We attempted to create five translated versions of the PHRF-SCL (SF) in English, Chinese, Korean, Indonesian, and Vietnamese to consider a multifaceted yet simple and convenient approach for evaluating the stress responses of foreign nationals residing in Japan. We verified the reliability and validity of the English, Chinese, Korean, Indonesian, and Vietnamese versions of the PHRF-SCL (SF) through a survey targeting participants aged from 18 to 64 years, who were native speakers of the relevant languages.
Each subscale in each language version had sufficient reliability. A good fit was confirmed by confirmatory factor analysis, with results at a similar level to those reported by Imazu et al. (GFI = .94, AGHI = .93, CFI = .91, and RMSEA = .052) for Japanese participants [5]. The severity classification obtained from the DASS 21 subscale scores was used to examine construct validity. Approximately half of the participants in the present study were classified as “normal” for all language versions and all subscales. Scores in the PHRF-SCL (SF) were significantly lower in the normal group than in the severe groups (depression, anxiety, or stress) for all subscales, indicating construct validity.
Intended for use with healthy participants, the PHRF-SCL (SF) is a scale created based on psychological and physical stress responses; half of the items relate to the latter [5]. In contrast, the DASS 21 aims to distinguish between depression and anxiety symptoms, and physical reactions common to both are therefore excluded from the questions of the depression and anxiety scales [7]. Despite these differences in scale design, significant correlations were found between the PHRF-SCL(SF) and DASS 21, indicating concurrent validity.
Japan is attracting an increasingly diverse foreign resident population, representing more countries and regions of origin. The Japanese government encourages the provision of information intended for foreign nationals residing in and visiting Japan, not only in their respective native languages but also in plain Japanese (“Yasashii Nihongo”). Information translated into plain Japanese is effective not only in terms of more widely communicating rules and services in daily life but also in the context of emergencies, such as evacuation information in the event of a disaster. However, there is a limit to the information that can be provided for all services in plain Japanese. The Japanese Ministry of Health, Labour and Welfare is working on publishing multilingual explanatory literature for foreign nationals and providing remote interpretation services for multilingual support; both these services are intended for use in medical institutions [10]. Similar to medical care, when assessing mental and physical health, it is difficult to substitute terms with plain Japanese; therefore, it is desirable to conduct such assessments in the subject’s native language.
The translated versions of the PHRF-SCL (SF) are appropriate and fit for purpose of mental health screening and health education for foreign nationals in settings, such as workplaces and schools. If an individual’s mental health was to be accurately assessed in their native language, it would be possible to provide services to those needing support in their native language or in plain Japanese. Japan has insufficient mental health measures in place for foreigners; therefore, conducting stress checks in multiple languages is expected to broaden the range of individuals who have access to mental health support.
In this study, we deduced that a simple and effective evaluation of stress responses in healthy participants can be performed in multiple languages. However, the exploratory factor analysis identified differences in factor loadings for each language. It is not possible to clearly determine from the study findings whether such differences were due to cultural differences or participant characteristics. Additionally, as the data for this study were collected through online surveys, the possibility of biases existing in the educational background, or a sense of economic hardship existing that may affect stress responses in a manner that varies depending on the participants’ age and the country in which the survey was conducted, cannot be excluded. Future surveys should consider the backgrounds of participants.
While a characteristic feature of the PHRF-SCL (SF) is its use of question items relating to stress responses in daily life, Imazu et al. [5] suggest that the Japanese version of the PHRF-SCL (SF) may help in the identification of psychosomatic patients. The present study identified a high degree of correlation between the PHRF-SCL (SF) and the DASS 21, the purpose of which is to screen for symptoms of depression and anxiety. Therefore, in the future, we hope to clarify the relationship between the multilingual versions of the PHRF-SCL (SF) and depression and anxiety scales.