Coronavirus disease 2019 (COVID-19) has psychological effects such as anxiety and depression as well as direct infection in people. The Fear of COVID-19 scale is a scale that can measure anxiety related to COVID-19 in a short time. The purpose of this study was to verify the reliability and validity the Korean version of Fear of COVID-19 scale (KF-COVID-19S).
The data of total 186 normal adults and 17 patients were finally used for the statistical analysis. For internal consistency, Cronbach’s α was calculated. For concurrent and discriminant validity, the correlations with the Hospital Anxiety and Depression scale (HADS), Patient Health Questionnaire-15 (PHQ-15), World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were analyzed. For construct validity, exploratory and confirmatory factor analysis were conducted.
Cronbach alpha was 0.88. The two-factor model (factor 1: Physical fear, factor 2: Emotional fear) showed significantly positive correlations and appeared to be “good” fitness (CFI=0.906, IFI=0.907, NFI=0.902).
The KF-COVID-19S can be a useful scale that can measure the physical and emotional fears associated with COVID-19 in a short time. Because the psychiatric patients are a more vulnerable group to the fear, it is thought that the KF-COVID-19S will help to determine the patient’s level of anxiety and make a therapeutic plan for the underlying mental disorder.
Coronavirus disease 2019 (COVID-19), which occurred in Wuhan, China in December 2019, is spreading across the world. As of October 12, 2020, COVID-19 has infected 24,704 people and killed 433 in Korea [
Therefore, people may suffer more from anxiety-related symptoms even if they do not have COVID-19 or other symptoms [
As such, an accurate assessment of the level of fear felt by the people is necessary, as COVID-19 is severely impacting human society at a global scale. The Fear of COVID-19 Scale, developed by Ahorsu et al. [
This study developed the KF-COVID-19S, the Korean version of Fear of COVID-19 Scale, and analyzed its reliability and validity.
Prior to developing the KF-COVID-19S, the authors of this study obtained permission from the original authors of the Korean validation study to use the scale. Next, two psychiatrists and a clinical psychologist adapted the scale into Korean. Then, a Ph.D. holder from a U.S. university, fluent in both English and Korean, conducted the back-translation. Lastly, a psychiatrist and a clinical psychologist drafted the final version of KF-COVID-19S after discussion.
The study was conducted between June and November 2020. Participants are two groups (one for the normal adults and the other for the psychiatric patients). The normal participants were 207 adults aged 19 years or above, working at public institutions in Jeollabuk-do. A total of 186 responses were used for the research, after excluding 13 individuals with incomplete responses and 8 individuals with severe underlying medical conditions. The patient group included 23 individuals who visited the department of psychiatry and agreed to participate in the study. The study used data from 17 patients, excluding those experiencing a severe psychosis, with severe and clear underlying symptoms, and whose intellectual ability was questionable. This study was approved by the Institutional Review Board of Wonkwang University Hospital (No. WKUH 2020-05-040), and all the participants were given written informed consent.
The original F-COVID-19S was developed by researchers from Hong Kong, Iran, the United Kingdom, and Sweden, and involved Iranian participants at the time of development [
The Hospital Anxiety and Depression Scale (HADS) is a self-reported questionnaire developed to measure the levels of the most common symptoms of anxiety and depression of patients visiting hospitals in a short period of time. The HADS contains 14 questions, and is measured on a 4-point (0 to 3 points) scale [
The Patient Health Questionnaire-15 (PHQ-15) is a scale that is composed of 15 items related to physical symptoms [
The World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) is a scale developed by the World Health Organization, Quality of Life Group [
First, frequency analysis was conducted on the descriptive statistics of the participants. This study calculated the means and standard deviations of each scale for the two groups and verified the differences in the means. Then, internal consistency was verified for reliability. Cronbach’s alpha was used to verify internal consistency. To verify validity, this study used construct validity and concurrent validity. To verify construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were utilized, and correlation analysis was conducted to verify concurrent validity. The maximum likelihood (ML) and oblique rotation (direct oblimin) methods were used for EFA. For CFA, comparative fit index (CFI), incremental fit index (IFI), and normed fit index (NFI) were used for the goodness of fit indicators. CFI, IFI, and NFI were all “acceptable” at values higher than 0.90, indicating that the model has high goodness of fit [
Next, the average age of the psychiatric patients was 40.06 years, with 76.5% men and 23.5% women; 58.8% were single and 23.5% were married. In terms of their education level, the largest subset (41.1%) had 4-year college degrees, followed by those who had graduated high school, at 29.4%.
The differences for the age and gender between two groups were not statistically significant [t(101)=-0.294;
The Cronbach’s alpha of the KF-COVID-19S adapted in this study was 0.88, which can be interpreted as “good.”
The purpose of this study was to adapt the Fear of COVID-19 scale into Korean, and verify its reliability and validity. The implications based on the results are as follows:
First, the differences were significant between the two groups in terms of marital status and education level. However, this is not a study to verify the mean difference between those two groups; it is a scale validation study with the normal group as a sample. There were no statistical differences between the mean total scores of the KF-COVID-19S of the normal adult group and patient group.
However, technically, the mean score of the patient group was high. In the other scales, which were HADS-total, HADS-Anxiety, HADS-Depression, and PHQ-15, the mean scores of two groups had statistically significant differences, and the mean scores of patient group were higher than that of normal adult group. These results can be expected as the patients are psychiatric patients experiencing neurotic or psychotic symptoms. Furthermore, this study analyzed the individual scores according to percentiles for the total scores of KF-COVID19S; 93% of KF-COVID-19S total score corresponding to 1.5SD, which can be regarded as “Abnormal,” was 26.5 pts, and 90% of total score considered to be “rare” was 25.5 pts [
Next, in the reliability analysis, this study found that internal consistency was at reliable levels. In the original study and the one by Bitan et al. [
Concurrent validity and discriminant validity were verified in the analysis of validity. Results of the concurrent validity verification showed significant positive correlations with HADS-total, HADS-Anxiety, HADS-Depression, and PHQ-15. In the original study, the correlations between COVID-19S and HADS-Anxiety and HADS-Depression were significant (for depression, r=0.425, p<0.001; for anxiety, r=0.511, p<0.001) [
The implications for the verification of construct validity are as follows: This study utilized the two-factor model, referencing the results of the study by Bitan et al. [
Factor 1 was named “Physical fear” and, as the name suggests, it includes physical or physiological symptoms. These include symptoms such as insomnia, palpitation, and sweating. These physical or physiological symptoms may be experienced when the concerns around contracting COVID-19 are severe. One study found that panic attacks and generalized anxiety disorder symptoms, which could be diagnosed as mental disorders, could be experienced when these symptoms become extremely severe [
Factor 2 was named “Emotional fear” and, like the name of the factor, it includes other expressions of fear. They contain adjectives such as “afraid,” “uncomfortable,” “nervous,” and “anxious.” According to a meta-analysis, the prevalence of anxiety caused by COVID-19 was 29.6%, and the prevalence of depression was 33.7% [
COVID-19 not only causes a direct consequence of infections, but also has a significant influence on society as a whole and at a global level. While the development of infection-preventing measures and medical treatments should be prioritized, the influence of COVID-19 on mental health should not be overlooked [
Lastly, the limitations and future research directions of this study are as follows. First, the normal adult sample was based on employees of public institutions at a specific region, indicating that the representativeness of the sample is not good. A follow-up, re-verification study, which involves randomly sampled participants, is required. In addition, when the number of normal adult participants is more than 1,000, re-verification of the cut-off score is required, and it is expected that the prevalence study can be conducted using this cut-off score. Second, the number of patient sample was small. Patients visiting the department of psychiatry are more vulnerable to anxiety, and the COVID-19-related stress of psychiatric patients is thought to be significant. Other studies have indicated that patients with mood disorders were more susceptible to COVID-19-related stress, which exacerbates the symptoms that they are experiencing [
The online-only Data Supplement is available with this article at
This study was supported by Wonkwang University in 2020.
The authors have no potential conflicts of interest to disclose.
Conceptualization: Sang-Yeol Lee, Seung-Ho Jang. Data curation: Sang-Yeol Lee, Seung-Ho Jang. Formal analysis: Jeong-Wan Hong, Hye-Jin Lee. Funding acquisition: Min-Cheol Park. Investigation: Kyu-Sic Hwang, Hye-Ji Choi. Methodology: Kyu-Sic Hwang, Chan-Mo Yang. Project administration: Sang-Yeol Lee, Seung-Ho Jang, Min-Cheol Park. Resources: Kyu-Sic Hwang, Hye-Ji Choi. Software: Kyu-Sic Hwang, Chan-Mo Yang. Supervision: Sang-Yeol Lee, Seung-Ho Jang, Min-Cheol Park. Validation: Kyu-Sic Hwang, Chan-Mo Yang. Visualization: Kyu-Sic Hwang, Jeong-Wan Hong, Hye-Jin Lee. Writing—original draft: Kyu-Sic Hwang, Hye-Jin Lee. Writing—review & editing: Kyu-Sic Hwang, Jeong-Wan Hong.
Two-factor structure of KF-COVID-19S confirmatory factor analysis.
Participants’ demographic characteristics and descriptive statistics of measures
Variable | Group |
Statistic |
|
---|---|---|---|
Normal adult (N=186) | Patient (N=17) | t, χ2 | |
Age, years: mean±SD | 39.19±10.93 | 40.06±17.81 | -0.294 |
Gender, Male: N (%) | 104 (55.9) | 13 (76.5) | 2.70 |
Marital status, N (%) | 12.09 |
||
Unmarried | 73 (39.2) | 10 (58.8) | |
Married | 105 (56.5) | 4 (23.5) | |
Separated | 0 (0.0) | 0 (0.0) | |
Divorced | 6 (3.2) | 3 (17.7) | |
Lost | 2 (1.1) | 0 (0.0) | |
Education level, N (%) | 49.38 |
||
Elementary school | 0 (0.0) | 2 (11.8) | |
Middle school | 0 (0.0) | 2 (11.8) | |
High school | 25 (13.0) | 5 (29.4) | |
2-year college | 25 (13.0) | 1 (5.9) | |
4-year college | 142 (74.0) | 7 (41.1) | |
Measures, mean±SD | |||
KF-COVID-19S | 18.90±5.16 | 19.82±7.93 | -0.668 |
HADS-total | 10.81±7.05 | 24.18±8.83 | -7.324 |
HADS-anxiety | 4.64±3.63 | 12.12±4.96 | -7.864 |
HADS-depression | 6.17±3.96 | 12.06±4.56 | -5.804 |
PHQ-15 | 5.26±4.57 | 12.65±6.25 | -6.164 |
WHOQOL-BREF | 90.87±16.50 | 64.65±12.89 | 6.372 |
p<0.01,
p<0.001.
N: number, SD: standard deviation, KF-COVID-19S: Korean version of the fear of COVID-19 Scale, HADS: Hospital Anxiety and Depression Scale, PHQ-15: Patient Health Questionnaire-15, WHOQOL-BREF: World Health Organization Quality of Life Assessment Instrument Brief Form
Total score for each percentile using Z-score calculation (N=186)
Percentile (%) | Total score of the KF-COVID-19S (pts) |
---|---|
99 | 30.9 |
98 | 29.5 |
97 | 28.6 |
96 | 27.9 |
95 | 27.4 |
94 | 26.9 |
93 | 26.5 |
92 | 26.2 |
91 | 25.8 |
90 | 25.5 |
KF-COVID-19S: Korean version of the fear of COVID-19 Scale
Correlation analysis for the concurrent validity and discriminant validity (N=186)
KF-COVID-19S | HADS-total | HADS-Depression | HADS-Anxiety | PHQ-15 | WHOQOL-BREF | |
---|---|---|---|---|---|---|
KF-COVID-19S | 1.00 | |||||
HADS-total | 0.260 |
1.00 | ||||
HADS-depression | 0.175 |
0.941 |
1.00 | |||
HADS-anxiety | 0.314 |
0.940 |
0.770 |
1.00 | ||
PHQ-15 | 0.266 |
0.735 |
0.642 |
0.740 |
1.00 | |
WHOQOL-BREF | -0.224 |
-0.721 |
-0.685 |
-0.671 |
-0.616 |
1.00 |
p<0.05,
p<0.01.
KF-COVID-19S: Korean version of the fear of COVID-19 Scale, HADS: Hospital Anxiety and Depression Scale, PHQ-15: Patient Health Questionnaire-15, WHOQOL-BREF: World Health Organization Quality of Life Assessment Instrument Brief Form
The goodness-of-fit for the 2-factor model by factor analysis solutions (N=186)
Factor analysis solution | Cumulative % of variance explained | χ2 | df | CFI | IFI | NFI |
---|---|---|---|---|---|---|
EFA | 73.65% | 32.270 | 8 | N/A | N/A | N/A |
CFA | 82.730 | 13 | 0.906 | 0.907 | 0.902 |
FAS: factor analysis solutions, EFA: exploratory factor analysis, CFA: confirmatory factor analysis, CFI: comparative fit index, IFI: incremental fit index, NFI: normed fit index
Factor loading, meansĀ±SDs, and item-total correlations of the two-factor model for the KF-COVID-19S (N=186)
Item no. | Factor loading | Mean±SD | Item-total correlation |
---|---|---|---|
Factor 1: Physical fear | |||
03. My hands become clammy when I think about the coronavirus | 0.727 | 2.30±1.00 | 0.780 |
06. I cannot sleep because I’m worrying about getting the coronavirus | 0.921 | 1.97±0.96 | 0.802 |
07. My heart races or palpitates when I think about getting the coronavirus | 0.867 | 2.24±1.08 | 0.817 |
Factor 2: Emotional fear | |||
01. I am most afraid of the coronavirus | 0.729 | 3.34±0.96 | 0.668 |
02. It makes me uncomfortable to think about the coronavirus | 0.739 | 3.77±0.93 | 0.611 |
04. I am afraid of losing my life because of the coronavirus | 0.622 | 2.56±1.09 | 0.809 |
05. When watching news and stories about the coronavirus on social media, I become nervous or anxious | 0.620 | 2.81±1.08 | 0.825 |
p<0.01.
KF-COVID-19S: Korean version of the fear of COVID-19 Scale, SD: standard deviation