Volume 26, Issue 3 (Autumn- Special Issue on COVID-19 2020)                   IJPCP 2020, 26(3): 374-387 | Back to browse issues page

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Mohammadpour M, Ghorbani V, Moradi S, Khaki Z, Foroughi A A, Rezaei M R. Psychometric Properties of the Iranian Version of the Coronavirus Anxiety Scale. IJPCP 2020; 26 (3) :374-387
URL: http://ijpcp.iums.ac.ir/article-1-3270-en.html
1- Department of clinical psychology, School of Behavioral Sciences and Health Mental (Psychiatry of Institute Tehran), Iran University of Medical sciences, Iran, Tehran.
2- Department of Psychology Clinical, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
3- Department of Psychology, School of Medicine (Kermanshah Science and Research International Campus), Islamic Azad University, Kermanshah Branch, Kermanshah, Iran.
4- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. , mohammadreza.rezaei@kums.ac.ir
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1. Introduction
oronavirus disease first broke out in Wuhan, China, in December 2019 [1]. Today, most countries globally, including Iran, are thinking of controlling the disease’s spread through social distance and observing health protocols. Still, little attention has been paid to its psychological aspects [678]. Anxiety is considered a common symptom among patients with chronic respiratory disorders and could significantly reduce patients’ quality of life [13]. Regarding coronavirus, anxiety is common among people because it is unknown and undecided [14, 15]. 
Similarly, different tools have been developed to measure chronic respiratory disorders like SARS and MERS in the past. In most cases, anxiety measurement also included physical symptoms due to chronic respiratory diseases and medications’ side effects [13, 20, 21]. It is necessary to create tools to identify anxiety related to this disease and the strategies to prevent it from spreading in the current situation. With the onset of coronavirus, Lee [26] developed a mental health screening tool related to coronavirus. However, considering its limitations, it is necessary to explore its psychological characteristics across the world.
Therefore, a valid and short tool is needed to measure anxiety related to coronavirus due to the increasing anxiety and concern among people because of the impact of this virus on their various functions such as occupation and education. Thus, this study aims to determine the coronavirus anxiety scale’s psychometric characteristics in the Iranian statistical population. 
2. Method
The participants in this study consisted of 399 adults from Kermanshah city who participated online in this study from May 4 to May 7. The authors also obtained the informed consent of participants to take part in this study before filling out demographic information. CAS was conducted based on guidelines needed to standardize instruments in different cultures [33, 34].
Coronavirus anxiety scale: this scale includes 5 questions that measure cognitive, behavioral, emotional and physiological dimensions related to coronavirus anxiety during the past two weeks. The questions are scored based on a 5-point Likert scale from 0 (Never) to 4 (Almost every day) [26]. 
The Fear of COVID-19 Scale (FCV-19S): This scale was developed by Kwasi Ahorsu et al. to examine the fear of coronavirus by people. A higher score indicates more fear of coronavirus. Internal consistency and retest reliability were found to be 0.82 and 0.72, respectively [6]. 
Difficulties in Emotion Regulation Scale (DERS): DERS is a self-report tool consisting of 36 materials that measure the normal levels of difficulty in emotion regulation. The whole main scale’s reliability coefficient and the retest reliability were reported to be 0.93 and 0.88, respectively, and the construct and predictive validity were reported to be desirable [35]. This scale was normalized in Iran by Khanzadeh et al. [36]. 
Second version of the Acceptance and Action Questionnaire  (AAQ-II): This questionnaire measures the construct associated with diversity, acceptance, experiential avoidance, and psychological flexibility. Higher scores suggest greater mental flexibility. The mean alpha coefficient was found to be 0.84, and retest reliability, in 3 to 12 months, was found to be 0.81 and 0.79, respectively [37]. This instrument in Iran has appropriate psychometric features [39].
Statistical analysis
Data were analyzed using SPSS software V. 25 and Lisrel software V. 8.8. Descriptive statistics were used to analyze data, and Cronbach’s alpha was used to examine internal consistency. Confirmatory factor analysis was also used to determine to construct validity using Lisrel software V. 8.8.
3. Results
This study was conducted on 399 people with a mean age of 31.57±9.74. Cronbach’s alpha was used to analyze validity. The results of this study suggested that internal consistency using Cronbach’s alpha equals 91.5.
The correlation between the coronavirus anxiety scale and the Fear of COVID-19 Scale, difficulty in emotion regulation questionnaire, and acceptance and action questionnaire were analyzed to determine validity. The correlation between CAS and FCV-19S and the correlation between CAS and the overall score of DERS were found to be 0.45 and 0.27, respectively, which indicates favorable convergence validity of this scale. Moreover, the coronavirus anxiety scale negatively correlates with AAQ-II (r=0.43), suggesting its desirable divergence validity.
Confirmatory factor analysis was used to analyze the validity of the construct. The results of this study indicated that the single-factor model has proper fitting(P= 0.18, df= 2, chi-square = 4.83, RMSEA = 0.04, χ2/df =1.61). Table 1 shows the results of this study.

4. Discussion and Conclusion
CAS showed proper internal consistency, and its Cronbach’s alpha was found to be 91.5. These results are consistent with those of Lee [28], who reported that Cronbach’s alpha for coronavirus anxiety scale is 0.93. The convergence validity results indicated that CAS has a positive and significant correlation with FCV-19S, indicating that those who are more afraid of coronavirus experience more anxieFIty. This finding supports the work of other studies [6, 14, 28]. Also, all of the sub-components of difficulty in emotion regulation(except for difficulties engaging in goal-directed behaviors) had a positive and significant relationship with CAS. The problems of emotion regulation have been identified in many Axis I and Axis II disorders [4344]. Emotional dysregulation has a significant relationship, especially with depression and anxiety disorders [4748]. Thus, it could be argued that those who can hardly regulate their emotions in response to coronavirus disease will experience more anxiety. 
The results of divergence validity also indicated that experiential avoidance had a negative relationship with CAS. The growing body of literature has shown that those with low flexibility reported higher depression and anxiety levels [51, 54]. These findings agree with other studies in this area, analyzing the psychological aspects of coronavirus [55, 56, 57]. The results related to constructing validity also revealed that the single-factor construct has a proper fitting, according to the initial studies [26]. This study had a few limitations, namely convenience sampling and brief analysis by WhatsApp.
Finally, CAS showed proper psychometric characteristics, and health care professionals could use this screening tool to detect coronavirus-related anxiety, which might last for months. 
Ethical Considerations
Compliance with ethical guidelines
This research has been approved in Kermanshah University of Medical Sciences with the code 3010137.
This article is taken from the Mentor Plan approved by Kermanshah University of Medical Sciences. 
Authors' contributions
Conceptualization: Mohsen mohammadpour, Ali akbar foroughi; Methodology: Mohammad reza Rezaei, Samira moradi; Investigation, sources, preparation, writing-review & editin: Mohsen mohammadpour, Vajiheh Ghorbani; Validation, analysis, Project administration: All authors.
Conflicts of interest
This authors declared no conflict of interest
The authors would link to thank the Research and Technology Center of Kermanshah University of Medical Sciences and all health advocates. 

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Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2020/06/19 | Accepted: 2020/10/27 | Published: 2020/07/31

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