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

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.

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.

Applicability and Psychometric Comparison of the General-Population Viral Anxiety Rating Scales among Healthcare Workers in the COVID-19 Pandemic

We aimed to explore the reliability and validity of viral anxiety rating scales (developed for the general population) among healthcare workers. In addition, we compared the psychometric properties of rating scales in accordance with the Generalized Anxiety Scale-7 items (GAD-7) during this COVID-19 pandemic. The viral anxiety of 330 healthcare workers was measured with Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), SAVE-6, Coronavirus Anxiety Scale (CAS), Fear of COVID-19 Scale (FCV-19S), and COVID-19 Anxiety Scale (CAS-7). Factor analyses, item response theory, and Rasch model analyses were conducted to confirm the construct validities of the scales and compare the psychometric properties of rating scales. The receiver operating curve (ROC) analysis examined the cutoff scores of rating scales in accordance with a mild degree of generalized anxiety. The SAVE-9, SAVE-6, CAS, FCV-19S, and CAS-7 scales showed good reliability of internal consistency among healthcare workers. Their construct validity and convergent validity of each scale were similarly good. Furthermore, in comparing the psychometric properties of rating scales, we observed that the CAS scale was the most discriminating and difficult among the scales. The CAS and FCV-19S provided more information and were more efficient than the SAVE-9, SAVE-6, and CAS-7 scales when they were used to measure healthcare workers' viral anxiety. Viral anxiety rating scales can be applied to healthcare workers with good reliability and validity.

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.

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-9 scale among frontline nursing professionals working in the COVID-19 inpatients ward

This study examined the reliability and validity of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale among nursing professionals working in a COVID-19 inpatient ward. An anonymous, online survey was conducted among working frontline nursing professionals between April 7 and 18, 2022. We collected information about the participants' age, sex, years of employment, shift work, and marital status. In addition, the participants were asked whether they had dealt with infected patients recently, and whether they had been quarantined, infected, or vaccinated. SAVE-9, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate symptoms. We used the Confirmatory Factor Analysis (CFA) to determine the validity of the two-factor model of the SAVE-9 scale. We also tested reliability and convergent validity using the PHQ-9 and GAD-7 scales. A total of 136 responses was analyzed, and CFA for two-factors model of the SAVE-9 scale showed a good model fit among frontline nursing professionals (CFI = 1.000, TLI = 1.040, RMSEA = 0.000, RSMR = 0.060). Multi-group CFAs revealed that the SAVE-9 scale can measure work-related stress and viral anxiety in the same way across sex, having depression, or having generalized anxiety. The internal consistency was shown to be good, and the SAVE-9 scale was significantly correlated with the GAD-7 (r = 0.328, p < 0.001) and PHQ-9 score (r = 0.361, p < 0.001). The two-factor model of the SAVE-9 is a valid and reliable scale for frontline nursing professionals.

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.