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<title xml:lang="en">The Fear of COVID-19 Scale: Development and Initial Validation</title>
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<name sortKey="Ahorsu, Daniel Kwasi" sort="Ahorsu, Daniel Kwasi" uniqKey="Ahorsu D" first="Daniel Kwasi" last="Ahorsu">Daniel Kwasi Ahorsu</name>
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Hung Hom, Hong Kong</nlm:aff>
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<name sortKey="Lin, Chung Ying" sort="Lin, Chung Ying" uniqKey="Lin C" first="Chung-Ying" last="Lin">Chung-Ying Lin</name>
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Hung Hom, Hong Kong</nlm:aff>
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<name sortKey="Imani, Vida" sort="Imani, Vida" uniqKey="Imani V" first="Vida" last="Imani">Vida Imani</name>
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Tabriz, Iran</nlm:aff>
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<name sortKey="Saffari, Mohsen" sort="Saffari, Mohsen" uniqKey="Saffari M" first="Mohsen" last="Saffari">Mohsen Saffari</name>
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Tehran, Iran</nlm:aff>
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<name sortKey="Griffiths, Mark D" sort="Griffiths, Mark D" uniqKey="Griffiths M" first="Mark D." last="Griffiths">Mark D. Griffiths</name>
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50 Shakespeare Street, Nottingham, NG1 4FQ UK</nlm:aff>
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<name sortKey="Pakpour, Amir H" sort="Pakpour, Amir H" uniqKey="Pakpour A" first="Amir H." last="Pakpour">Amir H. Pakpour</name>
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Shahid Bahonar Blvd., Qazvin, 3419759811 Iran</nlm:aff>
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<institution>Jönköping University,</institution>
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Jönköping, Sweden</nlm:aff>
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<title xml:lang="en" level="a" type="main">The Fear of COVID-19 Scale: Development and Initial Validation</title>
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<name sortKey="Ahorsu, Daniel Kwasi" sort="Ahorsu, Daniel Kwasi" uniqKey="Ahorsu D" first="Daniel Kwasi" last="Ahorsu">Daniel Kwasi Ahorsu</name>
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<institution>The Hong Kong Polytechnic University,</institution>
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Hung Hom, Hong Kong</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lin, Chung Ying" sort="Lin, Chung Ying" uniqKey="Lin C" first="Chung-Ying" last="Lin">Chung-Ying Lin</name>
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<institution>The Hong Kong Polytechnic University,</institution>
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Hung Hom, Hong Kong</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Imani, Vida" sort="Imani, Vida" uniqKey="Imani V" first="Vida" last="Imani">Vida Imani</name>
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<institution>Tabriz University of Medical Sciences,</institution>
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Tabriz, Iran</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Saffari, Mohsen" sort="Saffari, Mohsen" uniqKey="Saffari M" first="Mohsen" last="Saffari">Mohsen Saffari</name>
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<institution>Baqiyatallah University of Medical Sciences,</institution>
</institution-wrap>
Tehran, Iran</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Griffiths, Mark D" sort="Griffiths, Mark D" uniqKey="Griffiths M" first="Mark D." last="Griffiths">Mark D. Griffiths</name>
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50 Shakespeare Street, Nottingham, NG1 4FQ UK</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pakpour, Amir H" sort="Pakpour, Amir H" uniqKey="Pakpour A" first="Amir H." last="Pakpour">Amir H. Pakpour</name>
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<institution>Qazvin University of Medical Sciences,</institution>
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Shahid Bahonar Blvd., Qazvin, 3419759811 Iran</nlm:aff>
</affiliation>
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<nlm:aff id="Aff6">
<institution-wrap>
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<institution>Jönköping University,</institution>
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Jönköping, Sweden</nlm:aff>
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<title level="j">International Journal of Mental Health and Addiction</title>
<idno type="ISSN">1557-1874</idno>
<idno type="eISSN">1557-1882</idno>
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<div type="abstract" xml:lang="en">
<sec>
<title>Background</title>
<p>The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. The present study developed the Fear of COVID-19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases.</p>
</sec>
<sec>
<title>Methods</title>
<p>The sample comprised 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties.</p>
</sec>
<sec>
<title>Results</title>
<p>After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven-item scale. More specifically, reliability values such as internal consistency (
<italic>α</italic>
= .82) and test–retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression,
<italic>r</italic>
= 0.425 and anxiety,
<italic>r</italic>
= 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability,
<italic>r</italic>
= 0.483 and germ aversion, r = 0.459).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The Fear of COVID-19 Scale, a seven-item scale, has robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the general population and will also be useful in allaying COVID-19 fears among individuals.</p>
</sec>
</div>
</front>
<back>
<div1 type="bibliography">
<listBibl>
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</listBibl>
</div1>
</back>
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<pmc article-type="case-report">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Int J Ment Health Addict</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Ment Health Addict</journal-id>
<journal-title-group>
<journal-title>International Journal of Mental Health and Addiction</journal-title>
</journal-title-group>
<issn pub-type="ppub">1557-1874</issn>
<issn pub-type="epub">1557-1882</issn>
<publisher>
<publisher-name>Springer US</publisher-name>
<publisher-loc>New York</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">32226353</article-id>
<article-id pub-id-type="pmc">7100496</article-id>
<article-id pub-id-type="publisher-id">270</article-id>
<article-id pub-id-type="doi">10.1007/s11469-020-00270-8</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Brief Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>The Fear of COVID-19 Scale: Development and Initial Validation</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Ahorsu</surname>
<given-names>Daniel Kwasi</given-names>
</name>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lin</surname>
<given-names>Chung-Ying</given-names>
</name>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Imani</surname>
<given-names>Vida</given-names>
</name>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Saffari</surname>
<given-names>Mohsen</given-names>
</name>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Griffiths</surname>
<given-names>Mark D.</given-names>
</name>
<address>
<email>mark.griffiths@ntu.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff4">4</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Pakpour</surname>
<given-names>Amir H.</given-names>
</name>
<address>
<email>pakpour_amir@yahoo.com</email>
</address>
<xref ref-type="aff" rid="Aff5">5</xref>
<xref ref-type="aff" rid="Aff6">6</xref>
</contrib>
<aff id="Aff1">
<label>1</label>
<institution-wrap>
<institution-id institution-id-type="GRID">grid.16890.36</institution-id>
<institution-id institution-id-type="ISNI">0000 0004 1764 6123</institution-id>
<institution>Department of Rehabilitation Sciences,</institution>
<institution>The Hong Kong Polytechnic University,</institution>
</institution-wrap>
Hung Hom, Hong Kong</aff>
<aff id="Aff2">
<label>2</label>
<institution-wrap>
<institution-id institution-id-type="GRID">grid.412888.f</institution-id>
<institution-id institution-id-type="ISNI">0000 0001 2174 8913</institution-id>
<institution>Pediatric Health Research Center,</institution>
<institution>Tabriz University of Medical Sciences,</institution>
</institution-wrap>
Tabriz, Iran</aff>
<aff id="Aff3">
<label>3</label>
<institution-wrap>
<institution-id institution-id-type="GRID">grid.411521.2</institution-id>
<institution-id institution-id-type="ISNI">0000 0000 9975 294X</institution-id>
<institution>Health Research Center, Life Style Institute,</institution>
<institution>Baqiyatallah University of Medical Sciences,</institution>
</institution-wrap>
Tehran, Iran</aff>
<aff id="Aff4">
<label>4</label>
<institution-wrap>
<institution-id institution-id-type="GRID">grid.12361.37</institution-id>
<institution-id institution-id-type="ISNI">0000 0001 0727 0669</institution-id>
<institution>International Gaming Research Unit, Psychology Department,</institution>
<institution>Nottingham Trent University,</institution>
</institution-wrap>
50 Shakespeare Street, Nottingham, NG1 4FQ UK</aff>
<aff id="Aff5">
<label>5</label>
<institution-wrap>
<institution-id institution-id-type="GRID">grid.412606.7</institution-id>
<institution-id institution-id-type="ISNI">0000 0004 0405 433X</institution-id>
<institution>Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases,</institution>
<institution>Qazvin University of Medical Sciences,</institution>
</institution-wrap>
Shahid Bahonar Blvd., Qazvin, 3419759811 Iran</aff>
<aff id="Aff6">
<label>6</label>
<institution-wrap>
<institution-id institution-id-type="GRID">grid.118888.0</institution-id>
<institution-id institution-id-type="ISNI">0000 0004 0414 7587</institution-id>
<institution>Department of Nursing, School of Health and Welfare,</institution>
<institution>Jönköping University,</institution>
</institution-wrap>
Jönköping, Sweden</aff>
</contrib-group>
<pub-date pub-type="epub">
<day>27</day>
<month>3</month>
<year>2020</year>
</pub-date>
<fpage>1</fpage>
<lpage>9</lpage>
<permissions>
<copyright-statement>© Springer Science+Business Media, LLC, part of Springer Nature 2020</copyright-statement>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract id="Abs1">
<sec>
<title>Background</title>
<p>The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. The present study developed the Fear of COVID-19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases.</p>
</sec>
<sec>
<title>Methods</title>
<p>The sample comprised 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties.</p>
</sec>
<sec>
<title>Results</title>
<p>After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven-item scale. More specifically, reliability values such as internal consistency (
<italic>α</italic>
= .82) and test–retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression,
<italic>r</italic>
= 0.425 and anxiety,
<italic>r</italic>
= 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability,
<italic>r</italic>
= 0.483 and germ aversion, r = 0.459).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The Fear of COVID-19 Scale, a seven-item scale, has robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the general population and will also be useful in allaying COVID-19 fears among individuals.</p>
</sec>
</abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd>COVID-19</kwd>
<kwd>Fear</kwd>
<kwd>Iran</kwd>
<kwd>Psychometrics</kwd>
<kwd>Fear of COVID-19 Scale</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<p id="Par1">One of the emergent global challenges in managing infectious diseases is dealing with the novel coronavirus 2019 (COVID-19). The most common symptoms within 2–14 days include fever, fatigue, dry cough, myalgia, and dyspnea (Wang et al.
<xref ref-type="bibr" rid="CR14">2020</xref>
). As of March 1, 2020, the mortality rate was 3.6% in China and 1.5% outside China (Baud et al.
<xref ref-type="bibr" rid="CR2">2020</xref>
), and as of March 14, 2020, 135 countries/territories had confirmed cases (World Health Organization
<xref ref-type="bibr" rid="CR15">2020</xref>
). With the extremely high infection rate and relatively high mortality, individuals naturally began worrying about the COVID-19. Indeed, fear of contacting individuals who are possibly infected by COVID-19 has been reported (Lin
<xref ref-type="bibr" rid="CR9">2020</xref>
). Unfortunately, fear may amplify the damage of the disease itself. The emergence of the COVID-19 (Guan et al.
<xref ref-type="bibr" rid="CR7">2020</xref>
; Huang et al.
<xref ref-type="bibr" rid="CR8">2020</xref>
) and its pandemic nature has exacerbated fears worldwide leading to stigma in some cases (Centers for Disease Control and Prevention
<xref ref-type="bibr" rid="CR3">2020a</xref>
,
<xref ref-type="bibr" rid="CR4">b</xref>
; Lin
<xref ref-type="bibr" rid="CR9">2020</xref>
). One characteristic nature of infectious disease compared with other conditions is fear. Fear is directly associated with its transmission rate and medium (rapidly and invisibly) as well as its morbidity and mortality. This further leads to other psychosocial challenges including stigmatization, discrimination, and loss (Pappas et al.
<xref ref-type="bibr" rid="CR12">2009</xref>
). With the high levels of fear, individuals may not think clearly and rationally when reacting to COVID-19.</p>
<p id="Par2">However, current treatment on COVID-19 worldwide has mainly focused on infection control, effective vaccine, and treatment cure rate (Dong et al.
<xref ref-type="bibr" rid="CR5">2020</xref>
; Wang et al.
<xref ref-type="bibr" rid="CR14">2020</xref>
). The psychosocial aspect has yet to be thoroughly considered. Nevertheless, as countries worldwide have to work on reducing the transmission rate of COVID-19, they should also work on individual fears to achieve the holistic goal of having a society free of COVID-19. One of the reasons that current treatment on COVID-19 pays little attention to the fear of COVID-19 is the lack of an appropriate psychometric instrument. Therefore, developing a brief and valid instrument to capture an individual’s fear of COVID-19 is both timely and important. With the information on how an individual fears COVID-19, healthcare providers can further design appropriate programs to take care of the fear. Therefore, this study developed and validated a scale assessing the fear of coronavirus—the Fear of COVID-19 Scale (FCV-19S) (see “
<xref rid="Sec11" ref-type="sec">Appendix</xref>
” section)—using two types of psychometric testing: classical test theory (CTT) analysis and Rasch analysis. Consequently, the FCV-19S will be useful in providing valuable information on fear of COVID-19 so as to facilitate public health initiatives on allaying public’s fears.</p>
<sec id="Sec1">
<title>Methods</title>
<sec id="Sec2">
<title>Development of the Scale</title>
<p id="Par3">Several steps were taken to develop the Fear of COVID-19 Scale (McCoach et al.
<xref ref-type="bibr" rid="CR10">2013</xref>
). First, an extensive literature review was conducted to assess all general scales on fear. Thirty measures on fear were identified that assess fear on different populations and diseases (available on request from the corresponding authors). Relevant and possible items were pooled by two researchers (i.e., the third and last authors). After removing those items with similar content or expressions, 28 items were retained for further evaluation. Second, an expert panel (comprising a psychologist, virologist, health psychologist, psychiatrist, general physician, and nurse) evaluated the 28 items, and 11 items were deleted based on the suggestion from the expert panel. Third, the retained 17 items were sent out to a different expert panel (comprising a health education specialist, pulmonologist, social psychologist, and sociologist in Iran) to review. Seven items were further omitted based on the comments from the second expert panel. Finally, the 10-item scale was piloted on 46 individuals (26 males and 20 females, mean age 39.63 years, number of years in education = 9.38 years) to obtain initial assessment of the scale. A four-point Likert scale was used to test whether the individuals understand the item descriptions. The results showed that all respondents fully understood the item descriptions (mean 3.81, SD = 1.04). Additionally, an individual telephone-based cognitive interview was implemented on the same pilot participants to explore their thoughts about each scale item and their responses. No further changes were made because the pilot participants indicated no changes were needed.</p>
</sec>
<sec id="Sec3">
<title>Participants and Procedure</title>
<p id="Par4">The target population was the general Iranian population. Inclusion criteria were being (i) an Iranian, (ii) aged 18 years or older, and (iii) being able to understand spoken Persian or Farsi. Participants were recruited from online advertisements, e-mail campaigns, blogs, social media, and SMS campaigns. All procedures conducted were approved by the Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1398.375). Informed consent was obtained electronically before data were collected from the participants.</p>
</sec>
</sec>
<sec id="Sec4">
<title>Measures</title>
<sec id="Sec5">
<title>Demographic Information</title>
<p id="Par5">A background information sheet consisting of age, educational year, gender, and whether they were a current smoker was used to obtain demographic information about the participants.</p>
</sec>
<sec id="Sec6">
<title>Hospital Anxiety and Depression Scale</title>
<p id="Par6">The Persian version of Hospital Anxiety and Depression Scale (HADS) was used to assess the anxiety and depression levels of participants. The HADS is a 14-item scale in which items are answered in a four-point response format with a total score ranging from 0 to 21 for each of the subscales (anxiety and depression with seven items each). Example items include
<italic>“I have lost interest in my appearance”</italic>
(depression) and
<italic>“Worrying thoughts go through my mind” </italic>
(anxiety). A higher score is indicative of severe anxiety or depression. The scale has acceptable reliability (Cronbach’s
<italic>α</italic>
of 0.78 and 0.86 for the HADS anxiety and depression respectively) and a satisfactory validity (Montazeri et al.
<xref ref-type="bibr" rid="CR11">2003</xref>
).</p>
</sec>
<sec id="Sec7">
<title>Perceived Vulnerability to Disease Scale</title>
<p id="Par7">The Persian version of the 15-item Perceived Vulnerability to Disease Scale (PVDS) was used to assess participant’s perceived vulnerability to infectious disease specifically perceived infectability (seven-item subscale) and germ aversion (eight-item subscale). Participants respond to each item on a seven-point scale (from “strongly disagree” to “strongly agree”) with approximately half of the items reverse-scored (Ahmadzadeh et al.
<xref ref-type="bibr" rid="CR1">2013</xref>
; Duncan et al.
<xref ref-type="bibr" rid="CR6">2009</xref>
). Example items include
<italic>“In general, I am very susceptible to colds, flu and other infectious diseases” </italic>
(perceived infectability) and
<italic>“I prefer to wash my hands pretty soon after shaking someone’s hand” </italic>
(germ aversion). A higher score indicates a severe form of perceived infectability, germ aversion, or perceived vulnerability to disease (as a whole). It has a Cronbach’s
<italic>α</italic>
of 0.70, 0.72, and 0.70 for perceived infectability, germ aversion, and total PVDS score respectively (Ahmadzadeh et al.
<xref ref-type="bibr" rid="CR1">2013</xref>
).</p>
</sec>
<sec id="Sec8">
<title>Data Analysis</title>
<p id="Par8">Descriptive statistics were used to understand participants’ characteristics. Analyses on psychometric properties included CTT analysis and Rasch model analysis. CTT analysis included internal consistency, test-retest reliability, corrected item-total correlation, average variance extracted (AVE), composite reliability, standard error of measurement, concurrent validity, and exploratory factor analysis (EFA). Rasch model analysis included infit and outfit mean square (MnSq) for each item, item and person separation reliability, and item and person separation index. Also, differential item functioning (DIF) based on Rasch analysis was used to test the measurement invariance across gender and age (Wu et al.
<xref ref-type="bibr" rid="CR16">2017</xref>
). All the descriptive and CTT analyses were conducted using IBM SPSS 23.0 (IBM Corp., Armonk, NY). Also, the Rasch model analyses were conducted using WINSTEPS 3.75.0.</p>
</sec>
</sec>
<sec id="Sec9">
<title>Results</title>
<p id="Par9">The mean age of the participants (
<italic>n</italic>
 = 717) was 31.25 years (SD ± 12.68), and the participants had, on average, 8.9 years of education (SD ± 4.1). More than half of the participants were males (
<italic>n</italic>
 = 416; 58%), and nearly one-fifth of the participants were current smokers (
<italic>n</italic>
 = 139; 19.4%). According to the corrected inter-item correlation, three items with low corrected item-total correlations were deleted (i.e., Item 3, − 0.06; Item 4, − 0.03; Item 5 − 0.05). The remaining seven items in the scale all had acceptable corrected item-total correlation (0.47 to 0.56) and were used for following psychometric testing (Table
<xref rid="Tab1" ref-type="table">1</xref>
).
<table-wrap id="Tab1">
<label>Table 1</label>
<caption>
<p>Descriptive statistics and item-total correlation of the Fear of COVID-19 Scale (
<italic>n</italic>
 = 717)</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th>Item number</th>
<th>Mean (SD)</th>
<th>Corrected item-total correlation</th>
<th>Skewness</th>
<th>Kurtosis</th>
<th>Missing data (%)</th>
<th>Floor effect (%)</th>
<th>Ceiling effect (%)</th>
<th>Item exclusion or retention</th>
</tr>
</thead>
<tbody>
<tr>
<td>Item 1. I am most afraid of coronavirus-19.</td>
<td>3.48 (1.14)</td>
<td>0.47</td>
<td>− 0.34</td>
<td>− 0.61</td>
<td>6.69</td>
<td>5.7</td>
<td>22.2</td>
<td>Retained</td>
</tr>
<tr>
<td>Item 2. It makes me uncomfortable to think about coronavirus-19.</td>
<td>4.01 (0.84)</td>
<td>0.56</td>
<td>− 0.58</td>
<td>− 0.12</td>
<td>3.21</td>
<td>4.9</td>
<td>30.1</td>
<td>Retained</td>
</tr>
<tr>
<td>Item 3. I worry a lot about coronavirus-19.</td>
<td>3.43 (1.23)</td>
<td>− 0.06</td>
<td>− 2.41</td>
<td>− 1.91</td>
<td>5.16</td>
<td>7.3</td>
<td>21.3</td>
<td>Excluded</td>
</tr>
<tr>
<td>Item 4. Coronavirus-19 is almost always terminal</td>
<td>2.62 (1.16)</td>
<td>− 0.03</td>
<td>0.24</td>
<td>− 2.12</td>
<td>9.34</td>
<td>18.4</td>
<td>3.8</td>
<td>Excluded</td>
</tr>
<tr>
<td>Item 5. Coronavirus-19 is an unpredictable disease</td>
<td>3.91 (0.96)</td>
<td>− 0.05</td>
<td>− 1.66</td>
<td>− 1.07</td>
<td>10.32</td>
<td>7.1</td>
<td>30.5</td>
<td>Excluded</td>
</tr>
<tr>
<td>Item 6. My hands become clammy when I think about coronavirus-19</td>
<td>3.76 (0.88)</td>
<td>0.51</td>
<td>− 0.42</td>
<td>0.12</td>
<td>3.21</td>
<td>0.7</td>
<td>47.6</td>
<td>Retained</td>
</tr>
<tr>
<td>Item 7. I am afraid of losing my life because of coronavirus-19</td>
<td>4.24 (0.90)</td>
<td>0.54</td>
<td>−1.18</td>
<td>0.98</td>
<td>3.07</td>
<td>0.4</td>
<td>34.3</td>
<td>Retained</td>
</tr>
<tr>
<td>Item 8.When watching news and stories about coronavirus-19 on social media, I become nervous or anxious.</td>
<td>3.53 (1.07)</td>
<td>0.51</td>
<td>− 0.36</td>
<td>− 0.47</td>
<td>2.51</td>
<td>1.4</td>
<td>20.5</td>
<td>Retained</td>
</tr>
<tr>
<td>Item 9. I cannot sleep because I’m worrying about getting coronavirus-19</td>
<td>4.11 (0.81)</td>
<td>0.48</td>
<td>− 0.79</td>
<td>0.56</td>
<td>5.43</td>
<td>3.9</td>
<td>20.8</td>
<td>Retained</td>
</tr>
<tr>
<td>Item 10. My heart races or palpitates when I think about getting coronavirus-19</td>
<td>4.26 (0.75)</td>
<td>0.53</td>
<td>− 0.91</td>
<td>0.78</td>
<td>5.86</td>
<td>2.5</td>
<td>42.1</td>
<td>Retained</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
<p id="Par10">All factor loadings from the retained seven items were significant and strong (0.66 to 0.74). Their properties tested using Rasch analysis were satisfactory: infit MnSq values were between 0.80 and 1.26; outfit MnSq values were between 0.84 and 1.25. No substantial DIF was found across gender and age (Table
<xref rid="Tab2" ref-type="table">2</xref>
). Table
<xref rid="Tab3" ref-type="table">3</xref>
demonstrates that the seven-item scale had robust psychometric properties in the scale level. From CTT analysis, the internal consistency was good (
<italic>α</italic>
 = .82), composite reliability (0.88) and AVE (0.51) were acceptable, and standard error of measurement was low (1.89). From Rasch analysis, item separation reliability (0.99), item separation index (11.45), person separation reliability (0.77), and the person separation index (2.82) were all satisfactory (Table
<xref rid="Tab3" ref-type="table">3</xref>
).
<table-wrap id="Tab2">
<label>Table 2</label>
<caption>
<p>Psychometric properties of the Fear of COVID-19 Scale at the item level (
<italic>n</italic>
 = 717)</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th>Item number</th>
<th>Factor loading*</th>
<th>
<italic>h</italic>
<sup>2</sup>
</th>
<th>Infit MnSq</th>
<th>Outfit MnSq</th>
<th>Difficulty</th>
<th>DIF contrast across gender
<sup>cd</sup>
</th>
<th>DIF contrast across age
<sup>ce</sup>
</th>
</tr>
</thead>
<tbody>
<tr>
<td>Item 1. I am most afraid of coronavirus-19.</td>
<td>0.66</td>
<td>0.38</td>
<td>1.26</td>
<td>1.25</td>
<td>0.98</td>
<td>− 0.10</td>
<td>− 0.05</td>
</tr>
<tr>
<td>Item 2. It makes me uncomfortable to think about coronavirus-19.</td>
<td>0.74</td>
<td>0.55</td>
<td>0.80</td>
<td>0.84</td>
<td>− 0.17</td>
<td>− 0.33</td>
<td>− 0.22</td>
</tr>
<tr>
<td>Item 6. My hands become clammy when I think about coronavirus-19.</td>
<td>0.71</td>
<td>0.51</td>
<td>0.81</td>
<td>0.85</td>
<td>0.39</td>
<td>− 0.29</td>
<td>0.25</td>
</tr>
<tr>
<td>Item 7. I am afraid of losing my life because of coronavirus-19.</td>
<td>0.74</td>
<td>0.55</td>
<td>1.11</td>
<td>1.0</td>
<td>−0.77</td>
<td>0.29</td>
<td>0.21</td>
</tr>
<tr>
<td>Item 8. When watching news and stories about coronavirus-19 on social media, I become nervous or anxious.</td>
<td>0.71</td>
<td>0.50</td>
<td>1.01</td>
<td>1.0</td>
<td>0.85</td>
<td>0.48</td>
<td>0.30</td>
</tr>
<tr>
<td>Item 9. I cannot sleep because I’m worrying about getting coronavirus-19.</td>
<td>0.71</td>
<td>0.50</td>
<td>0.90</td>
<td>0.94</td>
<td>− 0.43</td>
<td>− 0.24</td>
<td>− 0.31</td>
</tr>
<tr>
<td>Item 10. My heart races or palpitates when I think about getting coronavirus-19.</td>
<td>0.73</td>
<td>0.54</td>
<td>0.81</td>
<td>0.91</td>
<td>− 0.83</td>
<td>0.21</td>
<td>− 0.23</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>
<italic>MnSq</italic>
mean square error,
<italic>DIF</italic>
differential item functioning</p>
<p>*Extraction method: Oblimin rotation with Kaiser normalization.
<italic>h</italic>
2 = communalities</p>
<p>
<sup>c</sup>
DIF contrast > 0.5 indicates substantial DIF</p>
<p>
<sup>d</sup>
DIF contrast across gender = difficulty for males-difficulty for females</p>
<p>
<sup>e</sup>
DIF contrast across age groups = Difficulty for younger (i.e., ≤ 31.25 years) - Difficulty for older (i.e., > 31.25 years) patients</p>
</table-wrap-foot>
</table-wrap>
<table-wrap id="Tab3">
<label>Table 3</label>
<caption>
<p>Psychometric properties of the Fear of COVID-19 Scale at the scale level (
<italic>n</italic>
 = 717)</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th>Psychometric testing</th>
<th>Value</th>
<th>Suggested cutoff</th>
</tr>
</thead>
<tbody>
<tr>
<td>Composite reliability</td>
<td>0.88</td>
<td>> 0.7</td>
</tr>
<tr>
<td>Average variance extracted</td>
<td>0.51</td>
<td>> 0.5</td>
</tr>
<tr>
<td>Internal consistency (Cronbach’s
<italic>α</italic>
)</td>
<td>0.82</td>
<td>> 0.7</td>
</tr>
<tr>
<td>Standard error of measurement</td>
<td>1.89</td>
<td>The smaller the better</td>
</tr>
<tr>
<td>Item separation reliability from Rasch</td>
<td>0.99</td>
<td>> 0.7</td>
</tr>
<tr>
<td>Item separation index from Rasch</td>
<td>11.45</td>
<td>> 2</td>
</tr>
<tr>
<td>Person separation reliability from Rasch</td>
<td>0.77</td>
<td>> 0.7</td>
</tr>
<tr>
<td>Person separation index from Rasch</td>
<td>2.82</td>
<td>> 2</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
<p id="Par11">Concurrent validity was supported by the HADS and PVDS as indicated by the significant correlations (both
<italic>p</italic>
 < 0.001). There were significant positive correlations between fear of COVID-19 and (i) depression (
<italic>r</italic>
 = 0.425,
<italic>p</italic>
 < 0.001), (ii) anxiety (
<italic>r</italic>
 = 0.511,
<italic>p</italic>
 < 0.001), (iii) perceived infectability (
<italic>r</italic>
 = 0.483,
<italic>p</italic>
 < 0.001), and (iv) germ aversion (
<italic>r</italic>
 = 0.459,
<italic>p</italic>
 < 0.001).</p>
</sec>
<sec id="Sec10">
<title>Discussion</title>
<p id="Par12">The present study presented the development of a new scale, the Fear of COVID-19 Scale (FC-19S). Findings demonstrated that the FCV-19S has a stable unidimensional structure with robust psychometric properties. Initial psychometric results indicated that the FCV-19S had good properties from different types of testing (i.e., CTT and Rasch analysis). Moreover, the overall score of the summed-up items scores can indicate the severity of the fear of COVID-19. More specifically, the higher the score on the FCV-19S, the higher the scores on the HADS and the PVDS were. Therefore, higher overall scores on the FCV-19S indicate more severe fear of COVID-19. Also, gender and age appeared not to affect the response pattern of the fear on the FCV-19S. Therefore, it can be concluded that the FCV-19S can be relied upon to assess and deal with the psychological issues emanating from COVID-19 among males and females as well as individuals of all ages.</p>
<p id="Par13">Other studies have shown that negative effects of psychological reactions such as hypochondriasis and anxiety affect individuals’ health and well being during times of infectious epidemic crisis (Duncan et al.
<xref ref-type="bibr" rid="CR6">2009</xref>
; Pappas et al.
<xref ref-type="bibr" rid="CR12">2009</xref>
; Ropeik
<xref ref-type="bibr" rid="CR13">2004</xref>
). The FCV-19S could also help allay the fears of the public on COVID-19 and subsequently help in reducing the stigma, anxiety, and stress attached to it (Centers for Disease Control and Prevention
<xref ref-type="bibr" rid="CR3">2020a</xref>
,
<xref ref-type="bibr" rid="CR4">b</xref>
). The concurrent validity, ascertained using the HADS and PVDS, indicates that the FCV-19S is a valid tool for assessing fear of COVID-19. Also, the FCV-19S significantly correlated with depression, anxiety (on the HADS), perceived infectability, and germ aversion (on the PVDS) which suggests that individuals with severe fear of COVID-19 may have these comorbid disorders.</p>
<p id="Par14">The present study has some limitations. First, the studied participants were from the general Iranian population and no formal diagnoses on mood disorders were obtained (e.g., anxiety). Therefore, the sensitivity and specificity of the scale cannot be examined. Second, although fear is subjective and has shortcomings when trying to assess it objectively, the nature of the self-report cannot exclude the possibility that respondents provided responses affected by social desirability factors. Third, convenience sampling weakens the generalizability of the findings in the present study. Finally, the single-factor structure of the scale was based on EFA and Rasch analysis; consequently, further verification, such as using confirmatory factor analysis, on its factor structure is needed.</p>
<p id="Par15">In conclusion, this study demonstrated that the Fear of COVID-19 Scale is a seven-item unidimensional scale with robust psychometric properties. Moreover, total scores on the FCV-19S are comparable across both genders and all ages which suggest that it is a good psychometric instrument to be used in assessing and allaying fears of COVID-19 among individuals.</p>
</sec>
</body>
<back>
<app-group>
<app id="App1">
<sec id="Sec11">
<title>Appendix</title>
<p id="Par20">Fear of Coronavirus-19 Scale
<list list-type="order">
<list-item>
<p id="Par21">I am most afraid of coronavirus-19.</p>
</list-item>
<list-item>
<p id="Par22">It makes me uncomfortable to think about coronavirus-19.</p>
</list-item>
<list-item>
<p id="Par23">My hands become clammy when I think about coronavirus-19.</p>
</list-item>
<list-item>
<p id="Par24">I am afraid of losing my life because of coronavirus-19.</p>
</list-item>
<list-item>
<p id="Par25">When watching news and stories about coronavirus-19 on social media, I become nervous or anxious.</p>
</list-item>
<list-item>
<p id="Par26">I cannot sleep because I’m worrying about getting coronavirus-19.</p>
</list-item>
<list-item>
<p id="Par27">My heart races or palpitates when I think about getting coronavirus-19.</p>
</list-item>
</list>
</p>
<p id="Par28">The participants indicate their level of agreement with the statements using a five-item Likert-type scale. Answers included “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” and “strongly agree”. The minimum score possible for each question is 1, and the maximum is 5. A total score is calculated by adding up each item score (ranging from 7 to 35). The higher the score, the greater the fear of cororonavirus-19.</p>
</sec>
</app>
</app-group>
<fn-group>
<fn>
<p>
<bold>Publisher’s Note</bold>
</p>
<p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p>
</fn>
</fn-group>
<notes>
<title>Compliance with Ethical Standards</title>
<notes notes-type="COI-statement">
<title>Conflict of Interest</title>
<p id="Par16">The authors declare that they do not have any interests that could constitute a real, potential or apparent conflict of interest with respect to their involvement in the publication. The authors also declare that they do not have any financial or other relations (e.g., directorship, consultancy or speaker fee) with companies, trade associations, unions or groups (including civic associations and public interest groups) that may gain or lose financially from the results or conclusions in the study. Sources of funding are acknowledged.</p>
</notes>
<notes>
<title>Ethical Approval</title>
<p id="Par17">All procedures performed in this study involving human participants were in accordance with the ethical standards of the University’s Research Ethics Board and with the 1975 Helsinki Declaration.</p>
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<notes>
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