Systematic review of literature on stress assessment and evaluation: Methods, instruments, and applications in current biopsychosocial sciences

Amir Mohammad Shahsavarani, Mersedeh Esmatnia, Mina Fayazi, Maryam Hakimi Kalkhoran, Fatemeh Shahcheraghi, Kolsoum Sattari


Introduction: Stress has become an inevitable component of postmodern era extending its shade from inner world of mind to intercontinental and global issues. Every deliberate planning especially policy making for public health needs to evaluate the level of stress at first (implicitly affected by diathesis-stress model). The present study is devoted to systematically review of the psychosocial stress-related literature. 

Materials and Methods: With the keywords of this systematic review 9 scientific search engines sere searched for Persian and English relevant literature. According to relation to study parts, academic publishing, date of publication and Jadad system, relevant sources were selected. The manuscript then, finalized by evaluation of six experts in psychosocial stress domain via Delphi method.

Results: The final structure of the results encompassed six autoclitic inventories, two method of raters’ ratings, seven biological and physiological methods, three neurological methods, and seven executive functioning inspections.

Conclusion: It appears that there are several methodological issues in order to improve the process of stress assessment. Authors’ opinion about the optimum methodology, incorporation of biopsychosocial approach, currents limits, obstacle, feature directions and foresighting has been discussed.



Keywords: Stress, stress assessment, stress evaluation, systematic review, biopsychosocial model, Jadad, Delphi method.


Stress; stress assessment; stress evaluation; systematic review; biopsychosocial model; Jadad; Delphi method

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De Raeve L, Kant I, Jansen NW, Vasse RM, van den Brandt PA. Changes in mental health as a predictor of changes in working time arrangements and occupational mobility: results from a prospective cohort study. Journal of Psychosomatic Research. 2009;66(2): 137-145.

Edwards JA, Webster S, Van Laar D, Easton S. Psychometric analysis of the UK Health and Safety Executive's Management Standards work-related stress Indicator Tool. Work & Stress. 2008;22(2):96-107.

Vogel S, Schwabe L. Stress in the zoo: Tracking the impact of stress on memory formation over time. Psychoneuroendocrinology. 2016;71:64-72.

Tucker JS, Sinclair RR, Mohr CD, Adler AB, Thomas JL, Salvi AD. A temporal investigation of the direct, interactive, and reverse relations between demand and control and affective strain. Work & Stress. 2008;22(2):81-95.

Shahsavarani AM, Azad Marz Abadi E, Hakimi Kalkhoran M. Stress: Facts and theories through literature review. International Journal of Medical Reviews (IJMR). 2015;2(2):230-41.

Monroe SM, Cummins LF. Stress: Psychological Perspectives. In: Wright JD, editor. International Encyclopedia of the Social & Behavioral Sciences. 23. 2nd ed. Oxford: Elsevier; 2015. p. 583-7.

Taveira AD, Smith MJ. Social and organizational foundations of regonomics. In: Salvendy G, editor. Handbook of human factors and ergonomics. 4th ed. Hoboken, NJ, USA: John Wiley & Sons, Inc.; 2012. p. 274-97.

Lindegard A, Jonsdottir IH, Borjesson M, Lindwall M, Gerber M. Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion. BMC psychiatry. 2015;15:272.

Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic medicine: Journal of the Association of American Medical Colleges. 2006;81(4):354-73.

Grossi G, Perski A, Evengard B, Blomkvist V, Orth-Gomer K. Physiological correlates of burnout among women. Journal of Psychosomatic Research. 2003;55(4):309-16.

Burton CL, Bonanno GA, Hatzenbuehler ML. Familial social support predicts a reduced cortisol response to stress in sexual minority young adults. Psychoneuroendocrinology. 2014;47:241-5.

Wegner M, Schuler J, Budde H. The implicit affiliation motive moderates cortisol responses to acute psychosocial stress in high school students. Psychoneuroendocrinology. 2014;48:162-8.

Association AP. Diagnostic ans statistical manual of mental disorders (DSM-5). Arlington, VA, USA: American Psychiatric Association (APA); 2013.

Vicianova M. Historical Techniques of Lie Detection. Europe's journal of psychology. 2015;11(3):522-34.

Petticrew M, Roberts H. Systematic reviews in the social sciences. New York, NY, USA: Wiley Blackwell; 2006.

Valentine JC, Pigott T. D., Lau T. Systematic reviewing and meta-analysis. In: Wright JD, editor. International Encyclopaedia of the Social & Behavioral Sciences 2 ed. 23. Cambridge, MA, USA: Elsevier; 2015. p. 906-13.

Jadad AR, Murray E. Randomized Controlled Trials: Questions, Answers and Musings (2nd Ed.). New York, NY, USA: Blackwell; 2007.

Green KC, Armstrong J, Graefe A. Methods to Elicit Forecasts from Groups: Delphi and Prediction Markets Compared. Foresight: The International Journal of Applied Forecasting. 2007;4999(23):1-7.

Albert M. Delphi Method: 48 Most Asked Questions on Delphi Method - What You Need to Know (Success Secrets). Brisbane, QLD, Australia: Emereo Publishing; 2014.

Shields GS, Sazma MA, Yonelinas AP. The effects of acute stress on core executive functions: A meta-analysis and comparison with cortisol. Neuroscience & Biobehavioral Reviews. 2016;68:651-68.

Rezaei AM. Development and validation of short form of "Iran Police Stress Scale" (IPSS-A) with factor analysis. Daneshvar Raftar. 2006;13(16):37-48.

Smith ML. Rethinking cognition and behavior in the new classification for childhood epilepsy: Examples from frontal lobe and temporal lobe epilepsies. Epilepsy & Behavior. 20(16); Article in Press, doi: 10.1016/j.yebeh.2016.04.050.

Azad Marz Abadi E, Qolami Fesharaki M. Influnetial factors on occupational stress of military staff. Journal of Military Medicine. 2011;13(1):1-6.

Zhao C, Zhao M, Liu J, Zheng C. Electroencephalogram and electrocardiograph assessment of mental fatigue in a driving simulator. Accident Analysis & Prevention. 2012;45:83-90.

Heidari A, Sangari ZN. The comparison of emotional inability, attachment, and stress among married male and female perssonel of Ahwaz National Drilling Company. New Findings in Psychology. 2011;5(20):21-40.

Wu S, Li H, Zhu W, Lin S, Chai W, Wang X. Effect of work stressors, personal strain, and coping resources on burnout in Chinese medical professionals: a structural equation model. Industrial health. 2012;50(4):279-87.

Van Droogenbroeck F, Spruyt B, Vanroelen C. Burnout among senior teachers: Investigating the role of workload and interpersonal relationships at work. Teaching and Teacher Education. 2014;43:99-109.

Laranjeira C. EPA-0753 – Factor structure of maslach burnout inventory among portuguese nurses. European Psychiatry. 2014;29, Supplement 1:1.

Moqadam ZB, Maleki N, Kian FR, Hosseini M. Prevalence of burnout in midwives of Hospitals and clinics which are under supreviosion of Tehran University of Medical Sciences. Payesh Journal. 2014;13(3):339-46.

Kim JM, Stewart R, Kim SW, Kang HJ, Kim SY, Lee JY, et al. Interactions between a serotonin transporter gene, life events and social support on suicidal ideation in Korean elders. Journal of Affective Disorders. 2014;160:14-20.

Sadrossadat J, Hooshyari Z, Sadrossadat L. The construction and norm-finding of rating scale in elderly stressors. Iranian Journal of Ageing. 2013;8(1):24-32.

McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). Journal of anxiety disorders. 2014;28(2):259-65.

Tonsing KN. Psychometric properties and validation of Nepali version of the Depression Anxiety Stress Scales (DASS-21). Asian Journal of Psychiatry. 2014;8:63-6.

Matsuzaki K, Uemura H, Yasui T. Associations of menopausal symptoms with job-related stress factors in nurses in Japan. Maturitas. 2014;79(1):77-85.

Jafari A, Majd MA, Esfandiari Z. Relation between personality charactersitics and occupational stress coping styles in nurses. Nursing Management Quarterly. 2012;1(4):28-34.

Rutledge T, Nidich S, Schneider RH, Mills PJ, Salerno J, Heppner P, et al. Design and rationale of a comparative effectiveness trial evaluating transcendental meditation against established therapies for PTSD. Contemporary clinical trials. 2014;39(1):50-6.

Wen W, Qiu Y, Liu G, Cheng N, Huang X. Construction and cross-correlation analysis of the affective physiological response database. Science China Information Sciences. 2010;53(9):1774-84.

Steinisch M, Yusuf R, Li J, Stalder T, Bosch JA, Rahman O, et al. Work stress and hair cortisol levels among workers in a Bangladeshi ready-made garment factory - Results from a cross-sectional study. Psychoneuroendocrinology. 2014;50:20-7.

Jensen LF, Pedersen AF, Andersen B, Vedsted P. Self-assessed health, perceived stress and non-participation in breast cancer screening: A Danish cohort study. Preventive Medicine. 2015;81:392-8.

Chen MF. Self-efficacy or collective efficacy within the cognitive theory of stress model: Which more effectively explains people's self-reported proenvironmental behavior? Journal of Environmental Psychology. 2015;42:66-75.

Huffman AH, Van Der Werff BR, Henning JB, Watrous-Rodriguez K. When do recycling attitudes predict recycling? An investigation of self-reported versus observed behavior. Journal of Environmental Psychology. 2014;38:262-70.

Cassidy JD, Cancelliere C, Carroll LJ, Côté P, Hincapié CA, Holm LW, et al. Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Archives of Physical Medicine and Rehabilitation. 2014;95(3, Supplement):S132-S51.

Yegane ZM, Qalambor R. Development and validation of job strain of decsiplinary forces "Police Stress" of I.R. Iran. Tehran, Iran: The Center for Study and Research of Education and human Resorce of NAJA; 2004.

Mohammadzadeh H, Kazazi H, Kamel AJ. The sources of stress, reappraisal, and coping in police forces. Bimonthly Journal of Police Human Development. 2009;6(26):41-55.

Cousins R, MacKay C, Clarke SD, Kelly C, Kelly PJ, McCaig RH. Management standards and work-related stress in the UK: Practical development. Work & Stress. 2004;18(2):113-36.

Azad Marz Abadi E, Qolami Fesharaki M. Standardization and avlidation of HSE Management Standards Indicator Tool Journal of Behavioral Sciences. 2010;4(4):291-7.

Kerr R, McHugh M, McCrory M. HSE Management Standards and stress-related work outcomes. Occupational Medicine. 2009;59(8):574-9.

Casey RL, Masuda M, Holmes TH. Quantitative study of recall of life events. Journal of psychosomatic research. 1967;11(2):239-47.

Masuda M, Holmes TH. The social readjustment rating scale: A cross-cultural study of Japanese and Americans. Journal of psychosomatic research. 1967;11(2):227-37.

Masuda M, Holmes TH. Magnitude estimations of social readjustments. Journal of psychosomatic research. 1967;11(2):219-25.

Harmon DK, Masuda M, Holmes TH. The social readjustment rating scale: A cross-cultural study of Western Europeans and Americans. Journal of psychosomatic research. 1970;14(4):391-400.

Dekker DJ, Webb JT. Relationships of the social readjustment rating scale to psychiatric patient status, anxiety and social desirability. Journal of psychosomatic research. 1974;18(2):125-30.

Gerst MS, Grant I, Yager J, Sweetwood H. The reliability of the social readjustment rating scale: Moderate and long-term stability. Journal of psychosomatic research. 1978;22(6):519-23.

Kipper DA, Furcon J. Factors underlying the social readjustment rating scale. Personality and Individual Differences. 1981;2(1):31-6.

Holmes TH, Rahe RH. The social readjustment rating scale. Journal of psychosomatic research. 1967;11(2):213-8.

Hicks RE, Bahr M, Fujiwara D. The Occupational Stress Inventory-Revised: Confirmatory factor analysis of the original inter-correlation data set and model. Personality and Individual Differences. 2010;48(3):351-3.

Plake BS, Impara JC. The Fourteenth Mental Measurements Yearbook. Lincoln, NE, USA: Buros Center for Testing; 2001.

Ospiow SH. Occupational Stress Inventory- Revised (OSI-R): Professional Manual. Lutz, FL, USA: Psychological Assessment Resources, Inc; 2014.

Jackson AD. A Survey of the Occupational Stress, Psychological Strain, and Coping Resources of Licensed Professional Counselors in Virginia: A Replication Study. Blacksburg, VA, USA: Virginia Polytechnic Institute and State University; 2004.

Bahrami A, Akbari H, Moussavi SQ, Hanaei M, Ramazani Y. Occupational stress among Nurses of Kashan Hospitals During year 2009. Feyz Quarterly. 2011;15(4):367-73.

Haji-Amini D, Cheraqalipour A, Azad Marz Abadi E, Ebadi H, Koushali N. Comparison of occupational stress in military and non-military drivers of Tehran. Military Medicine. 2011;13(1):25-30.

Marcelino D, Gonçalves SP. Perturbação pós-stress traumático: características psicométricas da versão portuguesa da Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C). Revista Portuguesa de Saúde Pública. 2012;30(1):71-5.

Tsai J, Pietrzak RH, Hoff RA, Harpaz-Rotem I. Accuracy of screening for posttraumatic stress disorder in specialty mental health clinics in the U.S. Veterans Affairs Healthcare System. Psychiatry Research. 2016;240:157-62.

Wang M, Elhai JD, Dai X, Yao S. Longitudinal invariance of posttraumatic stress disorder symptoms in adolescent earthquake survivors. Journal of anxiety disorders. 2012;26(2):263-70.

Gardner PJ, Knittel-Keren D, Gomez M. The Posttraumatic Stress Disorder Checklist as a Screening Measure for Posttraumatic Stress Disorder in Rehabilitation After Burn Injuries. Archives of Physical Medicine and Rehabilitation. 2012;93(4):623-8.

Cao C, Wang L, Wang R, Dong C, Qing Y, Zhang X, et al. Stathmin genotype is associated with reexperiencing symptoms of posttraumatic stress disorder in Chinese earthquake survivors. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2013;44:296-300.

Shvil E, Sullivan GM, Schafer S, Markowitz JC, Campeas M, Wager TD, et al. Sex differences in extinction recall in posttraumatic stress disorder: a pilot fMRI study. Neurobiology of learning and memory. 2014;113:101-8.

Barnes JB, Dickstein BD, Maguen S, Neria Y, Litz BT. The distinctiveness of prolonged grief and posttraumatic stress disorder in adults bereaved by the attacks of September 11th. J Affect Disord. 2012;136(3):366-9.

Kacem I, Kalboussi H, Ayoub N, Brahem A, Maoua M, Boughattas W, et al. Burn-out chez les jeunes médecins : étude réalisée dans la région de Sousse. Annales Médico-psychologiques, Revue Psychiatrique. 2016; Article in Press,

Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN, et al. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clinic Proceedings. 2016;91(4):422-31.

Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. Journal of the American College of Surgeons. 2016;223(3):440-51.

Wei J, Rosen P, Greenspan JS. Physician Burnout: What Can Chairs, Chiefs, and Institutions Do? The Journal of Pediatrics. 2016;175:5-6.

Lin DT, Liebert CA, Tran J, Lau JN, Salles A. Emotional Intelligence as a Predictor of Resident Well-Being. Journal of the American College of Surgeons. 2016;223(2):352-8.

Maslach C, Leiter MP. Early predictors of job burnout and engagement. The Journal of applied psychology. 2008; 93(3): 498-512.

Laborda JG, Ozdamli F, Maasoglu Y, Yavuz G, Dogan N. 5th World Conference on Educational SciencesMaslach Burnout Inventory-Student Survey (MBI-SS): A Validity Study. Procedia - Social and Behavioral Sciences. 2014;116:2453-7.

Lings I, Durden G, Lee N, Cadogan JW. Socio-emotional and operational demands on service employees. Journal of Business Research. 2014;67(10):2132-8.

Bakeman R, Gnisci A. Sequential Observational Methods. In: Eid M, Diene E, editors. Handbook of Multimethod Measurement in Psychology. Washington, DC, USA: American Psychological Association (APA); 2006. p. 127-40.

Geisinger KF. APA Handbook of Testing and Assessment in Psychology. Washington, DC, USA: American Psychological Association (APA); 2013.

Hays DG. Assessment in counseling : A guide to the use of psychological assessment procedures. 5th ed. Alexandria, VA, USA: American Counseling Association; 2013.

Lezak MD, Howieson DB, Bigler ED, S. T. Neuropsychological assessment. New York, NY, USA: Oxford University Press; 2012.

Brown GW, Harris TO. Social Origins of Depression: A Study of Depressive Disorder in Women. New York, NY, USA: Free Press; 1978.

Brown GW, Harris TO. Life events and illness. New York, NY, USA: Guilford Press; 1989.

Dohrenwend BP. Inventorying Stressful Life Events as Risk Factors for Psychopathology: Toward Resolution of the Problem of Intracategory Variability. Psychological bulletin. 2006;132(3):477-95.

Spence R, Bunn A, Nunn S, Hosang GM, Kagan L, Fisher HL, et al. Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach. JMIR Research Protocols. 2015;4(3):e83.

Harris TO. Life stress and illness: The question of specificity. Annals of Behavioral Medicine. 1991;13(4):211-9.

Jeronimus BF, Riese H, Sanderman R, Ormel J. Mutual reinforcement between neuroticism and life experiences: a five-wave, 16-year study to test reciprocal causation. Journal of personality and social psychology. 2014; 107(4): 751-764.

McQuaid JR, Monroe SM, Roberts JE, Kupfer DJ, Frank E. A comparison of two life stress assessment approaches: prospective prediction of treatment outcome in recurrent depression. Journal of abnormal psychology. 2000;109(4):787-91.

Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) 2013 [Available from:

Pupo MC, Jorge MR, Schoedl AF, Bressan RA, Andreoli SB, Mello MF, et al. The accuracy of the Clinician-Administered PTSD Scale (CAPS) to identify PTSD cases in victims of urban violence. Psychiatry Res. 2011;185(1-2):157-60.

Barbosa Neto JB, Germain A, Mattos PF, Serafim PM, Santos RCM, Martini LC, et al. Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A). Revista Brasileira de Psiquiatria. 2014;36:330-5.

Bersani FS, Morley C, Lindqvist D, Epel ES, Picard M, Yehuda R, et al. Mitochondrial DNA copy number is reduced in male combat veterans with PTSD. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2016;64:10-7.

Ramaswamy S, Driscoll D, Smith LM, Bhatia SC, Petty F. Failed efficacy of ziprasidone in the treatment of post-traumatic stress disorder. Contemporary Clinical Trials Communications. 2016;2:1-5.

Kaye JL, Dunlop BW, Iosifescu DV, Mathew SJ, Kelley ME, Harvey PD. Cognition, functional capacity, and self-reported disability in women with posttraumatic stress disorder: Examining the convergence of performance-based measures and self-reports. Journal of Psychiatric Research. 2014;57:51-7.

Machado CL, de Azevedo RCS, Facuri CO, Vieira MN, Fernandes AS. Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence. International Journal of Gynecology & Obstetrics. 2011;113(1):58-62.

Lü W, Wang Z, Hughes BM. The association between openness and physiological responses to recurrent social stress. International Journal of Psychophysiology. 2016;106:135-40.

Salazar CR, Strizich G, Seeman TE, Isasi CR, Gallo LC, Avilés-Santa LM, et al. Nativity differences in allostatic load by age, sex, and Hispanic background from the Hispanic Community Health Study/Study of Latinos. SSM - Population Health. 2016;2:416-24.

Jiang CL, Liu L, Tasker JG. Why do we need nongenomic glucocorticoid mechanisms? Frontiers in Neuroendocrinology. 2014;35(1):72-5.

Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Frontiers in Psychology. 2014;5:1040.

McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Global advances in health and medicine : improving healthcare outcomes worldwide. 2015;4(1):46-61.

Gworys B, Rosińczuk-Tonderys J, Chrószcz A, Janeczek M, Dwojak A, Bazan J, et al. Assessment of late Neolithic pastoralist's life conditions from the Wroclaw–Jagodno site (SW Poland) on the basis of physiological stress markers. Journal of Archaeological Science. 2013;40(6):2621-30.


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