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Open Access Research article

Reliability and validity of the Adolescent Stress Questionnaire in a sample of European adolescents - the HELENA study

Tineke De Vriendt12*, Els Clays1, Luis A Moreno3, Patrick Bergman4, Germán Vicente-Rodriguez35, Eniko Nagy6, Sabine Dietrich7, Yannis Manios8, Stefaan De Henauw19 and the HELENA Study Group

Author Affiliations

1 Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 2 Blok A, B-9000 Ghent, Belgium

2 Research Foundation - Flanders, Egmontstraat 5, B-1000 Brussels, Belgium

3 Growth, Exercise, Nutrition and Development (GENUD) research group, Department of Physiotherapy and Nursing, University of Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain

4 Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, SE 141 57 Huddinge, Sweden

5 Faculty of Health and Sports Sciences, Department of Physiotherapy and Nursing. University of Zaragoza, Ronda Misericordia 5, 22001-Huesca, Spain

6 Department of Paediatrics, Medical Faculty, University of Pécs, Jzsef A 7, 7623 Pécs, Hungary

7 Department of Pediatrics, Division of Clinical Nutrition, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria

8 Department of Nutrition and Dietetics, Harokopio University, 70 E. Venizelou Ave., 17671 Kallithea, Athens, Greece

9 Department of Health Sciences Vesalius, Hogeschool Gent, Keramiekstraat 80, B-9000 Ghent, Belgium

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BMC Public Health 2011, 11:717  doi:10.1186/1471-2458-11-717

Published: 23 September 2011



Since stress is hypothesized to play a role in the etiology of obesity during adolescence, research on associations between adolescent stress and obesity-related parameters and behaviours is essential. Due to lack of a well-established recent stress checklist for use in European adolescents, the study investigated the reliability and validity of the Adolescent Stress Questionnaire (ASQ) for assessing perceived stress in European adolescents.


The ASQ was translated into the languages of the participating cities (Ghent, Stockholm, Vienna, Zaragoza, Pecs and Athens) and was implemented within the HELENA cross-sectional study. A total of 1140 European adolescents provided a valid ASQ, comprising 10 component scales, used for internal reliability (Cronbach α) and construct validity (confirmatory factor analysis or CFA). Contributions of socio-demographic (gender, age, pubertal stage, socio-economic status) characteristics to the ASQ score variances were investigated. Two-hundred adolescents also provided valid saliva samples for cortisol analysis to compare with the ASQ scores (criterion validity). Test-retest reliability was investigated using two ASQ assessments from 37 adolescents.


Cronbach α-values of the ASQ scales (0.57 to 0.88) demonstrated a moderate internal reliability of the ASQ, and intraclass correlation coefficients (0.45 to 0.84) established an insufficient test-retest reliability of the ASQ. The adolescents' gender (girls had higher stress scores than boys) and pubertal stage (those in a post-pubertal development had higher stress scores than others) significantly contributed to the variance in ASQ scores, while their age and socio-economic status did not. CFA results showed that the original scale construct fitted moderately with the data in our European adolescent population. Only in boys, four out of 10 ASQ scale scores were a significant positive predictor for baseline wake-up salivary cortisol, suggesting a rather poor criterion validity of the ASQ, especially in girls.


In our European adolescent sample, the ASQ had an acceptable internal reliability and construct validity and the adolescents' gender and pubertal stage systematically contributed to the ASQ variance, but its test-retest reliability and criterion validity were rather poor. Overall, the utility of the ASQ for assessing perceived stress in adolescents across Europe is uncertain and some aspects require further examination.