key: cord-284160-sgr8p78v authors: Satici, Begum; Gocet-Tekin, Emine; Deniz, M. Engin; Satici, Seydi Ahmet title: Adaptation of the Fear of COVID-19 Scale: Its Association with Psychological Distress and Life Satisfaction in Turkey date: 2020-05-08 journal: Int J Ment Health Addict DOI: 10.1007/s11469-020-00294-0 sha: doc_id: 284160 cord_uid: sgr8p78v The world is currently experiencing a pandemic of an infectious disease called COVID-19 which has drawn global intensive attention. While global attention is largely focusing on the effects of the coronavirus on physical health, the impacts of the coronavirus on psychological health cannot be overlooked. Therefore, this study aims to adapt the Fear of COVID-19 Scale into Turkish and investigate the relationships between fear of COVID-19, psychological distress, and life satisfaction. Data were collected by convenience sampling method, which allowed us to reach total 1304 participants, aged between 18 and 64 years, from 75 cities in Turkey. In the adaptation process of the Fear of COVID-19 Scale, confirmatory factor analysis, Item Response Theory, convergent validity, and reliability (Cronbach’s α, McDonald’s ω, Guttmann’s λ6, and composite reliability) analyses were performed. Additionally, the mediating role of psychological distress on the relationship between fear of COVID-19 and life satisfaction was tested. The uni-dimensionality of the 7-item scale was confirmed on a Turkish sample. Item Response Theory revealed that all items were coherent and fit with the model. The results indicated that the Turkish version of the scale had satisfactory reliability coefficients. The fear of COVID-19 was found to be associated with psychological distress and life satisfaction. Results indicated that the Turkish version of the Fear of COVID-19 Scale had strong psychometric properties. This scale will allow mental health professionals to do research on the psychological impacts of COVID-19 in Turkey. females and 387 (29.7%) were males whose ages ranged from 18 to 64 years (M = 29.47, SD = 10.54) . Detailed information about the participants is presented in Table 1 . In this study, Fear of COVID-19 Scale, Depression Anxiety Stress Scale-Short Form, and Satisfaction with Life Scale were administered. The Fear of COVID-19 Scale This is a unidimensional 7-item, 5-point Likert scale, developed by Ahorsu et al. (2020) . Factor loadings (.66 to .74) and corrected item-total correlation (.47 to .56) of the Fear of COVID-19 Scale were found acceptable. The internal consistency and the test-retest reliability of the scale (α = .82 and ICC = .72) was acceptable. The Fear of COVID-19 Scale was positively correlated with perceived vulnerability, hospital anxiety, and depression (Ahorsu et al. 2020) . Depressıon Anxiety and Stress Scale The scale was developed by Lovibond and Lovibond (1995) to provide a self-report measure of anxiety, depression, and stress. The DASS-21 (Depressıon Anxiety and Stress Scale) was developed from the original DASS-42 by Henry and Crawford (2005) and Mahmoud et al. (2012) . The DASS-21 contains three subscales: (1) depression, (2) anxiety, and (3) stress which include 12-items. The DASS-21 was adapted into Turkish by Yilmaz et al. (2017) . The factor loadings of the Turkish version of the scale ranged between .41 and .81 and reliability coefficients between .76 and .82 (Yilmaz et al. 2017) . In this study, the reliability coefficients of the scale were found to be α = .87, .82, and .89, respectively. Satisfaction with Life Scale It is a unidimensional 5-item, 7-point Likert scale, developed by Diener et al. (1985) . The higher scores indicate higher levels of satisfaction with life. The SWLS (Satisfaction with Life Scale) was adapted into Turkish by Durak et al. (2010) . The Turkish version of the SWLS was reported to have good validity (CFI = .99, IFI = .99, TLI = .98, SRMR = .020, and RMSEA = .043) and reliability (α = .80; Durak et al. 2010) . In this study, the reliability coefficient of the scale was found α = .83. Confirmatory factor analysis (CFA) was utilized in order to validate the factor structure of the Fear of COVID-19. As has been previously reported in the literature (e.g., Hu and Bentler 1999; Kline 2015) , GFI, NFI, and CFI ≥ .90 and SRMR ≤ .08 were considered an indication of acceptable fit. After establishing the factorial structure of the Fear of COVID-19 Scale, the discrimination, difficulty, and informativeness of the scale was examined using the Item Response Theory (IRT; Chalmers 2012), which allows us to have more detailed and reliable information at the individual and item level than classical test theory. These basic aspects of the IRT parameters can be described by the item characteristic curve (ICC), which is a curve shaped like an "S" was used in ICC analysis, and were carried out using the Graded Response Model (GRM) which is appropriate for 5-point Likert-type scales. Based on guidelines proposed by Baker (2001) , an α value > 1.0 is considered highly discriminant. Furthermore, corrected item-total correlation coefficients and descriptive statistics for each item were also examined. The correlations between fear of COVID-19, depression, anxiety, stress, and life satisfaction were examined to establish the concurrent validity of the scale. Furthermore, the mediating role of psychological distress on the relationships between fear of COVID-19 and life satisfaction was tested for incremental validity. Process Macro for SPSS developed by Hayes (2018) was adopted to test the proposed mediation model. Five thousand bootstrap replicates were drawn and coefficients for both direct and indirect effects were created in the 95% confidence interval. Significance was determined when the confidence interval did not include zero. Cronbach's alpha, McDonald's omega, Guttmann's lambda, and composite reliability were examined for the reliability of the Fear of COVID-19 Scale. The analyses of the present study were run using IBM SPSS Statistics 22.0, Amos Graphics 24, Stata 14, and JASP 0.11.1. CFA analyses showed that fit indices were all within the acceptable limit [χ 2 (13, N = 1304) = 299.47, p < .05; SRMR = .061; GFI = .936; NFI = .912; IFI = .915; CFI = .915]. The factor loadings of the Fear of COVID-19 Scale were found significant ranging from .484 to .723. Item analysis results for Fear of COVID-19 Scale is given in Table 2 . Results of the IRT are shown in Fig. 1 and Table 3 . As displayed in Table 3 , all α values were higher than 1.0. Hence, IRT results revealed that the Fear of COVID-19 Scale had appropriate item difficulty and the ability to discriminate between performers and non-performers. Following IRT analyses, concurrent validity was evaluated by computing Pearson's correlations of the Fear of COVID-19 Scale with the depression, anxiety, stress, and life satisfaction as validity scales. Data analysis revealed significant positive correlations between the Fear of COVID-19 Scale and depression (r = .38, p < .001), anxiety (r = .55, p < .001), and stress (r = .47, p < .001). On the other hand, the Fear of COVID-19 Scale is significantly and negatively correlated with life satisfaction, r = −.20, p < .001. The incremental validity of the Fear of COVID-19 Scale was also tested in a process model linking fear of COVID-19 to life satisfaction via depression, anxiety, and stress. Findings for the regression pathways and the direct and indirect effects examined for mediation are presented in Fig. 2 and Table 4 . Figure 2 shows the role of fear of COVID-19 on life satisfaction through depression, anxiety, and stress. When the direct effects were examined (see Table 4 At the time of writing, the coronavirus pandemic is undoubtedly the most important problem all around the world. Apart from its impacts on physical health, COVID-19 also has significant effects on mental health. Hence, there is a need for assessment tools to investigate the effects of COVID-19 on people's mental health. The aim of this study was to adapt The Fear of COVID-19 Scale (Ahorsu et al. 2020) into Turkish and investigate the relationships between fear of COVID-19, psychological distress, and life satisfaction. The CFA confirmed the unidimensionality of the 7-item scale on a Turkish sample. All factor loadings of the Fear of COVID-19 Scale were also found statistically significant. Therefore, we can conclude that the Turkish version of the Fear of COVID-19 Scale supported the structure of the original scale by Ahorsu et al. (2020) . In this study, Item Response Theory (IRT) was used to assess the validity of items of the Fear of COVID-19 Scale. IRT and classical test theory (CTT) are two different measurement frameworks. CTT has a significant shortcoming. The summed scores are sequential; statistical inferences derived from sequence scores are likely to be invalid since it is assumed that raw scores should be regarded as a range scale (Jafari et al. 2012) . To illustrate, CTT uses a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) as an interval scale in which items were scored from zero to four where the differences between the five points may not be equal whereas the IRT employs logistic regression which allows us to predict the underlying capabilities of participants and item challenges. Hence, the interval-level measurement of each participant's COVID-19 fear and the interval-level measurements of item challenges were examined. The characteristics and validity of the items are examined using IRT, and the fitness of the items was calculated. Based on IRT results, the item challenges and characteristics of the Fear of COVID-19 Scale were appropriate. The concurrent validity analysis revealed significant positive correlations between the fear of COVID-19, depression, anxiety, and stress. The fear of COVID-19 was found negatively correlated with life satisfaction. Additionally, the fear of COVID-19 was shown to increase depression, anxiety, and stress and to decrease life satisfaction. Limited number of studies also demonstrated that the fear of COVID-19 led to higher levels of psychological distress and poor mental health. For instance, Ahorsu et al. (2020) suggested that the fear of COVID-19 has positive associations with hospital anxiety and depression. Constant exposure to the news about worldwide fatalities or infection rate of the pandemic has led individuals to experience fear, anxiety, and depression. The worries about the risk of getting infected increase fear among the general public (Lin 2020). Finally, multiple techniques were used to establish the reliability of the Fear of COVID-19 Scale. Cronbach's alpha for the original scale was .82 (Ahorsu et al. 2020 ). In the present study, Cronbach's alpha, McDonald's omega, Guttmann's lambda, and composite reliability were assessed and reliability coefficients for total scale was found .84. The findings also indicated that the scale had a reliability coefficient over .70 which met the criterion of acceptable reliability recommended by Nunnally (1978) . Thus, we can conclude that Turkish Fear of COVID-19 Scale is a reliable measurement tool. The present study has some limitations. First, the data were collected using a non-clinical sample. Therefore, results may not be generalizable to a clinical sample. Second, the findings of this study were based on self-report data which has the risk of source bias. Third, although more than one reliability analyses were carried out, the test-retest reliability of the scale cannot be examined for the sake of the scale to be used in Turkish language promptly. Therefore, we do not have any information regarding the temporal reliability of the scale. Despite its limitations, the findings of this study will help mental health professionals to deal with the mental health problems of general public generated by COVID-19. Additionally, the adaptation study of The Fear of COVID-19 Scale was conducted using a large sample of participants with varying ages from 75 cities in Turkey. The use of the Fear of COVID-19 Scale can give a rise to the assessment of the psychological impacts of COVID-19 on individuals. Mental health professionals should investigate the relationships between the fear of COVID-19 and panic attack, obsessive compulsive disorder, and stigma. Finally, Pakpour and Griffiths (2020) emphasized the importance of determining the risk groups based on socio-demographic variables in order to develop prevention programs to help overcome fear of COVID-19. Therefore, psychological interventions can be designed to alleviate the traumatic effects of COVID-19 by using the Fear of COVID-19 Scale. All procedures performed in studies involving human participants were in accordance with the ethical standards and with the Helsinki Declaration and its later amendments or comparable ethical standards. The authors declare that they have no conflict of interest. Informed Consent Informed consent was obtained from all individual participants included in the study. We did not receive any financial support for the research, authorship, and/or publication of this article. 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