key: cord-0738774-zofba2b4 authors: Ransing, Ramdas; Ramalho, Rodrigo; Orsolini, Laura; Adiukwu, Frances; Gonzalez-Diaz, Jairo M.; Larnaout, Amine; da Costa, Mariana Pinto; Grandinetti, Paolo; i Bytyçi, Drita Gash; Shalbafan, Mohammadreza; Patil, Ishwar; Nofal, Marwa; Pereira-Sanchez, Victor; Kilic, Ozge title: Can COVID-19 related mental health issues be measured?: Assessment options for mental health professionals date: 2020-05-26 journal: Brain Behav Immun DOI: 10.1016/j.bbi.2020.05.049 sha: 9f87d97231ba32c9d066a82a5390828d572dd1eb doc_id: 738774 cord_uid: zofba2b4 nan To the Editor, The COVID-19 pandemic and mitigation efforts carry a mental health toll among health care workers, individuals infected and the general population (Li et al., 2020; Ransing et al., 2020) . A lack of specific robust screening tools or diagnostic instruments to identify relevant symptoms and attempts to study the epidemiology of COVID-19 related mental health issues using traditional assessment tools (e.g. PHQ-9, GAD-7) may lead to under-diagnosis or over-diagnosis due to their poor psychometric properties (e.g. face validity). There are new scales tailored to identify COVID-19 related mental health issues (Lee, 2020a; Taylor et al., 2020) , however, their clinical utility with methodological strengths and limitations have not yet been discussed in the literature. In this letter we provide a brief overview of these new assessment tools, with a focus on their multi-language availability. Our search (till May 15, 2020) in PubMed, Scopus, and Google Scholar databases yielded four published new scales (Table 1) (Ahorsu et al., 2020; Lee, 2020a Lee, , 2020b Taylor et al., 2020) : Coronavirus Anxiety Scale (CAS), the Obsession with COVID-19 Scale (OCS), the Fear of COVID-19 Scale , and the COVID Stress Scales (CSS). Almost all of them were developed as self-report and Likerttype scales and validated using online surveys. To our surprise, there was no available clinicianadministered scale to measure psychological distress or disorders in the context of COVID-19 infection. The CAS and OCS, developed from the same data source, assess symptoms of anxiety and dysfunctional thinking as per DSM-5 criteria. The OCS measures recurring symptoms of anxiety (i.e. cognitive and behavioral perpetuating factors). Both the OCS and CAS can assist with identifying the maintaining factors for COVID-19 anxiety and developing interventions to tackle them. Though translated versions of these tools are available in several languages, they are yet to be validated. The FCV-19S has been translated and validated in various languages with evidence of good reliability (internal consistency) and validity (convergent and construct) (Reznik et al., 2020; Sakib et al., 2020; Satici et al., 2020; Soraci et al., 2020) . The FCV-19S is a scale with a uni-dimensional structure, except for the Russian Version, which has a bi-dimensional structure. The CSS, CAS, and OCS have dimensional ratings for different yet interrelated underlying constructs or factors. Furthermore, some weaknesses [e.g. Italian FCV-19S was validated in an adequate but suboptimal sample (Table 1) ], and inconsistencies in their underlying factor structures (as mentioned above); warrant further refinement with more robust and stable factor structures. All scales were developed in the pre-peak period of the pandemic and may not be sensitive or specific enough to assess anxiety or dysfunctional thinking during peak or post-peak periods (Ransing et al., 2020) . Also, all scales have been validated in non-clinical samples consisting of middle-aged adults, a relatively less vulnerable group of people. Nevertheless, preliminary psychometric reports suggest that the CAS score was well correlated with distress, coping, and support, while the OCS score was associated with coronavirus anxiety, spiritual crisis, and alcohol/drug coping. All versions of FCV-19S and CSS were strongly correlated with depression and anxiety. Due to the unique discriminative ability of CAS and OCS, these assessment tools may prove more useful for clinicians. In the current scenario, self-report scales might prove useful as they are short, easy to administer (through paper or digital platform), cost-effective, and could be used in self-isolation or quarantine settings. However, these tools may have limited potential to measure outcome parameters of interventions as the findings may not be aligned with objective assessment and be more prone to response bias. It is therefore crucial to develop clinician-administered assessment tools consistent with DSM-5 or ICD-10/11 criteria, with strong psychometric properties, and sensitive to interventions. Our brief overview of scales provides several key directions for future research. First, there is a need to refine existing screening instruments with translation, validation, and cross-cultural adaptation without detracting from their psychometric properties to boost clinical and epidemiological research across the world. Also, future validation studies should include the elderly, children, adolescents, young adults, and people with pre-existing physical and mental illness in particular settings (e.g. isolation, quarantine), to determine the discriminative ability and widen their utility. Second, researchers need to compare the psychometric properties of these scales with each other or with traditional scales (e.g. PHQ-9, GAD-7) to ascertain the optimal measure in different countries, settings, and populations. However, these scales may be useful for epidemiological research, but perhaps not for interventional studies that need additional scales as outcome measures. For interventional research, the combination of scales or tools (e.g. traditional, self-report, and clinical-administered) either parallel or in a predefined sequence may be necessary to assess the change and to improve diagnostic coverage, psychometric properties, and comparative evaluation. Finally, there is a need to develop tools that can assist with the assessment of COVID-19 related psycho-social stigma, phobia, and post-traumatic stress disorder. The Fear of COVID-19 Scale: Development and Initial Validation How much "Thinking" about COVID-19 is clinically dysfunctional? Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control Mental Health Interventions during the COVID-19 Pandemic: A Conceptual Framework by Early Career Psychiatrists COVID-19 Fear in Eastern Europe: Validation of the Fear of COVID-19 Scale Psychometric Validation of the Bangla Fear of COVID-19 Scale: Confirmatory factor analysis and Rasch analysis Adaptation of the Fear of COVID-19 Scale: Its Association with Psychological Distress and Life Satisfaction in Turkey Validation and Psychometric Evaluation of the Italian Version of the Fear of Development and Initial Validation of the COVID Stress Scales 2020) COVID Stress Scales (CSS): Five subscales n=6854, Age:49.8 ±16.2 years, Canada and United states 21 st 39 (r~0.28 to 0.57) Other Concerns: Mixed populatio states) Abbreviations: #: five levels from strongly disagree (1) to strongly agree (5); *: Five levels from not at all (0) to nearly every day (4) over the last 2 weeks; LD: Structure c to extremely (4) over the last one weeks; HADS: Hospital Anxiety and Depression Scale, SMSP-A: Severity Measure for Specific Phobia-Adult; PHQ-9: (Psychometric properties are known or published); NA: Not available in the published manuscript Footnote: i) All scales except CSS, take 4-5 minutes to administer ii) CAS and OCS