Measuring psychological stress. Concept, model, and measurement instrument in primary care research.

F irst introduced by Selye, the term stress is now widely used to describe a state of tension often seen as being related to modern life. In the context of primary care, a defi nition integrated into a conceptual model with a validated measurement instrument would help to ensure that this term is used appropriately. This article is designed to provide primary care researchers with a concept, a model, and a psychological stress measurement tool adapted to their context and needs. Psychological stress concerns the state of " normal " tension, preoccupation, and agitation reported by many people. Sometimes extreme and sometimes an energy booster, its statistical distribution is normal , and it is considered a precipitating factor in the development of various physical and mental disorders. It is, however, different from distress and psy-chopathology, which are dysfunctional and morbid. All too often, researchers and clinicians use clinical psychiatric measurement tools (such as the Present State Examination, the Brief Symptom Inventor y, or the Beck Depression Inventor y) to assess stress. These were designed for pathologic disorders and validated using dysfunctional clinical populations. Their statistical distributions are not normal, and they are not particularly sensitive below the critical diagnostic threshold. In contrast, the concept of stress refers to a set of affective, cognitive, somatic, and behavioural manifestations within the range of functional integrity. The general theoretic framework we developed is based on a biopsychosocial model of stress that includes environmental parameters and individual processes of perception and coping with stressors. Developed outside the fi eld of psychopathology, this model is ideal for assessing psychological stress in primary care and population health research. The state of stress depends on the interaction between an individual's environment and his or her representation of that environment. It can result in physical or mental illness through the agency of neuro-endo-immune mediators and depending on various structural or functional vulnerabilities. Stress disorders occur only as a result of stress of great intensity or long duration or when other pathogenic processes are present. Psychological stress is, therefore, a hinge construct associated with both psychological phenomena and factual parameters. In our qualitative studies, stress was recognized as a target construct in the process of adapting to life events and circumstances; it appeared socially acceptable. For this reason, it warranted a measurement instrument validated for the specifi c concept of stress that is reliable, responsive, user-friendly, and economical. The …