Development of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Work-related Stress and Anxiety in Healthcare Workers in Response to Viral Epidemics

BackgroundThe coronavirus disease 2019, or COVID-19, has had a major psychological impact on healthcare workers. However, very few scales are available to specifically assess work-related stress and anxiety in healthcare workers responding to a viral epidemic. This study developed a new assessment tool, the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) and aimed to validate it among healthcare workers directly affected by COVID-19 in Korea.MethodsA total of 1,019 healthcare workers responded through anonymous questionnaires during April 20–30, 2020. Exploratory factor analysis (EFA) was conducted to explore the construct validity, and the reliability was assessed using internal consistency measures of Cronbach''s alpha coefficients. Receiver operating characteristic analysis was conducted to define the most appropriate cut-off point of SAVE-9 using the Generalized Anxiety Disorder-7 scale (GAD-7; ≥ 5). Second, Spearman''s rank correlation coefficient was used to establish convergent validity for the SAVE-9 questionnaire with GAD-7 and the Patient Health Questionnaire-9.ResultsThe nine-item scale had satisfactory internal consistency (Cronbach''s α = 0.795). It adopted a two-factor structure: 1) anxiety regarding viral epidemics and 2) work-related stress associated with viral epidemics. A cut-off score of 22 for the SAVE-9 ascertained levels of stress and anxiety in response to a viral epidemic in healthcare workers that warranted clinical attention. Correlations between the SAVE-9 and the other scales were statistically significant (P < 0.05).ConclusionThe results suggest that the SAVE-9 is a useful, reliable, and valid tool to evaluate stress and anxiety responses in healthcare workers during viral epidemics.     

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic

BackgroundThis study explored the clinical variables related to public workers'' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic.MethodsA total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields.ResultsMarried, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic.ConclusionIt is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.     

The Prevalence of Depression,Anxiety and Associated Factors among the General Public during COVID-19 Pandemic: a Cross-sectional Study in Korea

BackgroundSince its first case confirmed on January 20, 2020, Korea has been through three waves of the COVID-19 pandemic. Fears of the fourth wave persist as new cases continue to emerge. In such unpredictable times, the mental well-being of people is of crucial importance. This study examined the levels of depression and anxiety and their predictors among the Korean general public in Busan, Korea, during the COVID-19 pandemic.MethodsWe conducted a cross-sectional study via a self-reported questionnaire administered to 2,288 adult residents (aged 19–60 years) of Busan, Korea. Participants'' depression and anxiety were assessed using the Korean version of the Patient Health Questionnaire-4 (PHQ-4), which consists of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), with the cutoff score of 3.ResultsThe mean age of the participants was 39.71 years. COVID-19 had several psychosocial impacts on people. It was revealed that 80.3% had restrictions in outside activities, 47.3% reported financial difficulties, and 53.6% had a fear of death or fatal outcome when infected with COVID-19. We performed logistic regression analysis to identify the factors associated with depression and anxiety. A total of 30.7% participants were classified as at risk of depression based on cutoff score of 3 on PHQ-2. Logistic regression analysis revealed that changes in sleep pattern due to COVID-19 were most strongly associated with depression, followed by restrictions in outside activities due to social distancing and increased family conflicts due to COVID-19. Also, 22.6% participants were classified as at risk of anxiety based on a cutoff score of 3 on GAD-2. Analysis revealed that changes in sleep pattern due to COVID-19 were most strongly associated with anxiety, followed by spending a lot of time searching for COVID-19-related information and having a fear of death or fatal outcome when infected with COVID-19.ConclusionThe results are alarming; 30.7% had a PHQ-2 score of 3 or higher, indicating depression, and 22.6% had a GAD-2 score of 3 or higher, indicating anxiety. Changes in sleep pattern had the strongest association with both depression and anxiety. Our results can be used to formulate mental health policies tailored to the context of the city. Our findings suggest the high prevalence of depression and anxiety in the society during the COVID-19 pandemic, which places growing importance on early intervention for mental health problems during these times.     

Mediating Effects of Reassurance-Seeking Behavior or Obsession With COVID-19 on the Association Between Intolerance of Uncertainty and Viral Anxiety Among Healthcare Workers in Korea

BackgroundThis study explores whether the intolerance of uncertainty among healthcare workers prompts viral anxiety, and whether this association is mediated by their reassurance-seeking behavior and preoccupation with the coronavirus disease 2019 (COVID-19) in Korea.MethodsAn online survey was conducted among healthcare workers in Asan Medical Center, on November 29, 2021. Demographic characteristics and responses to items from rating scales were collected, including Stress and Anxiety to Viral Epidemics-9, Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Obsession with COVID-19 Scale (OCS), Patient Health Questionnaire-9, Insomnia Severity Scale, and Intolerance of Uncertainty-12 (IUS-12).ResultsAmong the 329 participants, viral anxiety of healthcare workers was predicted by being female (β = 0.14, P = 0.002), CRBS (β = 0.30, P < 0.001), OCS (β = 0.32, P < 0.001), and IUS-12 (β = 0.15, P = 0.002) scores (adjusted R² = 0.43, F = 31.1, P < 0.001). Mediation analysis showed that the intolerance of uncertainty directly influenced viral anxiety, and reassurance-seeking behavior and obsession with COVID-19 partially mediated the association.ConclusionThe intolerance of uncertainty among healthcare workers directly influenced their viral anxiety, and reassurance-seeking behavior and obsession with COVID-19 mediated this association in this era of “living with coronavirus” in Korea.     

广泛性焦虑量表在军人群体应用中的信度和效度

目的:检验广泛性焦虑量表(GAD-7)在军人群体中的信度与效度。方法:采用分层随机抽样方法抽取553名军人完成GAD-7、患者健康问卷抑郁症状群量表(PHQ-9)的评定;随机抽取113名接受美国精神障碍诊断和统计手册第4版临床定式访谈(Structured Clinical Interview for DSM-IV,SCID),并计算GAD-7的信度系数、敏感度、特异度等。结果:GAD-7的内部一致性系数为0.876;GAD-7与PHQ-9总分相关系数为0.653。在与SCID比较时,GAD-7的灵敏度为92.3%,特异度为90.5%,Kappa值为0.847(P0.05)。ROC曲线中,在GAD-7截点值取10分时,灵敏度和特异度分别为89%和82%,曲线下面积为91.7%。结论:GAD-7在军人群体应用中具有较好的信度和效度。     

医院焦虑抑郁量表的因素结构研究

目的：探索和检验医院焦虑抑郁量表（HADS）在综合医院内科门诊样本中的因素结构。方法：采用探索性因素分析和验证性因素分析的方法评价HADS在综合医院内科门诊样本中的因素结构。结果：探索性主成分分析最示，HADS的因素结构与原作者Zigmond等（1983）的结构模型基本一致，由焦虑和抑郁两个因子组成；验证性因素分析也支持HADS双因子结构模型。结论：综合医院内科门诊患者HADS呈现焦虑和抑郁双因子结构，不同人群因子结构可能不同。     

Validity of the Depression Anxiety Stress Scales in assessing depression and anxiety following traumatic brain injury

Background

Anxiety and depression following traumatic brain injury (TBI) are associated with poorer outcomes. A brief self-report questionnaire would assist in identifying those at risk, however validity of such measures is complicated by confounding symptoms of the injury. This study investigated the validity of the Depression Anxiety Stress Scales (DASS) and Hospital Anxiety and Depression Scale (HADS), in screening for clinical diagnoses of anxiety and mood disorders following TBI.

Methods

One hundred and twenty-three participants with mild to severe TBI were interviewed using the SCID (Axis I) and completed the DASS and HADS.

Results

The DASS, DASS21 and HADS scales demonstrated validity compared with SCID diagnoses of anxiety and mood disorders as measured by Area Under ROC Curve, sensitivity and specificity. Validity of the DASS depression scale benefited from items reflecting symptoms of devaluation of life, self-deprecation, and hopelessness that are not present on the HADS. Validity of the HADS anxiety scale benefited from items reflecting symptoms of tension and worry that are measured separately for the DASS on the stress scale.

Limitations

Participants were predominantly drawn from a rehabilitation centre which may limit the extent to which results can be generalized. Scores for the DASS21 were derived from the DASS rather than being administered separately.

Conclusions

The DASS, DASS21 and HADS demonstrated validity as screening measures of anxiety and mood disorders in this TBI sample. The findings support use of these self-report questionnaires for individuals with TBI to identify those who should be referred for clinical diagnostic follow-up.     

中文版焦虑敏感性指数-3在社区人群中的应用:基于双因素模型

目的:考察中文版焦虑敏感性指数-3的结构以及在社区样本中的适用性。方法:方便抽取黑龙江省某市和湖南省某市的社区人群609人填写问卷进行结构效度、信度等分析,其中101人进行间隔3周的重测,108人完成效标问卷。结果:中文版焦虑敏感性指数-3呈现出双因素结构,公共因素为焦虑敏感性,特殊因素分别为社会关注、认知关注和身体关注。双因素模型拟合良好(χ²/df=3.874,CFI=0.907,TLI=0.913,RMSEA=0.045,AIC=419.357,BIC=571.921)。量表的解释方差公共比例为0.585,未受影响的相关比例为0.706,同质性系数为0.774。总量表及社会关注、认知关注和身体关注分量表的合成信度分别为0.946、0.867、0.905、0.894,内部一致性信度分别为0.895、0.743、0.806、0.790,重测信度分别为0.842、0.773、0.760、0.815。焦虑敏感性及社会关注、认知关注和身体关注维度均与焦虑、抑郁、体验回避存在显著正相关。结论:中文版焦虑敏感性指数-3符合双因素模型结构,在社区人群中具有良好的信效度。     

沉思反应问卷中文版在大学生中的信效度检验

目的:沉思被认为是情绪障碍的典型特点,沉思反应问卷(RRS)是国际上应用广泛的测量个体沉思水平的问卷,具有良好的信效度,本文引进RRS以为国内研究同行及临床医生提供一个便捷可靠的沉思评价工具。方法:本文作者把英文版RRS翻译成中文,并对1450个中国大学生施测,对结果进行信效度分析。结果:中文版RRS及因子内部一致性α信度系数在0.736~0.934,分半信度在0.763~0.896,而重测信度在0.501~0.581,问卷各条目与量表总分之间的相关系数在0.22~0.79,分问卷与总问卷之间的相关为0.86~0.96,分问卷之间相关系数在0.73~0.79。调查数据显示中文版RRS没有性别差异(P0.05),但存在年龄差异,随着年龄的增长,RRS问卷的抑郁(F=50.766,P0.001)、强迫冥想(F=35.075,P0.001)、反思(F=29.587,P0.001)以及RRS总分(F=49.026,P0.001)显著增加。RRS各条目与BDI-II、PHQ总分之间的相关系数在0.21~0.49(除了条目12),抑郁、强迫冥想、反思分问卷、RRS总分与BDI-II、PHQ总分之间的相关系数在0.37~0.54。RRS总分与BDI-II、PHQ总分相关系数分别为0.52和0.51。结论:说明中文版RRS问卷在中国大学生群体中具有良好的信效度,年龄较大者沉思得分较高,RRS与抑郁呈中度相关。     

Prevalence of insomnia and anxiety among healthcare workers during the COVID-19 pandemic in Jilin Province

The outbreak of the 2019 novel coronavirus disease (COVID-19) has impacted the mental health of healthcare providers at the frontline. Therefore, we conducted this study to estimate the prevalence rate of anxiety and insomnia and identify associated risk factors among healthcare workers in Jilin, China, during the period from January 25 to February 25, 2020. Zung''s Self-Reported Anxiety Scale (SAS) and the Insomnia Severity Index (ISI) scale were used to diagnose anxiety and insomnia, respectively. Associated risk factors were identified through a multivariate logistic regression model. A total of 300 healthcare workers were invited and 236 completed the study. Of them, 234 (99.15%) were medical workers, 197 (83.47%) were working at frontline departments, and 159 (67.37%) were fighting against COVID-19. Fifty-seven respondents (24.15%) had anxiety (SAS index score ≥45) and 94 (39.83%) had insomnia (ISI score ≥8). Based on the multivariate analysis, contact with people from Hubei province during work (no vs not clear) [OR=0.25, 95%CI: 0.10-0.61] and personal protective equipment (PPE) (not in place vs in place) [OR=6.22, 95%CI: 2.23-17.40] were significantly correlated with anxiety. PPE (not in place vs in place) was the only significant risk factor of insomnia [OR=10.56, 95%CI: 4.00-27.87]. The prevalence of anxiety and insomnia was high in our study, reflecting the psychological impact of COVID-19 on healthcare workers. The unavailability of PPE in place was a significant risk factor of both anxiety and insomnia.     

Psychometric Evaluation of the Pain Anxiety Symptoms Scale (PASS) in Chronic Pain Patients

This study examined psychometric properties of the Pain Anxiety Symptoms Scale (PASS), a measure of pain-related fear. A recently developed shortened version of the PASS, the PASS-20, was also investigated. Previously reported factor structures of the PASS were tested by means of confirmatory factor analysis. Results indicated that all models fitted adequately but that a five-factor solution fitted slightly better compared to the other models tested. The four-factor solution of the PASS-20 was tested by means of confirmatory factor analysis and results indicated adequate fit. Moreover, the four-factor solution of the PASS-20 was invariant among fibromyalgia and low-back pain patients. Convergent validity of the original PASS and the PASS-20 was good and internal consistency reliability adequate to excellent. The suitability of the original PASS and the PASS-20 are discussed and directions for future research are provided.     

简易心理状况评定量表Kessler10中文版的信度和效度评价

目的:评价Kessler10心理量表中文版的信度和效度。方法:以某综合性大学整群随机抽取的大学生为研究对象。使用Kessler10量表对其心理健康状况进行评定。结果:复测结果Kappa指数为0.703(P<0.001)。K10量表中文版的折半信度为0.7076(P<0.001),克朗巴赫α系数为0.8011(P<0.001)。经模型拟合,二阶双因子模型很好,模型拟合可接受。结论:Kessler10量表中文版具有较好的信度和效度,可以在中国人群中推广使用。     

Barratt冲动量表中文版用于中学生的信度、效度分析

目的:分析和探索Barratt冲动量表(BIS-11)的信度和效度。方法:对396名高中学生进行Barratt冲动量表测查,并间隔一个月进行重测,对获取的数据进行相关分析和因素分析。结果:BIS-11量表内部一致性系数为0.80;重测信度0.81;与RBQ-A(青少年危险行为问卷)、RAPI(酒精使用问卷)冲动危险因子显著相关;验证性因素分析(CFA)显示此样本两个二阶因子拟合程度较好。结论:BIS-11是一个比较好的评估冲动行为的工具。     

Barratt冲动量表中文版在209名大三学生中的试用

目的：探索Barratt冲动量表（BIS-11）的信度和效度。方法：对209名在校大学生进行Barratt冲动量表测查，并间隔一个月进行重测。结果：条目分析结果表明，除条目9、12、22、25外，其他条目-总分相关r为0．16-0．58（P〈0．05，P〈0．01）；重测信度为0．83（P〈0．001）；探索性因素分析的结果得到注意、运动和缺少计划三个因子（特征根大于1，解释方差比率总计52．64％），除条目18、22和27外，其他条目的负荷范围在0．30～0．62之间；验证性因素分析GFI、AGFI、NNFI和CFI分别为0．91、0．85、0．75、0．80，RMSEA为0．09；量表及因子α系数为：注意0．73，运动0．60，缺少计划0．65，总分0．80。结论：BIS-11是一个比较好的评估冲动行为的工具。     

Inflammatory and thrombotic parameters associated with the COVID-19 course in Poland (SARSTer study)

PurposeThe aim of the study was to assess the coagulation and inflammatory markers connected with severe course of COVID-19 and no clinical improvement.Material and methodsThe study population included 2590 adult patients, diagnosed with COVID-19, selected from the SARSTer national database - an ongoing project led by the Polish Association of Epidemiologists and Infectiologists and supported by the Medical Research Agency. Clinical and laboratory parameters, such as C-reactive protein (CRP), white blood cells (WBCs), neutrophil and lymphocyte count, procalcitonin, ferritin, interleukin-6 (IL-6), D-dimer concentration and platelet (PLT) count were analyzed before and after treatment (remdesivir, tocilizumab, dexamethasone, anticoagulants).ResultsSignificant differences between patients with mild and severe course of the disease were observed in all examined parameters before treatment (p ?< ?0.05). After treatment only ferritin concentration did not differ significantly. In patients with pulmonary embolism, CRP concentration, neutrophil count, D-dimer and IL-6 concentration were significantly higher than in patients without embolism (p ?< ?0.05). The significant differences between the groups with and without fatal outcome were observed within all analyzed parameters. Significant differences in all examined parameters before treatment were observed between patients with and without clinical improvement (p ?< ?0.05).Multivariate logistic regression showed that no clinical improvement was associated with: IL-6>100 ?pg/ml (OR-2.14), D-dimer concentration over 1000 ?ng/ml (OR-1.62) and PLT count below 150,000/μl (OR-1.57).ConclusionsSevere course of the disease is associated with lower PLT and lymphocyte count, higher D-dimer, CRP, neutrophil count and IL-6 concentration. The best predictors of no clinical improvement in COVID-19 are: IL-6>100 ?pg/ml, D-dimer>1000 ?ng/ml and PLT<150,000/μl.     

综合医院焦虑抑郁量表在内科门诊病人中的应用

目的:在综合医院内科门诊病人中应用综合医院焦虑抑郁量表(Hospital Anxiety and Depres-sion Scale,HAD),并尝试建立上海地区常模。方法:采用两阶段抽样方法,首先在上海10余家综合医院中选取中山医院和瑞金医院内科门诊就诊人群,其次按10∶1比例在连续就诊序列中随机抽取11766例患者,采用HAD自评或辅助询问评估。结果:(1)内科门诊各年龄组病人在HAD焦虑均分(F=12.518,P0.001)和抑郁均分(F=28.066,P0.001)上差异显著,即随年龄递增焦虑评分有所降低,而抑郁评分则有所增高。(2)女性的HAD焦虑评分高于男性[(3.37±2.81)vs.(3.14±2.62),P0.001],HAD抑郁评分在总样本中差异无统计学意义;但在60岁以下样本中,女性抑郁评分高于男性[(3.67±3.01)vs.(3.39±2.91),P=0.038],而在60～69岁年龄段,男性抑郁总均分高于女性[(5.63±3.86)vs.(4.86±3.70),P0.001]。结论:综合医院焦虑抑郁量表在内科门诊病人应用过程中需注意年龄和性别因素的影响。     

学业厌烦量表中文版的信、效度分析

目的:对学业厌烦量表(The 10-item academic boredom scale,ABS-10)进行中文修订,并检验其信、效度。方法:先由心理学专家对原量表进行翻译、审校和回译,确定量表ABS-10中文版符合量表原意。采用方便取样选取342名大学生,施测中文版ABS-10。结果:ABS-10中文版保持原有10个条目,验证性因素分析的结果表明,在任务挑战度过低的情境下,一因素模型较理想,拟合指数CFI分别为0.95和0.97,RMSEA为0.061,在任务挑战度过高的情境下,相关二因素模型拟合度较好,拟合指数GFI分别为0.96和0.99,RMSEA为0.067,一般厌烦分量表、以任务为焦点的厌烦的分量表和以自我为焦点的厌烦的分量表的Cronbachα系数分别为0.89、0.82和0.80。大学生学业情绪量表(AEQ)的积极情绪快乐、希望、自豪和ABS-10呈负相关,相关系数在-0.24~-0.41之间,消极情绪生气、焦虑、厌烦、失望、羞愧和ABS-10呈正相关,相关系数在0.23~0.65之间。结论:ABS-10中文版具有良好的信度和效度,可用于大学生学业厌烦的有关研究。     

Deciphering the balance of IL-6/IL-10 cytokines in severe to critical COVID-19 patients

The severity of COVID-19 is largely determined by the inflammatory response, a “Cytokine storm,” that involves both pro- and anti-inflammatory cytokines. In the current study we investigated the balance of pro- and anti-inflammatory status as represented by the levels of IL-6/IL-10 in severe to critical COVID-19 patients. 66 confirmed COVID-19 patients admitted to the ICU were categorized into groups according to the mortality and respiratory failure. Data were collected retrospectively in ICU, including a peripheral immune cells and infection-related biomarker CRP. The measurements of cytokine levels were performed by Immulite analyzer for IL-6 and ELISA sandwich for IL-10. In addition, longitudinal measurement of IL-6 was performed during 5 days post admission. Longitudinal assays showed that IL-6 was sustained at a medium level within 5 days post admission in severe cases who survived or not requiring mechanical ventilation, whereas it was sustained at high levels throughout the disease course in either deceased cases or who developed respiratory failure. The ratio of IL-6/lymphocytes was positively correlated with the risk of mortality, while IL-10/lymphocytes ratio could predict respiratory failure in ICU. IL-6/IL-10 profiling revealed that deceased patients have different magnitudes of both IL-6 and IL-10 cytokine release. Notably, excessive levels of IL-6 concomitant with high levels of IL-10 were more common in diseased COVID-19 patients. Taking into account the IL-6/IL-10 profiling may help clinicians to identify the right time of anti-inflammation treatment and select patients who will respond to anti-cytokine therapies and maintain an adequate inflammatory response for SARS-CoV-2 clearance.