Psychometric Properties of the Spanish Language Version of the Stress in Children Questionnaire ( SiC )

This study describes an analysis of the psychometric properties of a Spanish language version of the Stress in Children (SiC) questionnaire. A group of Chilean school children was evaluated. The results show a tested version of the mentioned questionnaire which consists of 16 items distributed across two factors (emotional well-being and sources of distress). Internal consistency indices (Cronbach’s alpha-coeffi cients) were high. It is concluded there are appropriate psychometric properties for the Stress in Children questionnaire for this group of Chilean children. It is, therefore, a brief and easy to understand instrument of child assessment.

Other factors that can infl uence the manifestation of anxiety are related to cross-cultural differences.It is well known that the presentation of anxiety symptoms is affected by culture; this not only has an impact on adaptive behavior, but it may also affect how some psychopathological symptoms are formed and explained (Crane & Campbell, 2000).
In a study where the characteristics of anxiety in Latin adolescents living in the United States where compared with Colombians living in Colombia, cultural diffe-rences in beliefs and perceptions that could affect the way children and adolescents express anxiety symptoms were found.These differences are related to how young Latinos expresses' their fears and anxieties.In the Latino culture, it is unacceptable to express negative emotions or psychological problems, as this is seen as a weakness of character and leads to shame and social stigma (Crane & Campbell, 2000).In a study of Colombian and Australian children, it was found that Colombian children reported signifi cant higher levels of anxiety, which the authors suggested could be explained by environmental factors and the higher levels of violence that these children experience daily, in contrast to the atmosphere perceived by Australian children who may feel physically more safe.In both countries girls reported higher levels of anxiety, and that the anxiety levels decrease by age (Crane & Campbell, 2000;Derluyn, Broekaert, & Schuyten, 2008).
In Chile, there is limited information on the epidemiology of anxiety symptoms in adolescents, and there are few instruments that facilitate the evaluation of these issues (Cova, Melipillán, Valdivia, Bravo, & Valenzuela, 2007).Despite this, a study carried out in the South of Chile, points out that anxiety disorders are the most frequent diagnostic Group (18.9%), decreasing to 8.7% to correct for disability criterion.To study specifi c diseases it is possible to observe higher prevalence of disorders anxiety of separation (9.5%) and generalized anxiety disorder (9.2%).However, to correct for disability criterion these down to 4.2% and 2.3% respectively.There is a higher percentage of presence of anxiety disorder in women than in men, with similar distribution among children from 4 to 11 (19%) and adolescents from 12 to 18 (18.9)according to DSM-IV diagnosis (Vicente et al., 2010).
There are similar scales that evaluate more specifi c aspects of anxiety such as: the Social Anxiety Scale for Children-revised (SASC-R; Sandín, Chorot, Valiente, Santed, & Sánchez-Arribas, 1999); the Cuestionario de Ansiedad por Separacion Infantil (CASI-N; in English, the Separation Anxiety Questionnaire for Children, SASC) of Méndez, Espada, Orgilés, García-Fernández and Hidalgo (2008); the Escala para la Detección de la Ansiedad Social (EDAS; in English, scale for the detection of social anxiety) of Olivares and García-López (1998), validated in Chile by Vera-Villarroel et al. (2007); the Anxiety Sensitivity Index for Children (Sandín et al., 2002); as well as physiological indicators in response to anxiety measured on the Magallanes Anxiety Scale (García-Pérez & Magaz-Lago, 1995); and state-trait anxiety measured using Spielberger's (Spielberger, 1973) State-Trait Anxiety Inventory for Children (STAIC), validated in Spanish by Castrillón and Borrrero in 2005.On the other hand, the Spence Children's Anxiety Scale (SCAS; Spence, 1997), the Spanish language version of which was developed by Hernández-Guzmán et al. (2010), is sensitive to changes induced by treatment.
On the other hand and relating directly to stress as a signifi cant variable in the development of anxiety is observed a lesser amount of research in this issue.Stress is a phenomenon that is understood by the response to a demand, but in general is notorious as the negative affection and effects, also negative, produced when the person is exposed to a real environmental pressure, a situation of stress, for which lacks of time or resources for coping and resolved effi ciently.Stress, to cease the pressure, or provide adequate response to the demand, should fi nish the emotional distress (Labrador & Crespo, 1993).
Other studies have shown that the relationship between stress and psychological symptoms is highly complex.Stress, anxiety and depression have overlapping symptoms, with stress being more strongly correlated with anxiety and depression relative to the correlation between anxiety and depression.In fact, stress, anxiety and depression may represent three domains of continuously distributed phenomena (T. A. Brown, Chorpita, Korotitsch, & Barlow, 1997;Cuijpers, 1998;De Beurs, van Dyk, Marquenie, Lange, & Blong, 2001;Lovibond, & Lovibond, 1995, in Kraag et al., 2009).
Considering the diverse social changes, such as economic crises and immigration, as well as the natural disasters that children currently experience in various parts of the world, a Spanish language version of an instrument is needed to enable measuring the consequences of psychosocial stress.
The objective of this research was to study the psychometric properties of the Stress in Children (Sic) questionnaire in a sample of boys and girls of the Chilean population.For the purposes of this study, stress will be defi ned as a concept that includes various factors, psychological as well as somatic, and high levels of the latter are associated with negative consequences of emotional and psychopathological health (Jose & Ratcliffe, 2004;Seiffge-Krenke, 2000;Steer, Kumar, Beck, & Beck, 2001;Trianes et al., 2009).

Subjects
Study participants included 1678 individuals including 765 (45.6%) boys and 913 (54.4%) girls with ages between 8 and 18, and a mean of 11.9 years (SD=2.75)from public, private and subsidized (state-supported public) high schools.Since the study was conducted in two steps, the database was divided into two parts.The fi rst group was for the purpose of performing preliminary analyses and consisted of 600 subjects of which 281 (46.8%) were males and 319 (53.2%) were females, with an age range from 8 to 18 years and a mean age of 12 years (SD=2.68).The second group was made up by 1078 subjects of which 484 (44.9%) were males and 594 (55.1%) were females, with an age range from 8 to 18 years and a mean age of 11.9 years (SD=2.78).

Instrument
Stress in Children Questionnaire (SiC; Osika et al., 2007).This easily self-administered questionnaire for children 9 to 12 years old was designed with the objective of detecting levels of perceived anxiety and the presence of symptoms or low levels of well-being as well as important aspects related to social confrontation and support.These factors can be considered part of a higher order dimension of subjective health, such as stress (Osika et al., 2007).
The questionnaire consists of 21 items that are scored on a 4-point Likert scale: none (0), sometimes (1), almost always (2) and always ( 3).An overall score is obtained by summing the points obtained for the 21 items, with a greater number of points indicating a higher degree of perceived stress.The mean  standard deviation in a normal Swedish population was 2.05  .41(girls = 1.99  .42,boys = 2.15  .37)with no signifi cant differences detected between sexes.
Prior factorial analysis showed the existence of three factors: Anxiety (distress), lack of well-being, and lack of social support (Osika et al., 2007).
The SiC contains three questions about common symptoms of potential psychosomatic origin; headache, stomach pain, and diffi culties falling asleep at night.A statistically signifi cant association was found between the global mean score of the SiC questionnaire and two of these symptoms, stomach pain (r = .356,r2 = .127,p = .001)and diffi culties falling asleep at night (r = .505,r2 = .255,p=≤.001).
This questionnaire has high internal consistency (Cronbach's alpha = .86)and shows strong association with the scales of the Beck Youth Inventories of Emotional and Social Impairment (BYI; Desi-Lewis, 1988).

Procedure
First of all, authorization was obtained from the author of the instrument to conduct the study.Second, the items were translated with subsequent back-translation by two persons whose native language was English.Third, approval for the study was obtained from the Ethics Committee of the Universidad Católica del Norte.
Following this process, participation by the Principal of each High School was requested in writing, and informed consent was requested of the parents.
Participants completed the Stress in Children questionnaire in groups in their own class rooms.The questionnaire was administrated by last year psychology students who oversaw the evaluation process at all time to answer any questions about the instrument.The parents signed the informed consent form, in which the objectives of the study and the voluntary nature of participation were explained.

Data Analysis
Two stages of analysis with different samples were made; the steps are specifi ed later.The Statistical Package for the Social Sciences (SPSS version 15.0) was utilized for the statistical analysis.Analyses performed included a reliability analysis of the instrument, items analysis, and confi rmatory factor analysis.

Results
Step 1 Preliminary Analyses The correlation was calculated between every item and all other items for the 21 original items of the scale, to obtain a Cronbach's alpha of .77.
It was decided to eliminate all items with an item-total scale correlation below .20,which eliminated the items: "I get headaches" (.18), "I get stomach pains" (.13), "The other kids tease me" (.09), "Sometimes I can't manage the things I have to do" (.09) and "When I'm sad I show it" (.15).
The remaining 16 items had a total correlation with all other items of between .24 and .60 and a total-scale alpha of .80.These 16 items were subjected to exploratory factor analysis by the method of principal components extraction with Varimax rotation.
The KMO index of sample size adequacy (.83) as well as Bartlett's test of sphericity X 2 (120) = 1850.937,p<.001) supported the appropriateness of the analysis.A fi ve-component solution was obtained that explained 57% of the variance.Considering the percentage of variance explained and the scree plot, it was opted to extract a two-factor solution, which explained 37% of the variance (Factor 1=19.18%;Factor 2=18.38%).The following four items, which either had a factor loading below .3 or else loaded indistinctly on both factors, were eliminated: "I fall asleep easily at night", "Things work out as I have planned (thoughts)", "When I have a hard time there is an adult to talk to", "If anybody teases me, I will protest".
These two factors, even though with factor structure different from that originally proposed by Osika et al. (2007), had internal consistency and construct validity, and were denoted the Emotional well-being and Sources of distress factors.Table 1 shows the loading of the items on these factors.This factor solution is the one utilized in Step 2.
Step 2 The last analyses were performed on 1080 subjects.The correlations of each item with all other scale items and of each item with its factor are given in Table 2. Cronbach's alpha-coeffi cients were .80 for the total scale, .77for the Emotional well-being factor, and .69for the Sources of distress factor.
In order to evaluate the fi t of the data to the theoretical two factor model, a confi rmatory type of factor analysis was performed.The results of fi t indices obtained for the model show X 2 = 627.703(gl = 43).
Although the Comparative Fit Index (CFI = .78)and Normal Fit Index (NFI = .76)had values below .90(the value considered to indicate a good or better fi t; Bentler & Dudgeon, 1996), they were near that value.A similar result was obtained for RMSEA = .11(Root Mean Square Error of Approximation) indices, which were signifi cant with values below .08 (Browne & Cudeck, 1993) and with the goodness of fi t index (GFI = .88),which represents the combined fi t (values between 0 = bad fi t and 1 = perfect fi t).

Discussion
The factor structure making up Spanish language version of the Stress in Children Questionnaire, indicates the presence of two factors that are characterized by the fi rst one including symptomatology associated with well-being, and the second one, daily stressors experienced by minors.
These factors are in agreement with the literature regarding cognitive symptoms relating to anxiety and worrying (i.e., the mental interpretation one makes of his own situation); in other words, the factors reveal as part of anxiety, the youth's personal appreciation of the situation in which he fi nds himself.In the case of the fi rst factor measured by this instrument, assessments such as: "I feel lonely"; "I get sad"; "I feel calm", would be expressive of what for the minor means a greater or lesser degree of emotional well-being.
The second factor, denoted Sources of distress, basically includes responses that deal with daily stressors, with high school being one of those with the highest factor loading.Thus, as in previous studies, exposure to certain stressing environmental factors, as proposed by Rodríguez  Brown et al., 2011;Rodríguez & Martínez, 2001), may become a predisposing factor for the development of an emotional problem, especially when some degree of vulnerability is present (Diez & Sánchez, 2000;Esparza & Rodríguez, 2009).Other studies have suggests a predisposition which, in combination with high levels of stress, inadequate appraisal, poor coping and insuffi cient adequate support, may increase one's risk for developing health problems (Ingram & Luxton, 2005;Rutter, Kim-Cohen, & Maughan, 2006).Specifi cally, exposure to stressors related to scholastic performance are associated with the manifestation of anxiety, and likewise, exposure to situations such as the evaluations to which the boys and girls see themselves exposed (academic as well as those relating to confl ict resolution with their peers at school) constitute a significant stressor (Barraza, 2006;Esparza & Rodríguez, 2009;Oros & Vogel, 2005;Pellicer, Salvador, & Benet, 2002).
The latter can lead to emotional exhaustion, as proposed by Garcés in 1995 and as well by Laursen et al., in 2010, who pointed out that when children in school environments are exposed to high demands they may perceive lack of control, generating frustration, apathy and anguish within themselves, with extreme overload also being observed relative to demands, which may produce emotional exhaustion from school or "School Burnout", with associated academic failure, dropping out, academic phobia and depression (Laursen et al., 2010).High expectations of parents and teachers also can signifi cantly infl uence school burnout (Yildirim & Ergene, 2003).
Reducing the items in the original version was another result obtained by analyzing the psychometric properties of the Spanish version of the questionnaire.Reducing the items from 21 to 16 provided an even shorter instrument that will facilitate wider use of this type of self-administered test in Chilean boys and girls, of particular interest because low reading comprehension is a major educational problem in this country (Fuentes, 2009;Ramos, 2006;Rosas, Jiménez, Rivera, & Yáñez, 2003).
Despite the reduction in items, the instrument has adequate reliability and validity (factor structure); there is, however, a need to continue adapting instruments to the Spanish language to achieve early detection and care for these minors (Aypay, 2011;Spielberger, 1973).

Conclusion
The Spanish language version of the Stress in Children Questionnaire has acceptable psychometric properties and includes 16 of the original 21 items, making it a short and easily understood scale.
The instrument was demonstrated to have adequate factor structure which, in spite of the difference from the original factor structure, has internal construct consistency in addition to a high Cronbach's alpha-coeffi cient, attesting to its reliability.
The study presents a series of limitations, fi rst of all, many more girls and boys were invited to participate in this research than chose to take part, which could fi nally, introduces selection bias.Secondly, family socio-economic status was not formally assessed, even though the community where the study was predominantly middle-class.Third this study only reports on children older than 8 years, this is because there is a lack of validated anxiety questionnaires for younger population.As a consequence, the study cannot draw conclusions on younger children, although they also express symptoms of anxiety.
Future studies, like the one conducted by Osika et al. (2007), should consider saliva cortisol measurements as a stress indicator.
It is necessary the replication of the study with a large sample whereas a greater diverse geographical origin within Latin America enable as generalization of the results.In addition, results obtained for populations that are as dissimilar as those in Scandinavian and Latin American countries need to be examined.
Finally, longitudinal data are necessary to correctly evaluate the development of anxiety symptoms and their consequences during the life-span.

Table 1
Matrix of Rotated Components

Table 2
Item-Total Scale and Item-Factor Correlations