The development of a Thai Adolescent Stress Test (TAST)

Main Article Content

Katchaneeya Wanarome
Sirichai Hongsanguansri
Komsan Kiatrungrit
Masatha Thongpan
Wanlop Atsariyasing


Objective: To develop a Thai adolescent stress test (TAST) assessment with statistical qualifications that are well-trusted at an acceptable level and used for tracking the stress level of Thai adolescents aged 12 to 18.

Methods: To develop a stress assessment for surveying the stress among Thai adolescents aged 12 to 18 years based on reviewing literature about stress theory and stress questionnaires both in Thailand and abroad, along with a focus group interview of 23 students in grades 7 to 12 studying in Bangkok Metropolitan Region, the generated assessment was divided into two parts: the level of stress and the causes of stress. The tool’s quality was then assessed by three experts using the content validity index (CVI) approach and evaluated with a trial group to determine internal consistency and test-retest reliability, revealing that the assessment has a high level of reliability. Then, a purposive sampling of 439 students in grades 7 to 12 across Thailand was recruited to complete the assessment via a google form. After that, 100 students were selected using quota sampling to enter the interview process via Zoom and Webex applications and assessed for their stress level with the clinician rate by four child and adolescent psychiatrists. The first 20 students were calibrated, and another 80 were used to analyze the data. Descriptive statistics were used to analyze general information. The intra-class correlation coefficient (ICC) was used to assess inter-evaluator confidence. The Pearson correlation was used to examine the association between the Thai adolescent stress test and the clinician rate. The stress score criteria were determined using ROC analysis, the grouping and exclusion of questionnaire questions using exploratory factor analysis and item analysis, respectively.

Results: The trial group data collection revealed equal internal consistency for both parts of the TAST assessment, which was a high statistical result (α = 0.973). The test-retest reliability showed that the intra-class correlation (ICC) for part 1 level of stress in single and average measures were 0.895 and 0.945 respectively, and 0.850 and 0.919 for the causes of stress, which is part 2 of the TAST. The analysis of data collected from a sample of 439 students, exploratory factor analysis (EFA), indicated that part 1 of the TAST was divided into 4 components with a factor loading greater than 0.4 for all items. The item analysis was used to analyze part 2, revealing a corrected item-total correlation greater than 0.5 for all items. The Thai adolescent stress test scores were significantly correlated with the scores of the child and adolescent psychiatrists interviewed (p < 0.001, r = 0.734). The inter-rater reliability analysis revealed that assessors were consistent at a high level (single measures = 0.806, average measure = 0.943).

Conclusion: Thai Adolescent Stress Test (TAST) is found to be reliable at an acceptable level, which makes it appropriate to track Thai adolescents' stress levels.

Article Details

How to Cite
Wanarome, K., Hongsanguansri, S. ., Kiatrungrit, K. ., Thongpan, M. ., & Atsariyasing, W. . (2023). The development of a Thai Adolescent Stress Test (TAST). Journal of the Psychiatric Association of Thailand, 68(1). Retrieved from
Original Articles


Pascoe AC, Hetrick SE, Parker AG. The impact of stress on students in secondary school and higher education. Int J Adolesc Youth 2019;25(1):104-112. (Internet). World Mental Health Day 2020 Podcast making waves to promote youth mental health in Thailand (updated 2020 Oct 10; cited 2020 Dec 12). Available from: (Internet). According to the Department of Mental Health, Thai teenagers consult the most about "stress problems". Provide stress-management techniques (updated 2020 Feb 11; cited 2020 Dec 12). Available from:

Suanprung Hospital Department of Mental Health. Suanprung Stress Test-20 (Brochure). Nonthaburi: Department of Mental Health Ministry of Public Health; 2007.

Mahatnirankul S, Pumpisanchai W, Tapanya P. The construction of Suan Prung Stress Test for Thai population. Bulletin of Suanprung 1997:13(3):1-20.

Jakkapan S, Wanitcharommanee K, Chuprayoon L, Chaiyasit W, Pornpipatkul S, Usaha S, et al. Development of Thai Computerized Self-Analysis Stress Test. Nonthaburi: Department of Mental Health Ministry of Public Health; 1995.

Phattharrayuttawat S, Ngamthipwattana T, Sukhatungkha K. The development of the Thai Stress Test. J Psychiatr Assoc Thailand 2000;45(3):237-50.

Wongpakaran N, Wongpakaran T. The Thai version of the PSS-10: An investigation of its psychometric properties. Biopsychosoc Med 2010;4:1-6.

Byrne DG, Davenport SC, Mazanov J. Profiles of adolescent stress: the development of the adolescent stress questionnaire (ASQ). J Adolesc. 2007;30(3):393-416.

Mental Health America of Northern Kentucky & Southwest Ohio (Internet). Teen Stress Test. (cited 2021 May 23). Available from:

Strubbe MA. An assessment of early adolescent stress factors. Middle School Research Selected Studies1989;14(1):47-59.

Janjaroen K. Identifying population and sample. In: Jirojanakul P, ed. Nursing research: concepts, principles, and practices. 2nd ed. Nonthaburi: Praboromarajchanok Institute, Ministry of Public Health; 2009. p.85-114.

Sathirapanya C, Witthaya H. Stress among students in university. J of Lib Arts Maejo Uni 2013;1(1):42-58.

Kaewsomnuck S. The effectiveness of coping skills training program for lower secondary school students (dissertation). Nakhon Pathom: Mahidol University; 2016.

Shahsavarani AM, Marz Abadi EA, Kalkhoran MH. Stress: Facts theories through literature review. IJMR 2015;2(2):230-241.

American Psychological Association (Internet). Stress in America Generation Z (updated 2018 Oct; cited 2021 May 18). Available from: (Internet). Work-Related Stress. Melbourne: Deakin University. (updated 2019 Sep 5; cited 2021 May 25). Available from:

Mingprasert A. A study of mental health and the stress of undergraduate students in Faculty of Pharmacy at Rangsit University. J of Soc Sci & Hum 2014;40(2):211-27.

Krohne HW. Stress and coping theories. IESBS 2001:15163-15170.

Areemit R. Growth and development during adolescence. In: Areekul W, Hongsanguansri S, Tripathi S, Manaboriboon B, Prasertwit J, Iniw S, editors. Practical points in adolescent health care. Bangkok: A-plus print; 2012. p.11-18.

Noipayak P, Rawdaree P, Supawattanabodee B, Manusirivitthaya S. Factor associated with early age at menarche among Thai adolescents in Bangkok: A cross-sectional study. BMC Women’s Health 2017;17:16.

Rukumnuaykit P. A study of the situation of puberty in Thai girl children. Paper presented at the results of A study of the situation of puberty in Thai girl children 2020 Conference; 2020 Oct 29; Bangkok, Thailand.

Lortrakul M, Sukanich P. Ramathibodi Psychiatry. 4th ed. Bangkok: Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; 2015.

Thawaroj C. The analysis of Andrei Tarkovsky’s personality through the film “the mirror” (dissertation). Pathum Thani: Thammasart University; 2017.

Sadock BJ, Sadock VA, eds. Kaplan & Sadock’s comprehensive textbook of psychiatry, 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

Lewis M, ed. Child and adolescent psychiatry: a comprehensive textbook. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2002.

Shapiro T, Hertzig ME. Normal child and adolescent development. In: Hales RE, Yudofsky SC, editors. Essentials of clinical psychiatry. Washington, DC: American Psychiatric Publishing. Inc.;1999. p.29-54.

Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry.11th ed. Philadelphia: Lippincott Williams & Wilkins; 2015.

Hauser-Cram P, Nugent JK, Thies K, Travers JF. Development of children and adolescents. New Jersey: John Wiley & Sons; 2014.

Child and Adolescent Psychiatric Association of Thailand. Textbook of child and adolescent psychiatry. Vol. 2. Bangkok: Thana press; 2007.

Piaget J. The origins of intelligence in children. New York: International Universities Press; 1952.

Takashi Naito. Moral development. In Kenneth D, Keith ED, editors. The encyclopedia of cross-cultural psychology. New York: John Wiley & Sons; 2013. p.891-897.

Kohlberg L. Essays on moral development, Vol. 2: the psychology of moral development. San Francisco: Harper and Row; 1984.

Center for morality promotion. An analysis of trends in Thai people's moral and ethical development. Bangkok: center for morality promotion; 2008.

Coward IG. Adolescent stress: Causes, consequences, and communication as an interventional model. CJFY 2018;10(1):25-51.