Validation and Psychometric Evaluation of the Italian Version of the Fear of COVID-19 Scale

Does COVID-19 Impact Less on Post-stroke Aphasia? This Is Not the Case

Background

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected people’s mental health resulting in severe psychological consequences. One of the leading causes of long-term disability worldwide is aphasia. The language changes experienced by a person with aphasia (PWA) often have a sudden and long-lasting negative impact on social interaction, quality of life, and emotional wellbeing. The main aim of this study was to investigate the impact of COVID-19 on the different psychosocial dimensions which affect PWA.

Methods

This retrospective study included 73 PWA and 81 elderly matched controls. All patients were in the chronic phase. They were all discharged from rehabilitation services, which left them with different degrees of language deficits (i.e., severe vs. mild vs. moderate). All participants were administered the hospital anxiety and depression scale (HADS) through an online survey. PWA also took part in the stroke and aphasia quality of life scale questionnaire (SAQOL-39).

Results

Although the comparison between two different time points [one month before (T0) and one month after the lockdown (T1)] led to a significant increase in depression and anxiety symptoms in both groups (PWA vs. control), lower rates of depression and anxiety were found in PWA compared to the healthy group. Significant deterioration was also present in PWA in the communication and psychosocial scales of the SAQOL-39 test, which correlated with the observed changes in the psychological domains. Interestingly, the results were not significantly influenced by the degree of aphasia severity. Similarly, in both groups, none of the demographic variables (gender, age, and educational level) significantly affected the scores in the different subscales.

Conclusions

This evidence which, at first glance, seems to suggest that PWA have been partially spared from the impact of COVID-19, actually masks a dramatic situation that has always characterized this population. Indeed, given that PWA already live in a state of social isolation and emotional instability, these conditions might have, paradoxically, limited the effects of the coronavirus. However, as our results showed a deterioration in the emotional state and communication skills of our patients, possible solutions are discussed in order to prevent further decline of their cognitive abilities.

How to Assess Perceived Risks and Safety Behaviors Related to Pandemics: Developing the Pandemic Risk and Reaction Scale during the Covid-19 Outbreak

Objective: The aim of the present study was to develop a self-report questionnaire to assess the level of perceived risks and safety behaviors during pandemics. Method : We went through recommended phases and their corresponding steps to create a valid and reliable scale: (a) item development (including 1. domain identification and item generation, 2. content validity), (b) scale development (including 1. pretesting questions, 2. sampling and survey administration, 3. item reduction, and 4. extraction of factors), and (c) scale evaluation (including 1. tests of dimensionality, 2. tests of reliability, and 3. tests of validity). Results: We found four factors with eigenvalues greater than 1 that were accounted for 0.63 of the total variance. The 4-factor solution showed all items had factor loading greater than 0.4 and each belonged to one factor. The fit indices indicated the 4-factor solution model was fitted to our data. Conclusion: In sum, the Pandemic Risk and Reaction Scale (PRRS) is a valid and reliable self-reported scale to assess the level of perceived risk and safety behaviors during pandemics.

Adaptation and Validation of the Brazilian Version of the Fear of COVID-19 Scale

The pandemic caused by COVID-19 has generated psychological impacts, such as fear of this disease. The authors developed the Fear of COVID-19 Scale (FCV-19S), which aims to assess the fear of COVID-19 in the general population. Adapt and validate the FCV-19S for the Portuguese language in the Brazilian context. Four main initial steps were performed: translation, back-translation, semantic validation, and experimental application. Snowball sampling corresponded to 354 Brazilian participants. Psychometric tests were performed to investigate the validity and reliability of the test, such as confirmatory factor analysis (CFA). Analysis of the data showed satisfactory internal consistency (α = 0.88), and CFA (factor loads from 0.57 to 0.86) confirmed the unidimensional structure. The Brazilian version of FCV-19S is considered valid, reliable, and appropriate for application among the general Brazilian population and may contribute to the prevention, treatments, and mental health programs, resulting from the pandemic of COVID-19.

Mental Health Screening for COVID-19: a Proposed Cutoff Score for the Greek Version of the Fear of COVID-19 Scale (FCV-19S)

The COVID-19 pandemic elicited fear. The Fear of COVID-19 Scale (FCV-19S) is a newly developed self-reported measure, originally developed in Persian to assess COVID-19-related fear. To date, the scale has been translated and validated in 19 other languages, among which Greek. This study, conducted through an online survey, aimed to further explore the validity of the Greek FCV-19S version, as well as to identify appropriate cutoff scores. A total of 538 respondents completed the sociodemographic data sheet, the Generalized Anxiety Disorder 7-item scale, the Short Health Anxiety Inventory, and the Posttraumatic Stress Disorder-8 inventory. According to the results, a cutoff point score of 16.5 or higher revealed a significant predictive power for anxiety, health anxiety, and posttraumatic stress symptoms. Altogether, although the cutoff scores of the Greek FCV-19S version were explored to further evaluate the scale's validity, they may facilitate discrimination of adults with extreme COVID-19-related fear from those with normal fear reactions.

The Anxiety-Buffer Hypothesis in the Time of COVID-19: When Self-Esteem Protects From the Impact of Loneliness and Fear on Anxiety and Depression

INTRODUCTION

The coronavirus (COVID-19) disease has spread worldwide, generating intense fear of infection and death that may lead to enduring anxiety. At the same time, quarantine and physical isolation can intensify feelings of dispositional loneliness that, by focusing on thoughts of disconnection from others, can trigger intense anxiety. Anxiety, generated by both fear of COVID-19 and dispositional loneliness, can activate negative expectations and thoughts of death, potentially generating alarming depressive symptoms. However, the anxiety-buffer hypothesis suggests that self-esteem acts as a shield (buffer) against mental health threats - fear and loneliness - thus hampering anxiety and depressive symptoms.

OBJECTIVE

This study aims to test the process - triggered by COVID-19 fear and loneliness - in which self-esteem should buffer the path leading to anxiety symptoms, then to depression.

METHODS

An observational research design with structural equation models was used. A sample of 1200 participants enrolled from the general population answered an online survey comprising: the fear of COVID-19 scale, the UCLA loneliness scale, the Rosenberg self-esteem scale, and the anxiety and depression scales of the Symptom Checklist-90-Revised.

RESULTS

Structural equation models showed the link between anxiety symptoms (mediator) with both the fear of COVID-19 and dispositional loneliness (predictors), as well as its association with consequent depressive symptomatology (outcome). In line with the anxiety-buffer hypothesis, self-esteem mediated the relationship between the predictors and their adverse psychological consequences.

CONCLUSION

Self-esteem represents a protective factor from the antecedents of depression. Targeted psychological interventions should be implemented to minimize the psychological burden of the disease whilst promoting adaptation and positive psychological health outcomes.

On the Nature of Fear and Anxiety Triggered by COVID-19

Emergencies that occur during natural disasters, such as avalanches, earthquakes, and floods, tend to be sudden, unexpected, and ephemeral and recruit defensive responses, similar to the ones recruited when faced with dangerous animals. Defensive behaviors are triggered by activity in survival circuits that detects imminent threats and fear is the conscious emotion of that follows immediately. But this particular threat (COVID-19) is useable and mysterious, triggering anxieties much more than fear. We conducted a literature search on May 1, 2020 in Google Scholar, PsychInfo, and PubMed with search terms related to COVID-19 fears and found 28 relevant articles. We categorized the papers into six groups based on the content and implications: fear of the unknown, social isolation, hypochondriasis, disgust, information-driven fears, and compliance. Considering the nature of fear and anxiety, combined with the characteristics of the present COVID-19 situation, we contemplate that physicians and other health care workers of several specialties, as well as police officers, fire-fighters, and rescue personnel, and first responders might be more able to deal with COVID-19 if they have (a) some tolerance of the unknown, (b) low illness anxiety disorder, (c) tolerance to social isolation; (d) low levels of disgust sensitivity; (e) be granted financial support, (f) have priority if needed medical assistance (g) use caution relatively to the COVID-19 media coverage and (h) be trained to have high levels of efficacy. Possibilities for preventive and therapeutic interventions that can help both health care personnel and the general population are also discussed.

Impact of COVID-19 on anxiety levels among patients with cancer actively treated with systemic therapy

BACKGROUND

Life-threatening diseases have a negative impact on emotional well-being and psychosocial functioning. This study aimed to assess the relationship between the level of anxiety caused by a neoplasm and the threat of coronavirus infection among patients with cancer actively treated with systemic therapy during the COVID-19 pandemic. Additionally, we searched for clinical factors associated with a higher level of anxiety.

METHODS

In this multicentre, prospective, non-interventional study conducted in Poland, we enrolled 306 actively treated patients with cancer and collected their clinical data, including age, gender, cancer type and treatment intention. The fear/anxiety of SARS-CoV-2 were rated in Fear of COVID-19 Scale (SRA-FCV-19S) and Numerical Anxiety Scale (SRA-NAS). The fear and anxiety associated with cancer (CRA) were rated with the NAS (CRA-NAS).

RESULTS

The mean level of SRA-FCV-19S was 18.5±7.44, which was correlated with the SRA-NAS (r=0.741, p<0.001). SRA-FCV-19S was significantly higher in women versus men (20.18±7.56 vs 16.54±6.83; p<0.001) and was tumour type-dependent (p=0.037), with the highest anxiety observed in patients with breast cancer (17.63±8.75). In the multivariate analysis, only the female gender was significantly associated with higher SRA. CRA-NAS was higher in women versus men (7.07±2.99 vs 5.47±3.01; p<0.001), in patients treated with curative versus palliative intention (7.14±3.06 vs 5.99±3.06; p=0.01) and in individuals aged ≤65 years versus >65 years (6.73±2.96 vs 5.66±3.24; p=0.007).

CONCLUSIONS

For an actively treated patient with cancer, cancer remains the main life-threatening disease during the COVID-19 pandemic. The need for more attentive psychological care should be provided especially to female patients, patients with breast cancer, those under 65 years of age and treated with curative intention, as these factors are associated with a higher level of anxiety.

Fear of COVID-19, Stress, and Anxiety in University Undergraduate Students: A Predictive Model for Depression

Depression is a disabling illness which increases the risk of suicide. The Corona Virus Disease 2019 (COVID-19) pandemic has led to a rise in fear, anxiety, stress, and depression among the population: of these, university undergraduates from countries severely affected by COVID-19 are some of the most vulnerable of all, as they face strict lockdown measures and have fewer resources to cope with it. The aim of this study was to analyze the levels of fear of COVID-19, stress, anxiety, and depression during lockdown among undergraduates from Ecuador, and to test these possible predictors of depression using a model taken from our study of the scientific literature. A total of 640 undergraduates (72% women) between 18 and 47 years old (M = 21.69; S.D = 4.093) were surveyed. The resulting mean levels found for stress, anxiety, and depression were above levels considered non-pathological. Women showed higher levels of fear of COVID-19 than men. The statistical prediction for depression showed a good fit. This depression could be related: both directly and positively by fear of COVID-19 and stress, and indirectly, as a result of these two factors, positively mediated by anxiety. Our study concludes by highlighting the important role that the complex relationships between fear, stress, and anxiety can play in the development of depression symptoms and how they can be taken into account in programs aimed at preventing and alleviating this disorder. We propose some general measures for reducing fear of COVID-19 and stress and suggest that specific programs be designed to control and overcome anxiety among undergraduates.

The Japanese version of the Fear of COVID-19 scale: Reliability, validity, and relation to coping behavior

COVID-19 is spreading worldwide, causing various social problems. The aim of the present study was to verify the reliability and validity of the Japanese version of the Fear of COVID-19 Scale (FCV-19S) and to ascertain FCV-19S effects on assessment of Japanese people's coping behavior. After back-translation of the scale, 450 Japanese participants were recruited from a crowdsourcing platform. These participants responded to the Japanese FCV-19S, the Japanese versions of the Hospital Anxiety and Depression scale (HADS) and the Japanese versions of the Perceived Vulnerability to Disease (PVD), which assesses coping behaviors such as stockpiling and health monitoring, reasons for coping behaviors, and socio-demographic variables. Results indicated the factor structure of the Japanese FCV-19S as including seven items and one factor that were equivalent to those of the original FCV-19S. The scale showed adequate internal reliability (α = .87; ω = .92) and concurrent validity, as indicated by significantly positive correlations with the Hospital Anxiety and Depression Scale (HADS; anxiety, r = .56; depression, r = .29) and Perceived Vulnerability to Disease (PVD; perceived infectability, r = .32; germ aversion, r = .29). Additionally, the FCV-19S not only directly increased all coping behaviors (β = .21 - .36); it also indirectly increased stockpiling through conformity reason (indirect effect, β = .04; total effect, β = .31). These results suggest that the Japanese FCV-19S psychometric scale has equal reliability and validity to those of the original FCV-19S. These findings will contribute further to the investigation of various difficulties arising from fear about COVID-19 in Japan.

Psychological Health Issues Subsequent to SARS-Cov 2 Restrictive Measures: The Role of Parental Bonding and Attachment Style

Background: The novel coronavirus 2019 (COVID-19) has caused severe panic among people worldwide. In Italy, a nationwide state of alert was declared on January 31st, leading to the confinement of the entire population from March 11 to May 18, 2020. Isolation and quarantine measures cause psychological problems, especially for individuals who are recognized as being vulnerable. Parental bonding and attachment styles play a role in the programming of the stress response system. Here, we hypothesize that the response to restricted social contact and mobility due to the pandemic has detrimental effects on mental-psychological health and that this relationship is, at least in part, modulated by parental bonding and attachment relationships that are experienced at an early age. Methods: A sample of 68 volunteer University students was screened for psychopathological symptoms (SCL-90-R and STAI-Y), stress perception (PSS), attachment style (RQ), and parental care and overcontrol (PBI) 6 months before the confinement. In the same subjects, psychopathological symptoms and stress perception were measured again during confinement. Results: Overall, psychological health and stress management deteriorated across the entire sample during confinement. Specifically, a significant increase in phobic anxiety, depression, psychological distress, and perceived stress was observed. Notably, parental bonding and attachment styles modulated the psychological status during the lockdown. Individuals with secure attachment and high levels of parental care (high care) showed increased levels of state anxiety and perceived stress in phase 2, compared with phase 1. In contrast, individuals with insecure attachment and low levels of parental care (low care) already showed a high rate of state anxiety and perceived stress in phase 1 that did not increase further during phase 2. Conclusion: The general deterioration of psychological health in the entire sample demonstrates the pervasiveness of this stressor, a decline that is partially modulated by attachment style and parental bonding. These results implicated disparate sensitivities to environmental changes in the high- and low care groups during the lockdown, the former of which shows the greatest flexibility in the response to environment, suggesting adequate and functional response to stress in high care individuals, which is not observable in the low care group.

Fear of COVID-19 Scale for Hospital Staff in Regional Hospitals in Mexico: a Brief Report

The presence of COVID-19 has had psychological consequences among health personnel; these include fear, anxiety, and depression. In the current study, we used the Fear of COVID-19 Scale (FCV-19S) to assess the response to fear within health staff in Mexico. This was a cross-sectional survey study in which we administered the Spanish version of the FCV-19S to hospital staff. The FCV-19S is a seven-item questionnaire that assesses the severity of fear caused by COVID-19. A total of 2860 participants—1641 female and 1218 male personnel from three hospitals—were included in the study. The internal reliability of the scale was good, with Cronbach’s alpha of .902. A confirmatory factor analysis (CFA) was conducted on the seven items of the FCV-19S, showing good model fit (χ² (7) = 29.40, p < .001; CFI = .99; TLI = .99; RMSEA = .03; SRMR = .010; AIC = 71.40). We found a global FCV-19S mean score of 19.3 ± 6.9, with a significant difference in scores between women and men. Our survey shows a significantly higher level of fear in nursing and administrative personnel, which may be explained by the nursing staff being in close contact with infected patients and the administrative staff lacking understanding of the possible implications of the infection, compared with nonclinical hospital personnel. Our results are consistent with those of other researchers. We must remember that fear is a reaction and that we must be courageous enough to trust validated infection prevention practices to provide the highest standard of care, in the safest environment that we can, for as long as we can.

The fear of COVID-19 scale: Validation in spanish university students

The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. Recently, Ahorsu et al. (2020) developed the Fear of COVID-19 Scale (FCV-19S). The present study aimed to translate and validate the FCV-19S in Spanish university students. The sample comprised 606 Spanish´undergraduates with a mean age of 21.59 years old. We also used a six items from the State Trait Anxiety Inventory (STAI) by van Knippenberg, Duivenvoorden, Bonke & Passchiner (1990). The Fear of COVID-19 scale used for the present survey evidenced a good alpha measure of internal consistency or reliability analysis with ordinal alpha and ordinal omega. Seven items with acceptable corrected item-total correlation were retained and further confirmed by significant and strong factor loadings. Concurrent validity was supported by the six items of the State Trait Anxiety Inventory (STAI). The Fear of COVID-19 Scale, a seven-item scale, has a stable unidimensional structure with robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the Spanish university students.

COVID-19 Student Stress Questionnaire: Development and Validation of a Questionnaire to Evaluate Students' Stressors Related to the Coronavirus Pandemic Lockdown

Clinical observations suggest that during times of COVID-19 pandemic lockdown university students exhibit stress-related responses to fear of contagion and to limitations of personal and relational life. The study aims to describe the development and validation of the 7-item COVID-19 Student Stress Questionnaire (CSSQ), a measurement tool to assess COVID-19-related sources of stress among university students. The CSSQ was developed and validated with 514 Italian university students. Exploratory Factor Analysis (EFA) was conducted with one split-half sub-sample to investigate the underlining dimensional structure, suggesting a three-component solution, which was confirmed by the Confirmatory Factor Analysis (CFA) with the second one split-half sub-sample (CFI = 0.95; TLI = 0.95; RMSEA = 0.06). The CSSQ three subscales measure COVID-19 students' stressors related to (1) Relationships and Academic Life (i.e., relationships with relatives, colleagues, professors, and academic studying); (2) Isolation (i.e., social isolation and couple's relationship, intimacy and sexual life); (3) Fear of Contagion. A Global Stress score was also provided. The questionnaire revealed a satisfactory internal consistency (Cronbach's alpha = 0.71; McDonald's omega = 0.71). Evidence was also provided for convergent and discriminant validity. The study provided a brief, valid and reliable measure to assess perceived stress to be used for understanding the impact of the COVID-19 pandemic lockdown among university students and for developing tailored interventions fostering their wellbeing.

Italians on the Age of COVID-19: The Self-Reported Depressive Symptoms Through Web-Based Survey

The pandemic of coronavirus disease 2019 (COVID-19) has affected the Italian community. The widespread use of quarantine had the desired impact of controlling the epidemic, although it caused many psychological consequences. To date, compliance of the Italian public with voluntary home quarantine has been very high, but little is known about the impact of psychological health on sociodemographic categories during the quarantine. The purpose of this study was to assess the prevalence of depressive symptoms in specific sociodemographic categories during the COVID-19 quarantine lockdown and the potential factors that contribute to, or mitigate, these effects. In the very early stage of the nationwide lockdown, 3,672 quarantined Italian adult residents (65% females, ranging from 18 to 85 years) participated in a web-based cross-sectional survey, including measures of depressive symptoms, which were measured by the Teate depression inventory, and state anxiety levels. The overall prevalence was 27.8% for moderate and 9.3% for severe levels of depressive symptoms. A generalized logistic model was used to identify the factors associated with mental health problems. Among these factors, sociodemographic variables (e.g., sex, age, employment status) and adherence to quarantine guidelines were analyzed. Females, younger people, students, singles, residents in northern Italy, people who were reluctant to adhere to quarantine guidelines, and people less worried about being infected with COVID-19 were at high risk of developing depressive symptoms during the COVID-19 epidemic, also after controlling for state anxiety. These findings showed that public levels of depressive symptoms did not increase the greater likelihood of being infected. Our study suggested that the monitoring of psychological outcomes for outbreaks could identify groups at higher risk of psychological morbidities due to the current pandemic in order to target future psychological interventions for implementation.

"Acute Myocardial Infarction in the Time of COVID-19": A Review of Biological, Environmental, and Psychosocial Contributors

Coronavirus disease 2019 (COVID-19) has quickly become a worldwide health crisis.Although respiratory disease remains the main cause of morbidity and mortality in COVID patients,myocardial damage is a common finding. Many possible biological pathways may explain therelationship between COVID-19 and acute myocardial infarction (AMI). Increased immune andinflammatory responses, and procoagulant profile have characterized COVID patients. All theseresponses may induce endothelial dysfunction, myocardial injury, plaque instability, and AMI.Disease severity and mortality are increased by cardiovascular comorbidities. Moreover, COVID-19has been associated with air pollution, which may also represent an AMI risk factor. Nonetheless,a significant reduction in patient admissions following containment initiatives has been observed,including for AMI. The reasons for this phenomenon are largely unknown, although a real decreasein the incidence of cardiac events seems highly improbable. Instead, patients likely may presentdelayed time from symptoms onset and subsequent referral to emergency departments because offear of possible in-hospital infection, and as such, may present more complications. Here, we aim todiscuss available evidence about all these factors in the complex relationship between COVID-19and AMI, with particular focus on psychological distress and the need to increase awareness ofischemic symptoms.

Psychometric data on knowledge and fear of coronavirus disease 2019 and perceived stress among workers of filipino origin in Hong Kong

Data on knowledge and fear of coronavirus disease 2019 (COVID-19) and perceived stress were collected in July 2020 from a convenience sample of Filipino domestic workers in Hong Kong by asking participants to take part in three questionnaires. First, twelve questions related to knowledge associated with the prevention and identification of COVID-19 were used to assess participants’ knowledge regarding COVID-19. Second, the Fear of COVID-19 Scale (FCV-19S) was used to assess participants’ perceived fear of infection. Third, the Short Form Perceived Stress Scale (PSS-4) was used to measure participants’ perceived stress. Pearson product-moment correlation coefficients were obtained to assess the relationships between the total scores of the three questionnaires. The relationship between knowledge of COVID and fear of COVID was significant, r(108) = +0.23, p = .02; the relationship between fear of COVID and perceived stress was not statistically significant, r(108) = +0.17, p = .08; the relationship between knowledge of COVID and perceived stress was not statistically significant, r(108) = -0.11, p = .26. Cronbach's alpha coefficients were obtained for each of the three questionnaires to assess internal consistency reliability.

Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress

BACKGROUND

As evidenced by several studies, mental distress increased substantially during the COVID-19 pandemic. In this period, citizens were asked to exercise a high degree of self-control with regard to personal and social health behavior. At the same time, we witnessed an increase of prosocial acts and shared creative expressions, which are known to serve as sources of meaning. Meaning in life and self-control are acknowledged psychological resources. Especially in times of crisis, meaning in life has been shown to be a crucial factor for resilience and coping. However, threatening and stressful situations can also jeopardize existential security and trigger crises of meaning. The present study aimed to document levels of acute COVID-19 stress and general mental distress in Germany and Austria during the lockdown and in the weeks thereafter. In order to identify potential risk factors related to demographics and living conditions, their associations with COVID-19 stress were analyzed exploratively. The primary objective of the study, however, was to investigate the buffering effect of two psychological resources-meaningfulness and self-control-with regard to the relation between acute COVID-19 stress and general mental distress. Finally, a potential aggravation of mental distress due to the occurrence of crises of meaning was examined.

METHOD

A cross-sectional survey was conducted online during lockdown (survey group 1) and the subsequent weeks characterized by eased restrictions (survey group 2). A total of N = 1,538 German-speaking participants completed a questionnaire battery including a novel measure of acute COVID-19 stress, meaningfulness and crisis of meaning (SoMe), self-control (SCS-KD), and a screening of general mental distress, measured by core symptoms of depression and anxiety (PHQ-4). In a first step, associations between living conditions, demographics, and COVID-19 stress were explored. Second, a moderation and a mediation model were tested. Meaningfulness, a measure of presence of meaning in life, as well as self-control were proposed to serve as buffers in a time of crisis, thus moderating the relation between acute COVID-19 stress and general mental distress (double moderation). Crisis of meaning, operationalizing an experienced lack of meaning in life, was proposed to mediate the relationship between acute COVID-19 stress and general mental distress, with an assumed moderation of the association between COVID-19 stress and crisis of meaning by survey group (lockdown versus eased restrictions after lockdown), and a hypothesized moderation of the link between crisis of meaning and general mental distress by self-control (dual moderated mediation).

RESULTS

COVID-19 stress was slightly right-skewed. Scores were higher during lockdown than in the weeks thereafter. The rate of clinically significant general mental distress was high, exceeding prevalence rates from both the general population and clinical samples of the time before the pandemic. In the weeks following the lockdown (group 2), general mental distress and crisis of meaning were significantly higher than during lockdown (group 1), whereas meaningfulness and self-control were significantly lower. Demographically, age had the strongest association with COVID-19 stress, with older participants perceiving less acute stress (r = -.21). People who were partnered or married suffered less from COVID-19 stress (η2 = .01). Living alone (η2 = .006), living in a room versus a flat or house (η2 = .008), and being unemployed due to the pandemic (η2 = .008) were related to higher experience of COVID-19 stress. COVID-19 stress and general mental distress were strongly related (r = .53). Both meaningfulness and self-control were negatively associated with general mental distress (r = -.40 and -.36, respectively). They also moderated the relationship between COVID-19 stress and general mental distress: When meaningfulness was high, high COVID-19 stress was related to substantially lower PHQ-4 scores than when meaningfulness was low. The same held for self-control: High scores of self-control were associated with lower PHQ-4 scores especially when COVID-19 stress was high. Crisis of meaning mediated the relationship between COVID-19 stress and PHQ-4. There was a higher likelihood of crises of meaning occurring when COVID-19 stress was high; crisis of meaning, in turn, was associated with general mental distress. Survey group moderated the first path of this mediation, i.e., the relationship between COVID-19 stress and crisis of meaning: High scores of COVID-19 stress were associated more strongly with crisis of meaning in the second survey group (after the lockdown). Self-control moderated the second path, i.e., the relationship between crisis of meaning and PHQ-4: When a crisis of meaning was present, self-control could buffer its effect on general mental distress.

CONCLUSIONS

Also in the present study among German-speaking participants, general mental distress was high. Scores were higher after than during the lockdown, indicating an ongoing destabilization for a significant part of the population. People who saw a meaning in their lives and who were capable of self-control reported substantially less mental distress. Meaningfulness and self-control also served as buffers between COVID-19 stress and general mental distress: When COVID-19 stress was high, the presence of meaningfulness and self-control accounted for lower general mental distress. Moreover, people who suffered strongly from COVID-19 stress were more likely to develop a crisis of meaning which, in turn, was associated with higher general mental distress. This suggests that ongoing anxiety and depression might (also) be based on existential struggles. Again here, self-control buffered the impact of crisis of meaning on general mental health. We conclude from these findings that public health policies can support citizens in coping with large-scale crises by enabling experiences of meaningfulness, e.g., through transparent and reliable modes of communicating goals and necessary intermediate steps. Moreover, health professionals are well advised to invite individuals to confront existential questions and struggles, and to encourage them to exercise self-control. The latter can be boosted by keeping higher-order goals salient-which again is inherently linked to an understanding of their meaning.

Moderation Effect of Physical Activity on the Relationship Between Fear of COVID-19 and General Distress: A Pilot Case Study in Arabic Countries

Aims

This study aimed to investigate the effects of the fear of COVID-19, level of physical activity, and gender on negative stress (distress) in an Arab population by means of structural equations based on partial least squares.

Materials and Methods

The sample population comprised of 459 participants from four Arab countries (age M = 33.02, SD = 8.46; n = 237 women and n = 222 men). The level of education was basic (<9 years of study; n = 144), secondary/vocational (between 9 and 12; n = 178), and university (n = 137). The “Fear of COVID-19” Scale, the short form of the “International Physical Activity Questionnaire,” and the “Perceived Stress Scale” questionnaires were disseminated by emails and social networks via Google Forms. SMARTPLS software version 3.2.9 was used to model the relationships between the variables under study.

Results

Results confirmed the links between level of physical activity, fear of COVID-19, and gender, showing a significant mediating effect of the fear of COVID-19 on the relationship between gender and general distress. The level of physical activity was also found to influence the fear of COVID-19, varying depending on gender. In addition, the model highlighted the presence of a moderation effect of the level of physical activity.

Conclusion

Based on the model presented in the present study, we can conclude that the COVID-19 pandemic has a profound impact on psychological distress in the target populations. The impact of the level of physical activity on psychological distress is shown to be very important during the pandemic phase.

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID‐19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational‐theoretical structure of the CIES. Adequate goodness‐of‐fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face‐to‐face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.

Assessing Fear and Anxiety of Corona Virus Among Dental Practitioners

OBJECTIVE

Originating in China in December 2019, coronavirus disease 2019 (COVID-19) rapidly spread to more than 216 countries in the world by May 2020. Because dentists are at a higher risk of contracting the disease, the present study assessed the fear and anxiety among dental practitioners of becoming infected with COVID-19.

METHODS

An online cross-sectional questionnaire survey comprising of 9 questions was conducted among dental practitioners of Telangana. Age, gender, qualification, type of practice, years of practice, and place of residence were the demographic variables recorded. The response to each question was recorded in a YES or NO format, and mean fear score was calculated to categorize answers into low and high levels of fear. Comparison of mean fear score was done using t-test for 2 variables and analysis of variance for 3 or more than 3 variables. Multiple logistic regression analysis of the levels of fear with demographic variables was done. P < 0.05 was considered statistically significant.

RESULTS

The mean fear and anxiety score of this study population reported was high 6.57 ± 2.07, with 58.31% of the population presenting with a low level of fear and anxiety. Only qualification (P = 0.045) and gender (P = 0.035) revealed a significant difference in fear to Q7and Q8, respectively. Irrespective of the age, gender, qualification, type of practice, and years in practice, the levels of fear reported in the present study were very similar. Respondents between 41 and 60 y of age (6.70 ± 2.01 y) and those with individual practices (6.70 ± 2.06 y) exhibited high fear scores.

CONCLUSIONS

The present study demonstrates cross-sectional data of fear and anxiety among dental practitioners during the COVID-19 outbreak. Heightened levels of fear observed in this study call for a nationwide analysis of fear among dentists and deliberate management strategies for the same.

Psychometric Properties of Three Simplified Chinese Online-Related Addictive Behavior Instruments Among Mainland Chinese Primary School Students

BACKGROUND/OBJECTIVE

There are inadequate screening instruments for assessing specific internet-related addictions among mainland Chinese primary school students. Therefore, the present study validated the psychometric properties of three simplified Chinese online-related addictive behavior instruments among mainland Chinese primary school students.

METHOD

Fourth to sixth graders (n = 1108; 48.3% males; mean [SD] age = 10.37 years [0.95]) completed the nine-item Internet Gaming Disorder Scales-Short Form (IGDS-SF9), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application-Based Addiction Scale (SABAS) in a classroom. The factorial structures and the unidimensionality of the three scales were examined using confirmatory factor analyses (CFAs). Measurement invariance of the three scales was examined using multigroup confirmatory factor analyses (MGCFAs) across gender.

RESULTS

The findings demonstrated that the three scales (Cronbach's α = 0.73 to 0.84) had unidimensional structure as supported by satisfactory fit indices (comparative fit index = 0.98 to 1.00). The MGCFA findings indicated that the unidimensional structures of the three scales were invariant across gender.

CONCLUSIONS

The findings indicate that the three simplified Chinese scales (IGDS-SF9, BSMAS, and SABAS) are valid instruments for assessing online-related addictive behaviors among mainland Chinese primary school students irrespective of their gender.

Measuring the Impact of COVID-19 on Mental Health: A Scoping Review of the Existing Scales

BACKGROUND

The coronavirus disease (COVID-19) pandemic, associated with the economic consequences of non-pharmaceutical interventions such as lockdown, has led to mental health consequences among people worldwide. Protecting the mental well-being of populations is an imperative component of fighting the COVID-19 pandemic. This scoping review attempts to present an overview of the existing tools to measure COVID-19-related mental health problems.

METHODS

Literature search was conducted in the PubMed electronic database using developed key search terms. Reference lists of the identified eligible articles were reviewed to locate relevant articles missed from the electronic database search. Fifteen scales measuring COVID-19-associated mental health problems, validated among diverse populations across the world, were included in this review.

RESULTS

The majority of these scales were validated among middle-aged adults in Turkey. Only a few validated scales encompass the negative socioeconomic consequences of COVID-19. None of the available scales focused on the aspects of suicidal ideation or behavioral responses/coping strategies, neither were they inclusive of participants from diverse age, geographic, and COVID-19 exposure groups.

CONCLUSION

This scoping review highlights the need for future research to develop and validate comprehensive psychometric tools to assess COVID-19-associated mental health problems. Also, in view of the vulnerable nature of healthcare professionals for developing mental health concerns in the course of providing services for COVID-19-affected individuals, future psychometric research needs to concentrate on the development of measures specific for these professionals.

Perceived Job Insecurity and Depressive Symptoms among Italian Dentists: The Moderating Role of Fear of COVID-19

Containment measures adopted to reduce the spread of coronavirus disease 2019 (COVID-19) have produced a general perception of job insecurity. Dentists have been highly affected by such measures, as they represent an easy source of contagion. As perceived job insecurity is associated with psychological distress and Italian dentists have been highly affected by the COVID-19 outbreak in terms of potential financial loss and the risk of being infected, this study aimed at assessing whether the fear of COVID-19 moderated the effect of perceived job insecurity on depressive symptoms. This cross-sectional online study has included 735 Italian dentists recruited during the lockdown and ranging in age from 27 to 70 years old (495 men and 240 women). A quantile regression model with an inference based on the median and with an interaction term between the fear of COVID-19 and perceived job insecurity has been used to estimate the hypothesized associations. The results indicated that both perceived job insecurity and fear of COVID-19 were positively associated with depressive symptoms, and that the effect of perceived job insecurity on depressive symptoms was weaker among those with a low fear of COVID-19. The findings may inform public health policies for dentists in relation to reducing the risk of developing negative mental health outcomes.

Validation and Psychometric Properties of the Japanese Version of the Fear of COVID-19 Scale Among Adolescents

In the context of the global outbreak of COVID-19, there is an urgent need to explore the effects of this pandemic on the mental health of adolescents. The present study aims to adapt and validate a Japanese-version Fear of COVID-19 Scale (FCV-19S) with a sample of adolescent students from Japan. To this end, the Japanese-version FCV-19S, Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire for Adolescents (PHQ-A), and Perceived Vulnerability to Disease Scale (PVDS) were administered to a sample of Japanese adolescents in schools. The results of statistical analyses revealed that the Japanese-version FCV-19S has a bi-factor model consisting of the emotional response factor and the physiological response factor, with high reliability (emotional: α = .71; physiological: α = .82). Constructive validity was shown by the significant positive correlation between the GAD-7 and emotional (r = .11) and physiological response (r = .25), between PHQ-A and physiological response (r = .19), and between both factors and the PVDS subscale (rs > .16). Taken together, these results indicate that the Japanese-version FCV-19S has a high internal consistency and a moderately good construct validity.

The Psychometric Validation of FCV19S in Urdu and Socio-Demographic Association with Fear in the People of the Khyber Pakhtunkhwa (KPK) Province in Pakistan

This study rests on two important considerations: the rapid increase of COVID-19 cases in Pakistan and also the marginalization of the people of the KPK province, which would make them more vulnerable in fearing COVID-19. We aim to translate and validate FCV-19S into the Urdu language and to identify the socio-demographic associations with fear in the people of the KPK. Using an online Google survey, we were able to sample 501 respondents from the KPK. The Cronbach alpha α value for the Urdu FCV-19S displayed good internal reliability at .846. The unidimensional structure of the FCV-19S in Urdu was confirmed, and all of the items were found to be statistically significant, ranging from 0.59 to 0.80. The results of the confirmatory factor analysis show that fit indices are all within an acceptable limit. The FCV-19S was also significantly and positively correlated with preventive behavior (r = .328, p < .01) and general anxiety (r = .458, p < .01). The results of independent sample t tests show that women (t = 4.086, p < 0.001), married people (t = − 2.709, p < .001), and unemployed people (t = − 3.199, p < 0.001) of the KPK experienced great fear of COVID-19. We conclude that that the Urdu version of the FCV-19S is a valid and reliable tool and must be used by healthcare practitioners, government bodies, and researchers, to identify the prevalence of fear and to subsequently plan improved social and health policies to reduce anxiety in the public.

Psychometric Testing of Three COVID-19-Related Scales Among People with Mental Illness

Fear of novel coronavirus 2019 (COVID-19) may result in psychological health problems among different populations. Moreover, believing COVID-19 information and preventive COVID-19 infection behaviors are relevant constructs associated with fear of COVID-19. Therefore, the present study validated three instruments assessing fear, beliefs, and preventive behaviors related to COVID-19 among individuals with mental illness. Moreover, relationships between the three constructs were examined. Individuals with mental illness (N = 400; 178 females; mean age = 46.91 years) completed the Fear of COVID-19 Scale (FCV-19S), Believing COVID-19 Information Scale (BCIS), Preventive COVID-19 Infection Behaviors Scale (PCIBS), and Depression Anxiety Stress Scale-21 (DASS-21). The FCV-19S, BCIS, and PCIBS demonstrated a single-factor structure with satisfactory fit indices. Moreover, believing COVID-19 information positively and significantly associated with fear of COVID-19, and fear of COVID-19 negatively and significantly associated with preventive behaviors and positively and significantly associated with psychological distress. The FCV-19S, BCIS, and PCIBS may assist healthcare providers in assessing COVID-19-related information among individuals with mental illness. Consequently, relevant programs may be designed to help individuals with mental illness going through the period of crisis.

Validation of the Fear of COVID-19 Scale in a US College Sample

The COVID-19 pandemic has impacted college students' coursework, stress levels, and perceived health. Various estimates indicate that high proportions of college students have experienced increased amounts of stress (Dziech, Inside Higher Education, 2020; Hartocollis, New York Times, 2020), yet other sources indicate that many college students respond to these changes with resilience (Kelley, Cornell Chronicle, 2020). A method for assessing student anxiety regarding the pandemic is thus needed. The Fear of COVID-19 Scale (FCV-19S) (Ahorsu et al., International Journal of Mental Health and Addiction, 2020) is a seven-item scale which has been validated and shown to possess good psychometric qualities in studies of participants from multiple countries. The current study used a cross-sectional convenience sample of US college student participants (n = 237) and found that the FCV-19S has high reliability and validity as demonstrated by its internal consistency and strong one-factor solution. Scores on the FCV-19S were positively correlated with anxiety for students who were married or of Asian descent. Additionally, the FCV-19S was only moderately correlated with the Generalized Anxiety Disorder-7 Scale (GAD-7), suggesting that the FCV-19S may bring added utility to research and clinical practice with populations impacted by the COVID-19 pandemic.

Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru

The current pandemic of the novel coronavirus COVID-19 has increased the anxiety and fear experienced by many. The main objective of this study was to analyze the psychometric properties of the Spanish-translated version of the Fear of COVID-19 Scale (FCV-19S) using a sample of population in Peru. This is a cross-sectional instrumental study. Data were collected by a convenience sampling method, resulting in a total of 832 participants, and the collection took place over 1 week, April 17–23, 2020. The original version of the FCV-19S was translated from English into Spanish. The results support a bifactor model consisting of one general factor and two specific factors—one of emotional fear reactions and another of somatic expressions of fear of COVID-19 (CFI = 0.988, RMSEA = 0.075). Invariance between healthcare workers and age groups was reached (ΔCFI < 0.01), but the invariance between men and women was not met (ΔCFI = 0.02). Convergent validity was found with depressive, anxious, and posttraumatic stress symptoms. The general factor of the fear of COVID-19 and two specific factors had an optimal level of internal consistency (ω > 0.89 and α > 0.83). The study found the Spanish-translated version of the FCV-19S has good psychometric properties and presents evidence of validity and reliability.

Fear of COVID-19 and Positivity: Mediating Role of Intolerance of Uncertainty, Depression, Anxiety, and Stress

This study aimed to investigate the mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. The participants consisted of 960 individuals, including 663 females (69.1%) and 297 males (30.9%). The age of the participants ranged between 18 and 76 (29.74 ± 9.64). As a result of the correlation analysis, a positive relationship was found between fear of COVID-19 and intolerance of uncertainty, depression, anxiety, and stress, and a negative relationship was determined between the fear of COVID-19 and positivity. The result of the analysis for the study model indicated that there was a mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. Eliminating uncertainty from the fear of COVID-19 will contribute to reducing depression, anxiety and stress, and increasing positivity.

Depression and Anxiety in Hong Kong during COVID-19

It has been three months since the first confirmed case of coronavirus disease 2019 (COVID-19) in Hong Kong, and people now have a more complete picture of the extent of the pandemic. Therefore, it is time to evaluate the impacts of COVID-19 on mental health. The current population-based study aimed to evaluate the depression and anxiety of people in Hong Kong during the COVID-19 pandemic. Respondents were randomly recruited and asked to complete a structured questionnaire, including the patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder-7 (GAD-7), the global rating of change scale and items related to COVID-19. Of the 500 respondents included in the study, 19% had depression (PHQ-9 score ≥ 10) and 14% had anxiety (GAD score ≥ 10). In addition, 25.4% reported that their mental health had deteriorated since the pandemic. Multiple logistic regression analysis found that not experiencing the SARS outbreak in 2003, being worried about being infected by COVID-19, being bothered by having not enough surgical masks and being bothered by not being able to work from home were associated with a poorer mental health status. Psychological support, such as brief, home-based psychological interventions, should be provided to citizens during the pandemic.

Psychometric Evaluation of the Arabic Version of the Fear of COVID-19 Scale

Fear is a central emotional response to imminent threats such as the coronavirus-19 disease (COVID-19). The Fear of COVID-19 Scale (FCV-19S) assesses the severity of fear towards COVID-19. The present study examined the psychometric properties of the Arabic version of the FCV-19S. Using a forward-backward translation, the FCV-19S was translated into Arabic. An online survey using the Arabic versions of FCV-19S and the Hospital Anxiety and Depression Scale (HADS) was administered. Reliability and concurrent and confirmatory validity were examined. The dataset consisted of 693 Saudi participants. The internal consistency of the Arabic FCV-19S was satisfactory (α = .88), with sound concurrent validity indicated by significant and positive correlations with HADS (r = .66). The unidimensional structure of the FCV-19S was confirmed. The Arabic version of the FCV-19S is psychometrically robust and can be used in research assessing the psychological impact of COVID-19 among a Saudi adult population.

Psychometric Validation of the Bangla Fear of COVID-19 Scale: Confirmatory Factor Analysis and Rasch Analysis

The recently developed Fear of COVID-19 Scale (FCV-19S) is a seven-item uni-dimensional scale that assesses the severity of fears of COVID-19. Given the rapid increase of COVID-19 cases in Bangladesh, we aimed to translate and validate the FCV-19S in Bangla. The forward-backward translation method was used to translate the English version of the questionnaire into Bangla. The reliability and validity properties of the Bangla FCV-19S were rigorously psychometrically evaluated (utilizing both confirmatory factor analysis and Rasch analysis) in relation to socio-demographic variables, national lockdown variables, and response to the Bangla Health Patient Questionnaire. The sample comprised 8550 Bangladeshi participants. The Cronbach α value for the Bangla FCV-19S was 0.871 indicating very good internal reliability. The results of the confirmatory factor analysis showed that the uni-dimensional factor structure of the FCV-19S fitted well with the data. The FCV-19S was significantly correlated with the nine-item Bangla Patient Health Questionnaire (PHQ-90) (r = 0.406, p < 0.001). FCV-19S scores were significantly associated with higher worries concerning lockdown. Measurement invariance of the FCV-19S showed no differences with respect to age or gender. The Bangla version of FCV-19S is a valid and reliable tool with robust psychometric properties which will be useful for researchers carrying out studies among the Bangla speaking population in assessing the psychological impact of fear from COVID-19 infection during this pandemic.