|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 101
In reply: Concerns on methods while altering intervals in the questionnaire - Results that are statistically fixed: Commenting on perceived stress and its correlates among medical trainees in Oman – A single-institution study
Samir Al-Adawi Ph.D 1, Siham Al Shamli M.D 2
1 Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khoud, Sultanate of Oman
2 Psychiatry Residency Program, Oman Medical Specialty Board, Muscat, Sultanate of Oman
|Date of Submission||04-May-2022|
|Date of Decision||05-May-2022|
|Date of Acceptance||06-May-2022|
|Date of Web Publication||29-Jun-2022|
P. O. Box 35, Al-Khoud 123, Muscat, Oman
Sultanate of Oman
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Adawi S, Al Shamli S. In reply: Concerns on methods while altering intervals in the questionnaire - Results that are statistically fixed: Commenting on perceived stress and its correlates among medical trainees in Oman – A single-institution study. Taiwan J Psychiatry 2022;36:101
|How to cite this URL:|
Al-Adawi S, Al Shamli S. In reply: Concerns on methods while altering intervals in the questionnaire - Results that are statistically fixed: Commenting on perceived stress and its correlates among medical trainees in Oman – A single-institution study. Taiwan J Psychiatry [serial online] 2022 [cited 2023 May 29];36:101. Available from: http://www.e-tjp.org/text.asp?2022/36/2/101/348852
Thank you for giving us a chance to reply to this letter. It is good to hear that the article written by our colleagues and us  and the Taiwanese Journal of Psychiatry have been read by critical readers around the world.
The gist of the letter-to-the-editor written by Ahmed  is about how we scored outcome measures, i.e., the Perceived Stress Scale (PSS) . While we did acknowledge how PSS is conventional scored in the literature (”Some studies have endorsed the score of 0 –13 to constitute “low stress,” 14 – 26 as “moderate stress,” and 27 – 40 as “high perceived stress,” page 190), instead we have used cutoff previous employed by Sathiya et al. , namely cutoff score of ≥ 20 to differentiate “caseness” for perceived stress or otherwise. Cutoff points are widely used in psychiatric epidemiology whereby, in some instances, the receiver operating characteristics curve is used to calculate a cutoff score that most effectively compromises between sensitivity and specificity . In our study, as a dependent variable (PSS), the cutoff point is required for meaningful analysis. This cutoff point is used because it has been derived from the doctors and nurses since our study was conducted among medical trainees as reported by Sathiya et al. .
While perceived stress is not yet recognized as a diagnostic entity, as is often the case in psychiatric epidemiology, the self-reported questionnaires (SRQs) such as the PSS, in parallel to other SRQs for soliciting mental health status, are often inferior to “gold standard” interview . SRQs are known to give spurious results regardless of whether they were scored in established cutoff or lumping the composite score into “mild,” “moderate,” etc. . The way forward to circumvent this confounder is to wait for the nascent field of neurosciences to tell us whether an amorphous entity as mental stress is accompanied by specific biomarkers.
Overall, we feel that the content in the letter-to-the-editor written by Ahmed  is out of synch with our write-up. Hence, the author might have misread our article .
| Financial Support and Sponsorship|| |
| Conflicts of Interest|| |
The authors declare no conflicts of interest.
| References|| |
Al Shamli A, Al Omrani S, Al-Mahrouqi T, et al.: Perceived stress and its correlates among medical trainees in Oman: a single-institution study. Taiwan J Psychiatry
2021; 35: 188-96.
Ahmed HS: Concerns on methods while altering intervals in questionnaire – results that are statistically fixed: commenting a on perceived stress and its correlates among medical trainees in Oman – a single-institution study. Taiwan J Psychiatry
Sathiya N, Ruwaidha R, Nusrath FS, et al.: Perceived stress levels and its sources among doctors and nurses working in a tertiary care teaching hospital, Kancheepuram, Tamil Nadu. Nat J Community Med
2016; 7: 603-8.
Al-Adawi S, Dorvlo AS, Burke DT, et al.: A survey of anorexia nervosa using the Arabic version of the EAT-26 and “gold standard” interviews among Omani adolescents. Eat Weight Disord
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Everett VS, Crochiere RJ, Dallal DH, et al.: Self-report versus clinical interview: Discordance among measures of binge eating in a weight-loss seeking sample. Eat Weight Disord
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