Assessing the validity, reliability and efficacy of the Cross-Cultural Stress Scale (CCSS) for psychosomatic studies.

OBJECTIVE: The impact of stressful life events (SLEs) on health has been empirically studied with significant correlations documented. We developed a comprehensive stress rating toolkit, the Cross-Cultural Stress Scale (CCSS) from a triangulated qualitative research study. This article describes our pilot test of the scale to explore demographic-specific patterns of SLE scores and evaluate the scale's aptitude in assessing the stress-health correlation. METHODS: The face and content-validated CCSS was shared via a web-based survey to diverse individuals grouped by: (a) gender, (b) age, (c) race and ethnicity, (d) native, foreign-born or first-generation, (e) educational attainment, and (f) income. Participants from the Amazon crowdsourcing marketplace MTurk (N = 216) first indicated perceived stress intensities assuming experiences of all the SLEs in the CCSS. They then selected SLEs they had personally experienced in the last 12 months (N = 176). Multivariable analyses were conducted on perceived intensities. Correlations of experienced SLEs with self-reported health based on the Centers for Disease Control and Prevention (CDC) Health Related Quality of Life (HRQOL) indicators measured by the Behavioral Risk Factors Surveillance System (BRFSS) were analyzed. RESULTS: We validated the CCSS and obtained a high internal reliability (Cronbach's alpha >0.9). We found significant differences in stress rating by and within demographics. We also correlated stress to perceived health using the HRQOL and presence of a chronic disease ascertaining the stress-health hypothesis. LIMITATION: Sampling limitations observed include data drawn from a convenience sample. CONCLUSION: Despite sampling limitations, our research highlights demographic-specific stressors and offers an updated methodology in the stress-health correlation.

Stressful life events and social capital during the early phase of COVID-19 in the U.S.

BACKGROUND: A novel coronavirus disease (COVID-19) was reported in Wuhan, China late December 2019. The disease has as of the end of March 2020, affected over 35 countries (with over 570,000 cases and 26,000 deaths) worldwide. This includes the U.S., where cases are increasing by the thousands every day (100,000 cases with 1500 deaths as of April 2020). We set out to investigate new or increased stressful life events (SLEs) as a result of this pandemic in the U.S. METHODS: In this exploratory qualitative study, we examined new or heightened SLEs during an active phase of this outbreak. We used a list of SLEs acquired from the first phase of our study, whereby we conducted open-ended surveys and performed an in-depth focus group. We applied Lazarus and Folkman's transactional model of stress and coping to understand diverse focus-group participants' appraisal of events. We coded survey data and applied sentiment analysis. RESULTS: Participants varied in perceived threat and challenge appraisals of COVID-19, indicating both calm and fear. From 267 coded and sentiment analyzed events from survey text, 95% were predominantly negative; 112 (42%) very negative and 142 (53%) moderately negative. Social capital was unanimously emphasized upon as monumental for example: family, friends or technology mediated. We additionally identified seven major themes of SLEs due to the pandemic. LIMITATIONS: Our sample profile is not inclusive of all subsets of the population. CONCLUSIONS: Participants mostly shared similar frustrations and a variety of SLEs such as fear of the unknown and concern for loved ones as a result of COVID-19.