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Investigating the psychometric properties of the Persian version of Psychological Emptiness Scale (PES) among nursing students

BMC Nursing volume 24, Article number: 388 (2025) Cite this article

Abstract

Background

Psychological emptiness plays a significant role in the mental health of nursing students. However, there is currently no valid Persian instrument for measuring psychological emptiness in Iranian nursing students.

Aim

This study aimed to translate and investigate the psychometric properties of the Persian version of the Psychological Emptiness Scale among Iranian nursing students.

Methods

In this methodological study, after translating and assessing the face and content validity of the Persian version of the Psychological Emptiness Scale, 400 nursing students were selected through proportional quota sampling from four nursing and midwifery colleges affiliated with Birjand University of Medical Sciences in 2024. The factorial structure of the measure was assessed using exploratory factor analysis. Confirmatory factor analysis was then undertaken. Finally, the reliability, including internal consistency and test-retest reliability, and the convergent and divergent validity of the measure were evaluated.

Results

The results of exploratory factor analysis revealed that a three-factor structure accounted for 60.20% of the total variance. The results of the CFA revealed that the three-factor model of the Persian version of the Psychological Emptiness Scale had good or acceptable fit indices. The reliability of the total scale was calculated with a Cronbach’s α coefficient of 0.949, McDonald’s omega of 0.949, and ICC of 0.840, suggesting acceptable reliability. Results also showed that the convergent and divergent validity of the measure were satisfactory.

Conclusion

The findings of this study suggest that the Persian version of the 19-item PES is a reliable and valid instrument for assessing psychological emptiness in Iranian nursing students.

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Introduction

Mental health refers to a condition of wellness where individuals recognize their abilities, manage typical life stresses, work effectively and profitably, and are capable of contributing to their community [1]. Mental health is a topic that has been extensively researched among students in recent years; because the number of health issues is significant and continues to rise among this group [2]. In other words, mental health issues are quite prevalent among college students [3].

Poor mental health is a complex and common psychological problem among university students in developed and developing countries [4]. The widespread incidence of depression, anxiety, and suicidal ideation within the student population has positioned student mental health as a critical global concern. These mental health challenges significantly detrimentally affect both the overall quality of life and academic performance of students [5,6,7]. One study conducted in Asia showed that about 66.86% of students had a diagnosis of depression and 57.39% had anxiety [8]. Regarding suicidal ideation, a systematic review was also conducted in 2021 and showed that the prevalence of suicidal ideation among students is high [9].

There are many stressors for students in healthcare fields such as nursing; these stressors include academic stressors (difficulties in understanding and learning a new curriculum, high workload, and repeated tests), psychosocial stressors (high family expectations and financial pressure), and sociodemographic stressors (such as being female, being single, and having parents with higher educational level) [10,11,12]. One of the things that often appears along with poor mental health is a feeling of psychological emptiness (PE) [13]. The feeling of PE is related to other emotional states, such as boredom and loneliness [14]. Previous research has suggested that experiencing boredom and loneliness can be linked to poor educational outcomes, decreased engagement, and lower academic achievement [15, 16].

PE is ambiguous [17], resembling emotional states such as boredom, numbness, loneliness, and hopelessness. However, PE does not overlap with these concepts [18]. PE is a state in which an individual lives a life devoid of emotion and purpose, such that the individual feels disconnected from others and unable to connect with them [19]. Identifying PE is very important; because it is associated with impulsivity, self-harm, suicidal behavior, and impaired psychosocial functioning [20]. The importance of this issue increases when we know that psychological emptiness is even associated with drug and alcohol abuse [21]. Given the high prevalence of psychological disorders in students, especially nursing students [22], and the impact that PE has on the development of these disorders, it is necessary to identify and manage this problem.

Understanding the essence of emptiness can be challenging and hard to articulate in precise terminology. Consequently, researchers have sought to delineate the characteristics and pinpoint specific elements of this concept [23]. Hazell (1984) was the first to develop the Experienced Level of Emptiness Scale for college students [24]. Also, Buggs (1996) made another attempt by developing the Emptiness Scale in clinical samples [25]. Lastly, Ermis-Demirtas et al. (2022) developed and validated a measure, named the Multidimensional Sense of Emptiness Scale (MSES) in the general population [23]. Finally, the Psychological Emptiness Scale (PES) was developed by Heron et al. (2024) [9] and then evaluated among patients with personality disorders [19].

Psychological emptiness plays a significant role in the mental health of nursing students. In order to measure psychological emptiness among nursing students, a valid and reliable instrument is necessary. However, there is currently no valid Persian instrument for measuring psychological emptiness in Iranian nursing students. Considering the changing and dynamic nature of concepts [26], it seems that a more recent scale, such as the PES, will be more suitable than the Experienced Level of Emptiness Scale and the Emptiness Scale for measuring emptiness among Iranian nursing students. Furthermore, the MSES had has a narrow conceptualisations of emptiness and ignored the inherent phenomenological complexity of this experience. While the items of PES have been derived from the findings of a phenomenological study [19]. Therefore, in this study we decided to translate and investigate the psychometric properties of the Persian version of the PES among Iranian nursing students.

Methods

Study design

This methodological study, conducted in 2024, was to translate and investigate the psychometric properties of the Persian version of PES in Iranian nursing students.

Participants and setting

The research population comprised nursing students from Birjand University of Medical Sciences (BUMS). The minimum sample size for conducting factor analysis is equal to 5–10 times the number of items intended in the Scale [27]. Therefore, the minimum sample size required for factor analysis in the present study is 380 participants. In this study, a total of 400 participants were chosen for exploratory factor analysis (EFA) and participants for confirmatory factor analysis (CFA). Then, this sample was randomly splitted into two halves; one half for EFA and the other half for CFA. It is notable that the simplest method for splitting a sample into two halves is to split it at random [28]. The sampling was done from October 2024 to December 2024 using proportional quota sampling method based on the population nursing students in four Nursing and Midwifery Colleges affiliated to BUMS. The inclusion criteria included: willingness to participate in the study, being enrolled in the second semester or beyond of a nursing program, not having obvious mental, physical, or cognitive disorders according to the participant’s statement or no using of psychoactive drugs and not experiencing an emotional crisis in the past 6 months (e.g., death of a loved one).

Upon obtaining the ethical approval code from the ethics committee at BUMS, one of the researchers (SS) attended students’ classrooms with permission from university authorities and approached the potential participants. The research purpose was thoroughly communicated to them. All participants were informed about the purpose of the study, and informed consent was obtained from all participants. Data collection was done using a paper-based survey.

Study instruments

Demographic information questionnaire

The demographic information in this study included age, gender, marital status, and place of residence.

Psychological Emptiness Scale (PES)

The items in the original version of the PES were generated based on a thematic analysis in which 178 individuals with lived experience of emptiness participated [13]. This scale comprises 19 items, which are rated on a four-point Likert scale with the following options: “Never = 0”, “Sometimes = 1”, “Often = 2”, and “All the time = 3”. PES includes two substantially correlated yet psychometrically independent subscales. The first subscale is Nothingness, which refers to the feeling of having no direction in life and lacking inner fulfillment (items 3, 4, 5, 9, 14, 15, and 18). The second subscale is Detachment, which reflects a sense of numbness, disconnection, indifference, and inefficacy (items 1, 2, 6, 7, 8, 10, 11, 12, 13, 16, 17, and 19). To calculate the total score for each subscale, the scores of all items within that subscale are summed. The total score of this scale ranges from 0 to 57. The validity and reliability of PES were confirmed in the study by Herron et al. [19].

De Jong Gierveld loneliness scale

In this study, the convergent validity of the Persian version of PES was examined using the Persian version of the De Jong Gierveld Loneliness Scale. This scale consists of eight items: five positive [1, 4, 7, 8, 11] and three negative [2, 5, 9] with three answer options: “yes”, “more or less”, and “no”. A response of “more or less” or “yes” to a positively framed item results in a score of zero, while for negatively framed items, such responses yield a score of one. The psychometric properties of the Persian version of this scale have been confirmed in Iran [29].

Oxford Happiness Questionnaire (OHQ)

To examine the divergent validity of the Persian version of the (PES), the Oxford Happiness Questionnaire (OHQ), developed and refined by Hills and Argyle (2002) was used. This questionnaire comprises 29 items across six dimensions: life satisfaction, joy, self-esteem, calmness, control, and efficacy. Respondents answer each item using a 4-point Likert scale, where 0 corresponds to strong disagreement and 3 indicates strong agreement. The total scores of the items in this questionnaire range from 0 to 87, with a higher score with higher scores reflecting greater happiness [30]. The validity and reliability of the Persian version of the OHQ have been confirmed in Iranian students [31].

Translation procedure

Initially, the first author (ME) received written permission from the developer of the PES. The World Health Organization protocol was used to translate and adapt the PES into the Persian language. Two bilingual translators independently translated the PES into Persian. An expert panel, including the researchers involved in this study and the two translators, assessed and compared the two translated scales. Any discrepancies were rectified, resulting to a consensus on a unified Persian version. In the next step, two additional bilingual translators, who were not familiar to the original scale, translated the Persian version back into English. The translated scales were then compared with the original, and any minor discrepancies were addressed. For example, in item 6, one of the translators used “apathy” instead of “numbness”. Additionally, in item 19, one of the translators applied “withdrawn” instead of “disengaged”. After the research team and two translators reviewed the items, they concluded that “numbness” and “disengaged” were more appropriate translations from the Persian version that were consistent with the original version of the instrument. Ultimately, this process resulted in the establishment of an initial Persian version of the PES.

Face validity and content validity

Face validity was evaluated both qualitatively and quantitatively. An expert panel, consisting of 12 faculty members from the Nursing and Midwifery College of BUMS, along with ten undergraduate nursing students, participated in the qualitative evaluation of face validity. They were asked to provide feedback on the difficulty, relevance, and clarity of each item on the scale. For the quantitative evaluation of face validity, a group of ten nursing students rated the importance of each item on a 5-point Likert scale. The scale ranged from “very important = 5” to “not important = 1”. The formula used to calculate the impact score of each item was “Impact score = frequency (%) × importance”. Frequency, represented as a percentage, indicates the proportion of students who rated the item a 4 or 5. Importance is determined by averaging all responses. Items with an impact score greater than 1.5 were considered suitable for further analysis [32, 33].

For content vality evaluation, the content validity ratio (CVR) and content validity index (CVI) for the items were calculated by 12 faculty members in nursing. The CVR examined the items’ necessity (not necessary = 1, useful but not essential = 2, essential = 3). The formula for CVR is (Ne − N/2)/(N/2), in which the Ne is the number of experts indicating “essential” and N is the total number of experts [34]. When the number of experts is 12, the minimum acceptable CVR is equal to 0.56 [35]. To calculate CVI, 12 experts (same as for CVR) evaluated the relevancy of items by dichotomous response: relevant = 4 and irrelevant = 1. The CVI was calculated by dividing the number of items experts rated as relevant (rating of 4) by the total number of experts (i.e., 12) [36].

Construct validity

To assess the construct validity of this scale, EFA and CFA were conducted.

EFA

Bartlett’s test with a significance level below 0.05 is also acceptable. The favorable results of both tests indicate a suitable correlation matrix for factor analysis.

Exploratory Factor Analysis (EFA) is employed to discover the underlying structure of a relatively large set of items. In this study, 200 students were included to examine the EFA. Bartlett’s test of sphericity was used to examine the significance of the correlation matrix between items [37]. A KMO was conducted to assess the adequacy of sampling. A KMO score closer to one is ideal for factor analysis, with scores above 0.5 generally acceptable and scores above 0.7 preferred [38]. Factor load value represents the relationship between each factor and each item on the scale. A minimum factor load value of 0.3 was considered in this study; anything lower suggests a weak relationship [39]. Principal Component Analysis (PCA) was used for factor extraction, considering skewness (± 2) and kurtosis (± 7) indices [40]. Then, according to the correlation results of more than 0.3 between factors, Promax rotation, the most common rotation used in humanities studies, was run [41]. The presence of an item in a latent factor is determined by a factor loading of around 0.3 Items with commonalities below 0.2, as suggested by Child (2006), were excluded from the EFA [42].

CFA

A CFA was performed to evaluate the structure of the factor results hypothesized by the EFA. To evaluate model fit in CFA, researchers compare goodness-of-fit indices against fixed cutoff values. Generally, the goodness of fit of a model is confirmed by the following indices: root mean square error of approximation (RMSEA) < 0.08, comparative fit index (CFI) > 0.90, incremental fit index (IFI) > 0.9, and normed chi-square (χ2/df) < 5.00. Additionally Parsimonious Normed Fit Index (PNFI) > 0.5 and Parsimonious Comparative Fit Index (PCFI) > 0.5 were evaluated. Moreover, the lower Akaike information criterion (AIC) was calculated to compare the models [43,44,45].

Convergent and discriminant validity

The convergent and discriminant validity of the Persian version of the PES were evaluated using Fornell and Larcker’s criteria and Anderson and Gerbing’s method. Composite reliability (CR) and Average Variance Extracted (AVE) for each factor should be greater than 0.7 and 0.5, respectively, for convergent validity. Also, when the 95% confidence interval for the all possible correlation between factors does not include 1.0, it indicates that there is evidence supporting the discriminant validity of the factors [46, 47].

Convergent and divergent validity of total scale

We assessed convergent validity by examining the correlation between the Persian version of the PES and its factor scores with the scores from participants on the De Jong Gierveld Loneliness Scale. Additionally, to evaluate divergent validity, we explored the relationship between the Persian version of the PES and its factor scores with the scores obtained by participants on the OHQ.

Reliability

We assessed internal consistency reliability by calculating Cronbach’s alpha (α) and McDonald’s omega (Ω). We also evaluated stability using inter-class correlations (ICCs). To assess stability, 15 nursing students filled out the scale on two occasions, with a three-week gap. When the values of the coefficients α and Ω were greater than 0.7, they are considered acceptable [48]. Lastly, the ICCs value ≥ 0.8 was considered acceptable [49].

Results

Demographic characteristics

A total of 400 undergraduate nursing students participated in the current study.The average age of the nursing students was 21.31 (standard deviation = 2.57) years. 255 participants (63.7%) were categorized as women, 374 participants (93.5%) were identified as single, and 365 participants (66.2%) were noted as living in student dormitories. The demographic details of the participants are displayed in Table 1.

Table 1 The characteristics of study participants (N = 400)
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Face and content validity

The findings from the face validity evaluation revealed that every aspect of the tool was considered appropriate, clear, and important. Furthermore, the quantitative face validity outcomes demonstrated that all scores surpassed the minimum requirement of 1.5.

Based on the insights provided by 12 experts, several items were revised to enhance their qualitative content validity. For the quantitative content validity, the content validity ratio (CVR) and content validity index (CVI) were computed for each item. None of the items were discarded when applying the suitable cutoff value of 0.56. The item-level content validity ratio (I-CVR) and scale-level content validity index (S-CVI) were determined to be 0.76 and 0.97, respectively (Table 2).

Table 2 I-CVR and I-CVI for the PES items
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Construct validity

In the principal component exploratory factor analysis, a Kaiser–Meyer–Olkin (KMO) value of 0.930 was obtained, suggesting a strong level of sampling adequacy. Furthermore, Bartlett’s test of sphericity produced a significant result of 2051.849 (P < 0.001), indicating that the correlations among variables were adequate for conducting factor analysis.

According to Table 3, the principal component EFA model identified three factors, which were established using eigenvalues exceeding one. The findings showed that these three factors collectively represented 60.20% of the overall variance. Given the 0.3 threshold, no items were excluded since the factor loadings for all scale items exceeded 0.3.

Table 3 Exploratory factors extracted from 19 items of the Persian version of the psychological emptiness scale (n = 200)
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Also, the scree plot created from the EFA is displayed in Fig. 1.

Fig. 1
figure 1

Scree plot showing three factors

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CFA

Three models were designed to conduct CFA. Ultimately, the third model provided the best indicators compared to the other models. CFA findings in Model 3 confirmed all goodness of fit indices of the final model (χ2 = 351.052; χ2 /DF = 2.356, P < 0.001, RMSEA = 0.068, CFI = 0.934, NFI = 0.892, PCFI = 0.732, PNFI = 0.700, IFI = 0.935, TLI = 0.916 and AIC = 471.052); (Table 4).

Table 4 Goodness of fit indexes results from CFA of the Persian version of PES
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Figure 2 displays the factor loading for each item.

Fig. 2
figure 2

The final model of the Persian version PES based on CFA (N = 200)

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Convergent and discriminant validity

In this study, CR for Factor 1, Factor 2, and Factor 3 were 0.899, 0.864, and 0.842 respectively. Also, AVE was 0.526, 0.480, and 0.0.571 for factors 1, 2, and 3, respectively. These values suggest an acceptable convergent validity. Also the 95% confidence interval for the correlation between factors did not include 1.0, suggesting there is evidence supporting the discriminant validity of the factors (Table S1).

Convergent and divergent validity of total scale

The results of the Spearman correlation test confirmed the convergent and divergent validity of the PES (P < 0.001; Table 5).

Table 5 The results for spearman’s correlation coefficients regarding the correlations between total Persian version of PES scores, factor 1, factor 2, factor 3, OHQ and loneliness scores
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Reliability

The reliability coefficients, including Cronbach’s alpha, Ω, and the Intra-class correlation (ICC) coefficients pertaining to the three factors derived from the PES, were determined to be adequate. The Cronbach’s alpha, Ω and Intra-class correlation coefficient for total scale was 0.949, 0.949 and 0.840, respectively (Table 6).

Table 6 Reliability analysis result of the Persian version of PES
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Discussion

This study was conducted to translate and investigate the psychometric properties of the Persian version of the PES among nursing students.

In the qualitative face validity assessment phase, all items of the initial Persian version of the PES were considered as clear and appropriate. Moreover, in the quantitative face validity assessment, the impact score for all items was above 1.5 [48] As such, all items were maintained for further analysis.

In terms of content validity of the initial Persian version of the PES, the CVR for all items was above 0.66, which was considered acceptable since the minimum CVR value for the twelve panel experts involved is 0.56 [50]. Additionally, an I-CVI above 0.78 and a S-CVI 0.9 or higher is desirable [48]. In our study, the I-CVI for all items ranged from 0.92 to 1, and the S-CVI was 0.97, which was deemed satisfactory.

To assess the factorial structure of the PES an EFA was conducted. The factor loadings in the EFA results ranged from 0.470 to 0.712, all greater than the value of 0.3 suggested by Kartal M & Bardakçı (2018) [51]. The results of the EFA revealed the existence of three factors with eigenvalues more than 1. It was found that items loaded on the first to third factor explained 48.20% (8 items), 6.32% (7 items), and 5.68% (4 items) of the total variance, respectively.

The combined variance explained by these three factors was 60.20%. This scale which encompasses an extensive spectrum of statements related to psychological emptiness was translated and validated in Iran for the first time. To the best of our knowledge, the EFA is not translated and validated to be used in countries other than England.

It is notable that Herron et al. (2024), as developers of 19-item PES, began their psychometric evaluation with 31 items. The results of EFA in Herron et al. study indicated the existence of two factors explaining 54% of the total variance of the scale [19]. This suggests that the Persian version of the PES among Iranian nursing students may offer a more robust three-factor model with a higher proportion of explained variance.

Although the original PES is reported to have a two-factor solution [19], results of an EFA in this study indicated a three-factor solution was more appropriate. A review of the literature on existing instruments designed to measure emptiness revealed that their factor structure is not necessarily the same. In this regard, Hazell (1984) developed the Experienced Level of Emptiness Scale, which consisted of two factors, namely, Experienced Level of Emptiness and Experienced Level of Existential Concern advantages and disadvantages [19]. Also, another attempt was made by Buggs (1996) to develop the Emptiness Scale which included two factors Inner sense of emotional hunger and yearning and [2] Generalized sense of emotional numbness [25]. Lastly, the MSES developed and validated by Ermis-Demirtas et al. (2022) had three factors: A sense of Inner Emptiness, a Sense of Absence of Relatedness, and a Sense of Meaninglessness [52].

Indeed, when assessing the factor structure of a scale, different studies can yield varying results. These discrepancies in findings may be attributed to the particular study population, the cultural context, and the distinct methodologies employed in each study. This underscores the necessity of taking these elements into account when interpreting and comparing research outcomes [53]. The sample recruited in the current study were nursing students, while in the study by Herron et al. (2024) individuals were recruited that felt empty. Furthermore, all participants in the Herron et al.’s study had high or low personality disorders [19]. This may account for discrepancies in the factor structure of the PES and the combined variance explained by extracted factors in the present study compared with the Herron et al. study.

In the next step, we used CFA to assess whether the data set fit the structural factor model constructed by the EFA. The results of the CFA revealed that the three-factor model of the PES had good or acceptable fit indices. Additionally, we tested two other models: (a) a one-factor model where all 19 items of the scale indicated one factor and (b) a two-factor model where 9 items were loaded on the one factor and 10 items indicated another factor. Notably, based on the model fit indices, these two models also had acceptable fits. The three models were compared using AIC. Since a model with smaller AIC values is considered more appropriate than others [54], we concluded that the three-factor model of the Persian version of PES is superior to the one-factor and two-factor models.

The results indicated good convergent validity of the Persian version of PES, as evidenced by moderate and positive correlations (0.7 > r > 0.3) of this scale and its factors with loneliness were assessed by the De Jong Gierveld Loneliness Scale. It is in line with previous research that suggests that the feeling of emptiness is related to a sense of loneliness [14, 55]. The Persian version of PES and its three factors showed moderately significant negative correlations with OHQ scores. This finding provides evidence for the divergent validity of the Persian version of PES. The self-determination theory supports the negative association between emptiness and happiness, positing that relatedness is fundamental for attaining happiness [56]. According to the previous research, disconnectedness is identified as one of the important attributes of emptiness [19]. Therefore, a negative correlation between emptiness and happiness is expected.

In this study, the internal consistency of the Persian version of PES was excellent, with a Cronbach’s alpha of 0.949 and an Ω of 0.949. This internal consistency is comparable to the original scale, the alpha of which had a value of 0.95 [19]. Also, Cronbach’s alphas and Ωs for the three factors of the scale were between 0.865 and 0.906 and 0.869 to 0.905, respectively. These criteria indicate good to excellent reliabilities for the factors of the Persian version of the PES. The stability reliability of the Persian version of PES was calculated using ICCs. ICCs between 0.5 and 0.75 and between 0.75 and 0.9 are indicative of moderate to good reliability, respectively [57]. In our study, the ICC for the total scale was 0.840 and for the two factors ranged from 0.741 to 0.784. Thus, the stability reliability of the total scale and its two factors was moderate to good.

From a practical viewpoint, this scale can be used to identify factors influencing feelings of emptiness among nursing students, particularly in academic settings. Additionally, it can serve as a valuable tool in assessing interventions aimed at reducing feelings of emptiness and in detecting changes in emptiness levels among nursing students over time.

This study has some limitations that should be considered when interpreting the results. Firstly, the data collected from all instruments relied on self-reported data of participants, which introduces the potential for self-reporting bias such as social desirability. The social desirability bias refers to the inclination of a research participant to portray themselves in a manner that aligns with societal norms, even if it does not accurately reflect the truth. Social desirability may have influenced the responses of nursing students to the PES. We attempted to mitigate this potential effect by ensuring the anonymity of the survey. Finally, this study exclusively involved nursing students from a single university. Generally speaking, single-center studies are conducted in a more homogeneous population than multi-center studies. This homogeneous population can limit the generalizability of research findings. It is notable that BUMS has diverse nursing students enrolled from various cities. Future studies should focus on more diverse samples from Iranian nursing students.

Conclusion

The findings of this study suggest that the Persian version of the 19-item PES is a reliable and valid instrument for assessing psychological emptiness in Iranian nursing students. The Persian version of the PES now is ready to be used in larger surveys in Iran to monitor psychological emptiness and guide health promotion. The PES sets a foundation for future research in the area of psychological emptiness area. Lastly, the provided data in this study serves as a basis for further exploration of the potential and limitations of the instrument.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AIC:

Akaike information criterion

AVE:

Average Variance Extracted

CFA:

Confirmatory factor analysis

CFI:

Comparative fit index

CR:

Composite reliablity

CVI:

Content validity index

CVR:

Content validity ratio

EFA:

Exploratory factor analysis

I-CVR:

Item-content validity ratio

IFI:

Incremental fit index

KMO:

Keiser-Meyer-Olkin

ML:

Maximum likelihood

MSES:

Multidimensional sense of emptiness scale

NFI:

Normed fit index

OHQ:

Oxford Happiness Questionnaire

PAF:

Principal axis factoring

PCA:

Principal component analysis

PCFI:

Parsimonious comparative fit index

PCEFA:

Principal component exploratory factor analysis

PE:

Psychological emptiness

PES:

Psychological emptiness scale

PNFI:

Parsimonious normed fit index

RMSEA:

Root means square error of approximation

S-CVI:

Scale-content validity index

TLI:

Tucker–Lewis’s index

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Acknowledgements

Our special thanks goes to the Deputy for Research and Technology Birjand University of Medical Sciences, Birjand, Iran, for its assistance during the current study.

Funding

This study was unfunded.

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Authors and Affiliations

  1. Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran

    Mohammad Esmaeelzadeh & Sajede Soleimani

  2. Department of Nursing, Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Southern Khorasan, Birjand, 97175-379, Iran

    Seyyed Abolfazl Vagharseyyedin

  3. Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran

    Zahra Zamaninasab

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  1. Mohammad Esmaeelzadeh
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Contributions

Study design: ME and SAV; data collection: SS and ME; analysis and statistics: ZZ, ME, and SAV, manuscript preparation: ME and SAV. All authors approved the final version for submission.

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Correspondence to Seyyed Abolfazl Vagharseyyedin.

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Our study adhered to the Declaration of Helsinki regarding research carried out on humans and/or human data. The Ethics Committee of Birjand University of Medical Sciences approved the study proposal (BUMS.REC.1403.274). Potential participants were informed about the purpose of the study, and informed consent was obtained from all participants. The authors followed the principles of the Committee on Publication Ethics (COPE) when publishing their findings.

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Esmaeelzadeh, M., Vagharseyyedin, S.A., Zamaninasab, Z. et al. Investigating the psychometric properties of the Persian version of Psychological Emptiness Scale (PES) among nursing students. BMC Nurs 24, 388 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12912-025-03024-w

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BMC Nursing

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