At a glance
Number of items: 4 questions.
Completion time: ~1 minute.
1. What is the Perceived Stress Scale – 4 item (PSS-4)?
The Perceived Stress Scale – 4 item (PSS-4) is a very brief version of the original Perceived Stress Scale developed by Cohen and colleagues. The PSS-4 captures the degree to which people appraise their lives as stressful in the past month. It focuses on:
- Feelings of being unable to control important things in life.
- Confidence in handling personal problems (positively worded).
- Whether things feel like they are going your way (positively worded).
- Feelings that difficulties are piling up so high that they cannot be overcome.
Clinically, the PSS-4 is used as a brief indicator of psychological stress that can be tracked over time and considered alongside symptoms of anxiety, depression, sleep problems and physical health.
2. How is it scored?
Each of the 4 items is rated from 0 to 4:
0 = never
1 = almost never
2 = sometimes
3 = fairly often
4 = very often
Questions 2 and 3 are positively worded and are reverse-scored i.e:
0 → 4, 1 → 3, 2 → 2, 3 → 1, 4 → 0.
Total PSS-4 score = sum of all 4 items (range 0–16). Higher scores indicate higher perceived stress. There are no formal diagnostic cut-offs for the PSS-4. Some studies suggest that scores around 6 reflect average stress levels in adult populations, with higher scores indicating above-average perceived stress. Local services may choose their own thresholds for flagging elevated stress.
3. How do I interpret change over time?
Improvement: A decrease of 2–3 points or more, particularly when moving from clearly elevated scores towards the average range, suggests a meaningful reduction in perceived stress.
Persistent high scores: Repeated scores in the higher range (e.g. well above 6) may indicate ongoing stress and should prompt further exploration of stressors, coping strategies, mental health symptoms and need for support or referral.