Validity and reliability of the Serbian COVID Stress Scales

Caring for a child with cancer during COVID-19 pandemic: an assessment of the parents' perception and stress level

Background

The emergence of COVID-19 pandemic has led to heightened fear and uncertainty among parents of children with cancer. This study was conducted to evaluate the parental perceptions toward effects of COVID-19 infection to children with cancer, determine their stress level and factors contributing to high stress level during the pandemic.

Methods

This cross-sectional study was conducted in three paediatric oncology centres in Malaysia from September 2020 until December 2022. A total of 167 parents were recruited. Parents completed a set of questionnaires to assess their perception on effect of COVID-19 infection to children with cancer and COVID Stress Scale (CSS) to assess the parents' stress level.

Results

Patients' mean age at study entry was 8.75 years (SD 4.38). Ninety-one (54.5%) patients were still on active treatment. More than 80% of the parents obtained information regarding COVID-19 infection from mass media and social networking. Fear of their children contracting COVID-19 infection was high especially among patients who were still on treatment. Forty-nine (29.3%) parents were significantly affected by the pandemic leading to loss of job or monthly income. Twenty-nine (17.4%) patients required treatment modification during the pandemic. The median total score for CSS was 78.0 (IQR 25th 64.0; 75th 95.0). Ninety-one (54.5%) respondents were very/extremely stressed based on the CSS scores. Components with high scores were xenophobia (median score 18.0; IQR 25th 13.0, 75th 22.0), fear of danger (median score 17.0; IQR 25th 14.0, 75th 20.0) and contamination fears (median score 16.0; IQR 25th 12.0, 75th 19.0). Lower household income was associated with higher stress level (p = 0.006).

Conclusion

Our study demonstrated high awareness regarding risk of COVID-19 infection among parents of oncology children. Half of the parents had high stress level, with low household income identified as a factor associated with high stress level.

A dataset on the socioeconomic and behavioural impacts in Sri Lanka through multiple waves of COVID-19

The impact of the COVID-19 pandemic was diverse and disproportionate among nations, and population segments. The impacts of the disease and the containment strategies adopted are broad and cut across multiple facets of life, society, and the economy, which are intimately interlinked. Therefore, a large household survey was conducted to ascertain the socioeconomic impact and human behavior changes due to the pandemic and the containment strategies covering all provinces of Sri Lanka. The ramifications on mobility and human behavior, income, economic status, food consumption, education, access to health services and information, and cultural and psychological changes were explored, and the data are reported in this paper. The survey was conducted on 3020 households, selected using a multistage clustering technique, to assess the impacts of the pandemic through three distinctly identified waves/phases of the pandemic in Sri Lanka. This dataset will enable researchers and policymakers to analyze the impact of the pandemic through a multifaceted perspective enabling a more holistic approach to decision-making.

Is there evidence for factorial invariance of the COVID Stress Scales? an analysis of North American and cross-cultural populations

The COVID-19 pandemic impacted the mental health of more citizens globally than any previous modern viral outbreak. In response to the psychological challenges associated with COVID-19, the COVID Stress Scales (CSS) were developed to assess the presence and severity of COVID-related distress. The initial North American validation study of the CSS identified that the scale comprised five factors: danger and contamination fears, fear of socioeconomic consequences, xenophobia, checking and reassurance seeking, and traumatic stress symptoms. The CSS have since been validated across a multitude of international populations. However, findings support a five- and six-factor model. Methodological issues make interpreting most studies supporting a five-factor model challenging. The purpose of this study was to re-evaluate the factor structure of the CSS using data from North American samples, to assess for potential factorial invariance, and compare these results to cross-cultural findings. Multiple confirmatory factor analyses (mCFA) were conducted across 28 different groups (e.g., age, ethnicity/race, sex) from two large independent North American samples from 2020 (n = 6827) and 2021 (n = 5787), assessing the fit indices of the five-, six-, and alternative-factor model of the CSS. The current results provide evidence for factorial invariance of the six-factor model of the CSS across different North American demographics and highlight potential challenges in interpreting the results of studies that have supported a five-factor model of the CSS.

Intolerance of Uncertainty and Worry Prospectively Predict COVID-19 Anxiety and Distress: A 4-Year Longitudinal Study

The COVID-19 pandemic precipitated an uptick in poor mental health outcomes, including coronavirus-related anxiety and distress. Preliminary research has shown that intolerance of uncertainty (IU) and worry proneness, two transdiagnostic risk factors for anxiety and related disorders, are associated cross-sectionally with pandemic-related fear and distress. However, the extent to which IU and worry proneness prospectively predict coronavirus-related anxiety and distress is unclear. Whether IU and worry may also interact in prospectively predicting coronavirus-related anxiety and distress is also unknown. To address this knowledge gap, the present study examined IU and trait worry as prospective predictors of the level and trajectory of coronavirus anxiety and COVID stress syndrome over time, as well as the extent to which worry moderated the relation between IU and pandemic-related outcomes. Participants (n = 310) who completed self-report measures of IU and trait worry in 2016 were contacted following the onset of COVID-19 in 2020 and completed biweekly measures of coronavirus anxiety and COVID stress syndrome for 30 weeks. Multilevel models revealed that IU assessed in 2016 significantly predicted the severity of both coronavirus anxiety and COVID stress syndrome throughout the study period in 2020. Worry also moderated the link between IU and coronavirus anxiety, such that individuals with high levels of trait worry and high IU in 2016 experienced the most coronavirus anxiety in 2020. Results suggest that IU and worry functioned as independent and interactive vulnerability factors for subsequent adverse psychological reactions to COVID-19. Clinical implications and future directions are discussed.

Anxiety Symptoms, COVID-19-Related Stress Reactions in the Italian General Population, and Validation of the Italian COVID Stress Scales (CSS-I)

Background. The COVID Stress Scales (CSS) assess COVID-related stress experienced in the past week related to danger and contamination fears, socioeconomic consequences, xenophobia, compulsive checking, and reassurance seeking, and traumatic stress symptoms. Our objective was to provide a translation into Italian, replication, and psychometric validation of the CSS in the general population. Moreover, we aimed to test the convergent and discriminant validity of the Italian CSS (CSS-I) with respect to anxiety, stress, and depressive symptoms in the general Italian population. Method. Adult participants (n = 935) over the age of 18 years were recruited from the general population in Italy. Psychological status was assessed using multiple validated measures, including the CSS, Depression, Anxiety and Stress Scales-21 (DASS-21), and the Prejudice Against Immigrants Scale (PAIS). Results. Our confirmatory factor analysis supported a 6-factor model, including danger fears (DAN), socioeconomic consequences (SEC), xenophobia (XEN), compulsive checking and reassurance seeking (CHE), contamination fears (CON), and traumatic stress symptoms (TSS). Strong reliability of the CSS-I (Cronbach's α = 0.863-0.936) and convergent validity with the DASS-21 and PAI were established with positive correlations between total and scale scores across measures. Conclusions. The CSS-I is a valid and reliable instrument to measure COVID-19-related distress in the Italian population.

Adherence to hemophilia patients with prophylaxis: Veritas-Pro and psychometric properties adapted to Turkish

The Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis (VERITAS-Pro) assesses adherence to prophylaxis treatment recommendations in hemophilia patients. This study aimed to adapt the VERITAS-Pro into Turkish and evaluate its reliability and validity. The research design used is a psychometric study. A convenience sample of 102 patients with hemophilia A or B was followed by the Aegean Adult Hemophilia and Thrombosis Center. The VERITAS-Pro was adapted to Turkish in six steps, including forward- and back-translation, committee review, and reliability and validity analysis. Based on the confirmatory factor analysis, modification indices suggested discrepancies amongst items, which were improved upon the removal of items 11 and 15. Findings from this alternative model are: χ2/df = 1.34; RMSEA = 0.05; SRMR = 0.09; and IFI = 0.92. The alternative model showed high adherence rates. Cronbach's alpha value for the Turkish version was found to be 0.83. The test-retest reliability of the Turkish scale ranged from 0.31 to 0.78. All items discriminated significantly between participants who were more adherent and those who were less adherent (t = 23.53; p<0.01). Translation of the VERITAS-Pro into local languages enables more accurate measurement of treatment adherence among people with hemophilia and facilitates cross-cultural comparison studies. According to the validity and reliability evidence obtained, the psychometric properties of the Turkish version of the VERITAS-Pro are suitable.

Do executive functions buffer against COVID-19 stress?: A latent variable approach

Levels of COVID-19 stress have soared worldwide as a result of the pandemic. Given the pernicious psychological and physiological effects of stress, there is an urgent need for us to protect populations against the pandemic's psychological impact. While there exists literature documenting the prevalence of COVID-19 stress among various populations, insufficient research has investigated psychological factors that might mitigate this worrying trend. To address this gap in the literature, the current study seeks to examine executive functions as a potential cognitive buffer against COVID-19 stress. To do so, the study adopted a latent variable approach to examine three latent factors of executive functions and their relation to COVID-19 stress among a sample of 243 young adults. Structural equation models showed differential associations between COVID-19 stress and the latent factors of executive functions. While the latent factor of updating working memory was associated with attenuated COVID-19 stress, task switching and inhibitory control were not significantly associated with COVID-19 stress. These results further our understanding of the critical processes of executive functions and highlight the nuanced link between executive functions and pandemic-related stress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04652-8.

COVID-19-Related Stress, Fear and Online Teaching Satisfaction among Nursing Students during the COVID-19 Pandemic

The COVID-19 pandemic has had a significant impact on mental health, particularly among students, due to COVID-19-related fear and also the transition from traditional to online lectures. In this questionnaire-based study, the COVID-19 Stress Scales (CSS), the Fear of COVID-19 Scale (FCV-19S), and the Online Teaching Satisfaction Scale were used to assess COVID-19-related fear, stress, and overall satisfaction with online teaching during the COVID-19 pandemic among nursing students in Serbia. A total of 167 students participated in the study, whose mean age was 21.3 ± 5.3, and the majority of whom were female and first-year students. Overall, most students experienced moderate to extremely high COVID-19-related stress levels. Overall, first-year and fourth-year students scored significantly lower regarding the Xenophobia and Traumatic stress subscales than second-year and third-year students, whereas first-year students also scored significantly lower on the Danger and Contamination subscales. First-year students experienced less COVID-19-related fear compared to senior students. Students were reasonably satisfied with online teaching. A stratified program is needed to prevent further decline of students' mental health and to improve their adaptation through public, health, and educational changes.

COVID-19 stress syndrome in the German general population: Validation of a German version of the COVID Stress Scales

The COVID Stress Scales (CSS) are a new self-report instrument for multidimensional assessment of psychological stress in the context of the pandemic. The CSS have now been translated and validated in over 20 languages, but a validated German version has not yet been available. Therefore, the aim was to develop a German version of the CSS, to test its factor structure, reliability, and validity, and to compare it with international studies. In an online survey (08/2020-06/2021), N = 1774 individuals from the German general population (71.5% female; Mage = 41.2 years, SD = 14.2) completed the CSS as well as questionnaires on related constructs and psychopathology. After eight weeks, participants were asked to participate again for the purpose of calculating retest reliability (N = 806). For the German version, the 6-factor structure with good model fit (Root Mean Square Error of Approximation, RMSEA = 0.06) was confirmed, with the six subscales: Danger, Socio-Economic Consequences, Xenophobia, Contamination, Traumatic Stress, and Compulsive Checking. Internal consistencies ranged from ω = .82-.94 (except Compulsive Checking ω = .70), and retest reliability from rtt = .62-.82. Convergent and discriminant validity were confirmed for the German version. Related constructs such as health anxiety, general xenophobia, obsessive-compulsive behavior, and posttraumatic stress disorder symptoms correlated moderately with the respective subscale and lower with the other scales. With anxiety and depression, Traumatic Stress showed the strongest correlation. Overall, there was a high degree of agreement in an international comparison. The CSS can help to identify pandemic-related psychological stress and to derive appropriate interventions.

Mental health during the COVID-19 pandemic: Stress and strain profiles in the German population

Clinical observations indicate that people frequently display stress-related behavior during the COVID-19 pandemic. Although numerous studies have been published concerning pandemic-related psychological distress, systematic data on the interrelationships between stress sensitivity, personality, and behavioral characteristics of people are still lacking. In the present cross-sectional online survey study, we applied a German version of the COVID Stress Scales (CSS) and standard psychological questionnaires to systematically identify the complex interplay between stress sensitivity, gender, and personality in the modulation of quality of life and mental health in the German population (N = 1774; age ≥ 16 years). A CSS-based cluster analysis revealed two clusters characterized by higher and lower stress levels. Study participants in each cluster differed significantly with respect to neuroticism, extraversion, agreeableness, quality of life, depression, and anxiety. Females were significantly overrepresented in the higher stress cluster, while there was an overrepresentation of males in the lower stress cluster. Neuroticism was identified as a risk factor and extraversion as a protective factor for enhanced pandemic-related stress responses. For the first time our data show a taxonomy of factors, which modulate pandemic-related stress sensitivity and warrant consideration as key indicators of quality of life and psychological distress during the COVID-19 pandemic. We suggest that our data may advise governmental regulation of pandemic-related public health measures, to optimize quality of life and psychological health in different groups of the population.

Psychometric properties of the traditional Chinese version of the COVID Stress Scales in Hong Kong

Introduction

The COVID Stress Scales (CSS) assess six domains of COVID-19-related stress, including (a) COVID danger, (b) COVID socioeconomic consequences, (c) COVID xenophobia, (d) COVID contamination, (e) COVID traumatic stress symptoms, and (f) COVID compulsive checking. Although the CSS have been validated in various cultural contexts, their psychometric properties in Hong Kong have not been examined. This study endeavors to validate the traditional Chinese version of the 36-item CSS (CSS-36) and the 18-item CSS (CSS-18) in Hong Kong.

Method

Participants were 521 Hong Kong undergraduate students (61% female) aged from 18 to 26 years (M = 20.65, SD = 1.56). An online questionnaire was used for data collection.

Results

The results of confirmatory factor analyses supported a six-factor structure for both the CSS-36 and the CSS-18. Multiple-group confirmatory factor analyses established the gender invariance of the six-factor model for both the CSS-36 and the CSS-18. The CSS-36 and the CSS-18 exhibited good internal consistency reliability and concurrent validity with fear of COVID-19 and negative emotional states.

Discussion

The findings offer evidence for the psychometric properties of the traditional Chinese version of the CSS-36 and the CSS-18 in the Hong Kong context.

Validation of the Hungarian Version of the COVID Stress Scale (CSS-H)

(1) Background: The COVID-19 pandemic is unprecedented and has affected every social class. The prevalence of moderate-to-severe stress and anxiety levels in the general population was reported to be 25%. This study aimed to describe the validation of the Hungarian version of the COVID Stress Scale. (2) Methods: The research study was a cross-section validation study with a representative sample (N = 1200) and a non-representative student sample (N = 350). The translation procedure was a four-step procedure. The interviewers conducted the data collection. (3) Results: The reliability of the Hungarian CSS was assessed using Cronbach's alpha. Convergent validity was evaluated by correlating the CSS with the PSS and WHO-WBI5. The Cronbach's alpha coefficient of the CSS-H factors was between 0.844 and 0.907 (representative sample) and between 0.878 and 0.936 (student sample), which qualified as very good. The reliability of the internal consistency was good for all six factors in both samples. The CSS-H total and all-domain scores significantly and positively correlated with the PSS total score and negatively correlated with well-being. (4) Conclusions: The Hungarian COVID Stress Scale is a valid, reliable instrument to measure COVID-19-related distress in the Hungarian population.

The adaption of the Chinese version of the COVID Stress Scales as a screening instrument of stress: Psychometric properties during the COVID-19 pandemic

The COVID Stress Scales (CSS) was used to access related distress concerning Corona Virus Disease 2019 (COVID-19). Based on China's epidemic prevention and control policies during the COVID-19 pandemic, the adaption of the Chinese version of the CSS was developed. Our study evaluated the reliability and validity of the Chinese adapted version of the CSS during the COVID-19 pandemic. An online survey was employed to construct a national sample of 2,116 participants in Chinese mainland. We examined the factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity. The results demonstrated that the six-factor solution for the Chinese adaptation of the CSS proved a good fit with the data after comparing the factor structure with the five-factor model. The six-factor model had good reliability and supported good convergent, discriminant, and concurrent validity of the CSS Chinese adaption. Overall, our findings supported the Chinese adapted version of the CSS as a psychometrically sound measure of stress during the COVID-19 pandemic in China.

How does COVID stress vary across the anxiety-related disorders? Assessing factorial invariance and changes in COVID Stress Scale scores during the pandemic

BACKGROUND

No studies have examined whether levels of COVID stress vary across anxiety-related disorders. Likewise, no studies have assessed structural invariance of the COVID Stress Scales (CSS) across clinical diagnoses. We sought to address these issues in the present study. Given the dynamic nature of pandemics, we also assessed whether COVID stress changed from the first to third wave in those with clinical diagnoses and those with no mental health conditions.

METHOD

Data were collected during COVID-19 from two independent samples of adults assessed about a year apart (early-mid in 2020, N = 6854; and early-mid 2021, N = 5812) recruited from Canada and the United States through an online survey. Participants provided demographic information, indicated the presence of current (i.e., past-year) anxiety-related or mood disorder, and completed the CSS.

RESULTS

The five CSS were reliable (internally consistent), and the five-factor structure was stable across samples. Scores tended to be highest in people with anxiety-related or mood disorders, particularly panic disorder. As expected, scores fluctuated over time, being higher during the early phases of the pandemic when threat was greatest and lower during the later phases, when vaccines were deployed and the COVID-19 threat was reduced.

CONCLUSION

The findings add to the growing number of studies supporting the psychometric properties of the CSS. The results encourage further investigations into the utility of the scales, such as their ability to detect treatment-related changes in COVID-19-related distress. The scales also show promise for studies of future pandemics or outbreaks because the CSS can be modified, with minor wording changes, to assess distress associated with all kinds of disease outbreaks.