Articles In Press / Online First
Back to the articles list |
Back to browse issues page
1- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia. & School of Rehabilitation Medicine, Jiangsu Medical College, Yancheng, Jiangsu, China.
2- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia. ,garry@usm.my
3- Department of Physical Education, Osmania University, Hyderabad, India.
4- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
2- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia. ,
3- Department of Physical Education, Osmania University, Hyderabad, India.
4- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Abstract: (11 Views)
Background. Medical students often face more stress than college students in other majors. The Medical Students' Stressor Questionnaire (MSSQ) is a tool commonly used to assess the stress levels and stressors experienced by medical students. However, no Chinese version has been validated to date.
Objectives. This study represents the first cross-cultural adaptation and validation of the MSSQ in Chinese medical students, filling an important gap in stress assessment tools.
Methods. Participants were 811 undergraduate medical students from a university in Yancheng, China, with a mean age of 20.96 years (SD = 1.98). The majority of the sample (66.6%) were female. Perceived stressors were measured using the 40-item Medical Students' Stressor Questionnaire (MSSQ), which assesses six domains of stressor (academic-related, intrapersonal and Interpersonal, teaching and learning, social, drive and desire, and group activities-related). The MSSQ was translated into Chinese following standard forward and backward translation procedures to ensure linguistic and conceptual equivalence. Participants completed the Chinese version of the MSSQ (MSSQ-C), and confirmatory factor analysis (CFA) was conducted using Mplus 8.3 to examine the factorial structure of the six-domain model.
Results. The CFA supported the six-factor structure of the MSSQ-C. The initial model showed poor fit, but after model re-specification with four residual correlations, the final model demonstrated good fit (RMSEA = 0.040, CFI = 0.956, TFI = 0.952, SRMR = 0.053). Construct reliability for the six factors ranged from 0.824 to 0.938, indicating satisfactory internal consistency.
Conclusion. The Chinese version of MSSQ is concise and has good reliability and validity, making it suitable for screening stress sources among Chinese medical students. Its strong psychometric properties make it a practical instrument for identifying stressors and guiding stress-management strategies in Chinese medical education.
Objectives. This study represents the first cross-cultural adaptation and validation of the MSSQ in Chinese medical students, filling an important gap in stress assessment tools.
Methods. Participants were 811 undergraduate medical students from a university in Yancheng, China, with a mean age of 20.96 years (SD = 1.98). The majority of the sample (66.6%) were female. Perceived stressors were measured using the 40-item Medical Students' Stressor Questionnaire (MSSQ), which assesses six domains of stressor (academic-related, intrapersonal and Interpersonal, teaching and learning, social, drive and desire, and group activities-related). The MSSQ was translated into Chinese following standard forward and backward translation procedures to ensure linguistic and conceptual equivalence. Participants completed the Chinese version of the MSSQ (MSSQ-C), and confirmatory factor analysis (CFA) was conducted using Mplus 8.3 to examine the factorial structure of the six-domain model.
Results. The CFA supported the six-factor structure of the MSSQ-C. The initial model showed poor fit, but after model re-specification with four residual correlations, the final model demonstrated good fit (RMSEA = 0.040, CFI = 0.956, TFI = 0.952, SRMR = 0.053). Construct reliability for the six factors ranged from 0.824 to 0.938, indicating satisfactory internal consistency.
Conclusion. The Chinese version of MSSQ is concise and has good reliability and validity, making it suitable for screening stress sources among Chinese medical students. Its strong psychometric properties make it a practical instrument for identifying stressors and guiding stress-management strategies in Chinese medical education.
Keywords: Cross-Cultural Comparison, Validation, Psychometric Properties, Stress, Students, Medical.
Full-Text [PDF 645 kb]
(6 Downloads)
APPLICABLE REMARKS
APPLICABLE REMARKS
- The MSSQ-C demonstrates strong reliability and validity, making it a suitable tool for identifying key stressors among Chinese medical students. For instance, the Academic Related Stressors (ARS) subscale consistently showed high factor loadings, suggesting that interventions should prioritize academic stress management within medical curricula.
- Compared with lower-scoring domains such as Drive and Desire Related Stressors (DRS), these findings highlight the need for targeted curriculum reforms and stress-management programs tailored to the specific stressor patterns of Chinese medical students.
Type of Study: Original Article |
Subject:
Sport Psychology and its Related Branches
Received: 2025/07/13 | Accepted: 2025/09/14
Received: 2025/07/13 | Accepted: 2025/09/14
References
1. 1. Bulo JG, Sanchez MG. Sources of stress among college students. CVCITC Res J. 2014;1(1):16-25.
2. Sousa JM, Moreira CA, Telles-Correia D. Anxiety, depression and academic performance: A study amongst Portuguese medical students versus non-medical students. Acta Med Port. 2018;31(9):454-62. [doi:10.20344/amp.9996] [ [DOI:10.20344/amp.9996] [PMID]
3. Heinen I, Bullinger M, Kocalevent RD. Perceived stress in first-year medical students: Associations with personal resources and emotional distress. BMC Med Educ. 2017;17(1):4. [doi:10.1186/s12909-016-0841-8] [ [DOI:10.1186/s12909-016-0841-8] [PMID] []
4. Elias H, Ping WS, Abdullah MC. Stress and academic achievement among undergraduate students in Universiti Putra Malaysia. Procedia Soc Behav Sci. 2011;29:646-55. [doi:10.1016/j.sbspro.2011.11.288] [DOI:10.1016/j.sbspro.2011.11.288]
5. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. JAMA. 2016;316(21):2214-36. [doi:10.1001/jama.2016.17324] [ [DOI:10.1001/jama.2016.17324] [PMID] []
6. Alvi T, Assad F, Ramzan M, Khan FA. Depression, anxiety and their associated factors among medical students. J Coll Physicians Surg Pak. 2010;20(2):122-6.
7. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354-73. [doi:10.1097/00001888-200604000-00009] [ [DOI:10.1097/00001888-200604000-00009] [PMID]
8. 8．Epel ES, Crosswell AD, Mayer SE, Prather AA, Slavich GM, Puterman E, et al. More than a feeling: a unified view of stress measurement for population science. Front Neuroendocrinol. 2018;49:146-69. [doi:10.1016/j.yfrne.2018.03.001] [ [DOI:10.1016/j.yfrne.2018.03.001] [PMID] []
9. Mao Y, Zhang N, Liu J, Zhu B, He R, Wang X. A systematic review of depression and anxiety in medical students in China. BMC Med Educ. 2019;19(1):327. [doi:10.1186/s12909-019-1744-2] [ [DOI:10.1186/s12909-019-1744-2] [PMID] []
10. Lin YK, Lin CD, Lin BYJ, et al. Medical students' resilience: a protective role on stress and quality of life in clerkship. BMC Med Educ. 2019;19(1):473. [DOI:10.1186/s12909-019-1912-4] [PMID] []
11. Deng Y, Cherian J, Khan NUN, Kumari K, Sial MS, Comite U, et al. Family and academic stress and their impact on students' depression level and academic performance. Front Psychiatry. 2022;13:869337. [doi:10.3389/fpsyt.2022.869337] [ [DOI:10.3389/fpsyt.2022.869337] [PMID] []
12. Motillon-Toudic C, Walter M, Séguin M, Carrier JD, Berrouiguet S, Lemey C. Social isolation and suicide risk: literature review and perspectives. Eur Psychiatry. 2022;65(1):e65. [doi:10.1192/j.eurpsy.2022.2320] [ [DOI:10.1192/j.eurpsy.2022.2320] [PMID] []
13. Zhang Y, Lin X, Yu L, et al. Sources of stress and coping strategies among Chinese medical graduate students: a qualitative study. BMC Med Educ. 2024;24(1):624. [doi:10.1186/s12909-024-05603-y] [ [DOI:10.1186/s12909-024-05603-y] [PMID] []
14. Liu X, Feng J, Liu C, Chu R, Lv M, Zhong N, Tang Y, Li L, Song K. Medical education systems in China: Development, status, and evaluation. Acad Med. 2023;98(1):43-9. [doi:10.1097/ACM.0000000000004919] [ [DOI:10.1097/ACM.0000000000004919] [PMID]
15. Xiong P, Hu SX, Hall BJ. Violence against nurses in China undermines task-shifting implementation. Lancet Psychiatry. 2016;3(6):501. [doi:10.1016/S2215-0366(16)30046-3] [ [DOI:10.1016/S2215-0366(16)30046-3] [PMID]
16. Wang W. Medical education in China: Progress in the past 70 years and a vision for the future. BMC Med Educ. 2021;21(1):453. [doi:10.1186/s12909-021-02875-6] [ [DOI:10.1186/s12909-021-02875-6] [PMID] []
17. Al-Jehani YM, Althwanay AM, Buainain HM, Abuhaimed AK, Almulhim AM, Abusrir FA, et al. Burnout prevalence and associated stressors in medical students of traditional and problem-based learning curricula in a Saudi university. Saudi J Med Med Sci. 2020;8(2):125-32. [doi:10.4103/sjmms.sjmms_301_19] [ [DOI:10.4103/sjmms.sjmms_301_19] [PMID] []
18. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96. [doi:10.2307/2136404] [ [DOI:10.2307/2136404] [PMID]
19. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43. [doi:10.1016/0005-7967(94)00075-U] [ [DOI:10.1016/0005-7967(94)00075-U] [PMID]
20. Cruchinho P, López-Franco MD, Capelas ML, Almeida S, Bennett PM, Miranda da Silva M, Gaspar F. Translation, cross-cultural adaptation, and validation of measurement instruments: A practical guideline for novice researchers. J Multidiscip Healthc. 2024;17:2701-28. [doi:10.2147/JMDH.S419714] [ [DOI:10.2147/JMDH.S419714] [PMID] []
21. Borsa JC, Damásio BF, Bandeira DR. Cross-cultural adaptation and validation of psychological instruments: Some considerations. Paidéia (Ribeirão Preto). 2012;22(53):423-32. [doi:10.1590/S0103-863X2012000300014] [DOI:10.1590/S0103-863X2012000300014]
22. Dagani J, Buizza C, Ferrari C, Ghilardi A. Psychometric validation and cultural adaptation of the Italian medical student stressor questionnaire. Curr Psychol. 2022;41(6):4132-40. [doi:10.1007/s12144-020-00922-x] [DOI:10.1007/s12144-020-00922-x]
23. Yusoff MSB, Rahim AFA, Yaacob MJ. The development and validity of the medical student stressor questionnaire (MSSQ). ASEAN J Psychiatry. 2010;11(1):231-5. [doi:10.1037/t15334-000] [DOI:10.1037/t15334-000]
24. Bob M, Popescu C, Pirlog R, Buzoianu A. Personality factors associated with academic stress in first year medical students. HVM Bioflux. 2014;6(1):40-4.
25. Eva EO, Islam MZ, Mosaddek ASM, Rahman MF, Rozario RJ, Iftekhar AFMH, et al. Prevalence of stress among medical students: a comparative study between public and private medical schools in Bangladesh. BMC Res Notes. 2015;8:327. [doi:10.1186/s13104-015-1295-5] [ [DOI:10.1186/s13104-015-1295-5] [PMID] []
26. Jayarajah U, Lakmal K, Athapathu A, Jayawardena AJ, de Silva V. Validating the Medical Students' Stressor Questionnaire (MSSQ) from a Sri Lankan medical faculty. J Taibah Univ Med Sci. 2020;15(5):344-50. [doi:10.1016/j.jtumed.2020.08.003] [ [DOI:10.1016/j.jtumed.2020.08.003] [PMID] []
27. Saxena Y, Shrivastava A, Singhi P. Gender correlation of stress levels and sources of stress among first year students in a medical college. Indian J Physiol Pharmacol. 2014;58(2):147-51.
28. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-91. [doi:10.1097/00007632-200012150-00014] [ [DOI:10.1097/00007632-200012150-00014] [PMID]
29. Kuan G, Kueh YC, Abdullah N, et al. Psychometric properties of the Health-Promoting Lifestyle Profile II: cross-cultural validation of the Malay language version. BMC Public Health. 2019;19:751. [doi:10.1186/s12889-019-7109-2] [ [DOI:10.1186/s12889-019-7109-2] [PMID] []
30. DeVon HA, Block ME, Moyle-Wright P, Ernst DM, Hayden SJ, Lazzara DJ, et al. A psychometric toolbox for testing validity and reliability. J Nurs Scholarsh. 2007;39(2):155-64. [doi:10.1111/j.1547-5069.2007.00161.x] [ [DOI:10.1111/j.1547-5069.2007.00161.x] [PMID]
31. DiStefano C, Hess B. Using confirmatory factor analysis for construct validation: an empirical review. J Psychoeduc Assess. 2005;23(3):225-41. [doi:10.1177/073428290502300303] [DOI:10.1177/073428290502300303]
32. Raykov T, Marcoulides GA. Scale reliability evaluation under multiple assumption violations. Struct Equ Model. 2016;23(2):302-13. [doi:10.1080/10705511.2014.938597] [DOI:10.1080/10705511.2014.938597]
33. Yusoff MSB, Yee L, Wei L, Meng L, Bin L, Siong T, et al. A study on stress, stressors and coping strategies among Malaysian medical students. Int J Stud Res. 2011;1(2):45-50. [doi:10.5549/IJSR.1.2.45-50] [DOI:10.5549/IJSR.1.2.45-50]
34. Romero-Romero E, De León EG, Morán-Pinzón J, Salado-Castillo R, Castillo-Pimentel A. Academic stress, hair and saliva cortisol, and their relationship with body mass index and fat percentage in first year medical students. Physiol Int. 2023;110(3):277-90. [doi:10.1556/2060.2023.00178] [ [DOI:10.1556/2060.2023.00178] [PMID]
35. Heming M, Angerer P, Apolinário-Hagen J, Nater UM, Skoluda N, Weber J. The association between study conditions and hair cortisol in medical students in Germany: A cross-sectional study. J Occup Med Toxicol. 2023;18(1):7. [doi:10.1186/s12995-023-00373-7] [ [DOI:10.1186/s12995-023-00373-7] [PMID] []
36. Turakitwanakan W, Mekseepralard C, Busarakumtragul P. Effects of mindfulness meditation on serum cortisol of medical students. J Med Assoc Thai. 2013;96 Suppl 1:S90-5.
37. Biggs A, Brough P, Drummond S. Lazarus and Folkman's psychological stress and coping theory. The handbook of stress and health: A guide to research and practice. 2017:349-64. [doi:10.1002/9781118993811.ch21] [DOI:10.1002/9781118993811.ch21]
38. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. Upper Saddle River (NJ): Prentice Hall; 2009.
39. Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53-5. [doi:10.5116/ijme.4dfb.8dfd] [ [DOI:10.5116/ijme.4dfb.8dfd] [PMID] []
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
