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Development of the Stress Response Inventory and Its Application in Clinical Practice

From the Department of Psychiatry (K.B.K., C.H.K.), Yonsei University College of Medicine, Seoul and Brain Korea 21 Project for Medical Sciences, Yonsei University, the Department of Clinical Psychology (J.K.P.), Inje University, Ilsan Paik Hospital, Korea, and the Division of Clinical Psychology (S.C.), National Forensic Psychiatric Hospital, Kongju.

Address reprint requests to: Kyung Bong Koh, MD, PhD, Department of Psychiatry, C.P.O. Yonsei University College of Medicine, Box 8044, Seoul, Korea. Email: kbkoh{at}yumc.yonsei.ac.kr

OBJECTIVE: The purpose of this study was to develop the Stress Response Inventory (SRI), which includes emotional, somatic, cognitive, and behavioral stress responses, and then to use the scale in clinical practice.

METHODS: First, a preliminary survey was conducted using 109 healthy adults to obtain 75 response items. Second, the preliminary questionnaire was completed by 215 healthy subjects. Third, stress responses were compared among 242 patients (71 with anxiety disorder, 73 with depressive disorder, 47 with somatoform disorder, and 51 with psychosomatic disorder) and the 215 healthy subjects.

RESULTS: Factor analysis yielded seven subscales: tension, aggression, somatization, anger, depression, fatigue, and frustration. Reliability was computed by administering the SRI to 62 healthy subjects during a two-week interval. Test-retest reliability for the seven subscale scores and the total score was high, ranging between 0.69 and 0.96. Internal consistency was computed, and Cronbach’s for the seven subscales ranged between 0.76–0.91 and 0.97 for the total score. Convergent validity was computed by correlating the seven subscales and the total score of the SRI with the total score of the Global Assessment of Recent Stress (GARS) scale, the Perceived Stress Questionnaire (PSQ), and the subscale scores of the Symptom Checklist-90-Revised (SCL-90-R). The correlations were all at significant levels. The sensitivity of the SRI was 0.57, specificity 0.74, and the predictive value positive (PVP) was 0.71. The patient group also scored significantly higher on the six subscale scores and the total score than the control group, with the exception being the aggression subscale. The depressive disorder group was highest in total scores on the SRI among the four patient groups, and showed significantly higher total scores than the anxiety disorder and psychosomatic disorder groups. In total scores on the SRI, female subjects scored significantly higher than males.

CONCLUSIONS: These results indicate that the SRI is highly reliable and valid, and that it can be utilized as an effective measure of stress for research in stress-related fields. The depressive disorder group showed more prominent stress responses than the anxiety and psychosomatic disorder groups.

Key Words: Stress Response Inventory • reliability • validity • depressive disorder • anxiety disorder • somatoform disorder • psychosomatic disorder

Abbreviations: DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; GARS = Global Assessment of Recent Stress; GSI = Global Severity Index; MMPI = Minnesota Multiphasic Personality Inventory; PSDI = Positive Symptom Distress Index; PST = Positive Symptom Total; PSQ = Perceived Stress Questionnaire; PVP = Predicitive Value Positive; SCL-90-R = Symptom Checklist-90-revised; SRRS = Social Readjustment Rating Scale; STAI = State-Trait Anxiety Inventory.

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