation
The Children's Behavior Questionnaire is widely used in child development and behavior research and has excellent psychometric properties.
“The CBQ is a widely used measure of child development and behavior and has excellent psychometric properties ((Rothbart, Ahadi, Hershey, & Fisher, 2001).”
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Premisecitation
Self-efficacy is the belief that one can respond to stressful demands and has direct and indirect effects on health, including health-related behavior.
“Not a measure of the stress level itself, self-efficacy involves the belief that one is able to respond to demands of a stressful situation and it has both direct and indirect effects on health, including engaging in health-related behaviors (Schwarzer & Luszczynska, 2008).”
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Interpretationcitation
The General Self-Efficacy Scale was identified to measure general self-efficacy.
“The General Self-Efficacy Scale (GSES; Schwarzer & Jerusalem, 1995) scale was identified to measure general self-efficacy.”
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- cites Schwarzer & Jerusalem, 1995
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Premisecitation
Evaluating one's self-efficacy for implementing required strategies is an essential part of judging opportunities for personal control in a stressful situation.
“An essential component in judging opportunities for personal control in a stressful situation is the evaluation of one’s self- efficacy with respect to implementing the required strategies (Bandura, 1997).”
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Premisecitation
Emotion regulation is a process for monitoring and managing emotional experience and expression and can be conscious or unconscious.
“Emotion regulation is a process by which a person can attempt to monitor and manage the experience and expression of their emotions and it can involve both conscious and unconscious processes (Gross & John, 2003).”
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Premisecitation
The Emotion Control Factor of the How I Feel measure is a 10-item scale with established good reliability and validity.
“The Emotion Control Factor of the How I Feel measure (Walden, Harris, & Catron, 2003) is a 10-item scale that has established good reliability and validity.”
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- cites Walden, Harris, & Catron, 2003
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Premisecitation
The Perceived Stress Scale is the most frequently used measure of subjective stress, including in health and quality-of-life studies, and has excellent reliability and validity.
“This scale is the most frequently used measure of a person’s subjective experience of stress, including studies of health and quality of life, and has excellent reliability and validity (Cohen & Williamson, 1988, Monroe, 2008).”
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- cites Cohen & Williamson, 1988
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Interpretationcitation
The Perceived Stress Scale was selected for the perceived stress subdomain.
“For the subdomain of perceived stress, The Perceived Stress Scale (PSS) (Cohen, Kessler & Gordon, 1995) was selected.”
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- cites Cohen, Kessler & Gordon, 1995
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Premisecitation
The General Self-Efficacy Scale is a 10-item Likert scale with excellent reliability, stability, and validity, and has been used in many studies of health-related stress and behavior.
“It is a 10 item Likert scale and has excellent reliability, stability, and validity, and has been used in numerous studies related to health-related stress and behavior (Lusczynska, Gutierrez-Doña, & Schwarzer, 2005).”
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- cites Lusczynska, Gutierrez-Doña, & Schwarzer, 2005
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Premisecitation
The Kidcope has 10 items representing coping strategies, and the Coping Scale for Children and Youth has 29 items with good psychometric properties.
“For children and adolescents, two scales were initially considered: The Kidcope (Spirito, Stark & Williams, 1988), comprised of 10 items representing coping strategies and the Coping Scale for Children and Youth (CSCY) (Brodzinsky et al., 1992) comprised of 29 items with good psychometric properties.”
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- cites Spirito, Stark & Williams, 1988
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- cites Brodzinsky et al., 1992
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Interpretationown data
These emotion regulation and coping measures have good psychometric properties and remain useful for the constructs they represent, and were recommended as supplemental measures for research involving Toolbox measures.
“These measures have good psychometric properties, and, although they were not included as Toolbox measures, they remain useful measures of the constructs they represent and were recommended as supplemental measures for research involving Toolbox measures.”
Quote in the paperSubstantial claim
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Interpretationcitation
These findings are consistent with well-known complexities in assessing emotion regulation and coping.
“Although disappointing because of the conceptual importance attributed to these measures in this subdomain, these findings are consistent with well-known complexities that characterize their assessment (Bridges, Denham & Ganiban, 2004; Folkman, & Moskowitz, 2004).”
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- cites Bridges, Denham & Ganiban, 2004
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- cites Folkman, & Moskowitz, 2004
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Study design and conductreasoning
Items were reviewed for relevance and use by older respondents, cultural sensitivity and conceptual appropriateness across cultural groups, and future Spanish translatability.
“Items were reviewed for relevance and use by older respondents (Geriatric Working Group), for cultural sensitivity and conceptual appropriateness across cultural groups (Cultural Working Group) and for Spanish translatability in the future (Spanish Language Working Group).”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable).
Premisenone given
A key conceptual problem is that the adaptiveness or maladaptiveness of coping is determined in relation to a specific context.
“The key conceptual problem is that the evaluation of the adaptiveness/maladaptiveness of coping is determined in relation to a specific context.”
Quote in the paperNot a substantial claim
May combine two claims.
Interpretationreasoning
A main reason these scales were not included was the lack of a single outcome score, as most were multidimensional and too lengthy for inclusion.
“One main reason was the lack of a single outcome score, as most were multidimensional measures and resulted in being too lengthy for inclusion.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone given
The sample was purposive and designed with recruitment quotas for age, gender, and education.
“This was a purposive sample designed with recruitment quotas for age, gender, and education.”
Quote in the paperNot a substantial claim
May combine two claims.
Premisecitation
The Perceived Stress Scale authors also found a low factor loading for item 12 and three other items, reduced the scale to 10 items, and found the PSS10 reliability and validity equivalent to the PSS14.
“The scale authors (Cohen & Williamson, 1988) had also found a low factor loading for Item 12, as well as three other items and reduced the items to 10 (the PSS10). Their psychometric analyses found reliability and validity to be equivalent to the PSS14.”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites Cohen & Williamson, 1988
  Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning
Item response theory was not recommended for scoring because the measures had sufficient psychometric properties and using them as-is would preserve continuity with existing literature.
“Because measures in this subdomain had sufficient psychometric properties, item response theory was not recommended for scoring because using the measures “as is” would allow for continuity with the extant literature.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim.
Interpretationown data
The Perceived Stress Scale and General Self-Efficacy Scale were deemed appropriate for inclusion in the Stress and Self-Efficacy subdomain of the NIH Toolbox Emotional Health domain.
“Thus, these measures were deemed as appropriate for inclusion in this subdomain of the NIH Toolbox Emotional Health domain.”
Quote in the paperSubstantial claim
May combine two claims.
Interpretationreasoning
Because of these challenges and the constraints of the NIH Toolbox, the emotion regulation and coping measures were judged unsuitable for the project, which may be a limitation of the NIH Toolbox.
“Because of these challenges and the constraints of the NIH Toolbox, these measures were judged unsuitable for this project, which may be a limitation of the NIH Toolbox.”
Quote in the paperSubstantial claim
May combine two claims.
Interpretationreasoning
The measures judged most appropriate for NIH Toolbox purposes are widely used, psychometrically sound, and brief.
“Thus, the measures that were judged most appropriate for NIH Toolbox purposes are widely used, psychometrically sound, and brief.”
Quote in the paperSubstantial claim
May combine two claims.
Interpretationown data
This may be evidence of participation bias, which is often unavoidable in volunteer research.
“This may be evidence of a participation bias which is often unavoidable in volunteer research.”
Quote in the paperNot a substantial claim
May combine two claims.
Premisecitation
A key methodological problem is that coping is multidimensional, with no agreement on the number of dimensions or a gold-standard classification system.
“The key methodological problem is that coping is multi-dimensional with no agreement about the number of dimensions or a gold standard classification system (Skinner, Edge, Altman, & Sherwood, 2003).”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites Skinner, Edge, Altman, & Sherwood, 2003
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoning
All items were reviewed by expert panels to identify and address potential assessment issues in special subgroups.
“As part of the NIH Toolbox project, all items were also reviewed by expert panels to identify and address potential issues related to assessment in special subgroups.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim.
Interpretationown data
After the analyses, the authors decided to recommend the 10-item Perceived Stress Scale for the Toolbox.
“After this analysis, we decided to recommend the PSS10 for the Toolbox.”
- Also stated in: § Discussion · plain
  “Based on our psychometric results, which were similar to those of the authors (Cohen & Williamson, 1988), we decided to recommend the 10-item version.”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites Cohen & Williamson, 1988
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given
Potential participants underwent rigorous screening that included validation of internet protocol addresses to prevent fraudulent survey participation.
“Potential participants completed a rigorous screening process to determine their eligibility, which included validation of their internet protocol addresses to ensure that they were not fraudulently participating in surveys..”
Quote in the paperNot a substantial claim

56 of 56

Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · cited 2× · see citing works
“For our CFAs, we assessed model fit using the comparative fit index (CFI; Bentler, 1990; Hu & Bentler, 1999) and the root mean square error of approximation (RMSEA; Browne, Cudeck, Bollen, & Long, 1993) to assess the fit of each model.”
Method
Self-efficacy: The exercise of control
Bandura, A., Freeman, W. H., & Lightsey, R. (1999) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.13.2.158 · Cited by 46,835 · see citing works
Stress, appraisal, and coping
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,026 · see citing works
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833 · see citing works
Self-citation
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · cited 1× · see citing works
“For our CFAs, we assessed model fit using the comparative fit index (CFI; Bentler, 1990; Hu & Bentler, 1999) and the root mean square error of approximation (RMSEA; Browne, Cudeck, Bollen, & Long, 1993) to assess the fit of each model.”
Method
Self-efficacy: the exercise of control
(1997) · Choice Reviews Online · doi:10.5860/choice.35-1826 · Cited by 24,409 · see citing works
Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being.
Gross, J. J., & John, O. P. (2003) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.85.2.348 · Cited by 11,929 · cited 1× · see citing works
“Emotion regulation is a process by which a person can attempt to monitor and manage the experience and expression of their emotions and it can involve both conscious and unconscious processes (Gross & John, 2003).”
Background
You want to measure coping but your protocol’ too long: Consider the brief cope
Carver, C. S. (1997) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm0401_6 · Cited by 7,361 · cited 1× · see citing works
“Another widely used scale of coping strategies is the Brief Cope (Carver, 1997), a 28-item scale with 14 2-item subscales with good psychometrics.”
Method
In Search of Golden Rules: Comment on Hypothesis-Testing Approaches to Setting Cutoff Values for Fit Indexes and Dangers in Overgeneralizing Hu and Bentler's (1999) Findings
Marsh, H. W., Hau, K.-T., & Wen, Z. (2004) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1207/s15328007sem1103_2 · Cited by 6,691 · see citing works
The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., et al. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.011 · Cited by 5,128 · cited 1× · see citing works
“In addition, our scientific team has found that recruiting samples from Internet panels can be a cost-effective, efficient, and valid means of data collection as evidenced by our experience with two other large-scale NIH-funded efforts (Cella et al., 2010; Gershon et al., 2012).”
Self-citation
Untitled work
(2000) · Cited by 4,106 · see citing works
Journal of Statistical Software
de Leeuw, J. (2009) · Wiley Interdisciplinary Reviews Computational Statistics · doi:10.1002/wics.10 · Cited by 3,608 · see citing works
Coping: Pitfalls and promise
Folkman, S., & Moskowitz, J. T. (2004) · Annual Review of Psychology · doi:10.1146/annurev.psych.55.090902.141456 · Cited by 3,485 · cited 2× · see citing works
“Although disappointing because of the conceptual importance attributed to these measures in this subdomain, these findings are consistent with well-known complexities that characterize their assessment (Bridges, Denham, & Ganiban, 2004; Folkman & Moskowitz, 2004).”
BackgroundResultSelf-citation
Fundamentals of item response theory
(1992) · Choice Reviews Online · doi:10.5860/choice.29-4185 · Cited by 3,417 · see citing works
Psychological stress and the human immune system: a meta-analytic study of 30 Years of inquiry
Segerstrom, S. C., & Miller, G. E. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.4.601 · Cited by 3,334 · cited 1× · see citing works
“The relevance of stress to disease and health has been demonstrated in both human and animal models (Cohen, Janicki-Deverts, & Miller, 2007; Segerstrom & Miller, 2004).”
Background
Psychological Stress and Disease
Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007) · JAMA · doi:10.1001/jama.298.14.1685 · Cited by 3,168 · see citing works
Personal control and stress and coping processes: A theoretical analysis.
Folkman, S. (1984) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.46.4.839 · Cited by 2,807 · see citing works
Self-citation
Searching for the structure of coping: A review and critique of category systems for classifying ways of coping
Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003) · Psychological Bulletin · doi:10.1037/0033-2909.129.2.216 · Cited by 2,639 · see citing works
Investigations of Temperament at Three to Seven Years: The Children's Behavior Questionnaire
Rothbart, M. K., Ahadi, S. A., Hershey, K. L., & Fisher, P. A. (2001) · Child Development · doi:10.1111/1467-8624.00355 · Cited by 2,424 · see citing works
Emotion Regulation as a Scientific Construct: Methodological Challenges and Directions for Child Development Research
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004) · Child Development · doi:10.1111/j.1467-8624.2004.00673.x · Cited by 2,013 · see citing works
Personal control and stress and coping processes: A theoretical analysis.
Folkman, S. (1984) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.46.4.839 · Cited by 1,936 · cited 4× · see citing works
“The most comprehensive and frequently cited definition of coping was formulated by Lazarus and Folkman (1984): “cognitive and behavioral efforts to manage specific external or internal demands (and conflicts between them) that are appraised as taxing or exceeding the resources of the person.””
BackgroundInfluentialSelf-citation
The social psychology of health
(1989) · Choice Reviews Online · doi:10.5860/choice.26-5686 · Cited by 1,797 · see citing works
Emotion regulation and mental health
Gross, J. J., & Muñoz, R. F. (1995) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.1995.tb00036.x · Cited by 1,595 · cited 1× · see citing works
“Difficulties in regulating emotions have been related to problems in psychological and physical functioning (Appleton, Buka, Loucks, Gilman, & Kubzansky, 2013; Gross & Munoz, 1995; DeSteno, Gross, & Kubzansky, 2013).”
Background
Stress and cardiovascular disease
Steptoe, A., & Kivimäki, M. (2012) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2012.45 · Cited by 1,321 · see citing works
Measures in Health Psychology: A User's Portfolio
Johnston, M., Wright, S., & Weinman, J. A. (1995) · Cited by 1,300 · see citing works
Vision assessment using the NIH Toolbox
Varma, R., McKean‐Cowdin, R., Vitale, S., Slotkin, J., & Hays, R. D. (2013) · Neurology · doi:10.1212/wnl.0b013e3182876e0a · Cited by 1,197 · see citing works
General self-efficacy in various domains of human functioning: evidence from five countries
Luszczynska, A., Gutiérrez‐Doña, B., & Schwarzer, R. (2005) · International Journal of Psychology · doi:10.1080/00207590444000041 · Cited by 1,127 · see citing works
The influence of bio-behavioural factors on tumour biology: pathways and mechanisms
Antoni, M. H., Lutgendorf, S. K., Cole, S. W., Dhabhar, F. S., Sephton, S. E., McDonald, P. G., Stefanek, M., & Sood, A. K. (2006) · Nature Reviews Cancer · doi:10.1038/nrc1820 · Cited by 981 · cited 2× · see citing works
“…and certain cancers, through increased autonomic nervous system activity, poor vagal tone, chronically elevated blood cortisol levels, and decreased immunocompetence (Antoni et al., 2006; Cohen & Williamson, 1988; Raposa, Hammen, Brennan, O’ Callaghan, & Najman, 2014; Steptoe & Kivimäki, 2012).”
Background
A validity and reliability study of the coping self‐efficacy scale
Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006) · British Journal of Health Psychology · doi:10.1348/135910705x53155 · Cited by 942 · see citing works
Self-citation
NIH Toolbox for Assessment of Neurological and Behavioral Function
Gershon, R. C., Wagster, M. V., Hendrie, H. C., Fox, N. A., Cook, K. F., & Nowinski, C. J. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872e5f · Cited by 895 · cited 4× · see citing works
“…the initial phase included acceptable psychometric properties, including reliability, validity, availability of normative data, ability to use or be adapted across the lifespan, suitability for diverse populations, and versatility and portability in terms of types of studies (Gershon et al., 2013).”
BackgroundMethodInfluential
Strategies for Measuring Stress in Studies of Psychiatric and Physical Disorders
Cohen, S., Kessler, R. C., & Gordon, L. U. (1995) · doi:10.1093/oso/9780195086416.003.0001 · Cited by 782 · see citing works
The Bi-Factor Method
Holzinger, K. J., & Swineford, F. (1937) · Psychometrika · doi:10.1007/bf02287965 · Cited by 771 · cited 1× · see citing works
“Because the PSS has some reversed-scored items, we suspected the presence of scoring factors, so we refit the model using a bifactor approach (Holzinger & Swineford, 1937), in which one general factor is included along with one or more group factors to model local dependence.”
Method
lordif : An R Package for Detecting Differential Item Functioning Using Iterative Hybrid Ordinal Logistic Regression/Item Response Theory and Monte Carlo Simulations
Choi, S. W., Gibbons, L. E., & Crane, P. K. (2011) · Journal of Statistical Software · doi:10.18637/jss.v039.i08 · Cited by 756 · cited 1× · see citing works
“We then examined each item across these groups using lordif – an algorithm developed by Choi, Gibbons, and Crane (2011) and implemented in the R statistical environment (see http:// www.r-project.org/).”
Method
Measuring stress: A guide for health and social scientists
Deary, I. J. (1996) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(96)00066-9 · Cited by 753 · see citing works
Development of a brief coping checklist for use with pediatric populations.
Spirito, A., Stark, L. J., & Williams, C. (1988) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/13.4.555 · Cited by 575 · see citing works
Modern Approaches to Conceptualizing and Measuring Human Life Stress
Monroe, S. M. (2008) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.4.022007.141207 · Cited by 567 · cited 1× · see citing works
“This scale is the most frequently used measure of a person’s subjective experience of stress, including studies of health and quality of life, and has excellent reliability and validity (Cohen & Williamson, 1988; Monroe, 2008).”
Method
Stress, coping, and hope.
Folkman, S. (2010) · Psycho-Oncology · doi:10.1002/pon.1836 · Cited by 496 · cited 2× · see citing works
“…acute or chronic diseases, coping is a key factor that can determine how well an individual conceptualizes and behaviorally manages a health condition, and ways of coping with stress can influence whether individuals cope in healthy or health-destructive ways (Carver & Vargas, 2011; Folkman, 2010).”
BackgroundSelf-citation
Coping with Stress
Eisenberg, N., Fabes, R. A., & Guthrie, I. K. (1997) · Issues in clinical child psychology · doi:10.1007/978-1-4757-2677-0_2 · Cited by 475 · cited 1× · see citing works
“Eisenberg, Fabes, and Guthrie (1997) used the term “self-regulation” to include both regulation of internal states and emotion-related behaviors.”
Background
Ways of Coping Questionnaire
Folkman, S., & Lazarus, R. S. (1988) · PsycTESTS Dataset · doi:10.1037/t06501-000 · Cited by 452 · see citing works
Self-citation
Representativeness of the Patient-Reported Outcomes Measurement Information System Internet panel
Liu, H., Cella, D. F., Gershon, R. C., Shen, J., Morales, L. S., Riley, W. T., & Hays, R. D. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.11.021 · Cited by 447 · cited 1× · see citing works
“Recent work, however, has shown that data collected from the Internet are comparable to data from probability-based general population samples (Liu et al., 2010).”
BackgroundSelf-citation
Perceived control and health
Wallston, K. A., Wallston, B. S., Smith, S., & Dobbins, C. J. (1987) · Current Psychology · doi:10.1007/bf02686633 · Cited by 429 · see citing works
Affective science and health: The importance of emotion and emotion regulation.
DeSteno, D. A., Gross, J. J., & Kubzansky, L. D. (2013) · Health Psychology · doi:10.1037/a0030259 · Cited by 417 · see citing works
Assessment of neurological and behavioural function: the NIH Toolbox
Gershon, R. C., Cella, D., Fox, N. A., Havlik, R. J., Hendrie, H. C., & Wagster, M. V. (2010) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70335-7 · Cited by 377 · cited 4× · see citing works
“…initiative was developed to identify, create when necessary, and validate measures in the broad domains of cognitive function, emotional health, motor function, and sensory function for use large-scale epidemiological studies (Gershon et al., 2010; Gershon, et al. 2013; Salsman, et al., 2013).”
BackgroundMethodInfluentialSelf-citation
Neuro-QOL: quality of life item banks for adults with neurological disorders: item development and calibrations based upon clinical and general population testing
Gershon, R. C., Lai, J. S., Bode, R. K., Choi, S. W., Moy, C. S., Bleck, T., Miller, D. M., Peterman, A. H., & Cella, D. F. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9958-8 · Cited by 361 · cited 1× · see citing works
“In addition, our scientific team has found that recruiting samples from Internet panels can be a cost-effective, efficient, and valid means of data collection as evidenced by our experience with two other large-scale NIH-funded efforts (Cella et al., 2010; Gershon et al., 2012).”
BackgroundSelf-citation
Coping self-efficacy perceptions as a mediator between acute stress response and long-term distress following natural disasters
Benight, C. C., & Harper, M. L. (2002) · Journal of Traumatic Stress · doi:10.1023/a:1015295025950 · Cited by 304 · see citing works
Definitional issues in emotion regulation research
Bridges, L. J., Denham, S. A., & Ganiban, J. M. (2004) · Child Development · doi:10.1111/j.1467-8624.2004.00675.x · Cited by 288 · see citing works
Emotion assessment using the NIH Toolbox
Salsman, J. M., Butt, Z. A., Pilkonis, P. A., Cyranowski, J. M., Zill, N., Hendrie, H. C., Kupst, M. J., Kelly, M. A. R., Bode, R. K., Choi, S. W., et al. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872e11 · Cited by 274 · cited 2× · see citing works
“A final criterion was that measures for each of the Emotional Health domains had to be brief enough so that respondents could complete the total emotion domain battery within 30 minutes (Gershon et al., 2010; Salsman et al., 2013).”
BackgroundMethodSelf-citation
Stress, Coping, and Health
Carver, C. S., & Vargas, S. E. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195342819.013.0008 · Cited by 228 · see citing works
Coping scale for children and youth: Scale development and validation
Brodzinsky, D. M., Elias, M. J., Steiger, C., Simon, J., Gill, M., & Hitt, J. C. (1992) · Journal of Applied Developmental Psychology · doi:10.1016/0193-3973(92)90029-h · Cited by 162 · cited 3× · see citing works
“For children and adolescents, two scales were initially considered: the Kidcope (Spirito, Stark, & Williams, 1988), comprised of 10 items representing coping strategies and the Coping Scale for Children and Youth (CSCY) (Brodzinsky et al., 1992) comprised of 29 items with good psychometric properties.”
MethodInfluential
Divergent associations of adaptive and maladaptive emotion regulation strategies with inflammation
Appleton, A. A., Buka, S. L., Loucks, E. B., Gilman, S. E., & Kubzansky, L. D. (2013) · Health Psychology · doi:10.1037/a0030068 · Cited by 157 · see citing works
How I Feel: A Self-Report Measure of Emotional Arousal and Regulation for Children.
Walden, T. A., Harris, V. S., & Catron, T. F. (2003) · Psychological Assessment · doi:10.1037/1040-3590.15.3.399 · Cited by 126 · see citing works
Early adversity and health outcomes in young adulthood: The role of ongoing stress.
Raposa, E. B., Hammen, C. L., Brennan, P. A., O’Callaghan, F., & Najman, J. M. (2013) · Health Psychology · doi:10.1037/a0032752 · Cited by 84 · see citing works
Using the NIH Toolbox in special populations
Victorson, D. E., Manly, J. J., Wallner‐Allen, K., Fox, N. A., Purnell, C., Hendrie, H. C., Havlik, R. J., Harniss, M. K., Magasi, S. R., Correia, H., et al. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872e26 · Cited by 44 · cited 2× · see citing works
“Recognizing the challenges in pediatric assessment the Pediatric consultant subgroup provided guidance in measurement selection and administration (Victorson et al., 2013).”
Background
Building PROMIS item banks: librarians as co-investigators
Klem, M. L., Saghafi, E. M., Abromitis, R. A., Stover, A. M., Dew, M. A., & Pilkonis, P. A. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9498-7 · Cited by 44 · see citing works
Input on NIH Toolbox inclusion criteria
Nowinski, C. J., Victorson, D. E., Debb, S. M., & Gershon, R. C. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872e4c · Cited by 12 · cited 1× · see citing works
“An NIH Toolbox Request for Information from experts in the field (Nowinski et al., 2013) was followed by consultation with an international group of content experts.”
Method

Flagged first, then by citations

1 of the 56 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

Browne M. W., 1993, Alternative ways of assessing model fit testing structural equation models
Schwarzer R., 2008, Health Behavior Constructs: Theory, Measurement and Research

Sorted by citations

The Perceived Stress Scale as a Measure of Stress: Decomposing Score Variance in Longitudinal Behavioral Medicine Studies
Harris, K. M., Gaffey, A. E., Schwartz, J. E., Krantz, D. S., & Burg, M. M. (2023) · Annals of Behavioral Medicine · doi:10.1093/abm/kaad015 · Cited by 187 · see citing works
Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society
Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., Apovian, C. M., Bindlish, S., Bonnet, J., Butsch, W. S., Christensen, S., Gianos, E., et al. (2025) · The American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.04.023 · Cited by 154 · see citing works
“Alternatively, setting an absolute protein target of 80 – 120 g/day may enhance adherence while ensuring adequate intake.”
Psychometric Evaluation of the PROMIS® Pediatric Psychological and Physical Stress Experiences Measures
Bevans, K. B., Gardner, W. P., PAJER, K. A., Becker, B. D., Carle, A. C., Tucker, C. A., & Forrest, C. B. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsy010 · Cited by 128 · see citing works
Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society
Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., Apovian, C. M., Bindlish, S., Bonnet, J., Butsch, W. S., Christensen, S., Gianos, E., et al. (2025) · Obesity · doi:10.1002/oby.24336 · Cited by 143 · see citing works
“Individuals who report high levels of stress on a Perceived Stress Scale 10-item questionnaire [193] or a brief Patient Health Questionnaire for Depression and Anxiety [194] may particularly benefit from stress mitigation interventions.”
Calibration and initial validation of a general self-efficacy item bank and short form for the NIH PROMIS®
Salsman, J. M., Schalet, B. D., Merluzzi, T. V., Park, C. L., Hahn, E. A., Snyder, M. A., & Cella, D. F. (2019) · Quality of Life Research · doi:10.1007/s11136-019-02198-6 · Cited by 88 · see citing works
“Similarly, convergent validity correlations with related constructs such as optimism and positive expectancies were large and in the expected direction [45, 46], and the PROMIS General Self-Efficacy measures were highly correlated with the Toolbox version of the same construct [20], suggesting comparable approaches to…”
Self-citation
A Lifespan Approach to Patient‐Reported Outcomes and Quality of Life for People on the Autism Spectrum
Holmes, L. G., Zampella, C., Clements, C. C., McCleery, J. P., Maddox, B. B., Parish‐Morris, J., Udhnani, M. D., Schultz, R. T., & Miller, J. S. (2020) · Autism Research · doi:10.1002/aur.2275 · Cited by 76 · see citing works
“, 2014], general self-efficacy [Kupst et al., 2015], cognitive functioning [Lai, Wagner, Jacobsen, & Cella, 2014], sleep disturbance and impairment [Buysse et al.”
Background
Validation of the NIH Toolbox in Individuals with Neurologic Disorders
Carlozzi, N. E., Goodnight, S. M., Casaletto, K. B., Goldsmith, A., Heaton, R. K., Wong, A., Baum, C. M., Gershon, R. C., Heinemann, A. W., & Tulsky, D. S. (2017) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acx020 · Cited by 73 · see citing works
Associations of Maternal Stress, Prenatal Exposure to Per- and Polyfluoroalkyl Substances (PFAS), and Demographic Risk Factors with Birth Outcomes and Offspring Neurodevelopment: An Overview of the ECHO.CA.IL Prospective Birth Cohorts
Eick, S. M., Enright, E. A., Geiger, S. D., Dzwilewski, K. L. C., DeMicco, E., Smith, S. C., Park, J.-S., Aguiar, A., Woodruff, T. J., Morello-Frosch, R. A., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18020742 · Cited by 62 · see citing works
“Perceived stress was harmonized by converting the PSS-4 and PSS-10 to T-scores using the NIH toolbox [38].”
MethodInfluential
Targeting self-regulation to promote health behaviors in children
Miller, A. L., Gearhardt, A. N., Fredericks, E. M., Katz, B., Shapiro, L. F., Holden, K., Kaciroti, N., Gonzalez, R., Hunter, C. M., & Lumeng, J. C. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.09.008 · Cited by 54 · see citing works
“The NIH Toolbox Self-Efficacy questionnaire, validated for 8-12 year-old children (Kupst et al., 2015), assesses belief in one’s capacity to manage and have control over meaningful events (e.g., “I can manage to solve difficult problems if I try hard enough”).”
Method
Prenatal PFAS and psychosocial stress exposures in relation to fetal growth in two pregnancy cohorts: Applying environmental mixture methods to chemical and non-chemical stressors
Eick, S. M., Enright, E. A., Padula, A. M., Aung, M. T., Geiger, S. D., Cushing, L. J., Trowbridge, J., Keil, A. P., Baek, H.-G., Smith, S. C., et al. (2022) · Environment International · doi:10.1016/j.envint.2022.107238 · Cited by 51 · see citing works
“This method is described in detail elsewhere (Kupst et al., 2015).”
Method
Exploring stress, cognitive, and affective mechanisms of the relationship between interpersonal trauma and opioid misuse
Williams, J. R., Cole, V. T., Girdler, S. S., & Cromeens, M. G. (2020) · PLoS ONE · doi:10.1371/journal.pone.0233185 · Cited by 49 · see citing works
“It is also important to note that this study used a self-report measure of perceived stress during the past month as an indicator of a person’s adaptive capacity overload [66].”
Background
Mindfulness-based group intervention in adolescents at-risk for excess weight gain: A randomized controlled pilot study
Shomaker, L. B., Berman, Z., Burke, M., Annameier, S. K., Pivarunas, B., Sánchez, N., Smith, A. D., Hendrich, S. G., Riggs, N. R., Legget, K. T., et al. (2019) · Appetite · doi:10.1016/j.appet.2019.05.022 · Cited by 51 · see citing works
Impact of the COVID-19 pandemic on CHD care and emotional wellbeing
Cousino, M. K., Pasquali, S. K., Romano, J. C., Norris, M. D., Yu, S., Reichle, G., Lowery, R., Viers, S., & Schumacher, K. R. (2020) · Cardiology in the Young · doi:10.1017/s1047951120004758 · Cited by 48 · see citing works
“In addition, the eight-item parent-reported NIH PROMIS Psychological Stress Experiences Scale 10 and 10-item self-reported NIH Toolbox Perceived Stress Scale 11,12 were administered as validated measures of general life stress.”
Implicit reappraisal as an emotional buffer: Reappraisal-related neural activity moderates the relationship between inattention and perceived stress during exposure to negative stimuli
Shahane, A. D., Lopez, R. B., & Denny, B. T. (2018) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-018-00676-x · Cited by 33 · see citing works
“In addition, the perceived stress measure used in the present study has been shown to reliably predict and/or reflect stress in normative populations (Kupst et al., 2015).”
Method
Together Means More Happiness: Relationship Status Moderates the Association between Brain Structure and Life Satisfaction
Zhu, X., Wang, K., Chen, L., Cao, A., Chen, Q., Li, J., & Qiu, J. (2018) · Neuroscience · doi:10.1016/j.neuroscience.2018.05.018 · Cited by 32 · see citing works
Nutritional priorities to support GLP-1 therapy for obesity: A joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society
Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., Apovian, C. M., Bindlish, S., Bonnet, J., Butsch, W. S., Christensen, S., Gianos, E., et al. (2025) · Obesity Pillars · doi:10.1016/j.obpill.2025.100181 · Cited by 28 · see citing works
Coping and Adaptation in Pediatric Cancer: Current Perspectives
Kupst, M. J., & Patenaude, A. F. (2015) · Springer eBooks · doi:10.1007/978-3-319-21374-3_5 · Cited by 26 · see citing works
Self-citation
Do trait psychological characteristics moderate sympathetic arousal to racial discrimination exposure in a natural setting?
Jelsma, E. B., Goosby, B. J., & Cheadle, J. E. (2021) · Psychophysiology · doi:10.1111/psyp.13763 · Cited by 25 · see citing works
A randomized controlled trial of a trauma-informed school prevention program for urban youth: Rationale, design, and methods
Mendelson, T., Clary, L. K., Sibinga, E., Tandon, D., Musci, R., Mmari, K., Salkever, D., Stuart, E. A., & Ialongo, N. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.105895 · Cited by 25 · see citing works
Mediators and Moderators of the Association Between Perceived Stress and Episodic Memory in Diverse Older Adults
Zaheed, A. B., Sharifian, N., Kraal, A. Z., Sol, K., Manly, J. J., Schupf, N., Brickman, A. M., & Zahodne, L. B. (2020) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617720001253 · Cited by 24 · see citing works
“Perceived stress was measured using the NIH Toolbox Perceived Stress Survey (Kupst et al., 2015; Salsman et al., 2013), a 10-item version of the Perceived Stress Scale (Cohen et al., 1983), which has been demonstrated to have good internal consistency (Cronbach’s alpha = .91) and concordance with objective measures of…”
Method
Stepped Transition to Employment and Postsecondary Education Success (STEPS) for Adolescents and Adults with Autism: Community Implementation Pilot Trial
White, S. W., Brewe, A. M., & Powell, N. P. (2025) · JMIR Formative Research · doi:10.2196/70137 · Cited by 24 · see citing works
“The GSES has shown strong internal consistency and convergent validity [40,41].”
Dynamic Changes in EEG Power Spectral Densities During NIH-Toolbox Flanker, Dimensional Change Card Sort Test and Episodic Memory Tests in Young Adults
Foy, J. G., & Foy, M. R. (2020) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2020.00158 · Cited by 22 · see citing works
Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory From the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society
Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., Apovian, C. M., Bindlish, S., Bonnet, J. P., Butsch, W. S., Christensen, S. M., Gianos, E., et al. (2025) · Obesity Pillars · doi:10.1016/j.obpill.2026.100269 · Cited by 26 · see citing works
Functional recovery outcomes following acute stroke is associated with abundance of gut microbiota related to inflammation, butyrate and secondary bile acid
Hammond, T. C., Powell, E. S., Green, S. J., Chlipala, G. E., Frank, J. A., Yackzan, A. T., Yanckello, L. M., Chang, Y., Xing, X., Heil, S. D., et al. (2022) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2022.1017180 · Cited by 23 · see citing works
Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study
Wulsin, L. R., Henson, S. J. S., Roos, L. G., Wang, D., Jenkins, B. N., Cohen, B. E., Shah, A. J., & Slavich, G. M. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001051 · Cited by 19 · see citing works
Multimodal neuroimaging data from a 5-week heart rate variability biofeedback randomized clinical trial
Yoo, H. J., Nashiro, K., Min, J., Cho, C., Mercer, N., Bachman, S. L., Nasseri, P., Dutt, S., Porat, S., Choi, P., et al. (2023) · Scientific Data · doi:10.1038/s41597-023-02396-5 · Cited by 18 · see citing works
Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial
Johnson, H. M., Sullivan-Vedder, L., Kim, K., McBride, P. E., Smith, M. A., LaMantia, J. N., Fink, J. T., Sinaise, M. R. K., Zeller, L. M., & Lauver, D. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.01.010 · Cited by 19 · see citing works
“, perceived self-efficacy [51, 52]; confidence in starting and maintaining behaviors to reach a goal) [50, 53–59].”
Background
Impact of a Genetic Diagnosis for a Child’s Autism on Parental Perceptions
Wynn, J., Karlsen, A., Huber, B. D., Levine, A., Salem, A. M., White, L. C., Luby, M., Bezborodko, E., Xiao, S., Chung, W. K., et al. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06273-x · Cited by 16 · see citing works
“At one-month follow-up, optimism, self-esteem, self-efficacy (i.e., confidence in one’s own ability; Kupst et al., 2015) and autism stigma were not significantly different from baseline for either group (Table S3).”
Understanding the Relationship between Food Security and Mental Health for Food-Insecure Mothers in Virginia
Liebe, R. A., Adams, L. M., Hedrick, V. E., Serrano, E. L., Porter, K., Cook, N. E., & Misyak, S. A. (2022) · Nutrients · doi:10.3390/nu14071491 · Cited by 17 · see citing works
“More than half of all respondents were experiencing a high level of perceived stress, which is severe enough to potentially necessitate clinical intervention [39].”
BackgroundMethod
A Pilot Study of Cognition Among Hypoparathyroid Adults
Rubin, M. R., Tabacco, G., Omeragic, B., Majeed, R., Hale, C., & Brickman, A. M. (2022) · Journal of the Endocrine Society · doi:10.1210/jendso/bvac002 · Cited by 16 · see citing works
“Duration of hypoparathyroidism, years 5 (2-10) [1-39]”
Background
Associations of parental feeding practices and food reward responsiveness with adolescent stress-eating
Smith, A. D., Sanchez, N., Reynolds, C., Casamassima, M., Verros, M., Annameier, S. K., Melby, C., Johnson, S. A., Lucas-Thompson, R. G., & Shomaker, L. B. (2020) · Appetite · doi:10.1016/j.appet.2020.104715 · Cited by 15 · see citing works
“—We measured and accounted for adolescents’ perceptions of general stress using the 10-item Perceived Stress Scale (Cohen & Williamson, 1988; Kupst et al., 2015).”
Method
Altered Effective Connectivity of Central Autonomic Network in Response to Negative Facial Expression in Adults With Cannabis Use Disorder
Ma, L., Steinberg, J. L., Bjork, J. M., Wang, Q., Hettema, J. M., Abbate, A., & Moeller, F. G. (2019) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2019.05.013 · Cited by 16 · see citing works
Targeting positive valence systems function in children of mothers with depressive symptoms: A pilot randomized trial of an RDoC-Informed preventive intervention
Burkhouse, K. L., Dao, A., Argiros, A. P., Granros, M., Cárdenas, E. F., Dickey, L., Feurer, C., Hill, K. E., Pegg, S. L., Venanzi, L., et al. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104384 · Cited by 15 · see citing works
A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders
Peterson, B. S., West, A. E., Weisz, J. R., Mack, W. J., Kipke, M. D., Findling, R. L., Mittman, B. S., Bansal, R., Piantadosi, S., Takata, G., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03314-y · Cited by 13 · see citing works
“Self-Efficacy NIH Toolbox Self-Efficacy [93] C,P 7–17 10 .”
Mindfulness-based intervention in adolescents at risk for excess weight gain: 1.5-year follow-up of pilot randomized controlled trial
Bernstein, R. M., Sánchez, N., Clark, E. L. M., Conte, I., Gulley, L. D., Legget, K. T., Cornier, M., Melby, C. L., Johnson, S. A., Lucas‐Thompson, R. G., et al. (2021) · Eating Behaviors · doi:10.1016/j.eatbeh.2021.101580 · Cited by 13 · see citing works
Stress and the brain: Emotional support mediates the association between myelination in the right supramarginal gyrus and perceived chronic stress
Guo, Y., Wu, H., Dong, D., Zhou, F., Li, Z., Zhao, L., & Long, Z. (2022) · Neurobiology of Stress · doi:10.1016/j.ynstr.2022.100511 · Cited by 12 · see citing works
“The perceived stress scale in the NIH toolbox consists of 10 items to measure the degree of stress a person feels during the last month (Kupst et al., 2015).”
Method
Single session therapy in pediatric healthcare: the value of adopting a strengths-based approach for families living with neurological disorders
Mulligan, J., Olivieri, H., Young, K., Lin, J., & Anthony, S. J. (2022) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-022-00495-6 · Cited by 10 · see citing works
“The NIHSE has shown strong psychometric properties in the areas of dimensionality and precision of scores [22].”
Method
Development and psychometric validation of the Pandemic-Related Traumatic Stress Scale for children and adults.
Blackwell, C. K., Sherlock, P., Jackson, K., Hofheimer, J. A., Cella, D. F., Algermissen, M., Alshawabkeh, A. N., Avalos, L. A., Bastain, T., Blair, C., et al. (2023) · Psychological Assessment · doi:10.1037/pas0001211 · Cited by 13 · see citing works
Self-citation
Total Pain and Illness Acceptance in Pelvic Cancer Patients: Exploring Self-Efficacy and Stress in a Moderated Mediation Model
Krok, D., Telka, E., & Zarzycka, B. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159631 · Cited by 10 · see citing works
“The lack of moderation effects does not necessarily invalidate earlier cross-sectional findings, as it seems feasible that the previous studies described more correlational mechanisms in their samples, or that the relationships may change over time due to potential fluctuations in total pain experiences and ensuing st…”
Result
Mindful Self-Care for Caregivers: A Proof of Concept Study Investigating a Model for Embedded Caregiver Support in a Pediatric Setting
Mount, K. B., Elliott, S. C., Hynan, L. S., Warren, B. A., & Jarrett, R. B. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05113-6 · Cited by 11 · see citing works
“, 2013), or defined by “a person’s self-report of adaptive capacity overload” (Kupst et al., 2015).”
Background
Refining and supplementing candidate measures of psychological well-being for the NIH PROMIS®: qualitative results from a mixed cancer sample
Salsman, J. M., Park, C. L., Hahn, E. A., Snyder, M. A., George, L. S., Steger, M. F., Merluzzi, T. V., & Cella, D. F. (2018) · Quality of Life Research · doi:10.1007/s11136-018-1896-2 · Cited by 10 · see citing works
“Participants reviewed items from the NIH Toolbox’s Positive Affect, General Life Satisfaction, Meaning & Purpose, and General Self-Efficacy Item Banks [16, 22].”
MethodSelf-citation
The Relationship Between Personality Traits and Well-Being via Brain Functional Connectivity
Li, L., Li, L. M. W., Ma, J., Lu, A., & Dai, Z. (2023) · Journal of Happiness Studies · doi:10.1007/s10902-023-00674-y · Cited by 12 · see citing works
Patterns of health‐promoting behaviors and associated factors in family caregivers of people receiving cancer treatment: A latent class profile analysis
Son, E. H., Wallen, G. R., Flynn, S. L., Yang, L., & Lee, L. J. (2023) · Psycho-Oncology · doi:10.1002/pon.6145 · Cited by 10 · see citing works
Subjective, neuropsychological, and neural markers of memory in older adults
Sheffler, J., Meynadasy, M. A., Taylor, D. T., Kiosses, D. N., & Hajcak, G. (2021) · International Psychogeriatrics · doi:10.1017/s1041610221002623 · Cited by 12 · see citing works
“Perceived stress was measured using the NIH Toolbox Emotion Battery (Kupst et al., 2015).”
Method
NIH Toolbox for assessment of neurocognitive, motor and emotional-behavioral function in childhood: a systematic review
Wei, X., McKinlay, C. J. D., Harding, J. E., Wouldes, T. A., Rogers, J., Brown, G., & Franke, N. (2024) · Child Neuropsychology · doi:10.1080/09297049.2024.2447444 · Cited by 9 · see citing works
“Evidence of moderate quality from three studies (5,496 children) showed the NAf, PWB, SSE and SR are separate constructs, especially in older children (Supplementary Table S19) (Kupst et al., 2015; Paolillo et al., 2020; Salsman et al., 2013).”
The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment
Zhang, M., Ho, E., Nowinski, C. J., Fox, R. S., Aytürk, E., Karpouzian‐Rogers, T., Novack, M. A., Dodge, H. H., Weıntraub, S., & Gershon, R. C. (2023) · Journal of Aging and Health · doi:10.1177/08982643231199806 · Cited by 10 · see citing works
“…good reliability (Cronbach α s ranging from .90 to .98 across scales) and acceptable convergent validity (correlation coef ﬁ cients ranging from .60 to .92 across scales) among adult participants in prior literature (Kupst et al., 2015; Pilkonis et al., 2013; Salsman et al., 2013, 2014).”
National Institutes of Health Toolbox Emotion Battery: Application of Summary Scores to Adults With Spinal Cord Injury, Traumatic Brain Injury, and Stroke
Babakhanyan, I., Carlozzi, N. E., McKenna, B. S., Casaletto, K. B., Heinemann, A. W., & Heaton, R. K. (2019) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2019.05.024 · Cited by 9 · see citing works
Targeted self-regulation interventions in low-income children: Clinical trial results and implications for health behavior change
Lo, S. L., Gearhardt, A. N., Fredericks, E. M., Katz, B., Sturza, J. S., Kaciroti, N., Gonzalez, R., Hunter, C. M., Sonneville, K. R., Chaudhry, K., et al. (2021) · Journal of Experimental Child Psychology · doi:10.1016/j.jecp.2021.105157 · Cited by 9 · see citing works
Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective
Leininger, B. D., Evans, R., Greco, C. M., Hanson, L., Schulz, C. A., Schneider, M. H., Connett, J. E., Keefe, F. J., Glick, R. M., & Brønfort, G. (2025) · Chiropractic & Manual Therapies · doi:10.1186/s12998-025-00570-7 · Cited by 6 · see citing works
Associations of prenatal maternal psychosocial stress and depression with neurodevelopmental outcomes in 7.5-month-old infants in the ECHO.CA.IL prospective birth cohorts
Cragoe, N. G., Sprowles, J. L. N., Eick, S. M., Harvey, L., Ramirez, X. R., Sugg, G. A., Morello-Frosch, R. A., Woodruff, T. J., & Schantz, S. L. (2025) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2025.107431 · Cited by 7 · see citing works
“Measures of perceived stress were harmonized by converting PSS scores to t-scores using the NIH toolbox method (Kupst et al., 2015).”
Psychometric Properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Resilience Short Form in a Sample With Spinal Cord Injury
Kuzu, D., Kallen, M. A., & Kratz, A. L. (2023) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2023.10.002 · Cited by 7 · see citing works
Measurement Properties of Patient Reported Outcome Scales: A Systematic Review
Stallwood, E., Elsman, E. B. M., Monsour, A., Baba, A., Butcher, N. J., & Offringa, M. (2023) · PEDIATRICS · doi:10.1542/peds.2023-061489 · Cited by 7 · see citing works
Tai Chi as a preventive intervention for improving mental and physical health in non-depressed college students with high perceived stress
Sun, J., Yao, K., Zhao, R., Li, H., & Cicchella, A. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1613384 · Cited by 7 · see citing works
Measures of Patient Activation and Self‐Efficacy
Hamilton, C. B., & LI, L. C. (2020) · Arthritis Care & Research · doi:10.1002/acr.24350 · Cited by 6 · see citing works
Differences Among Veterans With Chronic Overlapping Pain Conditions and Other Chronic Pain: Baseline Results From the LAMP Pain Management Trial
Adamowicz, J. L., Grant, A. D., Calvert, C., Elchert, D. M., Hadlandsmyth, K., Driscoll, M., Taylor, S. L., Allen, K. D., Taylor, B. C., & Burgess, D. J. (2025) · European Journal of Pain · doi:10.1002/ejp.70125 · Cited by 5 · see citing works
“The NIH Toolbox Perceived Stress Survey (PSS) (Kupst et al. 2015) was used to assess perceived stress.”
Influential
Sympathetic arousal among depressed college students: Examining the interplay between psychopathology and social activity
Jelsma, E. B., Zhang, A., Goosby, B. J., & Cheadle, J. E. (2024) · Psychophysiology · doi:10.1111/psyp.14597 · Cited by 5 · see citing works
BEhavioral Health Stratified Treatment (B.E.S.T.) to optimize transition to adulthood for youth with intellectual and/or developmental disabilities
Berg, K. L., Mihaila, I., Feinstein, R. T., Shiu, C. A., Gussin, H. A., Acharya, K., Gladstone, T. R. G., Bernard, L., Best, M., Renz, E., et al. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107374 · Cited by 5 · see citing works
Biobehavioral Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults with Cancer: Results from a Pilot Study
Thornton, C. P., Perrin, N., Kozachik, S., Lukkahatai, N., & Ruble, K. (2023) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2022.0067 · Cited by 5 · see citing works
GAP (gestational diabetes and pharmacotherapy) – study protocol for a randomized controlled, two-arm, single-site trial
Palatnik, A., Saffian, E., Flynn, K. E., Pan, A., Yee, L. M., Basir, M., & Cruz, M. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107237 · Cited by 5 · see citing works
Developing a conceptual framework for the relationship between food security status and mental health among low-income mothers
Liebe, R. A., Adams, L. M., Hedrick, V. E., Serrano, E. L., Porter, K., Cook, N. E., & Misyak, S. A. (2023) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2022.1078811 · Cited by 5 · see citing works
“Perceived stress over the past month was measured with the National Institutes of Health (NIH) Toolbox Perceived Stress—Adults tool (Kupst et al., 2015).”
Method
Feasibility of an Online Langerian Mindfulness Program for Stroke Survivors and Caregivers
Demers, M., Pagnini, F., Phillips, D., Chang, B., Winstein, C. J., & Langer, E. J. (2022) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492221091266 · Cited by 5 · see citing works
“For caregivers, the self-reported measures were (a) World Health Organization Quality of Life-BREF (WHOQOL-BREF; World Health Organization, 2004), (b) HADS, (c) Zarit Burden Interview (Zarit et al., 1980), (d) PSS, and (e) SQS (see Supplementary Material for a description of each measure).”
BackgroundMethodInfluential
Somatosensation Differences in Older Adults with and Without Diabetes, and by Age Group
Kim, Y. J., Rogers, J. C., Kwok, G., et al. (2016) · Occupational Therapy In Health Care · doi:10.3109/07380577.2015.1136758 · Cited by 5 · see citing works
Association between maternal stress and child sleep quality: a nationwide ECHO prospective cohort study
Geiger, S. D., Chandran, A., Churchill, M. L., Mansolf, M. A., Zhang, C., Musaad, S. M. A., Blackwell, C. K., Eick, S. M., Goin, D. E., Korrick, S., et al. (2024) · Pediatric Research · doi:10.1038/s41390-024-03542-4 · Cited by 5 · see citing works
Self-citation
Exploring Gender Differences in Veterans in a Secondary Analysis of a Randomized Controlled Trial of Mindfulness for Chronic Pain
Burgess, D. J., Campbell, E. H., Branson, M., Calvert, C., Evans, R., Allen, K. D., Bangerter, A. K., Cross, L. J. S., Driscoll, M., Hennessy, S., et al. (2024) · Women s Health Reports · doi:10.1089/whr.2023.0086 · Cited by 6 · see citing works
A true score imputation method to account for psychometric measurement error.
Mansolf, M. A. (2023) · Psychological Methods · doi:10.1037/met0000578 · Cited by 4 · see citing works
College Family Coping and Disruptions During COVID-19: A Consideration of the ABC-X Model of Family Stress
Dworkin, J., Cai, Q., LeBouef, S., & Hruska, E. (2023) · Journal of Comparative Family Studies · doi:10.3138/jcfs.53.4.040 · Cited by 4 · see citing works
“Parental Stress Parent stress was measured using the 10-item NIH Toolbox – Perceived Stress Fixed Form Age 18+ (Version 2.0; Kupst et al., 2015), for example, “How often have you been upset because of something that happened unexpectedly?” Parents responded using a Likert-type scale ranging from 1= Never to 5=Very Oft…”
MethodInfluential
A True Score Imputation Method to Account for Psychometric Measurement ErrorPreprint
Mansolf, M. A. (2022) · doi:10.31234/osf.io/vzqys · Cited by 4 · see citing works
Multi-level health indicators as predictors of students’ subjective well-being experience
Korjova, E., Veselova, E. K., & Валерьевна, Р. О. (2022) · Vestnik of Saint Petersburg University Psychology · doi:10.21638/spbu16.2022.405 · Cited by 4 · see citing works
Modeling neural and self-reported factors of affective distress in the relationship between pain and working memory in healthy individuals
Anderson, S. R., Witkin, J. E., Bolt, T., Llabre, M. M., Ashton-James, C. E., & Losin, E. A. R. (2021) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2021.107766 · Cited by 4 · see citing works
“The Perceived Stress Survey is a CAT-administered measure of how unpredictable, uncontrollable and overloaded participants feel about their lives over the past month (Kupst et al., 2015).”
Background
Culturally Informed Digital Behavioral Intervention Development for Inflammatory Bowel Disease: A Qualitative Study
Greywoode, R., Philippou, A., Ullman, T., & Keefer, L. (2025) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaf145 · Cited by 3 · see citing works
Validation of Perceived Stress Scale-10 Among Greek Middle Adolescents: Associations Between Stressful Life Events and Perceived Stress
Kourmousi, N., Kounenou, K., Pezirkianidis, C., Kalamatianos, A., & Chrousos, G. P. (2025) · Social Sciences · doi:10.3390/socsci14060344 · Cited by 4 · see citing works
Psychological flexibility in art therapy: Practice-based research
Potash, J. S., Tripp, T., & Baxter, C. (2024) · The Arts in Psychotherapy · doi:10.1016/j.aip.2024.102244 · Cited by 2 · see citing works
Differing Within-Household Food Security Statuses Are Associated with Varied Maternal Mental Health Outcomes
Liebe, R. A., Holmes, C., & Misyak, S. A. (2024) · Nutrients · doi:10.3390/nu16101522 · Cited by 3 · see citing works
“The National Institutes of Health (NIH) Toolbox Perceived Stress adults scale was used to assess perceived stress over the previous 30 days [34].”
Method
Relationship Factors in the Longitudinal Spillover of Stress Between Parents and Children During COVID-19
Hu, Y., Russell, B. S., Wu, R., Adamsons, K. L., Horton, A. L., & Tambling, R. R. (2024) · Journal of Family Issues · doi:10.1177/0192513x241236559 · Cited by 3 · see citing works
“Cronbach ’ s alpha reported from a sample of parents of children as young as eight years of age was acceptable ( α = .87; Kupst et al., 2015), as it was in the current sample ( α = .86 for baseline and .87 for follow-up).”
Multimodal neuroimaging data from a 5-week heart rate variability biofeedback randomized clinical trialPreprint
Yoo, H. J., Nashiro, K., Min, J., et al. (2022) · medRxiv · doi:10.1101/2022.12.28.22283798 · Cited by 3 · see citing works
Study Protocol to Evaluate Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults With Cancer
Thornton, C. P., Kozachik, S., & Ruble, K. (2022) · Nursing Research · doi:10.1097/nnr.0000000000000599 · Cited by 4 · see citing works
“These instruments were chosen due to brevity, ease of completion, and established validity and reliability in children and adults (Hodes et al., 2013; Kupst et al., 2015; Victorson et al., 2013).”
Background
Songwriting intervention for cognitively-impaired children with life-limiting conditions: Study protocol
Akard, T. F., Davis, K. A., Hills, T., Lense, M. D., Kim, D., Webber, R., Dietrich, M. S., & Gilmer, M. J. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100765 · Cited by 3 · see citing works
Positive psychological states and stress responses in caregivers of adults receiving an allogeneic bone marrow transplant: A study protocol
Tan, K., Santacroce, S. J., Wood, W. A., Mayer, D. K., Junior, H. P. D. O. S., Mucha, P. J., Schwartz, T. A., & Fredrickson, B. L. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14742 · Cited by 3 · see citing works
“Reponses are summed for a total score; higher scores indicate higher levels of perceived stress (Kupst et al., 2015).”
Background
Psychosocial stressors as modifiers of the associations between well-studied and understudied chemicals and birth outcomes in the ECHO Cohort
Eick, S. M., Brennan, P. A., Buckley, J. P., Liang, D., Li, X., Karvonen, K. L., Cowell, W., Zhu, Y., Barrett, E. S., Peterson, A. K., et al. (2026) · Environmental Pollution · doi:10.1016/j.envpol.2025.127441 · Cited by 2 · see citing works
Feasibility and acceptability of a digital storytelling intervention for children with serious illness
Cho, E., Gilmer, M. J., Dietrich, M. S., et al. (2025) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2025.10.002 · Cited by 2 · see citing works
Living with chronic myelogenous leukemia in rural communities: Exploring factors related to tyrosine kinase inhibitors adherence with a mixed methods approach
Sheng, J., Heiney, S. P., Wickersham, K. E., Nguyen, L. A., Harrison, K. W., & Adams, S. A. (2025) · The Journal of Rural Health · doi:10.1111/jrh.70028 · Cited by 3 · see citing works
“30 The PSScontains10items,withresponsecategoriesrangingfromnever(1) toveryoften(5).”
The Spinal Cord Injury Self-Management Program: A Pilot
Kraus, B., & Wolf, T. (2024) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492241271173 · Cited by 2 · see citing works
“Participants responded to the General Self-Efficacy (GSE) scale (Kupst et al., 2015), where higher scores ranging from 1 to 4 indicate increased feelings of self-efficacy.”
Linking the Perceived Stress Scale to the PROMIS Psychological Stress Experiences–Pediatric in adolescents.
Mansolf, M. A., Blackwell, C. K., Lai, J., & Cella, D. F. (2023) · Psychological Assessment · doi:10.1037/pas0001256 · Cited by 2 · see citing works
Self-citation
Neighborhood Disadvantage as a Moderator of Children’s Response to a Dyadic Positive Affect Intervention for Children of Mothers with Depressive Symptoms
Yerger, J., Cárdenas, E. F., Granros, M., et al. (2026) · Journal of Child and Adolescent Psychopharmacology · doi:10.1177/10445463261459344 · Cited by 1 · see citing works
Stress first aid for the harm reduction workforce: pilot test results of an occupational stress intervention
Desai, A., Rau, J., Samora, J., Mccormick, K., Rochani, H., Chang, P., Westphal, R. J., Watson, P. J., Benzer, J., Claborn, K., et al. (2026) · BMC Public Health · doi:10.1186/s12889-026-27343-y · Cited by 1 · see citing works
“…on well-being to include 1) social support (emotional and informational support, 2) burnout, 3) job-related affective well-being, 4) secondary traumatic stress, 5) coping strategies, 6) general self-efficacy to handle stressful situations, 7) work engagement, and 8) turnover intention [30–38].”
Digital phenotyping for assessment and prediction of interoception, chronic stress, and self-regulation in adults: a scoping review
Alvarez-Ambrosio, M., Chausa, P., Moreno-Blanco, D., Roca‐Ventura, A., García, I. O., Cattaneo, G., González, P. S., Sánchez, J. S., & Gómez, E. J. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1710891 · Cited by 3 · see citing works
Systematic Review and Meta-Analysis of Milk Fat Globule Membrane Supplementation for Mental Well-Being
Mawson, C., Carroll, A. M., Evas, S., Spies, S. J., & Fuad, M. (2026) · Nutrients · doi:10.3390/nu18020342 · Cited by 1 · see citing works
“Scores on the PSS range from 0 to 40, with higher scores reflecting greater perceived stress [19,20].”
Psychoemotional stress in the adult population of the Russian Federation perspective medical prevention directions
Ильинична, Г. Л., Balanova, Y. А., Shalnova, S. A., Ivlev, O. E., Kutsenko, V. A., Drozdova, L. Y., Ivanova, E. S., Васильевна, К. А., & Drapkina, O. M. (2025) · Russian Journal of Preventive Medicine · doi:10.17116/profmed20252812160 · Cited by 1 · see citing works
Bidirectional Longitudinal Associations Between Emotional Regulation, Perceived Stress, and Multiple Indices of Smartphone Use Among Young-Adult Women
Modica, C. A., & Bailey, K. (2025) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2025.2594151 · Cited by 1 · see citing works
“The 10-item PSS has evidenced both a two-factor structure (Franke F € oyen et al., 2024), and a one-factor structure (Kupst et al., 2015; Pretorius, 2023), and also invariance across gender (Lavoie & Douglas, 2012).”
Influential
The role of self-care in perceptions of satisfaction with life, organisational job satisfaction, and self-efficacy in zoo and aquarium professionals
Brando, S. I. C. A., Goulart, V. D. L. R., Buchanan‐Smith, H. M., Rey, S., & Caes, L. (2025) · Frontiers in Veterinary Science · doi:10.3389/fvets.2025.1677195 · Cited by 1 · see citing works
Evaluating the feasibility and acceptability of study procedures for a full factorial trial of ASCENT: protocol for a randomized pilot
Ingram, K. M., Glock, R., Williamson, L., Coffey, A., Anctil, R., Augustinovic, A., Yang, D., Victorson, D. E., Schoemann, A. M., Liles, D., et al. (2025) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01728-z · Cited by 2 · see citing works
Self-citation
Gestational PFAS concentrations in association with maternal depression and perceived stress during pregnancy and postpartum in the ECHO cohort
Mitro, S. D., Yang, W., Ferrara, A. M., Hedderson, M. M., Aung, M. T., Suthar, H., Raghunathan, R. S., Zhu, Y., Peterson, A. K., Reynolds, M., et al. (2025) · Environmental Research · doi:10.1016/j.envres.2025.122997 · Cited by 1 · see citing works
“We quantified perceived stress using the Perceived Stress Scale (PSS) t-score (Kupst et al., 2015/09).”
Patient‐Reported Outcomes Among an Observational Cohort of Individuals With Chronic Low Back Pain
Greco, C. M., Dodds, N. E., Acevedo, A. M., Anderst, W. J., Bell, K. M., Darwin, J., Delitto, A., Jakicic, J. M., McKernan, G., Patterson, C. G., et al. (2025) · JOR Spine · doi:10.1002/jsp2.70097 · Cited by 1 · see citing works
“0 Pain Interference 4a is a component of the PROMIS 29 + 2 profile [17–23] that assesses pain interference with life activities over the past 7 days using four questions rated 1 (Not at all) to 5 (Very much).”
Study design and protocol for cognitive anxiety sensitivity treatment for anxiety in adults with mild cognitive impairment or dementia
Markley, A. E., Stratton, K., Cho, G. Y., Schmidt, N. B., Suhr, J. A., Sheffler, J., Nguyen, C. C., Schubert, F. T., Quiles, J. R. G., Potter, M. R., et al. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108044 · Cited by 1 · see citing works
Structural Covariance of Early Visual Cortex Is Negatively Associated With Posttraumatic Stress Disorder Symptoms: A Mega-Analysis From the ENIGMA PTSD Working Group
Harnett, N. G., Joshi, S., Kumar, P., Russell, C. E., Dillon, D. G., Baker, J. T., Pizzagalli, D. A., Kaufman, M. L., Nickerson, L. D. H., Jahanshad, N., et al. (2025) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2025.07.005 · Cited by 1 · see citing works
Pelvic Floor and Psychosocial Symptoms in Female Collegiate Athletes: Exploring Nonrelaxing and Relaxing Pelvic Floor Dysfunction
Swake, T. T., & Young, D. K. (2025) · Journal of Women s & Pelvic Health Physical Therapy · doi:10.1097/jwh.0000000000000339 · Cited by 1 · see citing works
A Randomized, Placebo-Controlled, Double-Blind Trial to Assess the Effects of Apocynum venetum L. (A. venetum) Venetron® on Sleep and Stress in Those Expressing Feelings of Anxiety
White, K. P., Hewlings, S. J., Moseley, M., Moseley, M., D’Adamo, C. R., Colwell, C. S., Chen, J., & Pauli, E. K. (2025) · International Journal of Translational Medicine · doi:10.3390/ijtm5020023 · Cited by 1 · see citing works
Real-Time Assessment of Resilience in Individuals with Spinal Cord Injury and Chronic Pain: A Feasibility, Reliability, and Validity Study.
Kuzu, D., & Kratz, A. L. (2025) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2025.04.022 · Cited by 1 · see citing works
Longitudinal study of adolescent stress, critical consciousness and resilience trajectories in the context of structural racism: the RISE Baltimore study protocol
Clary, L. K., Mendelson, T., Webb, L., Jackson, D. B., Vázquez, M. G., Holifield, J., Musci, R. J., Johnson, R. M., Sanchez, D., Jans, M., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-094618 · Cited by 1 · see citing works
Pilot trial of a community-based transition support program for autistic adults
Brewe, A. M., & White, S. W. (2025) · Neurodiversity · doi:10.1177/27546330251319884 · Cited by 3 · see citing works
“The GSES has strong internal consistency and convergent validity (Kupst et al., 2015; Salsman et al., 2019).”

Authors: Kupst, M. J., Butt, Z., Stoney, C. M., Griffith, J. W., Salsman, J. M., Folkman, S., & Cella, D.
Affiliations: Medical College of Wisconsin (US)
Northwestern University (US)
National Institutes of Health (US)
Robert H. Lurie Comprehensive Cancer Center of Northwestern University (US)
University of California, San Francisco (US)
Corresponding author: Kupst, Mary Jo
ORCID: Butt, Zeeshan
Stoney, Catherine M.
Griffith, James W.
Salsman, John M.
Cella, David
Venue: Anxiety, Stress, & Coping
Publisher: Informa UK Limited
Published: 2015-02-10
Volume: 28
Issue: 5
Pages: 531-544
ISSN: 1061-5806 (ISSN-L)
1477-2205
DOI: 10.1080/10615806.2014.994204
PMC: PMC4515370
OpenAlex: W2001288118
Cited by: 133
References: 56
Citations by year: 2026: 20 · 2025: 36 · 2024: 14 · 2023: 16 · 2022: 14 · 2021: 10 · 2020: 8 · 2019: 6 · 2018: 5 · 2017: 2 · 2016: 1 · 2015: 1
FWCI: 3.75
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Anxiety Stress & Coping (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institutes of Health (HHS-N-260-2006-00007-C)
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Education › Health Education and Validation
Keywords: stress, self-efficacy, emotional well-being, Perceived Stress Scale, General Self-Efficacy Scale, instrument development, psychometric properties, factor analysis, coping strategies, emotion regulation
MeSH terms: Adaptation, Psychological, Adolescent, Adult, Affective Symptoms, Child, Child, Preschool, Cognition, Emotions, Factor Analysis, Statistical, Female, Humans, Male, National Institutes of Health (U.S.), Psychometrics, Psychomotor Performance, Surveys and Questionnaires, Stress, Psychological, United States, Self Efficacy, Young Adult

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Assessment of stress and self-efficacy for the NIH toolbox for neurological and behavioral function

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