The German Translation of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale: Results from Healthcare Workers during the Second Wave of 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.

Positive Mental Health of Frontline Healthcare Professionals during COVID-19 First Wave and Second Wave in Spain: The Protective Role of Social Recognition

BACKGROUND

The study of the COVID-19 disease consequences on healthcare professionals' mental health has drawn a great interest in psychology and other behavioral sciences. Previous studies mainly focused on professionals' health in terms of psychopathology, therefore, there is no research examining their positive mental health during both the first and the second wave. Also, there is no research studying healthcare professionals' social recognition during the pandemic and the influence of this variable on professionals' positive health.

METHODS

Following the WHO's recommendations, our objective was to measure pathology (i.e., anxiety and traumatic intensity), positive health (i.e., Hedonic, Psychological and Social Well-being) and social recognition in a sample of 200 healthcare professionals in the frontline care of Covid-19 patients.

RESULTS

In both waves, participants showed high levels of anxiety and traumatic intensity, although, as expected, in the second (vs. the first) wave psychopathological symptoms decreased. Concerning positive health indicators, in the second wave, health professionals showed more hedonic and psychological well-being than in the first one. However, in the second wave social well-being was lower than in the first wave, an expected though apparently paradoxical result, linked to the decrease in healthcare professionals' social recognition between the first and the second wave. In fact, bootstrapping procedures and Sobel Test confirm the mediating role of social recognition on the effect of Covid-19 wave on social well-being.

CONCLUSIONS

Public institutions, governments, and society in general, should recognize health professionals' work, given that social recognition is a fundamental protection factor for social well-being.

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.

Psychosoziale Belastung und psychosoziale Unterstützung für Fachkräfte im Gesundheitswesen während der COVID-19-Pandemie

Hintergrund

Ausgangspunkt der Studie ist die hohe psychosoziale Belastung von Fachkräften im Gesundheitswesen bei gleichzeitig geringer Inanspruchnahme eines Beratungs- und Unterstützungsangebots für Mitarbeiter*innen einer Universitätsklinik während der COVID-19-Pandemie.

Ziel der Arbeit

Die vorliegende Studie untersucht den Grad des psychosozialen Belastungserlebens von Fachkräften im Gesundheitswesen (n = 859) einer Universitätsklinik sowie Kenntnis, Inanspruchnahme und Bewertung innerbetrieblicher psychosozialer Versorgungsstrukturen.

Material und Methoden

Im Rahmen einer Online-Befragung (21.07.–19.10.2021) wurden die subjektiv empfundene Belastung durch die COVID-19-Pandemie, Depressivität (PHQ-8) des Personals sowie Kenntnis, Inanspruchnahme und Bewertung möglicher Versorgungsangebote der Universitätsklinik erhoben. Zusätzlich wurden qualitative Daten zu Informationsquelle, -vermittlung sowie Art der Kontaktaufnahme der innerbetrieblichen Versorgungsstrukturen erhoben.

Ergebnisse

Trotz hoher psychosozialer Belastung und überwiegender Kenntnis der Existenz innerbetrieblicher psychosozialer Versorgungsangebote ist deren Inanspruchnahme bei Fachkräften im Gesundheitswesen gering. Insbesondere der Kontakt zu Patient*innen stellte einen Risikofaktor für das psychosoziale Belastungserleben dar. Die qualitative Analyse zeigt, dass die Mitarbeiter*innen mehr über E‑Mails und Newsletters informiert werden möchten sowie eine übersichtliche Darstellung der Angebote vermissen.

Diskussion

Eine Überarbeitung der Angebotsdarstellung und Kontaktwege gemäß den Wünschen des Personals könnte die Inanspruchnahme innerbetrieblicher Angebote verbessern.

The prevalence and severity of insomnia symptoms during COVID-19: A global systematic review and individual participant data meta-analysis

INTRODUCTION

There have been no previous meta-analytic studies that have looked at the prevalence of insomnia symptoms in different COVID-19 groups using a single assessment instrument to evaluate insomnia symptoms while maintaining data homogeneity. The current review's associated goal is to undertake an individual participant data (IPD) analysis to further investigate past meta-analyses, a method that has been shown to be more robust than standard meta-analyses.

MEETHODS

Only studies that used the Insomnia Severity Index (ISI) to assess insomnia are used in this analysis. The IPDMA was performed and registered in PROSPERO in compliance with the PRISMA IPD Statement (CRD42021275817). From November 2019 to August 2021, researchers explored seventeen databases and six preprint services for relevant studies.

RESULTS

The pooled estimate of insomnia symptoms (subthreshold and clinically significant) was 52.57%. An estimated 16.66% of the population suffered from clinically significant insomnia, of which 13.75% suffered from moderate insomnia, and 2.50% suffered from severe insomnia. The different populations' grouping had no statistically significant differences in the prevalence of insomnia symptoms. Insomnia symptoms did not appear to be associated with age or sex.

CONCLUSION

Our findings imply that the COVID-19 pandemic is linked to a significant rise in subthreshold insomnia symptoms, but not to moderate or severe insomnia. Educating people from all walks of life about the importance of sleep and the risk of acquiring insomnia symptoms during this or future pandemics should be a top concern.

Adaptation and Validation of the Malay Version of the SAVE-9 Viral Epidemic Anxiety Scale for Healthcare Workers

Viral epidemics have surfaced frequently over the past quarter-century, with multiple manifestations of psychological distress. This study sought to establish the psychometric properties of the Malay version of SAVE-9 among healthcare workers. A total of 203 healthcare workers across Malaysia participated in the research. The Malay version of SAVE-9 was translated and back-translated using the WHO instrument validation protocols. Classical Test Theory (CTT) and Rasch analysis were used to assess the validity and reliability of the Malay version of the SAVE-9 scale. The analysis was run using IBM SPSS 26.0 and JAPS. Cronbach's alpha was used to measure the internal consistency of SAVE-9, which was found to be satisfactory (Cronbach's α = 0.795). The correlations between the SAVE-9 and other measured scales (GAD-7 and PHQ-9) were statistically significant. A score of 22 was defined as a cut-off point with good sensitivity (0.578) and specificity (0.165). The Malay version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale is valid and reliable after testing among healthcare workers. It is psychometrically suitable to be used in assessing healthcare workers' stress and anxiety specific to viral epidemics.

Effects of Changes in Environmental Color Chroma on Heart Rate Variability and Stress by Gender

With increasing time spent indoors during the coronavirus disease pandemic, occupants are increasingly affected by indoor space environmental factors. Environmental color stimulates human vision and affects stress levels. This study investigated how changing environmental color chroma affected heart rate variability (HRV) and stress. The HRV of nine males and fifteen females was measured during exposure to 12 color stimuli with changes in chroma under green/blue hues and high/low-value conditions, and a stress assessment was performed. The effect of chroma on the HRV of males and females was verified, but the interaction effect between chroma and gender was not. ln(LF) and RMSSD were valid parameters. ln(LF) of males and females decreased as chroma increased under the green hue and low-value conditions; RMSSD was reduced as chroma increased in the blue hue and low-value conditions. ln(LF) decreased as chroma increased under blue hue and high-value conditions in males. Color–stress evaluation revealed that the higher chroma under high-value conditions, the more positive the stress emotion, and the lower the chroma under low-value conditions, the more negative the stress emotion. As chroma increased under low-value conditions, color is a stress factor; for men, this effect was more evident in the blue hue.

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.

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.

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

Objectives: Many individuals around the world are suffering from psychological distress due to the COVID-19 outbreak. The aim of this study is to explore the validity and reliability of the English version of Stress and Anxiety to Viral Epidemics-6 (SAVE-6), which measures the anxiety response of the general population to the viral epidemic. Methods: A cross-sectional web-based study with self-reporting measures was conducted. A total of 314 United States residents were recruited via online platform in exchange for payment. The participants were asked to an anonymous questionnaire, collecting information on demographics, psychiatric history, SAVE-6, Patient Health Questionnaire-4 (PHQ-4), and the Coronavirus Anxiety Scale. Results: The result from confirmatory factor analysis (CFA) demonstrated that a single-factor model [χ ( 9 ) 2 = 11.53, p = 0.24] yielded excellent fit for all of indices [χ2/df ratio = 1.28; CFI = 1.00; TLI = 1.00; SRMR = 0.02; RMSEA = 0.03 (0.00, 0.07; 90% CI)] and yielded strong internal consistency reliability (Cronbach's α = 0.88). The results from multigroup CFAs showed that there were no gender differences [ Δ χ ( 6 ) 2 = 3.20, p = 0.78, ns] and no race differences [ Δ χ ( 6 ) 2 = 3.60, p = 0.73, ns] between the models, along with excellent model fits. Conclusions: The results of this study support the reliability and validity of SAVE-6 with strong psychometric properties for the English version of the U.S. population.

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.