Background
The 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.
Methods
A 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.
Results
The 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).
Conclusion
The 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.
The coronavirus disease 2019 (COVID-19) has had psychological impacts on healthcare workers. However, very few scales are available to specifically assess healthcare workers’ work-related stress and anxiety in response to viral epidemics. This study developed a new rating scale, the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), and validated it among healthcare workers directly affected by COVID-19 in Korea. A total of 1,019 healthcare workers responded through anonymous questionnaires during April 20-30, 2020. Internal consistency of the SAVE-9 was measured through Cronbach’s alpha, and principal component analysis with varimax rotation was used to determine its component structure. It was also compared with the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 scales. Its most appropriate cut-off point was determined by conducting receiver operating characteristic analysis. The nine-item scale had satisfactory internal consistency (Cronbach’s α=0.795). It adopted a two-factor structure: (1) anxiety about viral epidemics and (2) work-related stress associated with viral epidemics (Bartlett’s test of sphericity, p < 0.001; Kaiser-Meyer-Olkin=0.85). Correlations between SAVE-9 and the other scales were statistically significant. The cut-off points of the SAVE-9 and its anxiety subcategory were 22 and 15, respectively, compared with a GAD-7 score of 5. The 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.
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