key: cord-0754264-ynohlzwj authors: Mohsen, F.; Bakkar, B.; Khadem alsrouji, S.; Abbas, E.; Najjar, A.; Marrawi, M.; Latifeh, Y. title: Fear among Syrians: a Proposed Cutoff Score and Validation of the Arabic Fear of COVID-19 Scale- A National Survey date: 2021-05-25 journal: nan DOI: 10.1101/2021.05.25.21257637 sha: 77d74974bbe315011d13630f8bae4b6f11638d89 doc_id: 754264 cord_uid: ynohlzwj Abstract: Background: COVID 19 pandemic has led to psychological health issues one of which is fear. This study validates the Arabic version of the fear of COVID 19 scale and suggests a new cutoff score to measure fear of COVID 19 among the Syrian Population. Methods: A total of 3989 participants filled an online survey consisting of socio-demographic information, the fear of COVID 19 scale, the patient health questionnaire 9-item, and the generalized anxiety disorder 7 item. Receiver operating characteristic analysis was used to define cutoff scores for the fear of COVID 19 scale in relation to generalized anxiety disorder 7 item and the patient health questionnaire 9 item. Results: The Cronbach alpha value of the Arabic fear of COVID 19 scale was 0.896, revealing good stability and internal consistency. The inter-item correlations were between [0.420 and 0.868] and the corrected item-total correlations were between [0.614 and 0.768]. A cutoff point of 17.5 was deduced from analysis. According to the deduced cutoff point, 2111(52.9%) were classified as cases with extreme fear Conclusion: This cutoff score deduced from this study can be used for screening purposes to identify individuals that may be most vulnerable towards developing extreme fear of COVID 19. Therefore, early preventive and supportive measures can then be delivered. reported COVID-19 case in Syria.(6) The numbers have escalated since then with Syria now 55 entering its third wave.(7-9) 56 As the pandemic has embedded misconceptions around COVID-19, strict precautionary 57 measures have been adopted by governments, such as physical distancing, self-isolation, and 58 handwashing(10) to curtail the tide of the pandemic in the absence of vaccine or treatment at the 59 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Fear may lead to the incidence of new mental health disorders or worsening pre-existing 83 psychiatric symptoms such as depression, anxiety, and post-traumatic stress disorder, and even 84 suicide. (13, 17, 18) A recent study has developed the Fear of has proposed a cutoff score for the scale.(28) Given that Syria is one of the most vulnerable 89 countries in the world to be affected by mental health disorders due to both This study aimed to assess the fear of COVID-19 among the Syrian population, validate the 91 FCV-19S, and identify an appropriate cutoff score to differentiate adults with extreme fear of 92 COVID-19 from those with a normal fear reaction. This web-based cross-sectional study was conducted using an Arabic questionnaire over 97 a period of 12 days between May 2 and May 14 of 2020. The sample size calculated was 2401 98 participants based on a margin of error of 2%, and a confidence interval of 95%, for a population 99 of 17, 500, 657 people using a sample size calculator.(29, 30) All participants aged 18 and 100 above, residing in Syria, who completed the survey, were included in the study. The 101 questionnaire was distributed through various social media platforms. After providing informed 102 consent online, participants were directed to the first part of the survey to complete questions 103 about socio-demographic information including gender, age, residence, education level, 104 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 occupation, and economic status. Participants were also asked about the history of chronic scored on a 5-point scale, ranging from 1 (strongly disagree) to 5 (strongly agree). A total score 125 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 is calculated by summing all item scores with a possible total score ranging between 7 and 35. Higher scores indicate greater levels of fear of 127 The Arabic version of the Patient Health Questionnaire 9-item (PHQ-9) was used in the 128 study to assess depression symptom severity.(32) Items on the PHQ-9 were rated on a 4-point 129 Likert scale (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day), 130 providing a 0-27 severity score range. The scores were categorized into 5 groups: none (0-4), 131 mild (5-9), moderate (10-14), moderately severe (15) (16) (17) (18) (19) , and severe (20-27). The Arabic version of the Generalized Anxiety Disorder 7-item (GAD-7) was used in this 133 study to assess anxiety symptom severity.(33) Items on the GAD-7 were rated on a 4-point 134 Likert scale (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day), 135 providing a 0-21 severity score range. The Gad-7 is a self-rated scale used to evaluate the CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. percentages, means, and standard deviations (SD) were applied. The Cronbach's α test and inter-147 item correlation were used to assess the internal consistency, with satisfactory reliability set at ≥ were regarded as non-fear cases. The FCV-19S scores ranged between 7 and 35, the mode score was 14, and the mean 172 score was 18.5 (± 6.009) Fig 1. Participants' responses to the FCV-19S are shown in Table 2 . The responses to the GAD-7 scale were classified into two groups: non-anxious 177 symptoms (score < 9) and anxious symptoms (9 < score ≤ 21). The responses to the PHQ-9 scale 178 were classified into two groups: non-depressed symptoms (score < 9) and depressed symptoms 179 (9 < score ≤ 27) Table 3 . is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101/2021.05.25.21257637 doi: medRxiv preprint A cutoff point of 17.5 was deduced from the anxiety and depression ROC analysis. According to the deduced cutoff point, the majority 2111(52.9%) were classified as cases with 193 extreme fear Table 3 . 19, whereas participants scoring below this threshold were classified as having normal fear of 213 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. This study revealed a weak discriminatory ability from the AUC outcomes, whereas its 216 accuracy was moderate in a Greek study(46). The low precision of AUC signifies that not all CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. The present study has several limitations in its design. First, the convenience sampling 244 used in this study may have limited results' generalizability due to a "volunteer-effect" and the CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Conclusion: 257 This study provided empirical support for the scale's adequacy to assess COVID-19-258 related fear and determined a cutoff point of ≥ 17.5 with unsatisfactory predictive power for 259 anxiety and depression. This cutoff score can be used for screening purposes to identify 260 individuals that may be most vulnerable towards developing psychiatric symptomatology. Therefore, require further assessment to identify high-risk individuals and deliver early . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 25, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Gender: Female . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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