Development and validation of the Stress Sensation Inventory (SSI) to measure stress among students aged 15 to 19 years in Sri Lanka

Background Despite the fact that stress may be associated with adverse psychological effects, there are no validated scales to measure stress among Sri Lankan adolescents. Objectives To develop and validate a scale (SSI) to measure stress among students aged 15 to 19 years in Sri Lanka. Methods In-depth interviews and focus group discussions were conducted among adolescents, in order to explore physical symptoms and thoughts experienced and their behavioural responses, when faced with challenging problems and situations. Following this, a brief, self-administered instrument, the Stress Sensation Inventory (SSI) was developed by a group of experts. The SSI was then validated among 127 school-going adolescents, and the scores were compared with the GHQ30 score and the clinical assessments carried out by a psychiatrist. The cut-off point was determined using the receiver operator characteristic (ROC) curve. Results Cronbach’s alpha reliability of the SSI score was 0.8319. The reliability of the psychological, psychosomatic, emotional, and cognitive subscales were 0.7931, 0.6323, 0.6389 and 0.7439 respectively. Measures of validity were satisfactory, with a sensitivity of 84%, specificity of 72%, positive predictive value of 62%, and negative predictive value of 90%. The Kappa agreement between the SSI and GHQ 30 was fair (0.35). Conclusion The SSI is an acceptable, easy to use instrument for measuring stress in school-going adolescents in Sri Lanka. It fulfils stringent criteria of reliability and validity. The Sri Lanka Journal of Psychiatry Vol 6(1) : 17-21