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Article

Validation of Perceived Stress Scale-10 Among Greek Middle Adolescents: Associations Between Stressful Life Events and Perceived Stress

by
Ntina Kourmousi
1,2,*,
Kalliopi Kounenou
1,2,
Christos Pezirkianidis
3,
Antonios Kalamatianos
4 and
George P. Chrousos
5,6
1
Department of Education, School of Pedagogical & Technological Education, 151 22 Marousi, Greece
2
Laboratory of Psychological Interventions in Education, School of Pedagogical & Technological Education, 151 22 Marousi, Greece
3
Laboratory of Positive Psychology, Department of Psychology, Panteion University of Social & Political Sciences, 176 71 Athens, Greece
4
Department of Education, School of Education, University of Nicosia, Nicosia 2417, Cyprus
5
First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 115 27 Athens, Greece
6
University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
*
Author to whom correspondence should be addressed.
Soc. Sci. 2025, 14(6), 344; https://doi.org/10.3390/socsci14060344
Submission received: 12 March 2025 / Revised: 15 May 2025 / Accepted: 22 May 2025 / Published: 28 May 2025
(This article belongs to the Section Childhood and Youth Studies)
Versions Notes

Abstract

:
Stress significantly impacts adolescents’ health. Therefore, its measurement is of critical importance. This study aims to assess the psychometric properties of a Greek adolescent version of PSS-10 among middle adolescents. This study’s questionnaire, which was completed by 169 adolescents aged 15–18, included a Greek linguistic, cultural, and age-appropriate version of the PSS-10 and the validated Greek ASQ version. Confirmatory factor and exploratory factor analyses were conducted. Convergent validity was tested through Pearson’s r intercorrelations among PSS-10 scales and ASQ and PSS-10 scales. Discriminant construct validity was determined by the association between PSS-10 scales and gender, grade, diploma grade, and following daily routines using Student’s t-tests or analysis of variance (ANOVA). Confirmatory factor analysis was not satisfactory. Exploratory factor analysis revealed two factors: perceived coping and perceived control, which explained 25.8% and 23.8% of the variance, respectively. Internal consistency reliability was satisfactory (Cronbach’s alpha > 0.70). Positive and significant correlations were found between ASQ and PSS-10 scores, indicating satisfactory convergent validity. Concerning discriminant validity, students who followed daily routines appeared to have less perceived stress. The Greek version of the 10-item Perceived Stress Scale (PSS-10) for adolescents is a valid instrument and can be used by professionals to rapidly screen perceived stress in adolescent populations.

1. Introduction

1.1. Stress During Adolescence

Stress has been defined as a “state of imbalance within a person, elicited by an actual or perceived disparity between environmental demands and the person’s capacity to cope with these demands” (Maes et al. 1987, p. 567). It arises when homeostasis is either actually or perceived to be threatened and could be termed distress (Chrousos 2009).
As far as adolescence is concerned, since 1904, when Stanley Hall (1904) first characterized it as a period of stress, strain, storm, and strife, this stage of life has been recognized as highly stressful due to the intense psychological and physical changes that take place. These changes include the maturation of the brain and body, increased significance of social and peer interactions, a drive for independence, and emotional intensity (Casey et al. 2010).
Adolescents experience stress when they perceive a situation as difficult, painful, or threatening and feel like they are unable to cope with it. Stress has a significant impact on their health, shaping stress reactivity (Romeo 2010) and contributing to stress-related psychological dysfunctions, such as anxiety, depression, and substance abuse, which are commonly observed during this developmental stage (Eiland and Romeo 2013). Both acute and chronic stress can contribute to decreased levels of wellbeing and the onset or worsening of psychological and physical conditions, including anxiety disorders, depression, obesity, and cardiometabolic syndrome (Pervanidou and Chrousos 2012). The same connections have been found between academic stress and health issues among adolescents; it negatively affects learning capacity and academic performance but is also linked to increased depression symptoms, greater anxiety, sleep disturbances, physical health problems later in life, and substance use (Pascoe et al. 2020).

1.2. Perceived Stress and Stressful Life Events During Adolescence

Perceived stress refers to an individual’s subjective feelings or thoughts about the amount of stress they experience and their ability to manage it at a given time. It encompasses confidence in one’s ability to handle difficulties, feelings of uncontrollability and unpredictability, the severity and frequency of life changes, and daily hassles (Phillips 2015).
Exposure to stressful life events during adolescence is generally associated with greater levels of perceived stress, which can have both short- and long-term effects on wellbeing (Compas et al. 2017). Major stressors, such as academic pressure, family conflict, peer rejection, and socioeconomic adversity, contribute to increased stress perception among adolescents, often leading to emotional distress and maladaptive coping strategies (Grant et al. 2006). Additionally, the cumulative impact of multiple stressors exacerbates perceived stress, increasing the risk of anxiety, depression symptoms, and insomnia severity (Reis et al. 2020).
The relation between stressful events and perceived stress is also influenced by individual differences in cognitive appraisal and coping mechanisms. Adolescents who interpret stressors as overwhelming or unmanageable tend to report higher levels of perceived stress than those who perceive challenges as controllable (Lazarus and Folkman 1984). Negative cognitive styles, a stress-is-debilitating perception, and rumination can amplify the perception of stress, while adaptive coping strategies, such as problem-solving, emotional regulation, and a stress-is-enhancing mindset, can mitigate its effects (Hampel and Petermann 2006; Karampas et al. 2022, 2023). Moreover, social support from peers, parents, and teachers is a crucial buffer against perceived stress, helping adolescents manage difficult experiences more effectively (Thoits 2011).
Chronic exposure to stressors during adolescence has been linked to long-term consequences for mental and physical health. Persistently high levels of perceived stress have been associated with dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, leading to an increased risk of developing stress-related disorders, such as depression and anxiety in adulthood (McEwen 2017). In line with this, a prospective cohort study of 11,929 Danish adolescents found that those with high levels of perceived stress were more likely to develop a mental disorder later in life (Lindholdt et al. 2022). Furthermore, research suggests that prolonged stress exposure during adolescence can negatively impact cognitive functioning, emotional regulation, and academic performance (Evans et al. 2013). Given these findings, interventions aimed at reducing adolescent-perceived stress, promoting resilience, and enhancing coping skills are essential for supporting long-term wellbeing and preventing adverse health outcomes (Compas et al. 2017; Karampas et al. 2022, 2023).

1.3. Measuring Stress and Perceived Stress in Adolescence

Given these risks, measuring stress and perceived stress in adolescents is critically important. In addition to the biological or physiological approach in a stress assessment, which uses neuroendocrine biomarkers that assess stress hormones, such as glucocorticoids and catecholamines, and immunological biomarkers like inflammatory cytokines and CRP (Kokka et al. 2023), the environmental approach uses various tools to measure stressful events and stressors, and the psychological approach uses psychometric instruments to assess perceived stress (Andreou et al. 2011).
As far as the environmental approach is concerned, such tools that can be used in adolescent populations include the following:
The Adolescent Perceived Events Scale (APES; Compas et al. 1987), which investigates positive or negative stressful events that respondents have possibly experienced within the past 6 months. To date, the APES has been validated for use only in English and Spanish adolescent populations (Kopp et al. 2010).
The Adolescent Stress Questionnaire (ASQ; Byrne et al. 2007), which is a 58-item scale that measures stress in 10 domains/stress-inducing situations. The ASQ has been translated and validated in several languages (i.e., Spanish, Dutch, Turkish, Norwegian, Hungarian, etc.; Kopp et al. 2010), with Greek being one of them (Darviri et al. 2014).
The recently developed Perceived Stressors Global Scale for Adolescents (PSGS-A) (Barcelata-Eguiarte et al. 2020), which investigates six factors of stressful event types: critical events, daily hassles, social exhibition, family concerns, academic stressors, and social pressure. The PSGS-A has been validated only in a Mexican adolescent population for the moment.
Concerning the psychological approach, it includes self-report measures, with tools such as:
The Stress Appraisal Measure for Adolescents (SAMA), which is a 14-item questionnaire designed for youth of 14–18 years of age and measures primary (threat) and secondary (challenge) cognitive appraisals of stress using a 5-point Likert scale (Rowley et al. 2005).
The Impact of Event Scale for adolescents (IES; Horowitz et al. 1979), which is a self-report measure of current subjective distress, mostly administered to assess post-traumatic stress disorder (PTSD) symptoms.
The Perceived Stress Scale (PSS; Cohen et al. 1983) in three versions, namely the PSS- 14, the PSS-10, and the PSS-4, —that was designed to measure the degree to which individuals—adults and adolescents—appraise situations in the past 4 weeks of their lives as stressful. The instrument is widely considered the gold standard measure for assessing stress perception and is used to measure the degree to which a respondent finds life circumstances unpredictable, uncontrollable, and/or overwhelming (Harris et al. 2023). In fact, in 2015, the PSS was included in the National Institutes of Health’s Toolbox for the Assessment of Neurological and Behavioral Function (NIH Toolbox) because of its extensive supporting evidence, solid psychometric strengths, concise format, and relevance for use across various populations and age groups (Kupst et al. 2015). According to Cohen’s Laboratory for the Study of Stress, Immunity, and Disease, the PSS can be used in community samples with at least junior high school education. The PSS has been translated in 25 languages other than English, with Greek being one of them, but only for use in adults (Andreou et al. 2011; Katsarou et al. 2012).
Of course, the tools of the latter approach—being self-report tools—also carry the risk of self-report biases. Moreover, it has been shown that agreement between measures of psychological and physiological stress is low (Whitney 2021), and measures of perceived stress provide only partial knowledge about the responsiveness of the stress system, namely the autonomic system and the HPA-axis response (Oldehinkel et al. 2011). However, the use of perceived stress measures in children and adolescents, specifically the use of the PSS, has been proven to identify and highlight psychological and social factors that are associated with stress (Kornienko et al. 2024).
To date and to our knowledge, only the Adolescent Stress Questionnaire of 58 items, a tool from the environmental stress assessment approach, has been translated and validated for use in the Greek adolescent population. This fact highlights the need for more valid stress assessment tools, including those from the psychological approach, to be available for use in this country’s adolescents, capturing different aspects of stress-related concepts. The gap also underscores the necessity for more rapid, user-friendly, stress-assessing instruments for use in Greek adolescents.

1.4. The Purpose of the Present Study

This study aims to assess the psychometric properties of a linguistic and cultural adaptation of the PSS-10 (Cohen 1988) as a concise stress assessment measure from the psychological approach for use in Greek middle adolescents aged 15 to 18 years. The tool was chosen over other stress measurement instruments, on the one hand, because there is no other tool from the psychological approach available for use in adolescents in Greece and, on the other hand, because it is a short and user-friendly tool recognized worldwide. The ASQ was added to the study questionnaire to investigate the associations among stressful events during adolescence and perceived stress. Complementary methods of stress assessments, such as biological measures or behavioral observations, could not be considered due to the lack of funding and the study design. We hypothesized that the Greek version of the PSS-10 for adolescents would have sound psychometric properties and that correlation between the instrument’s dimensions and the ASQ dimensions would be identified. The study findings will enhance the Greek research efforts to understand, prevent, and decrease perceived stress among adolescents.

2. Materials and Methods

2.1. Study Design, Setting, and Participants

The empirical psychometric validation—both descriptive and exploratory—study was conducted from April to May 2023 and was organized by the School of Pedagogical and Technological Education (ASPETE), a Greek university specializing in training secondary school teachers, in collaboration with the University of West Attica and the UNESCO Chair on Adolescent Health Care. The study was approved by the ethics and conduct committee of ASPETE (Protocol no: 23-4/4/23).
The initial study sample comprised 170 secondary school students from various regions of Greece. To be eligible for participation, students had to be enrolled in a Greek lyceum (upper secondary school for students aged 15–18) in either the first, second, or third year and possess the ability to read, write, and understand Greek. Students who did not attend a Greek lyceum were excluded from the study.
Participants were recruited through an open invitation issued by the study organizers to parents of upper secondary students in Greece via parents’ associations and the Hellenic Federation of the Teachers of Tutoring Centers (OΕΦΕ). The online invitation outlined the study’s objectives and described the measures taken to ensure participant anonymity. Parents who consented to their child’s voluntary participation were provided with a link to the study questionnaire. Their children would be able to complete the questionnaire at home and download stress management instructions and techniques for teenagers upon completion. On the opening page, the students were informed about the organizers and the scope of the study, and the completion of the questionnaire would take approximately 15 min.

2.2. Measures

The study questionnaire, besides questions regarding demographic data (sex, age, region, etc.), school data (grade, general or vocational lyceum, general or special education, etc.), socioeconomic data (perceived family’s socioeconomic status, parents’ level of studies, parents’ profession, etc.), and data concerning daily habits (following routines, having breakfast, type of diet, etc.), included the 10-item Perceived Stress Scale (PSS-10), as well as the Adolescent Stress Questionnaire, the Greek version of which had already been determined to have sound psychometric abilities (Darviri et al. 2014).
The 10-item version of the Perceived Stress Scale (PSS-10) (Cohen 1988) is a self-report tool originally developed in a 14-item form (Cohen et al. 1983) and is designed to measure the degree to which situations of the latest month in one’s life are appraised as stressful. It consists of 10 items rated on a 5-point Likert-type scale, with answers ranging from 0 = never to 4 = very often. Higher scores indicate greater levels of stress. The two-factor structure of the PSS-10 shows one factor that is formed by the negative wording of items (non-reverse-worded scoring) and a second one that is formed by the positive wording of items (reverse-worded scoring) (Perera et al. 2017). Although it has been translated into 28 different languages and used mostly in adult populations within both general and clinical settings (Townsend and Medvedev 2022), during the last decade, the PSS-10 was also validated for use in adolescents in Russian (Marakshina et al. 2024), Chinese (Chen et al. 2024), and Danish (Lindholdt et al. 2022) populations. Additionally, it has been used to investigate perceived stress in relation to suicidal behaviors in early adolescents (Chen and Kuo 2020), future mental disorders (Lindholdt et al. 2022), gaming addiction among Saudi adolescents (Rajab et al. 2020), girls with polycystic ovary syndrome (Khafagy et al. 2020), etc.
The Adolescent Stress Questionnaire (ASQ) consists of 58 items that evaluate the following 10 domains which depict stress-inducing situations: (i) family living conditions, (ii) academic performance, (iii) school attendance, (iv) romantic relationships, (v) peer pressure, (vi) teacher interaction, (vii) uncertainty regarding the future, (viii) conflict within the school/leisure environment, (ix) financial pressure, and (x) emerging adult responsibility. The tool is rated on a 5-point Likert-type scale, with answers ranging from 1 = not at all stressful to 5 = very stressful. Higher scores indicate greater levels of stress in each life domain (Byrne et al. 2007).

2.3. Linguistic Validation

Before the present validation study, PSS-10 had already been translated and validated in Greek, as previously mentioned, but only for use in adults (Andreou et al. 2011; Katsarou et al. 2012). We obtained permission from Mapi Research Trust to adapt PSS-10 into a more adolescent-friendly version in Greek, as opposed to the one with the more formal (use of plural of nobility) and sophisticated language that already existed for use with adults (Andreou et al. 2011; Katsarou et al. 2012), to ensure clarity and accessibility, even for students who are not highly proficient in the language.
For the translation process, taking into consideration how language and cultural contexts may affect adolescents’ interpretation of the items, we followed the cross-cultural translation guidelines recommended by the International Quality of Life Assessment Project (Bullinger et al. 1998). The forward translation was independently carried out by bilingual translators, and minor discrepancies were resolved by the research team. The translated version was then backtranslated by additional bilingual translators. Finally, the tool was administered to 10 Greek adolescents, who were asked to identify any difficulties related to the comprehension, layout, and style of the e-tool, as well as to provide feedback and suggestions on wording (Kyriazos 2017).

2.4. Statistical Analysis

Quantitative variables were expressed as mean values (SD), while qualitative variables were expressed as absolute and relative frequencies.
A confirmatory factor analysis (CFA) with the maximum likelihood procedure was conducted to test how well the two-factor PSS-10 original structure fits the data. The variance of the latent constructs was fixed at one during parameter estimation, and the factors were allowed to be correlated. The fit of the CFA model was assessed using the chi square (χ2) method, the comparative fit index (CFI), the goodness of fit index (GFI), SRMR (Standardized Root Mean Squared Error), and the root mean square error of approximation (RMSEA) (Mueller 2000). There are several guidelines for interpreting the fit of a model based on these indicators (Bentler 1992; Greenspoon and Saklofske 1998; Hu and Bentler 1999). For the CFI and GFI indices, values close to or greater than 0.95 are taken to reflect a good fit to the data. RMSEA values of less than 0.05 indicate a good fit, and values as high as 0.08 indicate a reasonable fit. SRMR values of less than 0.08 indicate a good fit.
Since the original structure was not satisfactory, exploratory factor analysis (EFA) was carried out to evaluate construct validity, disclose underlying structures, and reduce the number of variables. Principal component analysis (PCA) was chosen as the extraction method using Varimax rotation. The Kaiser–Meyer–Olkin procedure for measuring sample adequacy was applied. The cut-off point for factor loadings was 0.40, and for Eigenvalues, it was 1.00. Internal consistency reliability was determined through the calculation of Cronbach’s alpha coefficient. Scales with reliabilities equal to or greater than 0.70 were considered acceptable. Convergent validity was tested through intercorrelations (via Pearson’s r) among the scales belonging to the PSS-10 as well as through the correlations (via Pearson’s r) between ASQ and PSS-10 scales. Discriminant construct validity was evaluated by analyzing the association between the PSS-10 scales and gender, grade, diploma grade, and systematically following a program in everyday life using Student’s t-tests or analysis of variance (ANOVA).
All reported p-values are two-tailed. Statistical significance was set at p < 0.05, and analyses were conducted using the SPSS statistical software (version 26.0) and STATA (version 15).

3. Results

3.1. Demographic Characteristics of the Sample

Data from 169 Greek students (73.4% females) coming from all regions of Greece were analyzed, with the mean age being 17.1 years (SD = 0.8 years). Their characteristics are presented in Table 1. Most participants were in third grade (59.8%), attended a general high school (94.6%), had siblings (87%), were living with both parents (87%), had a middle perceived family’s socio-economic level (78.7%), and were systematically following a daily program in everyday life (88.2%). The educational level of the majority of sample parents was the lyceum level, for both the father and the mother. Almost all students (97.6%) had Greek nationality.

3.2. PSS-10 Items

The analytical description of the PSS-10 items is provided in Table 2.

3.3. Exploratory Factor Analysis

Confirmatory factor analysis was conducted in order to examine the two-factor original structure of PSS-10, which was found to be not satisfactory [χ2 (34) = 121.96, p < 0.001, CFI = 0.78, TLI = 0.70, SRMR = 0.09, and RMSEA = 0.12]. Thus, an exploratory factor analysis was conducted, since the KMO value was 0.80 and Bartlett’s criterion was significant, p < 0.001, indicating the adequacy of the data for performing such an analysis. The results of the exploratory factor analysis are presented in Table 3. Two factors with eigenvalues over one emerged, explaining 49.6% of the variance. In contrast with the original structure, not all positive-worded items loaded in one factor, while not all negative-worded items were loaded in the other factor. The current structure points out two factors, one that has to do with feeling stressed and being unable to cope (items 1, 3, 4, 5, and 10), explaining 25.8% of the variance, and the other that has to do with feeling a lack of control (items 2, 6, 7, 8, and 9), explaining 23.8% of the variance. All items had a loading over 0.40; thus, all items were retained in the analysis. For the first factor, “Perceived coping”, the reliability index was 0.73, and for the factor “Perceived control”, the reliability index was 0.71, indicating acceptable reliability for both.

3.4. Internal Consistency and Intercorrelations

Item-total correlation coefficients and reliability indexes if an item is deleted are provided in Table 4. All item-total correlation coefficients were at least 0.30, and having any of the items deleted would not increase the reliability index of each factor.
The scores of the PSS-10 factors as well as the total score are described in Table 5.
The score in “Perceived coping” could range from 0 to 20, with the mean being 7.04 (SD = 5.17), and the score in “Perceived control” could range from 0 to 17, with the mean being 5.59 (SD = 4.21). The mean total PSS-10 score was 12.63 (SD = 8.08). Positive and significant correlations were found among the PSS-10 scores.

3.5. Convergent Validity

Moreover, positive and significant correlations were found between ASQ and PSS-10 scores (Table 6), indicating satisfactory convergent validity.

3.6. Discriminant Validity

PSS-10 scores did not differ significantly between boys and girls (Table 7). Also, PSS-10 scores were not significantly associated with the grade students attended or their diploma grade. On the contrary, it was found that students systematically following a program (routines) in everyday life had significantly lower scores in all PSS-10 scales, indicating significantly lower stress.

4. Discussion

This is the first validation study of PSS-10 in a Greek population of middle adolescent students. The findings indicate that the validated Greek version of the PSS-10 (adolescent form) can be used as a rapid sound measure in future studies in Greek adolescent populations. However, this study’s confirmatory factor analysis (CFA) did not find the original two-factor structure of the scale satisfactory, so exploratory factor analysis (EFA) was used. Other researchers have also used exploratory factor analysis and revealed a two-factor structure for the PSS-10 (e.g., Chen et al. 2021). The original scale’s two factors which are interpreted by researchers as “Perceived Helplessness or Distress” (negatively phrased items) and “Perceived Self-Efficacy or Coping” (positively phrased items) have been revealed in previous validation studies in adolescents (e.g., Chen et al. 2024; Liu et al. 2020; Marakshina et al. 2024). Still, the scale’s dimensionality remains a topic of ongoing debate in the literature (Pretorius 2023); Cohen and Williamson suggested the unidimensionality of the PSS-10 as a measure of perceived stress comprising dimensions of positive and negative items (1988), while other researchers reported a two-factor structure (e.g., Ruisoto et al. 2020), a three-factor structure (e.g., Bradbury 2013), and a bifactor structure consisting of a total scale and two subscales (e.g., Denovan et al. 2019). Regarding the factor structure analysis used for PSS-10, most studies have relied on the perspective of classical test theory (CTT), specifically exploratory factor analysis and confirmatory factor analysis (Pretorius 2023). Our study’s exploratory factor analysis results showed that the structure of the Greek adolescent version of the scale comprises two factors, one concerning the perception of coping and the other concerning the perception of control. An inability to cope and a loss of control are often the sources of stress and vulnerability of adolescents, as AAP states (American Academy of Pediatrics 2025), and the relationship between coping and psychological wellbeing has been shown to be mediated by the extent of perceived sense of control; strategies reflecting more engaged coping have been associated with more sense of control (Dijkstra and Homan 2016). Additionally, concerning Greece, coping strategies and locus of control have been shown to affect adaptation in the face of difficulties in Greek students (Leontopoulou 2006). From this perspective, Greek adolescents may perceive stress not as perceived helplessness and perceived efficacy, but as perceived lack of coping and perceived lack of control. Indeed, cultural differences have been found to affect PSS scoring in studies investigating perceived stress in various populations (e.g., Gamonal-Limcaoco et al. 2022; Vallejo et al. 2018).
This study’s results support the adequate internal consistency of the Greek version of PSS-10 in assessing perceived stress of adolescents, as found by researchers in other countries (e.g., Liu et al. 2020; Marakshina et al. 2024). Additionally, the significant correlations found between ASQ and PSS-10 scores show the tool’s acceptable convergent validity for stress-inducing situations, a finding also similar to that of other researchers who have tested it for stressful life events (e.g., Liu et al. 2020). According to our convergent validity analysis, the sample students felt more stressed due to their romantic relationships, financial issues, home life, and peer relationships regarding their perception of coping and due to peer pressure and teacher interactions regarding their perception of control.
Concerning the scale’s discriminant validity, this study’s results showed no significant differences in perceived stress between boys and girls, as also reported by Varsha and Jain (2023) regarding adolescents in India. Nevertheless, girls were found to have higher levels of perceived stress by Hampel and Petermann (2006) in Austria, Thorsén et al. (2022) in Sweden and Bulgaria, and Kaczmarek and Trambacz-Oleszak (2021) in Poland, while Thaker and Verma (2014) in India found that boys have higher perceived stress. Our finding, however, could be impacted by the fact that the majority of our sample, namely 73.4%, consisted of females. Our study’s results showed no significant difference regarding the grade students attended or their diploma grade, as well. Nevertheless, the study identified the importance of routines as a buffering effect, showing that students who stick to a consistent time schedule for their daily program appear to have a reduced perception of stress. This finding corroborates those of other researchers that have shown the positive effect of routines in adolescents, such as those regarding sleep (Buxton et al. 2015), mental health (Koome et al. 2012), academic success (Roche and Ghazarian 2012), and development in young adulthood (Barton et al. 2019). The predictability of a routine seems to help soothe adolescents’ mind, offering a sense of security and stability during times of crises, as shown in studies conducted during the COVID-19 pandemic (e.g., Ren et al. 2021). There is also a biological explanation for this phenomenon, as daily activity, the timing of meals, and sleep onset and ending are strongly coupled to the circadian biological clock, with uncoupling being a major stressor on its own (Agorastos et al. 2020; Nader et al. 2010; Nicolaides et al. 2017).
Moreover, the findings of this study indicate that Greek adolescents who face stressful life events experience high levels of perceived stress. Stressful events regarding home life, romantic relationships, and teacher interaction seem to be among the most stressful events for Greek adolescents, leading to a greater sense of helplessness and a lack of self-esteem against these stressors. Previous studies agree that adolescents’ perceived stress is significantly influenced by their family environment and financial conditions. Supportive family relationships are associated with lower stress levels, whereas family conflicts, economic hardships, and a lack of parental support can exacerbate stress (Conger et al. 2010). Adolescents from economically disadvantaged backgrounds often experience heightened stress due to concerns about family financial stability and their future financial independence (Mistry et al. 2009). Research also highlights that uncertainty regarding future career prospects, education, and societal expectations contributes to stress, with many adolescents expressing anxiety over their ability to meet future responsibilities (Arnett et al. 2014). These stressors can lead to adverse psychological outcomes, including anxiety and depressive symptoms, particularly among those with fewer coping resources (Hampel and Petermann 2006).
Also, in line with the findings of this study, academic performance and school-related factors are among the most prominent stressors for adolescents. The pressure to excel in school, high parental and teacher expectations, and a fear of failure significantly contribute to stress levels (Koumoundourou et al. 2011; Kounenou 2011; Pezirkianidis et al. 2013; Putwain and Pescod 2018).
Finally, social and interpersonal relationships also provide several stressors and significantly impact adolescents’ perceived stress. Peer pressure to conform to social norms, engage in risky behaviors, or maintain a certain social image can lead to psychological distress (Santor et al. 2000). Romantic relationships, while a source of emotional support, can also introduce stress due to conflicts, breakups, and a fear of rejection (Zimmer-Gembeck et al. 2001).

5. Study Limitations and Recommendations for Future Studies

This study had several limitations. Generalization about the total adolescent population is not guaranteed due to the relatively small sample and the significant majority of female students. Nevertheless, since the invitation for participation in this study was sent to parents of adolescents all over Greece via parents’ associations and the Hellenic Federation of the Teachers of Tutoring Centers (OΕΦΕ), the sample comprised students of all Greek regions, with the majority coming from the regions of Attica and Central Macedonia, where the capital and co-capital of the country are located. In fact, the Greek Statistical Authority (www.statistics.gr, https://www.statistics.gr/documents/20181/8fa5c436-3169-54c0-3ad1-1474a9caef0e (accessed on 20 January 2025).) finds that Attica hosts 37.7% of Greece’s Lyceum students, a percentage close to the one depicted in our study. Moreover, our study included students from all socioeconomic backgrounds. However, the fact that the students could complete the study questionnaire at home and at their own time could constitute another limitation of this study. Another limitation is that test–retest reliability was not assessed in this study. Moreover, only self-reported, negative valence measures were used. However, the Greek version of PSS-10 showed satisfactory validity and reliability, and its use in research and health care practice is recommended. Future studies need to broaden the validation of PSS-10 among early adolescents as well using larger and more heterogeneous samples and prospective research designs. Finally, there is a need to use qualitative data on the experiences and narratives of perceived stress among adolescents and test associations among perceived stress and neuroendocrine biomarkers that assess stress hormones.

6. Conclusions

The findings of this study indicate that PSS-10 is a valuable psychometric tool for health professionals to assess perceived stress in adolescents. Furthermore, this study highlights the complex relations between stressful life events and adolescent stress levels, emphasizing the need for effective coping strategies and strong social support networks. Providing adolescents with access to counseling services and implementing ecological, school-based interventions can help mitigate the negative impact of stressors on their mental health (Feiss et al. 2019).

Author Contributions

Conceptualization, N.K., K.K. and G.P.C.; Methodology, N.K., K.K. and G.P.C.; Validation, C.P. and A.K.; Formal analysis, C.P. and A.K.; Investigation, N.K. and K.K.; Resources, A.K.; Data curation, C.P.; Writing—original draft, N.K. and C.P.; Writing—review & editing, K.K., A.K. and G.P.C.; Supervision, N.K. and G.P.C.; Project administration, G.P.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of the School of Pedagogical and Technological Education (ASPETE) for studies involving humans (Protocol no: 23 and date of approval 4 April 2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

The authors NK and KK acknowledge financial support for the dissemination of this work from the Special Account for Research of ASPETE through the funding program "Strengthening ASPETE’s research”. Also, all the authors would like to thank the Hellenic Federation of the Teachers of Tutoring Centers (OEFE) http://www.oefe.gr (accessed on 14 May 2025), for their significant help in the implementation of the study. It was OEFE that sent the study invitation to students’ parents in all Greek regions.

Conflicts of Interest

The authors declare no conflict of interest.

Abbreviations

The following abbreviations are used in this manuscript:
PSSPerceived Stress Scale
ASQAdolescent Stress Questionnaire
ANOVAAnalysis of Variance
EFAExploratory Factor Analysis
CFAConfirmatory Factor Analysis
CFIComparative Fit Index
GFIGoodness of Fit Index
SRMRStandardized Root Mean Squared Error
RMSEARoot Mean Square Error of Approximation
PCAPrincipal Component Analysis

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Table 1. Sample Characteristics.
Table 1. Sample Characteristics.
n = 169n (%)
Sex
Girls124 (73.4)
Boys45 (26.6)
Grade
1st17 (10.1)
2nd51 (30.2)
3rd101 (59.8)
Type of Lyceum
General157 (94.6)
Vocational7 (4.2)
Experimental1 (0.6)
Pilot1 (0.6)
Diploma grade 1
<17.654 (32.1)
17.6–18.758 (34.5)
>18.756 (33.3)
Learning Difficulty16 (9.5)
Siblings147 (87)
Living with both parents143 (85.6)
Perceived family’s socio-economic status
Low11 (6.5)
Middle133 (78.7)
High25 (14.8)
systematically following a daily program in everyday life149 (88.2)
Sport involvement for at least 2 h a week67 (39.6)
Other activity or hobby83 (49.1)
Greek Nationality165 (97.6)
Region of Greece
Eastern Macedonia and Thrace8 (4.7)
Attica35 (20.7)
North Aegean1 (0.6)
Western Greece10 (5.9)
Western Macedonia5 (3)
Epirus1 (0.6)
Thessaly15 (8.9)
Central Macedonia55 (32.5)
Crete10 (5.9)
South Aegean2 (1.2)
Peloponnese21 (12.4)
Central Greece6 (3.6)
Paternal educational level
Elementary school8 (4.7)
High School (Middle School)25 (14.8)
Lyceum (Upper High School)67 (39.6)
Technical Institute24 (14.2)
University24 (14.2)
Master’s Degree19 (11.2)
PhD2 (1.2)
Maternal educational level
Elementary school8 (4.7)
High School (Middle School)9 (5.3)
Lyceum (Upper High School)51 (30.2)
Technical Institute46 (27.2)
University40 (23.7)
Master’s Degree15 (8.9)
PhD0 (0)
Mean (SD)
Age (years)17.1 (0.8)
Diploma grade18 (1.4)
Home life35.4 (9.4)
School performance23.2 (5.3)
School attendance8.1 (2.9)
Romantic relationships13.7 (4.2)
Peer pressure20.3 (5.9)
Teacher interaction16 (5)
Future uncertainty11.5 (2.8)
School/leisure conflict15.7 (4.6)
Financial pressure11.6 (4)
Emerging adult responsibility8.4 (2.9)
Total ASQ score163.9 (35.6)
1 divided into three categories based on tertiles.
Table 2. PSS-10 items.
Table 2. PSS-10 items.
NeverRarelySometimesOftenVery OftenMean (SD) 1
Itemn (%)n (%)n (%)n (%)n (%)
191 (53.8)31 (18.3)13 (7.7)20 (11.8)14 (8.3)1.02 (1.36)
2102 (60.4)26 (15.4)19 (11.2)13 (7.7)9 (5.3)0.82 (1.22)
364 (37.9)39 (23.1)20 (11.8)27 (16)19 (11.2)1.4 (1.42)
431 (18.3)13 (7.7)22 (13)18 (10.7)85 (50.3)2.67 (1.58)
539 (23.1)30 (17.8)37 (21.9)29 (17.2)34 (20.1)1.93 (1.44)
6103 (60.9)28 (16.6)16 (9.5)12 (7.1)10 (5.9)0.8 (1.22)
712 (7.1)16 (9.5)25 (14.8)26 (15.4)90 (53.3)2.98 (1.31)
89 (5.3)16 (9.5)41 (24.3)51 (30.2)52 (30.8)2.72 (1.16)
953 (31.4)29 (17.2)38 (22.5)21 (12.4)28 (16.6)1.66 (1.45)
1098 (58)11 (6.5)16 (9.5)12 (7.1)32 (18.9)1.22 (1.62)
1 range from 0 (never) to 4 (very often).
Table 3. Exploratory factor analysis results (item loadings, eigenvalues, percentages of variance explained and reliability indexes).
Table 3. Exploratory factor analysis results (item loadings, eigenvalues, percentages of variance explained and reliability indexes).
ItemPerceived CopingPerceived Control
10.51
30.76
4−0.52
5−0.72
100.69
2 0.50
6 0.65
7 −0.67
8 −0.64
9 0.71
Eigenvalue3.591.37
% variance explained25.823.8
Cronbach’s alpha0.730.71
Table 4. Cronbach’s alpha coefficients if an item is deleted and item-total correlation coefficients.
Table 4. Cronbach’s alpha coefficients if an item is deleted and item-total correlation coefficients.
ItemCorrected Item-Total CorrelationCronbach’s Alpha if an Item is Deleted
Perceived coping
10.420.71
30.520.68
40.470.70
50.520.68
100.540.67
Perceived control
20.400.64
60.530.58
70.500.60
80.470.61
90.300.69
Table 5. Descriptive measures and intercorrelations of PSS-10 scales.
Table 5. Descriptive measures and intercorrelations of PSS-10 scales.
MinimumMaximumMean (SD)Pearson’s r Correlation Coefficients
123
1Perceived coping0.0020.007.04 (5.17)1.00
2Perceived control0.0017.005.59 (4.21)0.48 ***1.00
3PSS-10 total score0.0037.0012.63 (8.08)0.89 ***0.83 ***1.00
*** p < 0.001.
Table 6. Correlation between PSS-10 and ASQ scales.
Table 6. Correlation between PSS-10 and ASQ scales.
Perceived Coping Perceived ControlPSS-10 Total Score
Home lifer0.580.450.61
P<0.001<0.001<0.001
School performancer0.380.290.40
P<0.001<0.001<0.001
School attendancer0.270.280.31
P<0.001<0.001<0.001
Romantic relationshipsr0.720.410.67
P<0.001<0.001<0.001
Peer pressurer0.520.520.60
P<0.001<0.001<0.001
Teacher interactionr0.430.620.60
P<0.001<0.001<0.001
Future uncertaintyr0.410.240.39
P<0.0010.002<0.001
School/leisure conflictr0.370.290.39
P<0.001<0.001<0.001
Financial pressurer0.600.270.52
P<0.001<0.001<0.001
Emerging adult responsibilityr0.390.230.37
P<0.0010.003<0.001
Total ASQ scorer0.640.510.68
P<0.001<0.001<0.001
Table 7. PSS-10 scores by gender, grade, diploma grade, and systematically following a program in everyday life.
Table 7. PSS-10 scores by gender, grade, diploma grade, and systematically following a program in everyday life.
Perceived CopingPerceived ControlPSS-10 Total Score
Mean (SD)pMean (SD)pMean (SD)p
Gender
Girls7.34 (5.27)0.216 +5.65 (4.23)0.731 +12.99 (8.14)0.332 +
Boys6.22 (4.83) 5.4 (4.2) 11.62 (7.92)
Grade
1st5.41 (5.56)0.085 ++6.88 (4.61)0.229 ++12.29 (9.25)0.242 ++
2nd6.2 (4.6) 4.92 (3.91) 11.12 (6.77)
3rd7.74 (5.3) 5.7 (4.27) 13.45 (8.44)
Diploma grade
<17.67.74 (5.63)0.090 ++6.06 (4.67)0.332 ++13.8 (9.12)0.094 ++
17.6–18.77.53 (4.39) 5.83 (4.24) 13.36 (7.27)
>18.75.79 (5.34) 4.93 (3.7) 10.71 (7.67)
Follow systematically a program (routines) in everyday life
No9.45 (7.07)0.026 +7.65 (5.56)0.019 +17.1 (11.52)0.008 +
Yes6.72 (4.8) 5.31 (3.94) 12.03 (7.35)
+ Student’s t-test; ++ ANOVA.
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Kourmousi, N.; Kounenou, K.; Pezirkianidis, C.; Kalamatianos, A.; Chrousos, G.P. Validation of Perceived Stress Scale-10 Among Greek Middle Adolescents: Associations Between Stressful Life Events and Perceived Stress. Soc. Sci. 2025, 14, 344. https://doi.org/10.3390/socsci14060344

AMA Style

Kourmousi N, Kounenou K, Pezirkianidis C, Kalamatianos A, Chrousos GP. Validation of Perceived Stress Scale-10 Among Greek Middle Adolescents: Associations Between Stressful Life Events and Perceived Stress. Social Sciences. 2025; 14(6):344. https://doi.org/10.3390/socsci14060344

Chicago/Turabian Style

Kourmousi, Ntina, Kalliopi Kounenou, Christos Pezirkianidis, Antonios Kalamatianos, and George P. Chrousos. 2025. "Validation of Perceived Stress Scale-10 Among Greek Middle Adolescents: Associations Between Stressful Life Events and Perceived Stress" Social Sciences 14, no. 6: 344. https://doi.org/10.3390/socsci14060344

APA Style

Kourmousi, N., Kounenou, K., Pezirkianidis, C., Kalamatianos, A., & Chrousos, G. P. (2025). Validation of Perceived Stress Scale-10 Among Greek Middle Adolescents: Associations Between Stressful Life Events and Perceived Stress. Social Sciences, 14(6), 344. https://doi.org/10.3390/socsci14060344

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