Studies & Articles Related to Your Scales

Scale 1 - Oxford Happiness Questionnaire (OHQ)

Foundational / Original Article

• This is the primary reference for the OHQ. It introduced the 29-item scale as a compact replacement for the Oxford Happiness Inventory (OHI). Validity tested against the OHI was satisfactory, with good associations between the OHQ and personality variables linked to happiness. The original article on ScienceDirect has been cited over 3,500 times.

Psychometric Validation Studies

1. Lung FW & Shu BC (2020). The Psychometric Properties of the Chinese Oxford Happiness Questionnaire in Taiwanese Adolescents: Taiwan Birth Cohort Study. Community Mental Health Journal. PMID: 31549294
   • Used a national sample of 17,694 adolescents. The 8-item short-form was double-translated into Mandarin. Exploratory factor analysis and SEM revealed a two-factor structure: Social Adaptation Status (SAS) and Psychological Well-Being (PWB) - a finding consistent with East Asian collectivist culture. Cronbach's alphas were adequate. Concluded the 7-item Chinese OHQ has good psychometric properties in adolescents.
2. Sinarajoo N, Kong YC, Kaur R, et al. (2025). Validation of the Subjective Happiness Scale, Oxford Happiness Questionnaire and Pemberton Happiness Index among women with breast cancer in a multi-ethnic Asian setting. Ecancermedicalscience. PMID: 40492218
   • Evaluated three happiness tools in a clinical cancer population. The OHQ showed Cronbach's alpha of 0.75-0.92 and a two-factor structure in confirmatory factor analysis (composite reliability >0.70). OHQ had a moderately positive correlation with health-related quality of life and a moderately negative correlation with psychological distress. Supports OHQ use beyond healthy populations.
3. Cruise SM & Lewis CA (Semantic Scholar). Internal consistency, reliability, and temporal stability of the Oxford Happiness Questionnaire short-form. Evaluated the 8-item short version specifically for consistency over time.

Review / Application Studies

1. Lukoseviciute J, Argusaite-Zailskiene G, Smigelskas K (2022). Measuring Happiness in Adolescent Samples: A Systematic Review. Children (Basel). PMID: 35204948
   • Reviewed 133 papers (2010-2019) on happiness measurement in adolescents. The OHQ was identified as one of the most commonly used multi-item scales alongside the 4-item Subjective Happiness Scale. Found a lack of robust happiness validation studies and made recommendations for future scale selection.
2. Al Kassaa I & Fuad M (2024). Effects of Lacticaseibacillus rhamnosus HN001 on Happiness and Mental Well-Being: Findings from a Randomized Controlled Trial. Nutrients. PMID: 39275252
   • RCT using the OHQ as an outcome measure to assess the effect of a probiotic on happiness - an example of the OHQ's application in intervention research.
3. Guerra-Bustamante J et al. (2019). Emotional Intelligence and Psychological Well-Being in Adolescents. Int J Environ Res Public Health. PMID: 31100799
   • Used the OHQ alongside emotional intelligence measures, demonstrating its role in studying well-being correlates.
4. Medvedev ON & Landhuis CE (2018). Exploring constructs of well-being, happiness and quality of life. PeerJ. PMID: 29876148
   • Examined the overlap and distinctiveness of well-being constructs, with the OHQ positioned within broader measurement frameworks.

Scale 2 - Perceived Stress Scale (PSS)

Foundational Reference

• The original development paper. The PSS was grounded in Lazarus & Folkman's transactional model of stress and coping. Demonstrated good reliability, validity, and predictive power for health outcomes.

Psychometric Reviews & Meta-Analyses

1. Yilmaz Koglar E & Koglar H (2024). A systematic review and meta-analytic confirmatory factor analysis of the perceived stress scale (PSS-10 and PSS-14). Stress and Health. PMID: 37341705 ⭐ Highest-quality evidence
   • Included 76 samples from 57 studies (PSS-14: N=28,632; PSS-10: N=46,053). Used Meta-Analytic Confirmatory Factor Analysis (MACFA). Key finding: the correlated two-factor model (perceived helplessness + perceived self-efficacy) best explained the PSS structure across populations. Strict measurement invariance was achieved across age groups and clinical status. High internal consistency (omega values).
2. Lee EH (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research. PMID: 25031113
   • Systematic review of 19 psychometric studies. Found PSS-10 superior to PSS-14 and PSS-4 in overall psychometric properties. Internal consistency, factorial validity, and hypothesis validity well established. Recommended broader population validation beyond students and workers.

Cross-Cultural Validation Studies

1. Remor E (2006). Psychometric properties of a European Spanish version of the PSS. Spanish Journal of Psychology. PMID: 16673626
   • Spanish translation validated in 440 adults. PSS-14: alpha=0.81, test-retest r=0.73. PSS-10: alpha=0.82, test-retest r=0.77. Both versions showed good concurrent validity and sensitivity.
2. Reis RS, Hino AAF, Anez CRR (2010). Perceived stress scale: reliability and validity study in Brazil. Journal of Health Psychology. PMID: 20064889
   • Portuguese validation in 793 Brazilian university teachers. Two-factor structure explaining 56.8% of variance. Cronbach's alpha=0.87 (total). Test-retest reliability=0.86. Supports use across Latin American populations.
3. Liu X, Zhao Y, Li J et al. (2020). Factor Structure of the PSS-10 and Measurement Invariance Across Genders Among Chinese Adolescents. Frontiers in Psychology. PMID: 32328009
   • Confirmed two-factor structure and measurement invariance across genders in a Chinese adolescent sample.
4. Mozumder MK (2022). Reliability and validity of the Perceived Stress Scale in Bangladesh. PLoS One. PMID: 36301974
   • Validated PSS in a South Asian context.
5. Jiang C, Ma H, Luo Y et al. (2023). Validation of the Chinese version of PSS-10 integrating exploratory graph analysis and confirmatory factor analysis. General Hospital Psychiatry. PMID: 37572467
6. Marakshina J, Adamovich T, Vasin G et al. (2024). Factor structure and psychometric properties of the PSS in Russian adolescents. Scientific Reports. PMID: 38191640
7. Schneider EE et al. (2020). Measuring stress in clinical and nonclinical subjects using a German adaptation of the PSS. Int J Clin Health Psychol. PMID: 32550857

Application Studies (PSS as Outcome/Predictor)

1. Graves BS, Hall ME, Dias-Karch C et al. (2021). Gender differences in perceived stress and coping among college students. PLoS One. PMID: 34383790
   • PSS administered to 448 undergraduates; females showed higher stress scores. Gender differences in coping strategies also identified.
2. Choi J (2020). Impact of Stress Levels on Eating Behaviors among College Students. Nutrients. PMID: 32349338
   • Used PSS to classify stress levels and examine links to eating patterns.
3. Berdida DJE, Lopez V, Grande RAN (2023). Nursing students' perceived stress, social support, self-efficacy, resilience, mindfulness and psychological well-being: A structural equation model. Int J Mental Health Nursing. PMID: 37249199
   • PSS used as a key variable in a structural equation model alongside well-being constructs - directly relevant if you plan to study stress and happiness together.
4. Pandit S, Srivastav AK, Sur TK et al. (2024). Effects of Withania somnifera Extract in Chronically Stressed Adults: A Randomized Controlled Trial. Nutrients. PMID: 38732539
   • RCT using PSS as the primary outcome measure.

Studies Linking Both Happiness and Stress

• Stress and subjective well-being are strongly inversely correlated; the PSS and OHQ have been used together in studies on burnout, resilience, and mental health interventions.
• Choudhary D et al. (2017) (Journal of Evidence-Based Complementary & Alternative Medicine, PMID: 27055824) used both OHQ and PSS as outcome measures in a weight/stress RCT with Ashwagandha.
• Gopukumar K et al. (2021) (Evidence-Based Complementary & Alternative Medicine, PMID: 34858513) also combined both scales in a cognitive function/stress RCT.

Quick Reference Summary Table

Happiness and Stress in Clinical Populations: Research Summary

1. Serious Mental Illness (Schizophrenia)

• People with schizophrenia reported lower happiness than healthy controls, but with substantial within-group variability - some patients reported relatively high happiness despite severe illness.
• Happiness in schizophrenia was significantly correlated with lower perceived stress, along with higher resilience, optimism, and personal mastery.
• Happiness was not associated with severity of positive/negative symptoms, duration of illness, cognitive functioning, or medical comorbidity - suggesting perceived stress may be a more modifiable target than symptom reduction alone.
• The authors concluded happiness is a viable treatment goal even in serious mental illness, and that psychotherapies targeting resilience and stress coping warrant further study.

2. Obstetric/Perinatal Populations (Recurrent Miscarriage)

• A structured happiness counseling program (intervention group, n=30) significantly reduced depression, anxiety, and stress measured by the DASS-21, compared to controls.
• Demonstrated that targeting happiness as a positive psychological construct directly attenuates perceived stress in a high-risk obstetric population.
• One of the few RCTs directly intervening on happiness to reduce stress in a clinical group.

3. Endocrine Disease (Type 2 Diabetes)

• 55.95% of patients had serious emotional disorders; diabetes-related distress and happiness were negatively correlated across all treatment groups (r = -0.335 to -0.436, p<0.001).
• Patients on combination therapy had significantly higher happiness than those on insulin or oral monotherapy.
• Age, complications, glycaemic control, lifestyle, and education explained approximately 18% of happiness variance.
• Stress/distress was a stronger predictor of unhappiness than clinical disease severity, reinforcing the primacy of the psychological dimension in chronic disease management.

4. Autoimmune Disease (Systemic Lupus Erythematosus)

• Mean PSS score was 5.3 (SD 3.6); high stress (PSS >6) was found in 253 participants (35%).
• Better mental component quality of life independently predicted reduced stress (protective effect).
• High stress at baseline was the strongest predictor of high stress at follow-up (OR=3.16, 95% CI 1.85-5.37) - stress is persistent in this population.
• SLE patients below the poverty line, with worse QOL, more comorbidities, and diabetes had significantly higher PSS scores.
• Authors recommend routine PSS screening in rheumatology clinics to identify patients at risk for poor outcomes.

5. Breast Cancer

• Mean perceived stress was 42.8 (±16.5) - notably elevated.
• Significant interaction between anxiety, depression, and surgical type in predicting stress level; patients with anxiety combined with non-surgical management had 2.5% higher PSS scores.
• Coordination between psychologists and oncologists was recommended as routine care, given stress's direct impact on treatment adherence and survival.

6. End-Stage Renal Disease / Hemodialysis

• Intervention significantly improved happiness, enthusiasm, self-confidence, and clarity of thought while reducing perceived stress.
• Improved kidney disease quality-of-life scores (symptom burden, disease impact).
• Qualitatively, 97.5% of participants reported feelings of peace and being inspired to manage illness.
• Supports happiness and stress as jointly modifiable targets via mind-body interventions in renal patients.

7. Healthcare Workers (Nurses/Clinical Staff)

• Laughter yoga consistently decreased stress and burnout in nurses (measured by multiple validated tools) while increasing subjective happiness, life satisfaction, and psychological well-being.
• Salivary cortisol (biological stress marker) also decreased post-intervention in two studies.
• Stress-happiness inverse relationship was confirmed across diverse nurse populations and settings.

8. Medical Students as a Clinical-Adjacent Population (COVID-19 Context)

• 60.8-85.8% of students were happy; 50-60% had some stress, but overall stress levels were low.
• No significant difference in OHQ or stress scores between pre-clinical and clinical students during COVID-19.
• Health satisfaction and regular exercise were the two factors significantly predicting happiness in multivariable analysis (p<0.001 and p=0.015 respectively).
• Demonstrates the OHQ as a useful tool in clinical training population research.

9. PSS Longitudinal Stability in Heart Failure Patients

• Between-person variance accounted for 42.3% of total PSS variance in heart failure patients - meaning the PSS captures a relatively stable trait-like stress perception, not just fluctuating state stress.
• This has important implications for clinical research: a single PSS administration may reflect a patient's chronic stress propensity, making it a meaningful baseline variable in longitudinal studies combining it with happiness measures.

10. Broad Cross-Disease Evidence (Systematic Review)

Summary Table: Populations, Scales Used, and Key Findings

Research Gaps and Recommendations

1. Direct co-application of OHQ + PSS in clinical populations is sparse - most studies use one or the other. The breast cancer validation study (2025) is a rare exception directly addressing both.
2. Studies in neurological populations (MS, Parkinson's, epilepsy) combining both scales are underrepresented.
3. Longitudinal RCTs using OHQ + PSS as dual primary outcomes are rare and represent a strong research opportunity.
4. Most existing studies are cross-sectional, limiting causal inference about the direction of the happiness-stress relationship.

INTRODUCTION

Stress and Happiness Among Nurses: A Cross-Sectional Study

Key References Cited in the Introduction

1. Cohen S, Kamarck T, Mermelstein R (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385-396.
2. Hills P & Argyle M (2002). The Oxford Happiness Questionnaire: a compact scale for the measurement of psychological well-being. Personality and Individual Differences, 33, 1073-1082.
3. Abdollahi A et al. (2014). Hardiness as a mediator between perceived stress and happiness in nurses. Journal of Psychiatric and Mental Health Nursing. PMID: 24661763
4. Galanis P et al. (2021). Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing. PMID: 33764561
5. Jarden RJ et al. (2021). New graduate nurse wellbeing, work wellbeing and mental health: A quantitative systematic review. International Journal of Nursing Studies. PMID: 34218048
6. Yilmaz Koglar E & Koglar H (2024). A systematic review and meta-analytic confirmatory factor analysis of the PSS-10 and PSS-14. Stress and Health. PMID: 37341705
7. Sinarajoo N et al. (2025). Validation of the OHQ among women with breast cancer in a multi-ethnic Asian setting. Ecancermedicalscience. PMID: 40492218