Perceived Stress Scale: Psychometric Validation in Spanish University Nursing Students and Applications for Mental Health

BACKGROUND: Nursing students-including those specializing in mental health and psychiatric care-as well as practicing psychiatric nurses frequently experience elevated levels of psychological stress. Such stress can adversely affect their academic performance, overall well-being, and future professional development. Accurate assessment of perceived stress is essential for identifying individuals at risk and for designing targeted support strategies. AIMS: This study aimed to examine the psychometric properties of the 14-, 10-, and 4-item versions of the Perceived Stress Scale, evaluating their validity, reliability, measurement invariance, and diagnostic utility using salivary cortisol as a physiological benchmark. METHODS: Participants completed the Spanish version of the Perceived Stress Scale, the Sense of Coherence-13 scale, and provided morning salivary cortisol samples. Confirmatory factor analysis, internal consistency assessment, measurement invariance testing across demographic subgroups, hypothesis testing, and Area Under the Curve-Receiver Operating Characteristic analysis using cortisol as a criterion standard were performed. RESULTS: The Perceived Stress Scale (14- and 10-item format) demonstrated a stable two-factor structure, high internal consistency, and measurement invariance across gender, educational level, employment status, and living arrangements. It also showed correlations with Sense of Coherence-13 scale scores. While it demonstrated moderate sensitivity relative to physiological stress (salivary cortisol), its specificity was lower. CONCLUSIONS: The Perceived Stress Scale-10 emerged as the most psychometrically robust and practical version for assessing perceived stress. Its use in educational and mental health settings may support early identification of individuals under high stress and facilitate the implementation of targeted interventions to promote well-being.