Internal Structure of the Perceived Stress Scale (PSS) in Medical and Nursing Personnel in Peru: An Exploratory Graph Analysis

Introduction: The Perceived Stress Scale (PSS), in its 14-item (PSS-14) and 10-item (PSS-10) versions, is a widely used instrument. However, it has been understudied in medical and nursing personnel, and a variety of factor structures have been reported. Objective: To To examine the internal structure of the PSS in Peruvian medical and nursing personnel using exploratory graph analysis and confirmatory factor analysis. Materials and Methods: The sample consisted of 2,848 nurses and 2,219 physicians who participated in the Peruvian Ministry of Health's ENSUSALUD in 2015 and were administered the PSS-14 and PSS-10. Analyses were performed using the EGAnet and lavaan packages in R. Results: The PSS-14 formed 2 dimensions in medical personnel and 3 dimensions in nursing personnel, but items 12 and 13 showed little robustness in the latter group. Reanalysis after removing these items indicated that the 12-item version is plausible in nurses. Additionally, the PSS-10 showed a robust two-dimensional structure in both groups. Confirmatory factor analysis found that the two-dimensional models had good fit, as well as adequate reliability and consistency. Conclusions: The PSS is a useful instrument for measuring stress in medical and nursing personnel. However, the PSS-10 is more appropriate; while in the PSS-14, items 12 and 13 should be omitted. Both versions are twodimensional for both physicians and nurses.