key: cord-0953896-ph5kgi4m authors: Zolotov, Yuval; Reznik, Alexander; Bender, Shmaya; Isralowitz, Richard title: COVID-19 Fear, Mental Health, and Substance Use Among Israeli University Students date: 2020-06-15 journal: Int J Ment Health Addict DOI: 10.1007/s11469-020-00351-8 sha: 4bf2a2086a10c18e0a44728796bc86032fb8b669 doc_id: 953896 cord_uid: ph5kgi4m nan The study protocol was approved by the Institutional Review Boards of both the School of Social Work and the Faculty of Health Sciences at Ben Gurion University of the Negev (BGU). The Qualtrics software platform was used for this online survey. The main instrument was the seven-item FCV-19S (Ahorsu et al. 2020) . The levels of agreement with FCV-19S statements are evaluated by a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Higher total scores correspond with more COVID-19 fear. The survey instrument was translated from English to Hebrew and back translated by lecturers from BGU to ensure uniform content and vocabulary. The translation method used is consistent with that described by the World Health Organization for research purposes (WHO 2020b) . In order to assess the criterion validity of the scale, we sought to examine changes in respondents' psycho-emotional state during the period of self-isolation and/or quarantine. Thus, respondents were asked whether during the previous month they have felt, as a result of COVID-19 situation, more depressed, exhausted, lonely, nervous, or angry. Optional answers were yes and no. Two additional questions were used to examine the negative impact of the COVID-19; and, respondents were asked to rate their level of agreement with the following statements: "I fear my university studies will be negatively affected by COVID-19," and "I am experiencing excess stress and anxiety due to the impact of COVID-19 on my social and family life." Similar to FCV-19S, the 5-point Likert scale for answers ranged from 1 (strongly disagree) to 5 (strongly agree). Descriptive statistics, correlation analysis, one-way ANOVA, t test, and chisquare test were used. Cronbach's alpha and McDonald's omega were used for reliability analysis. To test whether FCV-19S may be considered as having one or two dimensions, separate models of confirmatory factor analysis (CFA) were performed. All statistical analyses were conducted using SPSS, version 25 with AMOS module and JASP, a free and opensource program for statistical analysis supported by the University of Amsterdam (JASP 2020). This survey included 370 participants, 20.8% (n = 77) male, 78.1% (n = 289) female, and 1.1% (n = 4) other; also, 67.4% of the respondents reported being secular, 42.6% religious. As shown in Table 1 , which presents the background characteristics of the sample, the mean age of the respondents was 25.2 years (SD = 3.1). For the total sample, the mean value of the FCV-19S was 14.95 (SD = 4.80), median = 14.0, with a range of 7 to 32. The distribution of the FCV-19S values is shown in Fig. 1 . The scale showed good Cronbach's alpha and McDonald's omega measure of internal consistency or reliability (0.842 and 0.852, respectively). Table 2 shows summary statistics for each scale item in the FCV-19S, including the percentage of respondents who chose the lowest or highest value in the Likert scale. According to CFA criteria (Xia and Yang 2019), our CFA models showed weak fit indices for both the unidimensional and two-dimensional hypotheses for FCV-19S. Unidimensional CFA fit indices were as follows: CFI (comparative fit index) = 0.837; TLI (Tucker-Lewis Index) = 0.829; and RMSEA (root mean square error of approximation) = 0.146. The twodimensional CFA fit indices were as follows: CFI = 0.937; TLI = 0.865; and, RMSEA = 0.107. Although non-significant, a weak correlation was found between the age of the respondents and fear (r = 0.048). A significant difference was found regarding COVID-19 fear based on student gender-females reported higher levels of fear, on average, than males (22.03 vs. 18.99 respectively; t 338 = 3.787, p < .001). One-way ANOVA showed COVID-19 fear difference based on respondents' major field of study (e.g., medicine and social work) (F 2,338 = 5.052; p = .007). Bonferroni post hoc test showed a significant difference of the mean COVID- Table 3 presents the differences of the mean fear values between respondents who reported a change in their psycho-emotional state and respondents who reported no change. As evident in the findings, respondents who reported being more depressed during the previous month had a higher mean score on the FCV-19S than respondents reporting no change (24.38 vs. 19.19, respectively; p < .001). Similarly, significant differences were found for all other conditions (exhaustion, loneliness, nervousness, and anger; all p < .001). In addition, there was a significant positive correlation between the FCV-19S fear values and the answers to the additional questions related to university studies and social and family life (r = 0.503; p < .001). Greater concern and anxiety of the respondents about the effects of COVID-19 on university studies and on social and family life corresponded to higher values on the FCV-19S. Worldwide, efforts are moving toward addressing the multitude of factors affected by COVID-19. Understanding and mitigating human fear including that linked to physical and mental health are a major concern and focal point for intervention. The present study is the first to test the validity of the Hebrew version of the FCV-19S, using both Cronbach's alpha, McDonald's omega, and CFA (unidimension and two dimension) on a sample of Israeli medical and allied health service students. Our findings, similar to those reported by Alyami et al. (2020) , suggest there is an insufficient ground for concluding if the FCV-19S has one or two dimensions. Nevertheless, the present study shows the FCV-19S to be a valid tool that differentiates respondents by their level of fear and establishes relationships between fear and other psycho-emotional states of respondents. The results additionally evidence the variation of fear by gender and major field of study, particularly medicine and social work. The information generated by this survey and other studies drawing on FCV-19S (Ahorsu et al. 2020; Bitan et al. 2020; Reznik et al. 2020) should be used in applied ways. For example, such findings have relevance for education, training, and intervention purposes with front-line health and social service personnel and students to promote personal resilience and the ability to manage mental health and substance misuse that may arise from COVID-19 conditions. In turn, such skills may be passed on by such service providers to patients, family members, and community confronted with COVID-19 conditions now and other disasters to be addressed in the future. Based on disaster intervention experience, tip sheets of relevance should be considered and made available to health and social service personnel, online and in print, for distribution to at-risk populations to mitigate stress, anxiety, and prevention of harmful behavior (Findley et al. 2016; Arcaya et al. 2020; Stephenson 2020) . Clearly, continued research is needed about the utility of FCV-19S and its ability to contribute useful information about impact of COVID 19 and other pandemics on the health and well-being of people. About limitations, these findings are preliminary taken at one point in time across Israeli university students in front-line service professions. Additional studies are needed to determine the long-term effects of COVID-19 across locations, over time and population groups. The fear of COVID-19 scale: development and initial validation Psychometric evaluation of the Arabic version of the fear of COVID-19 scale The social consequences of disasters: individual and community change Fear of COVID-19 scale: psychometric characteristics, reliability and validity in the Israeli population The psychological impact of the COVID-19 epidemic on college students in China Psychological first aid: a tool for mitigating conflict in the Middle East Functional fear predicts public health compliance in the COVID-19 pandemic A fresh way to do statistics Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis COVID 19 and its mental health consequences Social reaction toward the 2019 novel coronavirus (COVID-19) The socio-economic implications of the coronavirus and COVID-19 pandemic: a review The fear of COVID-19 and its role in preventive behaviors COVID-19 fear in Eastern Europe: validation of the fear of COVID-19 scale Psychometric validation of the Bangla fear of COVID-19 scale: confirmatory factor analysis and Rasch analysis Adaptation of the fear of COVID-19 scale: its association with psychological distress and life satisfaction in Turkey Validation and psychometric evaluation of the Italian version of the fear of COVID-19 scale Structure of anxiety associated with the COVID-19 pandemic in the Russian-speaking sample: results from on-line survey More resilient supply chains needed to aid recovery from hurricanes and other disasters A longitudinal study on the mental health of general population during the COVID-19 epidemic in China Mental health and psychosocial considerations during the COVID-19 outbreak. World Health Organization Process of translation and adaptation of instruments RMSEA, CFI, and TLI in structural equation modeling with ordered categorical data: the story they tell depends on the estimation methods Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Acknowledgments The authors of "The Fear of COVID-19 Scale: Development and Initial Validation" published in the International Journal of Mental Health and Addiction are acknowledged. Dr. Oren Wacht