The Psychometric Properties of the Stress and Anxiety to Viral Epidemics-6 Items: A Test in the U.S. General Population

Loneliness, Social Isolation, and Obsession with COVID-19 among Older Adults

During the COVID-19 pandemic, older people were socially isolated for their protection against the virus impacting their mental health. Aiming to explore the role of loneliness and social isolation in the obsession with COVID-19 among older adults, we conducted an anonymous online survey with 300 older adults aged 65-80 years in South Korea between January and February 2023. The survey collected demographic information, past psychiatric history, medical disease, current psychological distress, and experiences related to COVID-19. Rating scales were the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-seeking Behaviors Scale (CRBS), Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), and Loneliness and Social Isolation Scale (LSIS). The regression analysis revealed that CRBS (β = 0.55, p < 0.001) and SAVE-6 (β = 0.34, p < 0.001) were significant predictors of obsession with COVID-19 (adjusted R2 = 0.63, F = 126.9, p < 0.001). Mediation analysis showed that loneliness and social isolation had a positive total effect on obsession with COVID-19, mediated by reassurance-seeking behavior and viral anxiety (Standardized Estimator = 0.21, standard error = 0.05, p < 0.001, 95% confidence interval 0.20-0.41). Loneliness and social isolation were found to be indirectly linked to obsession with COVID-19 through reassurance-seeking behavior and viral anxiety. The findings highlight the importance of addressing loneliness and social isolation among older adults during the COVID-19 pandemic to prevent obsession with COVID-19.

Comparison of the Stress and Anxiety to Viral Epidemic-9 and SAVE-6 scales among healthcare workers in Peru

Introduction

Peru is a country that has a high incidence of viral outbreaks and epidemics, which is why it is necessary to validate a scale that measures anxiety and stress in professionals who are on the front lines of these events. Therefore, our objective was to validate the Peruvian-Spanish version of the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9) scale and to concurrently compare its validity and internal consistency with the SAVE-6 scale among healthcare workers (HCWs).

Materials and methods

We conducted a cross-sectional study based on data collected from a self-reported survey in paper-and-pencil format between April and July 2023. A total of 203 HCWs participated in the research. We developed a confirmatory factor analysis (CFA) and item response theory (IRT). We calculated Cronbach's α coefficient and McDonald's ω to assess the internal consistency of the scales.

Results

The results show that SAVE-9 (a two-factor model) and SAVE-6 (a one-factor model) provided an excellent fit in the confirmatory factor analysis. Both scales demonstrated strong internal consistency (Cronbach's α 0.85 and 0.86, respectively). Significant correlations were found between the SAVE-9 and SAVE-6 scales and Generalized Anxiety Disorder-7 items scale (r = 0.44 and r = 0.38, respectively, p < 0.001) as well as the Patient Health Questionnaire-9 items (r = 0.39 and r = 0.35, respectively, p < 0.001). The optimal cutoff points for SAVE-9 and SAVE-6 were identified for assessing anxiety, aligned with a GAD-7 score ≥5 points.

Conclusion

The Peruvian-Spanish SAVE-9 and SAVE-6 scales are reliable and valid rating scales to assess the anxiety response of HCWs in response to viral epidemics. Though COVID-19 is diminished, these scales will be useful for other viral epidemics in the future.

The Pandemic Anxiety Inventory: A validation study

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

Application of Stress and Anxiety to Viral Epidemics-6 to Measure the Anxiety Response of Cold Chain Practitioners During the COVID-19 Post-Pandemic Era in China

OBJECTIVE

This study explored the psychometric properties of the Chinese version of the Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) scale for cold chain practitioners exposed to moderate-to-high risk of infection.

METHODS

A total of 233 cold chain practitioners participated in an anonymous online survey, conducted from October to November 2021. The questionnaire comprised participant demographic characteristics, the Chinese version of SAVE-6, the Generalized Anxiety Disorders-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) scales.

RESULTS

Based on the results of the parallel analysis, the single-structure model of the Chinese version of SAVE-6 was adopted. The scale showed satisfactory internal consistency (Cronbach's alpha=0.930) and good convergent validity based on Spearman's correlation coefficient with the GAD-7 (rho=0.616, p<0.001) and PHQ-9 (rho=0.540, p<0.001) scale scores. The optimal cutoff score for Chinese Stress and Anxiety to Viral Epidemics-9 Items was identified as ≥12 (area under the curve=0.797, Sensitivity=0.76, Specificity=0.66) for cold chain practitioners.

CONCLUSION

The Chinese version of the SAVE-6 scale has good psychometric properties and can be applied as a reliable and valid rating scale to assess the anxiety response of cold chain practitioners in the post-pandemic era.

Central Symptoms of Insomnia in Relation to Depression and COVID-19 Anxiety in General Population: A Network Analysis

BACKGROUND

Insomnia is prevalent among the general population, and studies have shown an increase in insomnia symptoms during the novel coronavirus (COVID-19) pandemic. Despite numerous studies of insomnia, few studies have investigated insomnia symptoms in detail. In this study, we used network analysis to investigate interactions between insomnia symptoms in the general population. Furthermore, given the effect of COVID-19 on mental health, we also investigated how anxiety response to COVID-19 and depression related to insomnia symptoms.

METHODS

Data from 785 non-infected participants were used. The Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics-6 Scale (SAVE-6), and Patient Health Questionnaire-9 (PHQ-9) were used to measure insomnia symptoms, anxiety response to COVID-19, and depression, respectively. Network analysis was performed using R Studio. Centrality indices and edge weights were obtained, and each index was evaluated using bootstrapping methods.

RESULTS

The network revealed ISI7 (worry about current sleep pattern) to be the most central insomnia symptom. ISI7 was strongly connected to SAVE-6 total score, and ISI2 (difficulty staying asleep) was strongly connected to PHQ-9 total score.

CONCLUSION

High centrality of ISI7 supports the role of dysfunctional cognitions in etiological models of insomnia and thus the cognitive behavioral therapy for insomnia. The relationship between ISI7 and SAVE-6 is explained by transposition of worry and fear of contracting COVID-19 to worry about sleep patterns. The link between ISI2 and PHQ-9 necessitate further investigations of whether specific symptoms of insomnia are more associated with depression.

The Psychometric Properties of the French-Canadian Stress and Anxiety to Viral Epidemics-6 Scale for Measuring the Viral Anxiety of the General Population During the COVID-19 Pandemic

Objective

This study examined the psychometric properties of the French-Canadian version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing the anxiety response to the viral epidemic among the general population in Quebec, Canada.

Methods

A total of 590 participants responded to a confidential online survey between September 28 and October 18, 2020. Confirmatory Factor Analysis (CFA) was conducted to explore the factor structure of the scale. Psychometric properties were assessed using the Item Response Theory (IRT) approach. To explore the convergent validity, a Pearson correlation analysis between the SAVE-6 scale and the depression (Patient Health Questionnaire-2, PHQ-2) or anxiety subscale (Generalized Anxiety Disorder-2, GAD-2) of the Patient Health Questionnaire-4 items scale was conducted.

Findings

The French-Canadian version of the SAVE-6 scale was clustered into a single factor. The CFA of the SAVE-6 scale showed a good model fit (CFI = 0.985, TLI = 0.976, RMSEA = 0.051, RSMR = 0.048), and the multi-group CFA revealed that the SAVE-6 scale can measure anxiety response in the same way across gender or the presence of elevated depressive and anxiety symptoms. It showed good internal consistency (Cronbach's alpha = 0.76, McDonald's Omega = 0.77) and significant correlation with the PHQ-2 score and GAD-2 score. The IRT model suggested the efficiency in discrimination among individuals in this latent trait.

Conclusion

The French-Canadian version of the SAVE-6 scale is a valid and reliable rating scale, which can measure the general population's anxiety response to the viral epidemic.

Mediation Effect of Self-Efficacy and Resilience on the Psychological Well-Being of Lebanese People During the Crises of the COVID-19 Pandemic and the Beirut Explosion

Introduction: Self-efficacy signifies an individual's belief in their own ability to perform the actions required to achieve a particular performance. In this study, we used an online survey to assess the mediation effect of resilience and self-efficacy on the overall psychological well-being of Lebanese people during the crises of the COVID-19 pandemic and the Beirut explosion. Methods: Overall, 567 Lebanese people participated in an online survey between March 17-28, 2021. The survey included the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 (PHQ-9), Connor-Davidson Resilience Scale-2 items, WHO-5 Well-being Index, General Self-Efficacy scale, and a single item on insomnia. We also assessed their risk perception regarding exposure to COVID-19 or explosions. Results: About 53% of participants were assessed as having depression (PHQ-9 ≥ 10) in the recent crisis. About half of participants (53.2%) reported feeling more stressed by COVID-19 than by the Beirut explosion, and 23.4% felt more stressed by the Beirut explosion than by COVID-19. Only the SAVE-6 score differed significantly between groups with greater stress responses to COVID-19 and the Beirut explosion. Self-efficacy mediated the influence of depression on people's psychological well-being, and self-efficacy and resilience mediated the influence of viral anxiety on psychological well-being. Conclusion: Self-efficacy is important for reducing people's depression and improving their psychological well-being during the Lebanon crises and also mediates the influence of anxiety in response to the viral epidemic on their psychological well-being in some people.

Psychometric Properties of the Bangla Version of the Stress and Anxiety to Viral Epidemics-6 Items Scale Among the General Population in Bangladesh

BACKGROUND

Any disease outbreak creates psychological stress and anxiety among the public [e.g., Coronavirus Disease 2019 (COVID-19)]. There are several scales that assess anxiety specifically related to the COVID-19 pandemic. The Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale is a reliable and valid tool to assess anxiety in any viral pandemic. The present study aims to validate the SAVE-6 scale in the Bangla language and culture, to assess such anxiety among the general Bangladeshi people.

METHODS

The SAVE-6 scale was translated into Bangla from English using the forward-backward translation procedure. A total of 357 Bangladeshi citizens participated via an online structured questionnaire. The items included questions on personal information, COVID-19 and vaccination, psychiatric history, the Bangla version of the SAVE-6 scale, the Generalized Anxiety Disorder-7 items (GAD-7) scale, and the Patient Health Questionnaire-9 items (PHQ-9) scale.

RESULTS

Both exploratory factor analysis and confirmatory factor analysis (CFA) were used to explore and confirm the single factor structure of the SAVE-6 scale in Bangla to be the same as that of the SAVE-6 scale. Multigroup CFA revealed invariance across sex, experience of being quarantined, experience of being infected, and presence of depression. Item analysis results showed good discrimination indices and internal consistency and reliability. The graded response model outputs also confirmed the validity and reliability of this scale, which had significant correlations with the GAD-7 and PHQ-9.

CONCLUSION

Overall, the Bangla version of the SAVE-6 is a psychometrically good scale to assess viral pandemic-related anxiety.

Validation of the Peruvian Spanish Version of the Stress and Anxiety to Viral Epidemics-6 Scale to Measure Viral Anxiety of Medical Students During COVID-19

INTRODUCTION

The COVID-19 pandemic has created academic problems for Peruvian medical students leading to anxiety and depression. Hence, validated scales, such as the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), are required to identify and propose interventions to improve mental health. We aimed to perform a psychometric validation of the Peruvian version of SAVE-6 on medical students during the COVID-19 pandemic in Lima, Peru, in 2022.

METHODS

A total of 260 medical students at National University of San Marcos (UNMSM) participated in an online survey in January 2022. We collected sociodemographic characteristics and classified psychiatric symptoms using SAVE-6, the Generalized Anxiety Disorder-7 items (GAD-7) scale, and the Patient Health Questionnaire-9 items (PHQ-9). We performed confirmatory and parallel factor analysis to examine the validity of the Peruvian Spanish version of SAVE-6.

RESULTS

We explored the reliability and validity of SAVE-6 and SAVE-6 after excluding item 5, since factor loading of item 5 is too low. Both scales showed good internal consistencies (Cronbach's α = 0.780 and.82 and McDonald's Ω = 0.792 and.829, respectively). Furthermore, SAVE-6 after excluding item 5 showed good convergent validity with GAD-7 (r = 0.224, p <.001) and PHQ-9 (r = 0.217, p <.001). Consequently, instead of the full SAVE-6, SAVE-6 excluding item 5 proved to be reliable and valid enough to assess the anxiety of Peruvian medical students during the pandemic.

CONCLUSION

The Peruvian Spanish SAVE-6 scale excluding item 5, rather than the full SAVE-6, can be applied to measure viral anxiety of medical students in Peru with good validity and reliability.

Psychometric Properties of the Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) Scale for High School Students During the COVID-19 Pandemic

OBJECTIVES

Owing to the COVID-19 pandemic, high school students have experienced a sudden change of school environment, which may result in difficulties related to mental health. The aim of this study is to estimate the reliability and validity of the Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) scale among high school students.

METHODS

A cross-sectional online survey was conducted among 300 high school students. The following scales were administered: the SAVE-6, Generalized Anxiety Disorder-7 Items (GAD-7), and Patient Health Questionnaire-9 Items (PHQ-9). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted, and the psychometric properties of the SAVE-6 were assessed.

RESULTS

The results of the CFA indicated good model fit for the SAVE-6 scale among high school students (χ2/df = 0.485, CFI = 1.000, TLI = 1.010, RMSEA < 0.001, and SRMR = 0.029). In addition, the SAVE-6 scale demonstrated good reliability (Cronbach's alpha = 0.844, McDonald's Omega = 0.848, and split-half reliability = 0.883). The appropriate cut-off score for the SAVE-6 scale was estimated as ≥15, which corresponds to a mild level of anxiety as assessed by the GAD-7 (≥5).

CONCLUSION

The SAVE-6 scale was found to be reliable and valid, and can be used as a tool to assess the stress and anxiety of high school students during the COVID-19 pandemic.

Adaptation and Validation of the Malay Version of the Stress and Anxiety to Viral Epidemics-6 Items Scale Among the General Population

The coronavirus disease pandemic has caused untold distress owing to both its physical and psychological sequelae, and such distress is further exacerbated by multiple socioeconomic ramifications. The Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6). Scale was developed to specifically assess the anxiety response of the general population to viral epidemics. This study aimed to establish the psychometric properties of the Malay version of the SAVE-6 Scale in the general population. Herein, a total of 257 individuals participated. World Health Organization instrument validation protocols were used to translate and back-translate the Malay SAVE-6 Scale. Subsequently, the classical test theory and Rasch analysis were used to ascertain the validity and reliability of the scale. Cronbach α was used to measure the internal consistency, which was found to be satisfactory (α = 0.866). The correlations between the SAVE-6 Scale and other scales, including the Generalized Anxiety Disorder-7 Items Scale (r = 0.421, p < 0.001) and Patient Health Questionnaire-9 Items (r = 0.354, p < 0.001) were significant. Taken together, the Malay version of the SAVE-6 Scale is valid and reliable for use in the general population and is psychometrically suitable for assessing stress and anxiety specific to viral epidemics.

The Validation Study of the Stress and Anxiety to Viral Epidemics-6 Scale Among Patients With Cancer in the COVID-19 Pandemic

INTRODUCTION

The study aimed to explore the psychometric properties of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale among patients with cancer who are in serious situations in the current COVID-19 pandemic.

METHODS

The survey included questions on the participants' demographic information, clinical history of cancer (including cancer type, stage, current treatment or diagnosis of complete remission), and scores on rating scales, including the SAVE-6 scale, Coronavirus Anxiety Scale (CAS), and the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

The confirmatory factor analysis (CFA) results determined that the model fits the single factor structure of the SAVE-6 scale among patients with cancer. The multi-group CFA showed that SAVE-6 can measure the anxiety response in a similar way across multiple variables, such as sex, presence of clinical depression, being in a state of complete remission, or currently undergoing cancer treatment. The SAVE-6 scale showed good reliability (Cronbach's alpha = 0.819) and convergent validity with the rating scales, such as CAS [r = 0.348 (95% CI, 0.273-0.419), p < 0.001] and PHQ-9 items score [r = 0.251 (95% CI, 0.172-0.328), p < 0.001].

CONCLUSIONS

This study confirms SAVE-6 as a reliable and valid rating scale for measuring the anxiety response of patients with cancer during the current COVID-19 pandemic.

Utility of the Stress and Anxiety to Viral Epidemic-3 Items as a Tool for Assessing Work-Related Stress, and Relationship With Insomnia and Burnout of Healthcare Workers During the COVID-19 Pandemic

Background and Objective The aim of this study is to explore the usefulness of the Stress and Anxiety to Viral Epidemic-3 items (SAVE-3) scale as a tool for assessing work-related stress in healthcare workers.Methods There were 389 participants and all remained anonymous. The SAVE-9, the Patient Health Questionnaire-4, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), the perceived stress scale (PSS), and single item insomnia measure were used. After checking whether the SAVE-3 scale is clustered into a sole factor from SAVE-9 scale based on principal component analysis with promax rotation, confirmatory factor analysis (CFA) was done on the 3 items of the SAVE-3 to examine the factorial validity for a unidimensional structure.Results The SAVE-3 was clustered with factor loadings from 0.664–0.752, and a CFA revealed that 3 items of the SAVE-3 cohered together into a unidimensional construct with fit for all of indices (comparative fit index = 1.00; Tucker Lewis index = 1.031; standardized root-mean-square residual = 0.001; root-mean-square-error of approximation = 0.00). The SAVE-3 scale showed acceptable reliability (Cronbach’s α = 0.56 and McDonald’s ω = 0.57) in this sample. A high SAVE-3 score correlated significantly with younger age (r = -0.12, p = 0.02), a high PSS score (r = 0.24, p < 0.001), a high total score for the MBI-HSS-MP (r = 0.35, p < 0.001) and all of its subscales (emotional exhaustion, r = 0.40, p < 0.001; personal accomplishment, r = -0.14, p < 0.005; depersonalization, r = 0.39, p < 0.001), and poor sleep quality (r = 0.15, p < 0.001).Conclusions Taken together, the data suggest that SAVE-3 is a reliable, valid, and usable scale for measuring work-related stress in healthcare workers during the COVID-19 epidemic.

Validity and Reliability of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) Scale to Measure Viral Anxiety of Healthcare Workers in Spain During the COVID-19 Pandemic

This study examined the validity and applicability of the Spanish version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale, which can be usually applied to the general population, to healthcare workers to briefly measure their anxiety responses to the viral epidemic. A total of 135 healthcare workers participated in this online survey from January to July 2021. Participants' sociodemographic characteristics were gathered, and their psychiatric symptoms were rated using SAVE-6, Goldberg Anxiety and Depression Scale (GDAS), and the Pittsburgh Sleep Quality Index (PSQI). The confirmatory factor analysis was conducted to examine the validity of the scales. The single-structure model of the SAVE-6 scale was adopted based on the results of the parallel analysis. We decided on the SAVE-6 scale, as it proved to be a good fit to measure healthcare workers' anxiety response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.827 and McDonald's omega = 0.834) and good convergent validity with Goldberg anxiety (r = 0.434, p < 0.001) and depression (r = 0.193, p = 0.043) scores, and PSQI score (r = 0.262, p = 0.002). The Spanish version of SAVE-6 is a reliable and valid rating scale to assess the anxiety response of healthcare workers specifically to the viral epidemic as a brief measure during the COVID-19 pandemic.