Development of the perceived stress scale for people living with HIV/AIDS in China

Stress among people living with HIV/AIDS (PLWHA) is associated with psychological morbidity. There are only a few stress scales specially developed for PLWHA and none of them is in Chinese. This study develops and validates a new Chinese Perceived Stress Scale among PLWHA (PSSHIV) in Shenzhen of Guangdong Province and Hengyang of Hunan Province in China during September 2006 through July 2007. In-depth interviews were administered to 58 PLWHA (33 males, mean age, 32) to generate the items, while 215 other PLWHA were interviewed in another survey to validate the instrument (136 males, mean age, 33). Exploratory factor analysis yielded 8 factors (percent variance explained, 71.47%), namely: social/psychological problems, sexual relationship, functional problems, social acceptance/rejection issues, work-related issues, family/offspring issues, accessibility to treatment, and treatment outcomes. The Cronbach alpha values ranged from 0.76 to 0.94 for the overall scale and the 8 subscales. The scores of the overall scale, the social/psychological problems, and functional problems subscales of the PSSHIV were significantly correlated with the Perceived Stress Scale (PSS), Depression, Anxiety and Stress Scale (DASS), and all domains of the Medical Outcomes Study HIV Health Survey (MOS-HIV) (correlation coefficient = 0.50 to 0.71 for positive correlations, and -0.73 to -0.21 for negative correlations, p < 0.05). The other 6 subscales of the PSSHIV were significantly correlated with the PSS, subscales of the DASS, and MOS-HIV (correlation coefficient = 0.16 to 0.39 for positive correlation, -0.58 to -0.15 for negative correlation, p < 0.05). This new instrument collected information from the PLWHA from qualitative interviews and the items are specific to the HIV/AIDS context. PSSHIV can be used for assessing the level of stress faced by PLWHA in China.