Exploring the Relationships Among Bio-Psycho-Social Measures of Stress: A Multifactorial Approach Towards the Evaluation and Reduction of Stress

Abstract

A sustained stress response is well documented as an added risk factor for disease progression in many chronic diseases, as well as in acute life-threatening conditions. Stress reduction is therefore desirable in diagnostic and therapeutic management, and valid stress measures are a prerequisite to such management. Since no such easy-to-use stress measurement tools currently exist, this retrospective study of archival data, gathered from 204 participants in a general medical practice using bio-psycho-social measures of stress, explored the bases for developing a comprehensive stress-assessment battery (SAB) as a means of improving accuracy for determining the level of stress in patients and clients in medical, psychological and research settings, as well as for monitoring stress-reducing therapeutic interventions. Using correlational study and factor analytic methods, this study investigated the validity of various stress measures, including: (a) 4 easy-to-measure stress biomarkers (SB), salivary cortisol (sC), salivary amylase (sAA), heart rate variability (HRV), and electrodermal skin activity (EDA); (b) 2 self-report stress measures (SR), the Perceived Stress Scale (PSS-10), and the Psychological Stress Measure (PSM-9), (c) an expert rating scale (ER), the Basic Documentation for Psycho-Oncology (PO-Bado), and (d) a qualitative interview (QI) with interviewer-rating scales to measure stress levels. It explored the concept of stress, its dimensionality as well as the viability of developing this SAB as a single-index measurement, combining these 8 measures and indicators. While the psycho-sociometric stress tests were highly intercorrelated with stress, the 4 biomarkers showed a lack of correlation between each other and between the psycho-sociometric tests. The biomarkers did not therefore add value to a SAB in this study using a random selection of participants, and focus was given to understanding the reasons for this, and optimizing the psycho-sociometric stress tests as the most effective means of measuring stress accurately. A novel stress model was presented to help elucidate these findings and to provide the theoretical framework for an expanded psycho-social measurement scale. This study could provide research and health services with a broader understanding of stress and its measurement, and may lay the groundwork for constructing an improved scientific tool for measuring and monitoring stress responses.