Volume 28, Issue 3 (Autumn 2022)                   IJPCP 2022, 28(3): 336-349 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Rostami H, Behrouzian F, Mousavi Asl E. Psychometric Properties of the Persian Version of the COVID-19 Anxiety Syndrome Scale in Iranian College Students. IJPCP 2022; 28 (3) :336-349
URL: http://ijpcp.iums.ac.ir/article-1-3549-en.html
1- Department of Psychiatry, Golestan Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2- Department of Psychiatry, Golestan Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. , seyedesmaeilmousaviasl@gmail.com
Full-Text [PDF 4482 kb]   (540 Downloads)     |   Abstract (HTML)  (1395 Views)
Full-Text:   (421 Views)
Introduction
There is strong evidence that people suffering from coronavirus disease 2019 (COVID-19)-related psychological problems show anxiety, health anxiety, elevated levels of post-traumatic stress disorder, general stress, and suicide attempts [15161718], which are not limited to the pandemic period. Because people cannot cope properly, it may be difficult for them to have full recovery and participate in society as before, which can exacerbate the COVID-19-related anxiety [19]. In this regard, the need for a reliable and valid scale to measure the COVID-19 anxiety syndrome is evident. Measuring the COVID-19 anxiety syndrome by combination of threat monitoring, checking, avoidance, and worry is very important.
The COVID-19 Anxiety Syndrome Scale (C-19ASS) has good psychometric properties (validity and reliability). It can measure the fear of COVID-19, diagnosis of COVID-19, history of anxiety, and functional impairment [13]. This scale examines other aspects of maladaptive coping (e.g., avoidance, threat monitoring, worry) that have not been explicitly examined so far, and covers these maladaptive coping styles in one scale [13]. The present study aims to assess the reliability and validity of the Persian version of C-19ASS. Due to the psychological consequences of The COVID-19 anxiety syndrome,and the absence of a valid and reliable Persian scale, the present study aimed at investigating the psychometric characteristics of The COVID-19 anxiety syndrome scale (C-19ASS).
Methods
This is a correlational study. Participants were 251 students of Ahvaz University of Medical Sciences in 2020. They were selected using a convenience sampling method. The sample size was determined according to the minimum sample size required for confirmatory factor analysis (n=200) [25]. Data collection tools were:
The C-19ASS is a short self-report tool to measure COVID-19 anxiety syndrome developed by Nikčević and Spada (13). It has 9 items and two subscales of perseveration (6 items) and avoidance (3 items). The items are rated on a five-point scale from 1= Not at all to 5= Nearly every day. Cronbach’s alpha is 0.77 for the avoidance dimension and 0.86 for the Perseveration dimension [13]. 
The COVID-19 Burnout scale (COVID-19-BS): This self-report tool was adapted from the Malach-Pines burnout short version [28] and developed by Yıldırım and Solmaz [27]. It has 10 items rated on a five-point scale from 1= Never to 5= Always [27].
Compassion Scale: This 16-item self-report tool was designed in 2020 by Pommier et al. [29] based on the Neff’ self-compassion model and measures compassion for others. Cronbach’s alpha for this scale is in range of 0.86-0.89 for different samples [29].
Due to the pandemic, the data were collected online by sending the questionnaires through WhatsApp and Telegram. The collected data were analyzed in SPSS v.25 software and LISREL 8.8 software. Cronbach’s alpha was used for examining the reliability of the Persian C-19ASS and its subscales. The validity was determined by assessing convergent validity, divergent validity, and construct validity (using confirmatory factor analysis).
Results
Participants were in the age range of 18-56 years with a mean age of 27.52±4.87 years. Of 251 students, six (2.4%) were divorced, 146 (58.16%) were single, and 99 (39.4%) were married. Moreover, 65 students (9.25%) had master’s degree, 79 (31.47%) had PhD, and 107 (42.62%) had bachelor’s degree. The mean score of the Persian C-19ASS and its subscale and the correlation between them are shown in Table 1.


The results of confirmatory factor analysis on the single-factor and two-factor structure of the Persian C-19ASS are shown in Table 2.


Based on the results, it can be said that both models had a good fit (Figures 1 and 2), where the two-factor model had a better fit to the data.

The results of divergent and convergent validity are shown in Table 3.


As can be seen, the relationship between the scores of C-19ASS and the compassion scale was negative and significant (P<0.01), which indicates the acceptable divergent validity of the Persian C-19ASS. The relationship of the C-19ASS score with COVID-19-BS score was positive and significant (P< 0.01), which shows the acceptable convergent validity of the Persian C-19ASS.
Cronbach’s alpha for the overall scale and the perseveration and avoidance subscales were reported 0.72, 0.71, and 0.70, respectively, which indicates good internal consistency of the Persian C-19ASS.
Discussion
Fear of the unknown diseases has always been stressful and worrying which reduces the perception of safety in people. Due to COVID-19 pandemic in Iran, the standardization of a short self-report tool for the assessment of anxiety caused by COVID-19 is very important. The C-19ASS is a useful tool for understanding and measuring the different dimensions of the COVID-19 anxiety. The main goal of this study was to investigate the validity and reliability of the Persian C-19ASS in college students in Ahvaz, Iran. The results of this study showed that the two-factor and single-factor structures of the Persian C-19ASS had a good fit. The two-factor model had a better fit. The results are in line with the factor structure of the main version of C-19ASS in the study by Nikčević and Spada [13].
The results of our research are in line with the studies that indicated the important role of maladaptive forms of coping in psychological distress [26, 2728]. According to Nikčević and Spada (13), the COVID-19 anxiety syndrome should be conceptually and psychometrically separated from the threat, fear and anxiety that reflects the nature of the COVID-19-related anxiety and not the response to it. The C-19ASS evaluates other aspects of maladaptive coping such as avoidance, threat monitoring, and worry.
The convergent and divergent validity of the Persian C-19ASS were also investigated in our study. The divergent validity was investigated in relation with the compassion scale whose results showed a negative and significant correlation. This is consistent with other studies [33, 34 35 36 37 38 39]. The convergent validity was examined in relation with COVID-19-BS whose results showed a positive and significant correlation. The Persian C-19ASS had good psychometric properties (validity and reliability) in a sample of college students and can be used in evaluating different aspects of COVID-19 anxiety syndrome in Iran. It is a short, useful, and practical tool that can be used clinical and research settings.
There were some limitations related to the generalization of the results to the general population of Iran. Moreover, the data was collected using self-report questionnaires. Future studies can use objective tools to determine the experience of COVID-19 anxiety syndrome. Furthermore, the study design was cross-sectional that does not allow to infer causality. The test-retest reliability of the Persian C-19ASS was not determined in this study, which should be investigated in future studies.

Ethical Considerations
Compliance with ethical guidelines

This article has an ethical approval from Ahvaz Jondishapur University of Medical Sciences (Code: IR.AJUMS.REC.1399.897).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declare that they have no conflict of interests.



References  
  1. Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity. 2020; 87:40-8. [PMID ] [PMCID ]
  2. Brooks SK, Smith LE, Webster RK, Weston D, Woodland L, Hall I, Rubin GJ. The impact of unplanned school closure on children’s social contact: Rapid evidence review. Eurosurveillance. 2020; 25(13):2000188. [DOI:10.2807/1560-7917.ES.2020.25.13.2000188 ]
  3. Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry. 2020; 66(4):317-20. [PMID ]
  4. Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. New England Journal of Medicine. 2020; 383(6):510-2. [DOI:10.1056/NEJMp2008017 ] [PMID ]
  5. Nikčević AV, Spada MM. The COVID-19 anxiety syndrome scale: Development and psychometric properties. Psychiatry Research. 2020; 292:113322. [DOI:10.1016/j.psychres.2020.113322 ] [PMID ] [PMCID ]
  6. Sirati Nir M, Karimi L, Khalili R. [The perceived stress level of health care and non-health care in exposed to covid-19 pandemic (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2020; 26(3):294-305. [DOI:10.32598/ijpcp.26.3405.1 ]
  7. Rezaei S, Sameni Toosarvandani A, Zebardast A. [Effect of COVID-19-induced Home Quarantine on parental stress and its relationship with anxiety and depression among children in Guilan Province (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2020; 26(3):280-93. [DOI:10.32598/ijpcp.26.3402.1 ]
  8. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General Psychiatry. 2020; 33(2):e100213. [DOI:10.1136/gpsych-2020-100213 ] [PMID ] [PMCID ]
  9. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health. 2020; 17(5):1729.[PMID ]
  10. Duffy B, Allington D. The accepting, the suffering and the resisting: the different reactions to life under lockdown. London: The Policy Institute, Kings College; 2020.
  11. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction. 2022; 20(3):1537-45. [DOI:10.1007/s11469-020-00270-8 ] [PMID ] [PMCID ]
  12. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Studies. 2020; 44(7):393-401. [DOI:10.1080/07481187.2020.1748481 ] [PMID ]
  13. Lee SA. How much “Thinking” about COVID-19 is clinically dysfunctional? Brain, Behavior, and Immunity. 2020; 87:97-8. [DOI:10.1016/j.bbi.2020.04.067 ] [PMID ] [PMCID ]
  14. Lee SA, Jobe MC, Mathis AA, Gibbons JA. Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. Journal of Anxiety Disorders. 2020; 74:102268. [PMID ] [PMCID ]
  15. Lee SA, Mathis AA, Jobe MC, Pappalardo EA. Clinically significant fear and anxiety of COVID-19: A psychometric examination of the Coronavirus Anxiety Scale. Psychiatry Research. 2020; 290:113112. [DOI:10.1016/j.psychres.2020.113112 ] [PMID ] [PMCID]
  16. Conway III LG, Woodard SR, Zubrod A. Social psychological measurements of COVID-19: Coronavirus perceived threat, government response, impacts, and experiences questionnaires.[Link]
  17. Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. The British Journal of Psychiatry. 2004; 185:127-33. [DOI:10.1192/bjp.185.2.127 ] [PMID ]
  18. Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognitive Therapy and Research. 2012; 36(3):210-8. [DOI:10.1007/s10608-011-9353-3 ]
  19. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. The Canadian Journal of Psychiatry. 2009; 54(5):302-11. [DOI:10.1177/070674370905400504 ] [PMID ] [PMCID ]
  20. Yip PS, Cheung YT, Chau PH, Law YW. The impact of epidemic outbreak: The case of severe acute respiratory syndrome (SARS) and suicide among older adults in Hong Kong. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 2010; 31(2):86-92. [DOI:10.1027/0227-5910/a000015 ] [PMID ]
  21. Wells A. Emotional disorders and metacognition: Innovative cognitive therapy. New Jersey: John Wiley & Sons; 2002. [DOI:10.1002/9780470713662 ]
  22. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy. 2016; 47(6):869–85. [PMID ]
  23. Barlow DH, Sauer-Zavala S, Carl JR, Bullis JR, Ellard KK. The nature, diagnosis, and treatment of neuroticism: Back to the future. Clinical Psychological Science. 2014; 2(3):344-65. [DOI:10.1177/2167702613505532 ]
  24. Mohammadpour M, Ghorbani V, Moradi S, Khaki Z, Foroughi AA, Rezaei MR. [Psychometric properties of the Iranian Version of the Coronavirus Anxiety Scale (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2020; 26(3):374-87. [Link]
  25. Mousavi Asl E, Dabaghi P, Taghva A. Screening borderline personality disorder: The psychometric properties of the Persian version of the McLean screening instrument for borderline personality disorder. Journal of Research in Medical Sciences. 2020; 25:97. [DOI:10.4103/jrms.JRMS_949_19 ] [PMID ] [PMCID ]
  26. Mousavi Asl E, Mahaki B, Gharraee B, Asgharnejad Farid AA, Shahverdi-Shahraki A. Beliefs about binge eating: The psychometric properties of the Persian version of the eating beliefs questionnaire. Journal of Research in Medical Sciences. 2020; 25:73. [DOI:10.4103/jrms.JRMS_623_19 ] [PMID ] [PMCID ]
  27. Kline RB. Principles and practice of structural equation modeling. New York: Guilford publications; 2015. [Link]
  28. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiology. 1993; 46(12):1417-32. [DOI:10.1016/0895-4356(93)90142-N] [PMID ]
  29. Yıldırım M, Solmaz F. COVID-19 burnout, COVID-19 stress and resilience: Initial psychometric properties of COVID-19 Burnout Scale. Death Studies. 2022; 46(3):524–32. [DOI:10.1080/07481187.2020.1818885 ] [PMID ]
  30. Malach-Pines A. The burnout measure, short version. International Journal of Stress Management. 2005; 12(1):78-88. [DOI:10.1037/1072-5245.12.1.78 ]
  31. Pommier E, Neff KD, Tóth-Király I. The development and validation of the Compassion Scale. Assessment. 2020; 27(1):21-39. [PMID ]
  32. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology. 2007; 60(1):34-42. [DOI:10.1016/j.jclinepi.2006.03.012 ] [PMID ]
  33. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999; 6(1):1-55. [DOI:10.1080/10705519909540118 ]
  34. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson GJ. Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders. 2020; 72:102232. [DOI:10.1016/j.janxdis.2020.102232 ] [PMID ] [PMCID ]
  35. Jungmann SM, Witthöft M. Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?. Journal of Anxiety Disorders. 2020; 73:102239. [DOI:10.1016/j.janxdis.2020.102239 ] [PMID ] [PMCID
  36. Asmundson GJ, Taylor S. Coronaphobia: Fear and the 2019-nCoV outbreak. Journal of Anxiety Disorders. 2020; 70:102196. [DOI:10.1016/j.janxdis.2020.102196 ] [PMID ] [PMCID ]
  37. Coyne LW, Gould ER, Grimaldi M, Wilson KG, Baffuto G, Biglan A. First things first: Parent psychological flexibility and self-compassion during COVID-19. Behavior Analysis in Practice. 2020; 14(4):1092–8. [DOI:10.1007/s40617-020-00435-w ] [PMID ] [PMCID ]
  38. Mohammadpour M, Ghorbani V, Khoramnia S, Ahmadi SM, Ghvami M, Maleki M. Anxiety, self-compassion, gender differences and COVID-19: Predicting self-care behaviors and fear of COVID-19 based on anxiety and self-compassion with an emphasis on gender differences. Iranian Journal of Psychiatry. 2020; 15(3):213-9. [DOI:10.18502/ijps.v15i3.3813 ] [PMID ] [PMCID ]
  39. Braus M, Morton B. Art therapy in the time of COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy. 2020; 12(S1):S267–8. [PMID ]

Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2021/08/7 | Accepted: 2021/10/18 | Published: 2022/12/22

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Iranian Journal of Psychiatry and Clinical Psychology

Designed & Developed by : Yektaweb