Adaptation and Validation of the Malay Version of the Stress and Anxiety to Viral Epidemics-6 Items Scale Among the General Population

Abstract

The coronavirus disease pandemic has caused untold distress owing to both its physical and psychological sequelae, and such distress is further exacerbated by multiple socioeconomic ramifications. The Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6). Scale was developed to specifically assess the anxiety response of the general population to viral epidemics. This study aimed to establish the psychometric properties of the Malay version of the SAVE-6 Scale in the general population. Herein, a total of 257 individuals participated. World Health Organization instrument validation protocols were used to translate and back-translate the Malay SAVE-6 Scale. Subsequently, the classical test theory and Rasch analysis were used to ascertain the validity and reliability of the scale. Cronbach α was used to measure the internal consistency, which was found to be satisfactory (α = 0.866). The correlations between the SAVE-6 Scale and other scales, including the Generalized Anxiety Disorder-7 Items Scale (r = 0.421, p < 0.001) and Patient Health Questionnaire-9 Items (r = 0.354, p < 0.001) were significant. Taken together, the Malay version of the SAVE-6 Scale is valid and reliable for use in the general population and is psychometrically suitable for assessing stress and anxiety specific to viral epidemics.

Comparison of the Stress and Anxiety to Viral Epidemic-9 and SAVE-6 scales among healthcare workers in Peru

“…The Peruvian-Spanish SAVE-9 and SAVE-6 also exhibited strong internal consistency and criterion‐related validity when compared with other anxiety scales like GAD-7 and PHQ-9. The internal consistency of the scales, based on Cronbach’s α and McDonald’s ω , was comparable to that of previous studies ( 18 , 23 , 25 , 26 ). Based on the ROC analysis, the appropriate cutoff point for SAVE-9 was ≥16 in accordance with the 5 points of the GAD-7 (mild degree of general anxiety).…”

“…Confirmatory factor analysis demonstrated a good fit for the two-factor model of Peruvian-Spanish SAVE-9, similar to the original scale ( 14 ): factor I (items 1, 2, 3, 4, 5, and 8) and factor II (items 6, 7, and 9). This clustering was parallel to the other validation studies of Italian ( 17 ), Japanese ( 16 ), Turkish ( 19 ), and Malaysian ( 23 ) versions of the SAVE-9 scale. However, that clustering was not observed in other languages such as Russian ( 15 ) and German ( 18 ): factor I (items 2, 3, 4, and 8) and factor II (items 1, 5, 6, 7, and 9).…”

“…The threshold parameters reveal that these two items, 4 and 5, are considerably more demanding in terms of the latent trait required for endorsing the highest response category. Regarding the items’ performance, all items of SAVE-9 performed almost similar patterns to the Japanese ( 16 ) and Malaysian ( 23 ) versions. For SAVE-6, most items in this analysis exhibit very high slope parameters, suggesting a high ability to discriminate between different levels of the latent trait.…”

“…SAVE-9 is a validated tool in many countries such as Russia ( 15 ), Japan ( 16 ), Italy ( 17 ), Korea ( 14 ), Germany ( 18 ), Turkey ( 19 ), and Malaysia ( 20 ). The SAVE-6 scale was developed from the SAVE-9 scale and validated in American ( 21 ), Lebanese ( 22 ), Malaysian ( 23 ), and Korean ( 24 ) samples to measure the general population’s anxiety response, and it has also been validated in Spain in HCWs ( 25 ) and in Peru in medical students ( 26 ). The application of SAVE-6 to particular populations was also investigated ( 27 – 29 ), Therefore, it could be suggested that SAVE-6 is a simplified version that does not consider some specific items for HCWs from SAVE-9; thus, it can be used in a broader population.…”