The development of a Thai Adolescent Stress Test (TAST)

Abstract

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.