Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-30T15:07:53.851Z Has data issue: false hasContentIssue false

Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic

Published online by Cambridge University Press:  11 October 2024

Michael H. Campbell*
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
Jill Gromer-Thomas
Affiliation:
College of Social Work, Florida State University, Tallahassee, FL, USA
Katija Khan
Affiliation:
Faculty of Social Sciences, The University of the West Indies, St. Augustine Campus, Trinidad & Tobago
Bidyadhar Sa
Affiliation:
Faculty of Social Sciences, The University of the West Indies, St. Augustine Campus, Trinidad & Tobago
Paula M. Lashley
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
Damian Cohall
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
Christine E. Chin
Affiliation:
School of Clinical Medicine and Research, The University of the West Indies, Nassau Campus, The Bahamas
Russell B. Pierre
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
Nkemcho Ojeh
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
Ambadasu Bharatha
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
Heather Harewood
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
O. Peter Adams
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
Md. Anwarul Azim Majumder
Affiliation:
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
*
Corresponding author: Michael H. Campbell; Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.

Type
Research Article
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Impact statement

This study addresses the need for culturally relevant and empirically validated measurement tools in mental health research in the Caribbean. Traditionally, the region has depended on psychological measures developed elsewhere, usually in North America or Europe, and relatively few have established psychometric properties for Caribbean populations. By providing support for the use of the Perceived Stress Scale (PSS-10) and Brief Resilient Coping Scale (BRCS) in the Caribbean setting, the current study enables more contextualized and culturally responsive measurement of key indicators of health and wellbeing. Research using these measures is useful to understand the complex dynamics of stress in the Caribbean, including factors such as climate threats, economic challenges, and social and political disruptions, which have been particularly pronounced during the COVID-19 pandemic. A more comprehensive understanding is crucial for creating mental health interventions and policies that address the needs of Caribbean people. These measures have broad application to support the work of health researchers, healthcare providers, policymakers and educational institutions in the region. The focus on health professions students is especially relevant, given their future role in promoting individual and community wellbeing in a region beset with vulnerabilities. More immediately, this study can inform efforts to develop effective mental health resources in Caribbean settings. This research further contributes to the broader conversation on global mental health, underscoring the importance of measures that are culturally valid. The study may be a useful example for other regions with similar needs for tailoring mental health tools to local contexts. In summary, this paper advances research on stress and coping in the Caribbean and contributes to the growing body of culturally responsive measures in global mental health.

Introduction

Measures with established reliability and validity in the English-speaking Caribbean are key for mental health research and practice. Efforts to develop a body of instruments for appropriate use involve both development of novel scales and psychometric evaluation in the Caribbean of those developed elsewhere (Alea and Ali, Reference Alea and Ali2018). Existing Caribbean mental health research has overwhelmingly employed measures developed and normed outside of the region, primarily in North America or Europe, and has only rarely evaluated the psychometric properties or contextual use of these instruments; and when doing so, studies have infrequently moved beyond cursory reports of Cronbach’s alpha (Lambert et al., Reference Lambert, Sewell, Levitch, Roopnarine and Chadee2016, Reference Lambert, Levitch, Robinson and Sweeney2018).

As the need for understanding climate threat in small island developing states (SIDS) increases, the regional literature on climate and health has not kept pace, and considerable gaps in knowledge of Caribbean climate threats, including mental health sequelae, persist (Rise et al., Reference Rise, Oura and Drewry2022). These gaps are crucial in a region with complex and dynamic vulnerabilities. Stressors experienced by Caribbean people are longstanding and multifactorial, as emerging climate threats are layered onto existing geographic, economic, social, political and health systems, whose dynamics vary among countries in the region (Granger, Reference Granger1997). Moreover, climate change may threaten post-colonial gains and needed further steps for sustainable development (Rhiney and Baptiste, Reference Rhiney and Baptiste2019).

Regional mental health professionals have responded to climate threats relatively quickly in terms of providing clinical services and policy consultation (e.g., Shultz et al., Reference Shultz, Sands, Holder-Hamilton, Hamilton, Goud, Nottage, Espinel, Friedman, Fugate, Kossin and Galea2020; Torres-Llenza and Safran, Reference Torres-Llenza, Safran, Dyer, Kohrt and Candilis2021), and research efforts are now emerging (e.g., Seon et al., Reference Seon, Greaves, Campbell, Anderson, Henry, Augustus, Simeon, Cummings, Kendall, Wheeler, Vercammen, Lawrence, Seemungal, Gold and Maharaj2024), with several studies still in development or in press (Campbell and Greaves, Reference Campbell and Greaves2022). For example, further study is needed on the psychological and behavioral implications of rising sea levels, ocean acidification and heat stress (Birthwright and Smith, Reference Birthwright and Smith2023). Relevant and psychometrically sound measures are essential to conduct this research and for the broader study and practice of public mental health. Notably, Caribbean practitioners have identified barriers posed by lack of appropriate clinical tools for use in disaster mental health interventions (Dudley-Grant and Etheridge, Reference Dudley-Grant, Etheridge, Marsella, Johnson and Watson2007).

Against this background, the COVID-19 pandemic presented an acute threat that has resulted in negative mental health outcomes, notably anxiety and depression, globally. These symptoms generally increased in concert with restrictions on activity, but there has been considerable variability across settings and populations (Salanti et al., Reference Salanti, Pete, Tonia, Holloway, White, Darwish, Low, Egger, Haas, Fazel, Kessler, Herrman, Kieling, DJF, Vigod, Patel, Li, Cuijpers, Cipriani, Furukawa, Leucht, Sambo, Onishi, Sato, Rodolico, Oliveira Solis, Antoniou, Kapfhammer, Ceraso, O’Mahony, Lasserre, Ipekci, Concerto, Zangani, Igwesi-Chidobe, Diehm, Demir, Wang, Ostinelli, Sahker, Beraldi, Erzin, Nelson, Elkis, Imai, Wu, Kamitsis, Filis, Michopoulos, Bighelli, JSW, Ballesteros, Smith, Yoshida, Omae, Trivella, Tada, Reinhard, Ostacher, Müller, Jaramillo, Ferentinos, Toyomoto, Cortese, Kishimoto, Covarrubias-Castillo, Siafis, Thompson, Karageorgiou, Chiocchia, Zhu and Honda2022). Disruptions in medical and health professions (MHP) education were widespread, and there has been a proliferation of studies examining the impact of COVID-19 on the well-being of MHP students. A recent meta-analysis of 201 studies including 198,000 medical students (Peng et al., Reference Peng, Hao, Liu, Chen, Wang, Yang, Wang, Li, Wang, He, Wang, Ma, He, Zhou, Wu and Liu2023) identified pooled prevalences for stress (34%), anxiety (38%), depression (41%), sleep disorder (52%), general psychological distress (58%), post-traumatic stress disorder (34%), suicidal ideation (15%) and burnout (36%). Studies across allied health professions have shown broadly consistent patterns of these symptoms (Chutiyami et al., Reference Chutiyami, Cheong, Salihu, Bello, Ndwiga, Maharaj, Naidoo, Kolo, Jacob, Chhina, Ku, Devar, Pratitha and Kannan2022; Pfeifer et al., Reference Pfeifer, Egger, Hughes, Tondl, High and Nelson2022).

Our research team was tasked in early 2020 with developing a rapid response survey to assess the well-being and academic performance of health professions students across The University of the West Indies campuses in the Caribbean, affording the opportunity to collect psychometric data from young adults in several Caribbean countries: The Bahamas, Barbados, Jamaica and Trinidad and Tobago. This coincided with emergency adaptations implemented by the university in response to the pandemic, including abrupt transition to blended and online learning (Cockburn and Chami, Reference Cockburn, Chami, Chami, Teelucksingh and Anatol2022) and comprehensive efforts to provide research and clinical support to Caribbean countries (Landis, Reference Landis, Campbell and Connell2021). Therefore, an important goal of the study was to inform efforts to provide student support in the early stages of the pandemic, when significant knowledge gaps hindered planning. The study further presented an opportunity to establish the psychometric properties of measures included in the survey with a large regional Caribbean sample.

We elected to include the Perceived Stress Scale, 10-item version (PSS-10; Cohen and Williamson, Reference Cohen, Williamson, Spacapan and Oskamp1988) and Brief Resilient Coping Scale (BRCS; Sinclair and Wallston, Reference Sinclair and Wallson2004) to assess stress and coping behavior among MHP students. The PSS-10 is the most widely used self-report measure of stress in health research with substantial psychometric evidence supporting its use globally (Crosswell and Lockwood, Reference Crosswell and Lockwood2020; Kogar and Kogar, Reference Kogar and Kogar2023). Additionally, there is considerable precedent for using the PSS-10 in research with MHP students, including a number of studies in the COVID-19 era (e.g., Puranachaikere et al., Reference Puranachaikere, Hataiyusuk, Anupansupsai, In-Iw, Saisavoey, Techapanuwat, Arunrodpanya, Charonpongsuntorn, Wiwattanaworaset, Siripongpan, Pruttithavorn, Wonglertwisawakorn, Pojanapotha, Rueangrong, Pattrakornkul, Piyawattanametha, Piyawattanametha and Ratanapichayachai2021; Twardowski et al., Reference Twardowski, Montemayor, Payton and Walle2023; Williams et al., Reference Williams, Estores and Merlo2020). Although the BRCS was developed more recently, the instrument has similarly been utilized in studies of coping behavior of medical and health professions students (Button et al., Reference Button, Fallon and Fowler2023; Heinen et al., Reference Heinen, Bullinger and Kocalevent2017). Both measures are available for use without proprietary fees.

The PSS-10 measures the extent to which respondents appraise their current life circumstances as stressful. The instrument seeks to “tap how predictable, uncontrollable and overloaded respondents find their lives” (Cohen and Williamson, Reference Cohen, Williamson, Spacapan and Oskamp1988, pp. 33–34). The instrument is a briefer measure derived from the original 14-item scale (Cohen et al., Reference Cohen, Kamarck and Mermelstein1983). The PSS-10 has demonstrated strong psychometric properties, including configural invariance, in a variety of settings and age groups (Lee, Reference Lee2012). Most studies using structural equation modeling (SEM) have reported a two-factor structure comprising perceived helplessness (negatively worded items: 1, 2, 3, 6, 9, 10) and perceived self-efficacy (positively worded items: 4, 5, 7, 8) (Yılmaz Koğar and Koğar, Reference Yılmaz Koğar and Koğar2024). The PSS-10 has been widely validated and employed for research in LMICs and, therefore, is an important tool for global mental health research (see, e.g., Adamson et al., Reference Adamson, Phillips, Seenivasan, Martinez, Grewal, Kang, Coetzee, Luttenbacher, Jester, Harris and Spiegel2020; Katus et al., Reference Katus, Foley, Murray, Luong-Thanh, Taut, Baban, Madrid, Fernando, Sikander, Ward, Osafo, Marlow, Du Toit, Walker, Van Vo, Fearon, Valdebenito, Eisner and Hughes2022; Lai et al., Reference Lai, Lee, Wang, Feng, Lai, Ho, Lam, Ip and Lam2020). A previous SEM study in Barbados (Campbell et al., Reference Campbell, Gromer, Maynard and Emmanuel2019) found acceptable fit for a two-factor model of the PSS-10. However, further analysis of this data indicated a better fit and improved internal consistency for a revised 7-item scale.

The BRCS is a very brief (4-item) scale designed to measure adaptive coping behaviors in response to stress. The instrument was originally developed for use with patients with rheumatoid arthritis (Sinclair and Wallston, Reference Sinclair and Wallson2004), but subsequent studies have established validity and a unidimensional factor structure in more general populations, including a nationally representative sample in Germany (Kocalevent et al., Reference Kocalevent, Zenger, Hinz, Klapp and Brähler2017) and university students in Spain (Limonero et al., Reference Limonero, Tomás-Sábado, Gómez-Romero, Maté-Méndez, Sinclair, Wallston and Gómez-Benito2014). The BRCS has been widely used in recent studies of coping among healthcare providers (HCPs) during the COVID-19 pandemic, including in Egypt (Khalaf et al., Reference Khalaf, Khalil and Abdelmaksoud2020; Sehsah et al., Reference Sehsah, Gaballah, El-Gilany and Albadry2021) and Ethiopia (Tsehay et al., Reference Tsehay, Belete and Necho2020). Cheng et al. (Reference Cheng, Chua, Cheng, Ang and Lau2022) conducted a meta-analysis of resilience among HCPs during the pandemic using several measures, including the BRCS. Some BRCS studies during the pandemic assessed configural invariance and generally supported a unidimensional factor structure, for example, in Italy (Murphy et al., Reference Murphy, Lami and Moret-Tatay2021) and Thailand (Nochaiwong et al., Reference Nochaiwong, Ruengorn, Awiphan, Phosuya, Ruanta, Kanjanarat, Wongpakaran, Wongpakaran and Thavorn2022).

The current study, with a larger and broader regional sample than our previous paper (Campbell et al., Reference Campbell, Gromer, Maynard and Emmanuel2019), seeks to evaluate the appropriateness of the PSS-10 and BRCS for future Caribbean research and to provide a more robust assessment of the psychometric strengths and configural invariance of the measures. Therefore, the aims of this paper are: 1) to describe the presentation of stress and coping behavior reported by Caribbean MHP students in the early stages of the COVID-19 pandemic; and 2) to evaluate the internal consistency, construct validity and factorial structure of the PSS-10 and BRCS in a sample including four Caribbean countries.

Methods

Study design and study sample

This paper capitalizes on a larger, emergently designed cross-sectional study meant to assess the unique needs of MHP students during the early to middle phases of the COVID-19 pandemic. We conducted an anonymous online survey using voluntary response sampling via SurveyMonkey to explore the relationships among readiness for online learning, stress and coping among undergraduate MHP students at The University of the West Indies campuses in The Bahamas, Barbados, Jamaica and Trinidad and Tobago. All MHP students currently enrolled during April–June 2020, during the emergency transition to virtual learning in the early phase of the COVID-19 pandemic, were invited to participate.

Measures

  1. a) Sociodemographic Questionnaire: Participants were asked to provide information on their age, gender, campus country and academic program.

  2. b) Perceived Stress Scale (PSS): The PSS-10 (Cohen and Williamson, Reference Cohen, Williamson, Spacapan and Oskamp1988) was used to assess participants’ perceived stress levels. This 10-item scale measures the degree to which situations in one’s life are appraised as stressful, with higher scores indicating higher levels of perceived stress. Possible scores range from 0 to 40. Although formal cut-off scores are not established, interpretive ranges are 0–13 (minimal stress), 14–26 (moderate stress) and 27–40 (high stress).

  3. c) Brief Resilient Coping Scale (BRCS): The BRCS (Sinclair and Wallston, Reference Sinclair and Wallson2004) was used to assess participants’ ability to cope with stress in a resilient manner. This 4-item scale measures the ability to bounce back or recover from stress, with higher scores indicating greater resilience. Possible scores range from 4 to 20. Interpretive ranges are 4–13 (low resilient coping), 14–16 (medium resilient coping) and 17–20 (high resilient coping).

Ethical considerations

The study protocol was approved by the following research ethics committees: (i) the University of the West Indies-Cave Hill/Barbados Ministry of Health Research Ethics Committee/Institutional Review Board, Barbados (IRB No. 200403-B; April 27, 2020) and (ii) the Campus Research Ethics Committee, the University of the West Indies, St Augustine Campus, Trinidad and Tobago (IRB No. 200403-B; April 28, 2020). No identifying information was collected from participants. The research protocol complied with the Declaration of Helsinki.

Statistical analysis

We examined the psychometric properties and factorial structure of the PSS-10 and BRCS. We evaluated the internal consistency of each measure using both Cronbach’s alpha (Cronbach, Reference Cronbach1951) and McDonald’s Omega (McDonald, Reference McDonald1986). Then, concurrent validity was assessed by correlating both measures. Finally, we explored configural invariance using confirmatory factor analysis (CFA) to test the two-factor structure of the PSS-10 and unidimensional structure of the BRCS reported in previous research. Analyses were conducted with SPSS Version 29.0 and Mplus 6.

Results

Participants

The sample size for the overall study was 1,519 undergraduate MHP students (1,144 females, 372 males, 3 other/did not say). The distribution of participants by campus country is shown in Table 1. The respondents included 1,122 medical (MBBS) students (73.9%); the next largest group comprised 113 pharmacy students (7.4%), followed by 66 dentistry students (4.3%). The remaining students were enrolled in a variety of allied health programs (Table 1). The average age of respondents was 22.9 years (SD = 3.57; range: 18–48).

Table 1. Gender, program and campus country of participants

Initial data screening

Of the 1,519 participants, 1,420 and 1,437 completed the PSS-10 and BRCS, respectively, and were included in the psychometric analysis. No more than 0.3% of data were missing for any item of the PSS-10 or BRCS, and Little’s (Reference Little1988) test suggested that data were missing completely at random for both the PSS-10 (χ 2 (36) = 50.01, p = 0.06) and BRCS (χ 2 (13) = 18.91, p = 0.15). Given this, estimation maximization (EM) was used to impute missing data.

Summary of scores, reliability and validity of the PSS-10 and BRCS

Scores on the PSS-10 ranged from 0 to 40, with a mean of 24.16 (SD = 7.70). Scores on the BCRS ranged from 4 to 20, with a mean of 13.33 (SD = 3.39).

Given concerns about the restrictive assumptions of Cronbach’s alpha (McDonald, Reference McDonald1986) and recommendations of Dunn et al. (Reference Dunn, Baguley and Brunsden2014), we calculated both alpha and McDonald’s omega to assess the internal consistency of both measures (and have reported these to three decimal places to illustrate very modest differences). Internal consistency for the PSS-10 (α = 0.910; ω = 0.912) was excellent according to both measures, which were essentially equivalent in this case. Internal consistency for the PSS-10 subscales was acceptable for perceived self-efficacy (α = 786; ω = 0.786) and good for perceived helplessness (α = 0.897; ω = 0.897). All items contributed to the full scale and their respective subscales.

Internal consistency for the BRCS was good (α = 0.810; ω = 0.813) but less robust than for the PSS-10. Differences between methods of calculating internal consistency were minimal. All items contributed to the full BRCS scale.

Concurrent validity of the PSS-10 and BRCS were examined using Pearson correlation (BRCS; n = 1,420, r = −0.44, p < 0.01). The observed moderate negative correlation between the two scales was as expected.

Factor structure

PSS-10. A CFA using maximum likelihood estimation examined the fit of the two-factor model reported in other samples. Alternate models, including a second-order model and a model of the abbreviated 7-item scale, were also tested but found to have inadequate fit to the data. All items were related to their associated factors, with factor loadings ranging from 0.64 (item 5) to 0.83 (item 10). The path diagram of this model is shown in Figure 1. Except for chi-square and relative chi-square, the fit indices (Table 2) calculated by Mplus 6 were within the acceptable ranges outlined by Kline (Reference Kline2016). The chi-square statistic and its transformations are not generally reliable as bases for model acceptance due in part to sensitivity to sample size (Schermelleh-Engel et al., Reference Schermelleh-Engel, Moosbrugger and Müller2003; Vandenberg, Reference Vandenberg2006). Further, while the fit indices are acceptable under Kline’s (Reference Kline2016) rubric, there are divergent perspectives on model fit (e.g., Hu and Bentler, Reference Hu and Bentler1999; Marsh et al., Reference Marsh, K-T and Wen2004) and under some other standards, the RMSEA would be considered moderate or mediocre.

Figure 1. Path diagram of two-factor model of Perceived Stress Scale (PSS-10).

Table 2. Fit indices for Perceived Stress Scale (PSS-10) CFA model

Note. CFI = comparative fit index; TLI = Tucker-Lewis index; SRMR = standardized root mean square residual; RMSEA = root mean square error of approximation; C.I. = confidence interval.

Note. Acceptable ranges sourced from Kline (Reference Kline2016).

BRCS. A CFA using maximum likelihood estimation confirmed the unidimensional structure of the BRCS. A second-order model was also tested but found to have inadequate fit to the data. Factor loadings were acceptable, ranging from 0.60 (item 1) to 0.80 (item 3). The path diagram for this model is shown in Figure 2. Fit indices, which, except for chi-square and relative chi-square, were all in acceptable ranges, are shown in Table 3. Again, the RMSEA meets the standards used in this study (Kline, Reference Kline2016) but may be considered moderate by those holding diverging perspectives (Hu and Bentler, Reference Hu and Bentler1999; Marsh et al., Reference Marsh, K-T and Wen2004).

Figure 2. Path diagram of one-factor model of Brief Resilient Coping Scale (BRCS).

Table 3. Fit indices for Brief Resilient Coping Scale (BRCS) CFA model

Note. CFI = comparative fit index; TLI = Tucker-Lewis index; SRMR = standardized root mean square residual; RMSEA = root mean square error of approximation; C.I. = confidence interval.

Note. Acceptable ranges sourced from Kline (Reference Kline2016).

Second-order models for both scales were tested for both the PSS-10 and BRCS, but the fit was not adequate for either measure using criteria from Kline (Reference Kline2016).

Gender differences

Significant differences in PSS-10 (t(1405) = −4.59, p < 0.01) and BRCS scores (t(1418) = 3.76, p < 0.01) by gender were observed using independent t tests. For men (n = 338), the mean PSS-10 score was 22.49 (SD = 8.08). For women (n = 1,069), the mean PSS-10 score was 24.68 (SD = 7.50). For men (n = 344), the mean BRCS score was 13.93 (SD = 3.30). For women (n = 1,084), the mean BRCS score was 13.14 (SD = 3.40).

Discussion

Findings support a two-factor structure of the PSS-10 comprising perceived helplessness and perceived self-efficacy subscales and provide further evidence of configural invariance, which is key for comparative research. Internal consistency was acceptable for the PSS-10 and its component subscales. Further, findings support a unidimensional structure of the BRCS and show adequate internal consistency for this measure of resilient coping, at least among the study population of future medical and health professionals in the Anglophone Caribbean. This is evidenced by the fit indices, aside from chi-square and relative chi-square, which are often reported but also outdated and problematic (Schermelleh-Engel et al., Reference Schermelleh-Engel, Moosbrugger and Müller2003; Vandenberg, Reference Vandenberg2006). Although these indices were within the acceptable ranges outlined by Kline (Reference Kline2016) for both scales, there are divergent perspectives on model fit (e.g., Hu and Bentler, Reference Hu and Bentler1999; Marsh et al., Reference Marsh, K-T and Wen2004) and it should be mentioned as a caveat that under some other standards, the RMSEA for both scales would be considered a moderate and therefore questionably acceptable fit.

Even so, the pattern of findings is consistent with extant literature (Kogar and Kogar, Reference Kogar and Kogar2023), including other Caribbean samples (Campbell et al., Reference Campbell, Gromer, Maynard and Emmanuel2019), so we believe that our data provide support for the valid use of the PSS and BRCS among Caribbean healthcare students.

Specifically, these results provide initial support for use of the BRCS as well as increased support for use of the PSS-10 in the Caribbean, building on a previous study (Campbell et al., Reference Campbell, Gromer, Maynard and Emmanuel2019), which included only Barbados and suggested that a modified 7-item scale would provide better fit. Importantly, the two-factor model reported in the current study included all 10 items of the measure, establishing support for use of the unmodified original PSS-10 (Cohen and Williamson, Reference Cohen, Williamson, Spacapan and Oskamp1988) in Caribbean settings.

This study has several important limitations. Voluntary sampling, restriction of participants to MHP students and data collection during the COVID-19 timeframe are important limitations to generalizability of findings. Further research evaluating and employing measures of stress and coping in broader Caribbean contexts is desirable. Several other limitations of this study can be addressed in future research. Because this paper capitalizes on a larger, emergently designed study meant to assess the unique needs of health professions students during the COVID-19 pandemic, some important features of a typical psychometric validation study are absent. For example, test–retest reliability and social desirability among participants were not examined.

With these limitations acknowledged, this paper makes an important contribution by examining the psychometric properties of the PSS-10 and BRCS in a large multi-country sample. Valid and reliable measures of stress and coping are especially important for people living in vulnerable settings, including SIDS, where existing socioeconomic stressors are now compounded by increasing climate threats to health and wellbeing. Measures for these important constructs lack empirical support for use in the Caribbean, where few measures for clinical or research have documented psychometric properties.

In addition to evaluating the appropriateness of the PSS-10 and BRCS for use in the Caribbean, this study sought to describe the presentation of stress and coping behavior reported by Caribbean MHP students in the early stages of the COVID-19 pandemic. Women in this study reported significantly more perceived stress than men, and perceived stress was negatively correlated with resilient coping scores. Extant literature indicates that North American and European women experience more stressful life events and have higher levels of perceived stress (e.g., Costa et al., Reference Costa, Briguglio, Mondello, Teodoro, Pollicino, Canalella, Verduci, Italia and Fenga2021). Globally, however, the effect sizes of gender differences in perceived stress and burnout vary by both region and occupation, suggesting that these differences are highly contextualized (Purvanova and Muros, Reference Purvanova and Muros2010; Templeton et al., Reference Templeton, Bernstein, Sukhera, Nora, Newman, Burstin, Guille, Lynn, Schwarze, Sen and Busis2019). It is worth examining whether the gender differences found here exist outside of the pandemic crisis and whether this difference varies with profession or field of study. Further work should first focus on examining whether the observed gender differences persist beyond the acute phase of the pandemic. Thereafter, research to identify and address factors in Caribbean medical education that contribute to these differences is needed.

Conclusion

Establishing acceptable psychometric properties of the PSS-10 and BRCS in the Caribbean context provides a useful contribution to the armamentarium of measures for Caribbean mental health research. Robust tools for assessing stress and coping are especially important in SIDS, whose people face a complex array of vulnerabilities related to geography, climate threat and socioeconomic factors. Further, both measures are tools for culturally responsive mental health research, intervention and policy development. Future research should further establish use of these scales across diverse communities and contexts in the Caribbean and other SIDS. Established measures of stress and coping are crucial for further work supporting regional resilience efforts in the context of socioeconomic and climate-related stressors.

Open peer review

To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.83.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgements

The authors would like to thank the medical and health professions students who participated in this study during the personal, professional and academic challenges of the COVID-19 pandemic.

Author contribution

M.H.C.: conceptualization; formal analysis; investigation; methodology; project administration; writing-original draft; writing-review & editing. J. G-T.: data curation; formal analysis; investigation; methodology; writing-original draft; writing-review & editing. K.K.: conceptualization; investigation; project administration; writing-review & editing. B.S.: conceptualization; investigation; project administration; writing-review & editing. P.M.L.: project administration; writing-review & editing. D.C.: project administration; writing-review & editing. C.E.C.: project administration; writing-review & editing. R.B.P.: project administration; writing-review & editing. N.O.: project administration; writing-review & editing. A.B.: writing-review & editing. H.H.: writing-review & editing. O.P.A.: project administration; writing-review & editing. M.A.A.M.: conceptualization; formal analysis; investigation; methodology; project administration; writing-original draft; writing-review & editing.

Financial support

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Competing interest

None.

References

Adamson, MM, Phillips, A, Seenivasan, S, Martinez, J, Grewal, H, Kang, X, Coetzee, J, Luttenbacher, I, Jester, A, Harris, OA and Spiegel, D (2020) International prevalence and correlates of psychological stress during the global COVID-19 pandemic. International Journal of Environmental Research and Public Health 17(24), 9248. https://doi.org/10.3390/ijerph17249248.CrossRefGoogle ScholarPubMed
Alea, N and Ali, S (2018) A spotlight on psychological measurement and methodology in the Caribbean: A special issue of the Caribbean journal of psychology. Caribbean Journal of Psychology 10, 713.Google Scholar
Birthwright, AT and Smith, RA (2023) Put the money where the gaps are: Priority areas for climate resilience research in the Caribbean. PLOS Climate 2(5), e0000211. https://doi.org/10.1371/journal.pclm.0000211.CrossRefGoogle Scholar
Button, P, Fallon, L and Fowler, K (2023). The impact of perceived social support and coping on distress in a sample of Atlantic Canadian health professional students during COVID-19 compared to pre-COVID peers. BMC Psychology 11(1), 175.CrossRefGoogle Scholar
Campbell, MH and Greaves, N (2022) Caribbean mental health professionals support climate resilience through community engagement, disaster response, and research. International Review of Psychiatry 34(5), 516519. https://doi.org/10.1080/09540261.2022.2093101.CrossRefGoogle ScholarPubMed
Campbell, MH, Gromer, J, Maynard, D and Emmanuel, MK (2019) Measuring stress in Caribbean university students: Validation of the PSS-10 in Barbados. Caribbean Journal of Psychology 10, 6588. https://www.uwipress.com/cjp-vol-10-i2-a3/Google Scholar
Cheng, CKT, Chua, JH, Cheng, LJ, Ang, WHD and Lau, Y (2022) Global prevalence of resilience in health care professionals: A systematic review, meta‐analysis and meta‐regression. Journal of Nursing Management 30(3), 795816. https://doi.org/10.1111/jonm.13558.CrossRefGoogle ScholarPubMed
Chutiyami, M, Cheong, AM, Salihu, D, Bello, UM, Ndwiga, D, Maharaj, R, Naidoo, K, Kolo, MA, Jacob, P, Chhina, N, Ku, TK, Devar, L, Pratitha, P and Kannan, P (2022) COVID-19 pandemic and overall mental health of healthcare professionals globally: A meta-review of systematic reviews. Frontiers in Psychiatry 12, 2600. https://doi.org/10.3389/fpsyt.2021.804525.CrossRefGoogle ScholarPubMed
Cockburn, BN and Chami, G (2022) Responding to the COVID-19: Technology and tertiary education. In Chami, G, Teelucksingh, J and Anatol, M (eds), Managing New Security Threats in the Caribbean. Palgrave Macmillan, 127152. https://doi.org/10.1007/978-3-030-98733-6_6.CrossRefGoogle Scholar
Cohen, S, Kamarck, T and Mermelstein, R (1983) A global measure of perceived stress. Journal of Health and Social Behavior 24, 385396. https://doi.org/10.2307/2136404.CrossRefGoogle ScholarPubMed
Cohen, S and Williamson, G (1988) Perceived stress in a probability sample of the United States. In Spacapan, S and Oskamp, S (eds), The Social Psychology of Health, 3167. Newbury Park, CA: Sage.Google Scholar
Costa, C, Briguglio, G, Mondello, S, Teodoro, M, Pollicino, M, Canalella, A, Verduci, F, Italia, S and Fenga, C (2021). Perceived stress in a gender perspective: A survey in a population of unemployed subjects of Southern Italy. Frontiers in Public Health 9, 640454. https://doi.org/10.3389/fpubh.2021.640454.CrossRefGoogle Scholar
Cronbach, LJ (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 297334. https://doi.org/10.1007/BF02310555.CrossRefGoogle Scholar
Crosswell, AD and Lockwood, KG (2020) Best practices for stress measurement: How to measure psychological stress in health research. Health Psychology Open 7(2), 2055102920933072. https://doi.org/10.1177/2055102920933072.CrossRefGoogle ScholarPubMed
Dudley-Grant, GR and Etheridge, W (2007) Caribbean Blacks (Haitians, Jamaicans, Virgin Islanders, Eastern Caribbean): Responses to disasters in cultural context. In Marsella, AJ, Johnson, J and Watson, P (eds), Ethnocultural Perspectives on Disaster and Trauma: Foundations, Issues, and Applications. New York, NY: Springer, 209240. https://doi.org/10.1007/978-0-387-73285-5_7.Google Scholar
Dunn, TJ, Baguley, T and Brunsden, V (2014) From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. British Journal of Psychology 105(3), 399412. https://doi.org/10.1111/bjop.12046.CrossRefGoogle Scholar
Granger, OE (1997) Caribbean Island states: Perils and prospects in a changing global environment. Journal of Coastal Research 24, 7193. https://www.jstor.org/stable/i25736082.Google Scholar
Heinen, I, Bullinger, M and Kocalevent, RD (2017). Perceived stress in first year medical students-associations with personal resources and emotional distress. BMC Medical Education 17(4), 114. https://doi.org/10.1186/s12909-016-0841-8.CrossRefGoogle ScholarPubMed
Hu, LT and Bentler, PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling 6(1), 155. https://doi.org/10.1080/10705519909540118.CrossRefGoogle Scholar
Katus, L, Foley, S, Murray, AL, Luong-Thanh, BY, Taut, D, Baban, A, Madrid, B, Fernando, AD, Sikander, S, Ward, CL, Osafo, J, Marlow, M, Du Toit, S, Walker, S, Van Vo, T, Fearon, P, Valdebenito, S, Eisner, MP and Hughes, C (2022) Perceived stress during the prenatal period: Assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity. Archives of Women’s Mental Health 25(3), 633640. https://doi.org/10.1007/s00737-022-01229-5.CrossRefGoogle Scholar
Khalaf, OO, Khalil, MA and Abdelmaksoud, R (2020) Coping with depression and anxiety in Egyptian physicians during COVID-19 pandemic. Middle East Current Psychiatry 27(1), 17. https://doi.org/10.1186/s43045-020-00070-9.CrossRefGoogle Scholar
Kline, RB (2016) Methodology in the Social Sciences. Principles and Practice of Structural Equation Modeling, 4th edn. New York: Guilford Press.Google Scholar
Kocalevent, RD, Zenger, M, Hinz, A, Klapp, B and Brähler, E (2017). Resilient coping in the general population: Standardization of the brief resilient coping scale (BRCS). Health and Quality of Life Outcomes 15(1), 18. https://doi.org/10.1186/s12955-017-0822-6.CrossRefGoogle ScholarPubMed
Kogar, EY and Kogar, H (2023) A systematic review and meta-analytic confirmatory factor analysis of the perceived stress scale (PSS-10 and PSS-14). Stress and Health 40(1). https://doi.org/10.1002/smi.3285.Google Scholar
Lai, AY, Lee, L, Wang, MP, Feng, Y, Lai, TT, Ho, LM, Lam, VS, Ip, MS and Lam, TH (2020) Mental health impacts of the COVID-19 pandemic on international university students, related stressors, and coping strategies. Frontiers in Psychiatry 11, 584240. https://doi.org/10.3389/fpsyt.2020.584240.CrossRefGoogle ScholarPubMed
Lambert, MC, Levitch, A, Robinson, J and Sweeney, TW (2018) Psychometric concerns associated with using psychological assessment tools from Eurocentric countries in Anglophone Caribbean nations. The Caribbean Journal of Psychology 10(1), 91119.Google Scholar
Lambert, MC, Sewell, WC and Levitch, AH (2016) Metamorphosing Euro American psychological assessment instruments to measures developed by and for English-speaking Caribbean people. In Roopnarine, JL and Chadee, D (eds), Caribbean Psychology: Indigenous Contributions to a Global Discipline. Washington, DC: American Psychological Association, pp. 327355. https://doi.org/10.1037/14753-014.CrossRefGoogle Scholar
Landis, RC (2021) Coronavirus and CARICOM: The benefit of a regional university in a coherent pandemic response. In Campbell, Y and Connell, J (eds), COVID in the Islands: A Comparative Perspective on the Caribbean and the Pacific. Singapore: Palgrave Macmillan, 7191. https://doi.org/10.1007/978-981-16-5285-1_4.Google Scholar
Lee, EH (2012) Review of the psychometric evidence of the Perceived Stress Scale. Asian Nursing Research 6(4), 121127. https://doi.org/10.1016/j.anr.2012.08.004.CrossRefGoogle Scholar
Limonero, JT, Tomás-Sábado, J, Gómez-Romero, MJ, Maté-Méndez, J, Sinclair, VG, Wallston, KA and Gómez-Benito, J (2014). Evidence for validity of the Brief Resilient Coping Scale in a young Spanish sample. The Spanish Journal of Psychology 17, E34. https://doi.org/10.1017/sjp.2014.35.CrossRefGoogle Scholar
Little, RJA (1988) A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association 83(404), 11981202. https://doi.org/10.2307/2290157.CrossRefGoogle Scholar
Marsh, HW, K-T, Hau and Wen, Z (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling 11(3), 320341. https://doi.org/10.1207/s15328007sem1103_2.CrossRefGoogle Scholar
McDonald, RP (1986) Describing the elephant: Structure and function in multivariate data. Psychometrika 51, 513534. https://doi.org/10.1007/BF02295591.CrossRefGoogle Scholar
Murphy, M, Lami, A and Moret-Tatay, C (2021) An Italian adaptation of the Brief Resilient Coping Scale (BRCS) and attitudes during the COVID-19 outbreak. Frontiers in Psychology 12, 641213. https://doi.org/10.3389/fpsyg.2021.641213.CrossRefGoogle Scholar
Nochaiwong, S, Ruengorn, C, Awiphan, R, Phosuya, C, Ruanta, Y, Kanjanarat, P, Wongpakaran, N, Wongpakaran, T and Thavorn, K (2022) Transcultural adaptation and psychometric validation of the Thai-Brief Resilient Coping Scale: A cross-sectional study during the coronavirus disease 2019 pandemic in Thailand. Scientific Reports 12(1), 21521. https://doi.org/10.1038/s41598-022-26063-8.CrossRefGoogle Scholar
Peng, P, Hao, Y, Liu, Y, Chen, S, Wang, Y, Yang, Q, Wang, X, Li, M, Wang, Y, He, L, Wang, Q, Ma, Y, He, H, Zhou, Y, Wu, Q and Liu, T (2023) The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis. Journal of Affective Disorders 321, 167181. https://doi.org/10.1016/j.jad.2022.10.040.CrossRefGoogle Scholar
Pfeifer, J, Egger, A, Hughes, M, Tondl, L, High, R. and Nelson, KL (2022) An investigation of stress and anxiety among health professions students in the early stages of the COVID-19 pandemic. Journal of Interprofessional Education & Practice 28, 100531. https://doi.org/10.1016/j.xjep.2022.100531.CrossRefGoogle ScholarPubMed
Puranachaikere, T, Hataiyusuk, S, Anupansupsai, R, In-Iw, S, Saisavoey, N, Techapanuwat, T, Arunrodpanya, F, Charonpongsuntorn, C, Wiwattanaworaset, P, Siripongpan, A, Pruttithavorn, W, Wonglertwisawakorn, C, Pojanapotha, P, Rueangrong, B, Pattrakornkul, N, Piyawattanametha, N, Piyawattanametha, S and Ratanapichayachai, D (2021). Stress and associated factors with received and needed support in medical students during COVID-19 pandemic: A multicenter study. Korean Journal of Medical Education 33(3), 203213. https://doi.org/10.3946/kjme.2021.200.CrossRefGoogle Scholar
Purvanova, RK. and Muros, JP (2010) Gender differences in burnout: A meta-analysis. Journal of Vocational Behavior 77(2), 168185. https://doi.org/10.1016/j.jvb.2010.04.006.CrossRefGoogle Scholar
Rhiney, K and Baptiste, AK (2019). Adapting to climate change in the Caribbean: Existential threat or development crossroads? Caribbean Studies 47(2), 5980. https://www.jstor.org/stable/45380283.CrossRefGoogle Scholar
Rise, N, Oura, C and Drewry, J (2022) Climate change and health in the Caribbean: A review highlighting research gaps and priorities. The Journal of Climate Change and Health 8, 100126. https://doi.org/10.1016/j.joclim.2022.100126.CrossRefGoogle Scholar
Salanti, G, Pete, N, Tonia, T, Holloway, A, White, IR, Darwish, L, Low, N, Egger, M, Haas, AD, Fazel, S, Kessler, RC, Herrman, H, Kieling, C, DJF, De Quervain, Vigod, SN, Patel, V, Li, T, Cuijpers, P, Cipriani, A, Furukawa, TA, Leucht, S, MHCOVID Crowd Investigators, Sambo, AU, Onishi, A, Sato, A, Rodolico, A, Oliveira Solis, AC, Antoniou, A, Kapfhammer, A, Ceraso, A, O’Mahony, A, Lasserre, AM, Ipekci, AM, Concerto, C, Zangani, C, Igwesi-Chidobe, C, Diehm, C, Demir, DD, Wang, D, Ostinelli, EG, Sahker, E, Beraldi, GH, Erzin, G, Nelson, H, Elkis, H, Imai, H, Wu, H, Kamitsis, I, Filis, I, Michopoulos, I, Bighelli, I, JSW, Hong, Ballesteros, J, Smith, KA, Yoshida, K, Omae, K, Trivella, M, Tada, M, Reinhard, MA, Ostacher, MJ, Müller, M, Jaramillo, NG, Ferentinos, PP, Toyomoto, R, Cortese, S, Kishimoto, S, Covarrubias-Castillo, SA, Siafis, S, Thompson, T, Karageorgiou, V, Chiocchia, V, Zhu, Y, Honda, Y and MHCOVID Crowd Investigators. (2022). The impact of the COVID-19 pandemic and associated control measures on the mental health of the general population: A systematic review and dose–response meta-analysis. Annals of Internal Medicine 175(11), 15601571. https://doi.org/10.7326/M22-1507.CrossRefGoogle ScholarPubMed
Schermelleh-Engel, K, Moosbrugger, H and Müller, H (2003) Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online 8(2), 2374.Google Scholar
Sehsah, R, Gaballah, MH, El-Gilany, AH and Albadry, AA (2021) Psychological distress among Egyptian physicians during COVID-19 pandemic. International Archives of Occupational and Environmental Health 94, 731740. https://doi.org/10.1007/s00420-020-01624-4.CrossRefGoogle ScholarPubMed
Seon, Q, Greaves, N, Campbell, MH, Anderson, SG, Henry, P, Augustus, E, Simeon, D, Cummings, E, Kendall, L, Wheeler, E, Vercammen, A, Lawrence, E, Seemungal, T, Gold, I and Maharaj, SB (2024). Exploratory empirical model of combined effects of COVID-19 and climate change on youth mental health. Nature Mental Health 2, 218227. https://doi.org/10.1038/s44220-023-00197-8.CrossRefGoogle Scholar
Shultz, JM, Sands, DE, Holder-Hamilton, N, Hamilton, W, Goud, S, Nottage, KM, Espinel, Z, Friedman, S, Fugate, C, Kossin, JP and Galea, S (2020) Scrambling for safety in the eye of Dorian: Mental health consequences of exposure to a climate-driven hurricane: Study examines the mental health consequences of exposure to Hurricane Dorian. Health Affairs 39(12), 21202127. https://doi.org/10.1377/hlthaff.2020.01203.CrossRefGoogle Scholar
Sinclair, V., and Wallson, K. (2004). The development and Psychometric evaluation of the Brief Resilient Coping Scale. Assessment 11(1), 94101.CrossRefGoogle ScholarPubMed
Templeton, K, Bernstein, CA, Sukhera, J, Nora, LM, Newman, C, Burstin, H, Guille, C, Lynn, L, Schwarze, ML, Sen, S and Busis, N (2019) Gender-based differences in burnout: Issues faced by women physicians. NAM Perspectives. Discussion Paper. Washington, DC: National Academy of Medicine. https://doi.org/10.31478/201905a.Google Scholar
Torres-Llenza, V and Safran, J (2021) Community response to disaster: Hurricanes in the Caribbean. In Dyer, AR, Kohrt, BA and Candilis, PJ (eds), Global Mental Health Ethics. Cham: Springer International Publishing, 351365.CrossRefGoogle Scholar
Tsehay, M, Belete, A and Necho, M (2020) Factors associated with psychological distress and brief resilient coping level during the COVID-19 pandemic among health-care professionals in Dessie, Ethiopia. Psychology Research and Behavior Management 13, 12131221. https://doi.org/10.2147/PRBM.S288562.CrossRefGoogle Scholar
Twardowski, D, Montemayor, J, Payton, M and Walle, J (2023). Impact of the USMLE Step 1 and COMLEX Level 1 transition to pass/fail on osteopathic medical student stress levels and board preparation. Journal of Osteopathic Medicine 123(12), 563569. https://doi.org/10.1515/jom-2023-0045.CrossRefGoogle ScholarPubMed
Vandenberg, RJ (2006) Introduction: Statistical and methodological myths and urban legends: Where, pray tell, did they get this idea? Organizational Research Methods 9(2), 194201. https://doi.org/10.1177/1094428105285506.CrossRefGoogle Scholar
Williams, MK, Estores, IM and Merlo, LJ (2020). Promoting resilience in medicine: The effects of a mind–body medicine elective to improve medical student well-being. Global Advances in Integrative Medicine and Health 9, 2164956120927367. https://doi.org/10.1177/2164956120927367.Google Scholar
Yılmaz Koğar, E and Koğar, H (2024). A systematic review and meta-analytic confirmatory factor analysis of the perceived stress scale (PSS-10 and PSS-14). Stress and Health: Journal of the International Society for the Investigation of Stress 40(1), e3285. https://doi.org/10.1002/smi.3285.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Gender, program and campus country of participants

Figure 1

Figure 1. Path diagram of two-factor model of Perceived Stress Scale (PSS-10).

Figure 2

Table 2. Fit indices for Perceived Stress Scale (PSS-10) CFA model

Figure 3

Figure 2. Path diagram of one-factor model of Brief Resilient Coping Scale (BRCS).

Figure 4

Table 3. Fit indices for Brief Resilient Coping Scale (BRCS) CFA model

Author comment: Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic — R0/PR1

Comments

Dear Professors Bass and Chibanda,

I write on behalf of my colleagues to submit the manuscript entitled, “Measuring Caribbean Stress and Resilient Coping: Psychometric Properties of the PSS-10 and BRCS in a Multi-Country Study During the COVID-19 Pandemic.” This paper presents findings from a four-country study measuring perceived stress and resilient coping in a sample of more than 1500 English-speaking Caribbean students in medicine and allied health professions during the early stages of the COVID-19 pandemic. We recognize that a number of papers examining stress and resilient coping during the pandemic have been published previously but believe that this study adds particular value by providing evidence from a large regional sample for reliability, construct validity, and configural invariance of two measures frequently used, but much less frequently evaluated psychometrically, in mental health research among Caribbean people.

All authors have contributed to and reviewed this final submission. There are no conflicts of interest to declare, and there are no requirements from funders to consider. Please note that Dr. Majumder (the last author) and I have agreed to be joint corresponding authors on this paper and hope that this is permissible. I have agreed to be the point of contact for all communication to facilitate consideration and any needed revision of our work.

Thanks for your consideration of our submission.

Best wishes,

Mike Campbell

Recommendation: Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic — R0/PR2

Comments

No accompanying comment.

Decision: Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic — R0/PR3

Comments

No accompanying comment.

Author comment: Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic — R1/PR4

Comments

No accompanying comment.

Recommendation: Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic — R1/PR5

Comments

No accompanying comment.

Decision: Measuring Caribbean stress and resilient coping: Psychometric properties of the PSS-10 and BRCS in a multi-country study during the COVID-19 pandemic — R1/PR6

Comments

No accompanying comment.