The purpose of this review was to use the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) method to gather all the relevant literature and identify the main findings about the connection between the perceived stress scale for children (White, 2014) and other psychological concepts.

A special note: This literature review investigated only the stress measured with the Perceived Stress Scale for Children (White, 2014), not that which was diagnosed with other measures. The authors made this decision based on the findings of T. Lynch and colleagues’ review of research on child stress and the highlighted need for a more comprehensive understanding of children’s perceived stress (Lynch et al., 2022).

Our literature review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched for scientific studies that explored the relationship between a child’s perceived stress as measured by the Perceived Stress Scale for Children (PSS-C), and other psychological characteristics, using “perceived AND stress AND scale AND children” as the first keyword phrase, and “perceived stress scale for children” as the second.

Initially, we used Google Scholar (5 bills), PsycInfo (3), PubMed (2210), Science Direct (186) databases containing the keywords “perceived AND stress AND scale AND children.” We also addressed the Web of Science and Scopus databases, which returned a wide number of publications aligned with other databases. This search yielded results that ranged from 3 to 5 billion links, and thus prompted us to modify our search strategy to avoid redundancy and ensure a focused search. We found the best results by using Google Scholar with the keyword phrase “perceived stress scale for children,” and we accepted 151 results for further examination.

Before screening, 38 records were removed because they either (a) showed up in scientific search engines as mere citations (2); (b) were reported in languages other than English (34); or (c) they were duplicates (2).

From the abstracts that we consulted (113), 80 were eliminated because they did not meet the inclusion criteria: namely, (1) being completed and published by 2014, when The Perceived Stress Scale for Children was published; (2) being accessible for consultation directly from the site where the viewing took place, through subscriptions belonging to the Moscow State University, or by request to the corresponding authors; (3) being written in English; and (4) being empirical studies.

Thirty-two reports were assessed for eligibility, but among them, 11 were excluded on the basis of criteria such as (1) the use of other measurements of perceived stress; (2) not being a research article (dissertations, theses, posters, protocols, and reviews being excluded), and (3) not addressing psychological concepts. The remaining 21 studies were included in this literature review (see Figure 1).

The analysis included all studies that used the Perceived Stress Scale for Children as an assessment tool. Additionally, these studies included statistical findings about the association between perceived stress and other variables.

The studies’ brief descriptions allowed us to group them by topic: Four studies aimed to find the effects of the COVID-19 pandemic and the return to school after the pandemic restrictions were removed; three were about mindfulness as an important feature for stress coping; three were about the use of breathing techniques for lowering stress; five studies concerned the implementation of the intervention program to lower mental health problems; and the last five studies were about stress in different cultural contexts, teacher-student relationships, and risk behavior.

It should be mentioned that some topics were related, e.g., the associations between mindfulness and self-reported COVID-19 impact.

Nine of the analyzed studies used an experimental design, two included a qualitative analysis in addition to some statistics, and the remaining one primarily used a cross-sectional design.

Table 1 presents a brief description of the included studies using the Perceived Stress Scale for Children (PSS-C).

Seven studies from North and Central America, five from Europe, four from India, two from Africa, and two from Asia made up the geographically distributed research in the literature review. It is important to note that the study only included papers published in English.

With one exception, all of the included studies were published within the previous 5 years.

Participants in the studies included in this review ranged in age from 2 to 17 years, with a mean age of 9.27. In most studies, school students made up the majority of the samples. Four studies reported the relationship between age and perceived stress (Beranbaum et al., 2023; Długosz, 2022; Jones et al., 2023; Takeuchi et al., 2022), but only two of them present statistical evidence. Only one study reported age as a significant predictor of perceived stress (Jones et al., 2023). The general result was that perceived stress was unrelated to the participants’ ages.

The description of the study’s limitations or participant descriptions indicated that the participants’ social status ranged from extremely low to middle and high socioeconomic status. Only one study presented a comparison of the participants with different indicators of social status (Długosz, 2022). They found that students from villages had higher scores of perceived stress (F = 19.18, p = 0.001) and lower school performance (F = 4.69, p = 0.01). Higher perceived stress among students was associated with lower financial status in their families (r = −0.10, p < 0.001) (Długosz, 2022).

The samples exhibit a range of sex distributions, with females comprising anywhere from 36 to 83% of the population. Only seven studies had an approximately equal distribution of sexes, with females accounting for 52–55%. The remaining studies had varying percentages of females: less than 50% in nine studies, two studies with percentages falling between 60 and 70%, and two studies with percentages ranging from 70 to 80%.

Seven studies reported the perceived stress score based on gender, but only three showed statistical evidence of a gender difference (Długosz, 2022; Journault et al., 2023; Marie et al., 2022); the remaining studies suggested no gender differences (e.g., Beranbaum et al., 2023).

In summary, we may speculate that girls had or had reported higher stress, but future studies need to clarify this finding.

The majority of studies used the Perceived Stress Scale for Children (PSS-C), which comprises 14 items. Each item can be answered on a Likert scale consisting of four options (never—a little—sometimes—a lot). The perceived stress score is obtained by summing the responses to all items (the first question is not included in the score).

A higher value on the total score suggests higher stress perceptions and questions. Feeling rushed or worried about not having enough time for a desired activity, the pressure of academic performance, the poor quality of friendships, and poor relationships with parents all contributed to stress perception. This scale assesses the extent to which individuals feel that their lives have been unpredictable, uncontrollable, and overloaded over the past weeks.

Ten studies reported the reliability of the PSS-C; Cronbach’s alpha varied from 0.52 to 0.84 with a mean of 0.73; two studies additionally reported McDonald’s omega (Journault et al., 2023; Treves et al., 2023b). In most studies, the scale’s reliability was acceptable. Only one study (Beranbaum et al., 2023) excluded the PSS-C results due to their low reliability.

Just one study used a modified version of the Perceived Stress Scale for Children, which consists of 8 items with a Likert scale from 5 (very often) to 0 (never). A higher total value on all questions corresponded to a higher stress perception. The alpha coefficient for that version was 0.81 (Długosz, 2022).

Two studies (Asemota et al., 2022; Takeuchi et al., 2022) modified the perceived stress scale for children (PSS-C) in response to the COVID-19 pandemic. In those studies, the participants were asked about their experiences “during the COVID-19 pandemic” instead of “in the last week.” In addition, those studies (Takeuchi et al., 2022) proposed new subscales for the PSS-C: stressor sensitivity, emotional state, security, and time pressure. These composite scores may be of interest for future studies.

The methodological quality of the studies varied due to differences in design, sample populations, and objectives. Bias ratings were generally split between ‘Low’ and ‘Some concerns,’ with confounding and measurement biases both nearly evenly divided (52 and 48%, respectively). Selection bias also showed a similar pattern (48% ‘Low,’ 48% ‘Some concerns’), while one study (5%) was rated ‘High’ risk due to lacking a control group. Four of the included studies reported a power analysis to determine a sample size calculation prior to the intervention or data collection (Maratos et al., 2024; Treves et al., 2023b). Among the reviewed studies, nine acknowledged a sample size of less than 100 participants. In three cases, the size of the sample was explained by the group’s uniqueness: HIV-infected children (Vasanthakumari et al., 2016), patients with juvenile idiopathic arthritis (Rongo et al., 2024), and children attending three non-profit organizations that provide support for groups experiencing social disadvantage (Takeuchi et al., 2022). One study, along with a sample of children, also included the children’s parents (Journault et al., 2023). For studies with experimental designs (38%), 10% were rated ‘High’ risk, 19% ‘Some concerns,’ and 10% ‘Low’ in terms of intervention bias. Three studies (Maratos et al., 2024; Sobko et al., 2020; Treves et al., 2023b) detailed the randomization of participants into groups and the randomization procedures. The other publications did not include any randomization. Missing data bias was mostly ‘Low’ (67%), while selective reporting bias was primarily ‘Low’ (62%). In the ‘Risk of bias from outcome measurement,’ 10% were ‘Low’ risk, 19% ‘Some concerns,’ and 10% ‘High,’ though 62% had insufficient information. Finally, reporting bias was predominantly ‘Low’ (62%), with 38% showing ‘Some concerns.’ (see Figure 2).

All the studies included in the analysis were susceptible to bias because of the difficulties in concealing the identities of participants, their families, and caregivers throughout the implementation of psychosocial interventions.

Five studies discussed the pandemic’s impact on perceived stress and other psychological characteristics. Two with the same approach stand out. The same researchers conducted these studies using similar methods (Asemota et al., 2022; Takeuchi et al., 2022). They used the perceived stress scale for children (PSS-C) in conjunction with questionnaires about COVID-19 and preventive measures. Both studies conducted quantitative analyses of each item on the perceived stress scale for children (PSS-C) and described the main general and home stressors, such as disruptions to schooling or pandemic restrictions, protective factors, and the quality of family and friends’ relationships. As for the qualitative data, one study reported the percentage of participants who had a moderate (53%) or high (11%) stress score with no gender or age differences (Takeuchi et al., 2022). Asemota et al. (2022) presented only the mean stress score and mean scores for genders, without making any statistical comparison.

In line with the importance of parent–child interactions as a supportive factor, another study dealt with that question (Journault et al., 2023). The main result was that during the onset of the COVID-19 pandemic, parents and children responded differently in terms of stress, anxiety, and emotion regulation strategies. A more comprehensive view revealed that children exhibited equivalent levels of stress during the pandemic as they did prior to it. Perceived stress did not differ significantly across three time points in these children but girls reported higher stress than boys [F(1, 114) = 10.15, p = 0.002, η2p = 0.08] (Journault et al., 2023).

A cross-sectional study among Polish students aimed to examine the relationship between mental health indicators after post-pandemic returning to school and level of financial deprivation in students’ families (Długosz, 2022). This study was done 3 months after the children returned to school after the COVID-19 pandemic. The student’s mental health indicators, specifically perceived stress and depression were assessed using the Perceived Stress Scale for Children (PSS-C) and five items from the WHO-5 Well-Being Index, respectively. Using a series of questions, the researcher assessed the issues that arise during distance education. Sixty-four percent of the surveyed students still indicated a moderate overall level of perceived stress (M = 16.1; SD = 5.92). The PSS-C item-level analysis indicated that students had a moderate to high level of stress upon returning to school following distant learning. The WHO-5 well-being index negatively correlated with the PSS-C index (r = −0.59, p < 0.001), leading to the conclusion that the higher well-being (low depression) is linked with higher perceived stress. In addition, girls (aged 11–15) reported a significantly higher level of perceived stress [F (1, 503) = 19.18; p < 0.001] (Długosz, 2022). The general conclusion was that returning to school does not have a positive impact on the students’ mental health.

The comparison of the Canadian and Australian adolescents’ perceived stress during the COVID-19 pandemic showed significant differences. Australian adolescents reported experiencing significantly more perceived stress than Canadian adolescents [F(1, 1,179) = 8.438, p = 0.004, n2 = 0.007], with the exception of the stress factors of feeling angry and social restrictions. Moreover, girls in both groups reported experiencing significantly higher perceived stress than boys [F(1, 1,179) = 40.105, p < 0.001, n2 = 0.033] (Marie et al., 2022).

Three studies paid attention to trait mindfulness and its associations with features of the participants’ personality, emotional characteristics, and social-behavioral features. The first correlational study aimed to investigate whether trait mindfulness moderated the relationship between self-reported COVID-19 impact and negative affect in children (Treves et al., 2023a). Along the evaluation of perceived stress (PSS-C), there were measures of mindfulness [Child and Adolescent Mindfulness Measure (CAMM), anxiety, depression (Revised Child Anxiety and Depression Scale (RCADS-25-C), and negative affect)]. The main result showed that mindfulness did moderate the relationship between COVID-19 child impact and negative affect. Increased levels of trait mindfulness may have assisted children in effectively managing a diverse array of COVID-19-related stresses including perceived stress. Greater trait mindfulness in children was associated with less perceived stress (r = −0.40, p < 0.0001), suggesting that trait mindfulness cloud allows youngsters to better manage a range of stressors (Treves et al., 2023a).

A randomized controlled trial with two control groups studied the effect of the remote application-based 8-week mindfulness intervention on promoting children’s well-being. Through parental reports, the mindfulness app revealed evidence of the intervention reducing self-perceived stress (measured with PSS-C) and negative affect in children. However, it did not significantly decrease symptoms of anxiety or depression (Treves et al., 2023b). The intervention led to larger decreases in child-perceived stress compared to the control groups [t (148.74) = 1.79, p = 0.038], but within-group change was greater than between the groups.

The other study investigated the effectiveness of compassionate mind training for pupils (CMT-Pupils) as a school-based intervention for adolescent well-being (Maratos et al., 2024). Along with the perceived stress level evaluation (with the PSS-C), researchers used measures of anxiety, self-esteem, self-compassion, and perfectionism. There was a significant time-by-group interaction effect for anxiety levels after the intervention, but not for perceived stress levels.

Three studies could be merged into one topic because they were about breathing techniques as an intervention to improve mental health, cognitive abilities, and lower perceived stress and behavioral problems (Angelopoulou et al., 2022; Kanchibhotla and Subramanian, 2021; Kanchibhotla et al., 2021). The first study about the effect of the simplified Pythagorean Self-Awareness Intervention (PSAI) on heart rate variability (HRV) parameters, perceived stress, and preschool children’s behaviors used the following measures: the Perceived Stress Scale for Children (PSS-C), the Checklist for Screening Behavioral Problems in Preschool Children and the photoplethysmographic (PPG) indices (Angelopoulou et al., 2022). There were large significant differences between the PSAI group and the control group in how stressed children felt (d = 0.65; p < 0.001); how often they exhibited behavioral problems (d = 0.79; p < 0.001); how often their heart rate went up and down (d = 0.70; p < 0.001); and how often they heard low or very low frequencies (d = 0.32; p = 0.034) (Angelopoulou et al., 2022).

Two other studies aimed to investigate the effects of a breath-based yogic technique on children’s mental health and cognition, as well as its long-term impact (Kanchibhotla and Subramanian, 2021; Kanchibhotla et al., 2021). They used the WHO-5 Well-Being Index for general mental health evaluation, the six-letter cancelation test (SLCT) for measuring cognitive abilities, and the Strength and Difficulty Questionnaire (SDQ) for assessment of the social behavoir. The Perceived Stress Scale for Children (PSS-C) measures perceived stress as one of the main outcomes. There was a positive effect of the intervention; 56% of participants experienced a significant decrease in stress levels. People who did the yogic breathing exercise had a significant improvement in their mental health (lower stress level) after the intervention (p < 0.01; d = 0.152), and this improvement continued after the intervention (p < 0.01; d = 0.567) (Kanchibhotla and Subramanian, 2021). Between-group comparison revealed that teenagers (regardless of gender) in the experimental group had lower scores on perceived stress (p < 0.001) than their counterparts in the control group, indicating a positive impact of intervention (Kanchibhotla et al., 2021).

We grouped five studies because they all examined the impact of intervention programs on various groups of children, including some with clinical conditions.

In one study, the researchers wanted to find out how TMJ (temporomandibular joint) symptoms and signs related to other health problems in kids with juvenile idiopathic arthritis. Stress is significantly linked to chronic illnesses such as juvenile idiopathic arthritis, adversely affecting quality of life and overall well-being (Rongo et al., 2024). The Perceived Stress Scale for Children (PSS-C) measures perceived stress as one of the main outcomes. There are also a variety of measures used, including anxiety, pain, and depression scales, health quality and well-being scales, and several orthodontic questionnaires. There was a strong link between perceived stress and anxiety (r = 0.507, p < 0.001), depression (r = 0.610, p < 0.001), pain catastrophizing (r = 0.287, p = 0.014), disease activity (r = 0.251, p = 0.032), general health status score (r = 0.534, p < 0.001), jaw function limitations (r = 0.306, p = 0.009), and the juvenile arthritis multidimensional assessment (JAMAR) score (r = 0.455, p < 0.001). The regression model for perceived stress had significant predictors: disease activity (b = 0.1, p = 0.03); general health status score (b = 0.44, p < 0.001); JAMAR Total Symptoms Score (b = 0.17, p = 0.002); JAMAR Total Score (b = 0.97, p < 0.001); and the impact of the disease on quality of life (b = 0.14, p = 0.003). However, perceived stress did not reveal a significant predictor of disease’s impact on quality of life. There was no difference in perceived stress between groups with orofacial signs and symptoms and their counterparts.

The other four studies looked at how interventions affected the physical and mental health of three groups of children: healthy children (Journault et al., 2024; Sobko et al., 2020), children who were pediatric oncology patients (Patil et al., 2021); and children with HIV (Vasanthakumari et al., 2016). All three studies utilized the Perceived Stress Scale for Children (PSS-C) to assess stress and as a primary outcome measure. The interventions included the educational ecological program, videos about embracing stress, art therapy, and breathing and relaxation techniques. All these intervention programs had a significant effect (from p < 0.05 to p < 0.001) on perceived stress.

For example, a significant reduction in perceived stress levels was found among the HIV-infected children in the experimental group after the application of the stress reduction technique (t = 4.190, p < 0.001), as well as in between-group comparison (t = 3.820, p < 0.001) (Vasanthakumari et al., 2016). The exception to this was a study conducted by Journault et al. (2024), which examined the potential immediate effects of an intervention on stress mindsets in adolescents through the use of stress-reduction videos. The results indicated a non-significant effect on perceived stress.

Five other studies had different objectives, but they examined perceived stress in different countries and involved participants with different cultural backgrounds.

A study about the cultural adaptation of preadolescents and teenagers due to migration was carried out in Switzerland (Jones et al., 2023). It revealed that perceived stress was a key factor that influenced mental health and sociocultural adjustment. Perceived stress [measured with the Perceived Stress Scale for Children (PSS-C)] negatively correlated with resilience (r = −0.56, p < 0.05) and positively with difficult sociocultural adaptation (r = 0.52, p < 0.01). Resilience mediated the relationship between perceived stress and mental health difficulties (b = 0.15, p < 0.05), suggesting that building resilience could improve mental health outcomes for children (Jones et al., 2023).

Groups of Latinx and European-American elementary students in rural regions of the United States underwent cross-cultural comparisons in perceived stress, cognitive abilities, and academic performance. The following measures were used — the Perceived Stress Scale for Children (PSS-C), the Wechsler Nonverbal Scale of Ability (WNV), and the Oregon Assessment of Knowledge and Skills (OAKS). While both groups reported similar levels of perceived stress, the associations between stress and cognitive abilities revealed differences. For Latinx students, better coding performance was linked to lower stress levels (r = −0.67; p < 0.05). European-American students’ higher spatial span abilities were related to lower perceived stress (r = −0.40; p < 0.05) (Manns et al., 2022).

The other study found that Puerto Rican preadolescents showed a moderate to low level of perceived stress (measured with the PSS-C), which the authors explained by the positive social and economic growth in Puerto Rico since 2017. Among the perceived stress factors, preadolescents mostly worried about their school grades and about having enough time to do what they wanted (Hodge et al., 2023). School-related problems were also discussed in the study of the role of teacher-student conflict and closedness on psychosocial functioning during adolescence (Keane et al., 2023). The Perceived Stress Scale for Children (PSS-C), the Achenbach System of Empirically Based Assessment (ASEBA) Youth Self-Report (YSR) and the Student-Teacher Relationship Scale (STRS) were used as measures. It was found that perceived stress was the main significant predictor of anxiety (b = 0.49, p < 0.01), aggressive behavior (b = 0.34, p < 0.01), and rule-breaking (b = 0.28, p < 0.01) among adolescents, but those effects disappear over the course of adolescence (Keane et al., 2023). A South African study’s results revealed a negative correlation between risk-taking propensity and perceived stress (PSS-C) (r = −0.29, p = 0.015) among adolescents, but no relationship with heart-rate indicators (Beranbaum et al., 2023).

This review was the first to describe and identify the breadth of evidence of stress among children of different age groups using the Perceived Stress Scale For Children (PSS-C) (White, 2014). Note that the methodology, with its tight inclusion criteria and search strategy, facilitated the comprehensive identification of studies. Several factors limit the conclusions that can be drawn from this systematic review. The most important factor is the quality of the included studies. The grading of many papers indicated a serious risk of bias and low overall quality. Many of the papers with a small sample size may have limited ability to demonstrate statistical significance, creating the possibility for the results to appear poorly correlated when, in fact, this may be due to poor study design. We subjectively created the possible topic groups for the reviewed studies, but they could change because of the intersecting aims and study variables.

A future study should focus on a narrower topic in order to undertake a comprehensive analysis, especially the perceived stress levels (evaluated with the Perceived Stress Scale for Children (PSS-C)) among adolescents with health conditions. An alternative approach would include evaluating many indicators of perceived stress in children to determine the advantages and disadvantages of these stress measures. This study has examined several techniques aimed at reducing perceived stress. However, it is important to note that the list of studies is not comprehensive, and future research should strive to find other viable interventions and methodologies. Finally, it is necessary to conduct research to determine whether the Perceived Stress Scale for Children (PSS-C) yields a single overarching variable for measuring perceived stress, or whether additional feasible subscales should be considered.