The Neurocritic: May 2020

Sunday, May 31, 2020

The COVID Stress Scales

Danger. Deprivation. Xenophobia. Contamination. These are some of the fears related to COVID-19. Scores of COVID questionnaires have popped up recently to assess fear, anxiety, stress, and depression related to the novel coronavirus and its massive disruption to daily life. Most are freely available for use as research tools, but few have been validated and peer reviewed.

The COVID Stress Scales (CSS) developed by Taylor and colleagues (2020) were recently published in the Journal of Anxiety Disorders. The authors propose a new COVID Stress Syndrome, and present evidence that the CSS subscales are intercorrelated (which is suggestive of a “coherent” condition).

To develop the CSS, representative samples of people in Canada (n=3,479) and the US (n=3,375) completed a 58-item survey on Qualtrics. Factor analysis identified five subscales...

COVID danger and contamination fears
COVID fears about economic consequences
COVID xenophobia
COVID compulsive checking and reassurance seeking
COVID traumatic stress symptoms

...and limited the questionnaire to 36 items. I'll note that “fears about economic consequences” were restricted to a lack of supplies at grocery stores and pharmacies, rather than fears of crushing debt, eviction, hunger, and homelessness because of unemployment.

One can view this new syndrome as a context-related extension of OCD contamination fears, compulsive checking, and health anxiety (preoccupation with the possibility of serious illness). Indeed, convergent validity was confirmed by showing correlations with established measures of those conditions. Unique aspects of COVID Stress Syndrome — not seen in other diagnoses — include fears that grocery stores would run out of toilet paper,¹ and especially a fear of foreigners (xenophobia). Xenophobia is promulgated by politicians and amplified by bad actors on social media and IRL. I don't think xenophobia (specifically, anti-Asian sentiment) is on the list of symptoms for any DSM diagnosis.

Basically, it seems that a coherent condition called COVID Stress Syndrome would require racist beliefs and a fear of people who are Chinese, Chinese-American, or Chinese-Canadian.² The prevalence of COVID Stress Syndrome in their Canadian and American samples was not specified, nor was the cut-off point for such a diagnosis. Plenty of Americans are xenophobic, but they don't have bad dreams about coronavirus.

In an editorial, Taylor and Asmundson (2020) said:

It appears that people who develop COVID Stress Syndrome have pre-existing psychopathology, particularly pre-existing high levels of health anxiety and obsessive-compulsive checking and contamination symptoms. It remains to be seen whether the COVID Stress Syndrome is simply an adjustment disorder, abating once the pandemic is over, or whether it will become chronic for some individuals.

So much about COVID-19 “remains to be seen”, and this level of uncertainly is a major source of anxiety on its own.

Footnotes

¹ The toilet paper question just missed the cut...included were worries about water, cleaning supplies, medications, etc. The original version also included “worry about looting & rioting.”

² One could really say East Asian people more broadly. Or actually, anyone considered “Other”.

References

Taylor S, Asmundson GJG. (2020). Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment. J Anxiety Disord. 2020; 72:102231.

Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson GJG. Development and initial validation of the COVID Stress Scales. J Anxiety Disord. 2020; 72:102232.

Additional Scales (from a compendium of COVID questionnaires on Google docs)

Epidemic-Pandemic Impacts Inventory Racial/Ethic Discrimination Addendum (15 items).

COVID-19 Stressful events (13 items)

COVID-19 Concerns (9 items)

Coronavirus Stressor Survey (9 items)

CRISIS (The CoRonavIruS Health Impact Survey V0.3) - more here

Covid-19 Staff Needs and Concerns Survey (18 items)

COVID-19 Family Stress Screener (10 items)

ADDENDUM (June 1, 2020): MORE!

UCLA Brief COVID-19 Screen for Child/Adolescent PTSD

Fear of COVID-19 Scale (10 items)

Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. International Journal of Mental Health and Addiction. 2020 Mar 27:1-9.

Coronavirus Anxiety Scale (5 items)