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Development and Validation of a New COVID-19 Anxiety Scale (NCAS)

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Article

Development and Validation of a New Journal of Health Management

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COVID-19 Anxiety Scale (NCAS) © 2022 Indian Institute of
Health Management Research
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DOI: 10.1177/09720634221114672
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Usama Rehman1, Mohammad Ghazi Shahnawaz2, Kaveri Gupta2,

Neda Haseeb Khan2, Korsi D. Kharshiing2, Drishti Kashyap2,
Ritika Uniyal2 and Masrat Khursheed2

Abstract
The study aimed to develop and validate a new coronavirus disease (COVID-19) anxiety scale. Three independent studies
were done to achieve the stated aim of the research. Study 1 explored the factor structure of the scale. Study 2 aimed at
confirming the factor structure and establishing test–retest reliability of NCAS. Study 3 aimed to test the incremental validity
of the new scale over two most widely used scale (FCV-19S & CAS). EFA resulted in a three-dimensional factor structure with
4, 3, 5 items in ‘anxiety pertaining to threat posed by COVID-19’, ‘Anxiety pertained to public policies’ and ‘Anxiety pertaining
to societal consequences’ respectively. CFA confirmed the findings of EFA and a higher order of ‘COVID-19 anxiety’ was also
established. The test–retest reliability was found to be 0.91. NCAS shared 48% variance with FCV-19S (fear of COVID-19
scale) and 27% with CAS (Coronavirus anxiety scale). NCAS has significant incremental validity over FCV-19S and CAS in
predicting self-reported mental health and life satisfaction. The scale would help in identifying people’s specific anxiety related
to COVID-19, which would further help in their intervention/treatment.

Keywords
New COVID-19 anxiety scale, EFA, CFA, concurrent and incremental validity

Introduction paramount. This fear of contracting the virus has been

The psychological impact of the Coronavirus disease 2019
(COVID-19) is evident all over the world (Luo et al., 2020).
Many strategies have been adopted by countries, such as
national lockdown (Chaudhry et al., 2020), creation of
containment zones (Varghese & John, 2020), and behavioural
change practices (Yıldırım et al., 2020) to contain and curb
the spread of COVID-19. These practices, despite promise of
containing the spread of COVID-19 had serious psychological,
social and economic implications besides the influence of
COVID-19 pandemic per se. There is evidence that COVID-
19 has triggered fear, uncertainty, panic and anxiety (Banerjee,
2020; Koffman et al., 2020; Mertens et al., 2020), and
impacted certain sections of the society more severely than
others (Emanuel et al., 2020; Rehman et al., 2021). Factors
such as speed of transmission, pattern, uncertainty about the
possible sources of transmission, fear of contagion and lack of
consensus regarding the best possible treatment (El Zowalaty
instrumental in giving rise to stigma and xenophobia (Mamun
& Griffiths, 2020) directed towards those who might be
infected. Presence of varied sources of information and
misinformation has played a significant role in enhancing the
anxiety related to COVID-19 (Sallam et al., 2020; Zhao &
Zhou, 2020).
Moreover, public health measures used in response to the
COVID-19 crisis including isolation, quarantine, travel
restrictions and limiting social gatherings may also evoke
many common features of mental health suffering like fear,
isolation, stress, anxiety (Ahorsu et al., 2020; Bao et al., 2020)
and worry (Mertens et al., 2020).
Until date, researchers have used various psychological
measures to assess anxiety and found significant anxiety
1 Department of Psychology, Aligarh Muslim University, Aligarh,
Uttar Pradesh, India
2 Department of Psychology, Jamia Millia Islamia, New Delhi, Delhi, India

& Järhult, 2020) are of grave concern. Despite lower mortality

Corresponding author:
in comparison to SARS and MERS, COVID-19 has evoked Mohammad Ghazi Shahnawaz, Department of Psychology, Jamia Millia
anxiety in numerous individuals (Velavan & Meyer, 2020), as Islamia, New Delhi 110025, India
for many, the apprehensive anticipation of being infected is E-mail: mgshahnawaz@gmail.com
2 Journal of Health Management
issues in COVID-19 era, globally (Rajkumar, 2020). What is
problematic, however, is that, whether people were actually
anxious because of COVID-19 per se? Or because of the
contextual factors related to COVID-19 such as not getting
the essentials due to full lockdown/partial lockdown, or
because of people’s professions (e.g. health profession)
(Rehman et al., 2021), or because of smoking, alcohol
(Rahman et al., 2020) or personal identity (Kharshiing et al.,
2021) or because people were forced to maintain social
distance. The reasons of experiencing COVID-19 anxiety
could thus be many. Thus, it would have been better if
COVID-19 anxiety is measured by a specific scale, which
assesses anxiety due to COVID-19 and its ramifications.
Need for a New COVID-19 Anxiety Scale
(NCAS)
Amid this aura of anxiety and fear, various organisations and
mental health professionals have come forward to offer
psychological services. However, a probable roadblock in the
overall delivery of psychological services has been a lack of
an appropriate psychometric tool that is specifically designed
to assess anxiety arising from the specific issues associated
with COVID-19. As discussed earlier, anxiety arising out of
the COVID-19 crisis is not very generic, its unique
manifestations and information/misinformation overload on
various media platforms also need to be considered in any
conceptualisation of coronavirus disease anxiety.
Considering the current situation and limitation of existing
tools, few tools have been developed. Fear of COVID-19
scale (FCV-19S) is one such tool that was constructed based
on reviewed literature pertaining to fear of coronavirus
disease (Ahorsu et al., 2020). However, fear is a motivational
state manifested as a defensive behaviour associated with a
sudden fight or flight response to immediate external danger
(McFarland, 1987), and in this situation the body is prepared
for immediate escape from the situation (Craig et al., 1995).
Anxiety on the other hand, is in anticipation of a future danger
or perceived threat manifested as apprehension, dysphoria
and somatic tension (Gauthier, 1999). Lee developed
‘Coronavirus anxiety scale (CAS)’ as a brief mental health
screener for easy usage (Lee, 2020). There are five items in
the scale/screener that are related to dizziness, sleep
disturbance, tonic immobility, appetite loss and nausea. These
are symptoms of generalised anxiety disorder. In addition, the
unidimensional tool might not be able to capture the anxiety
specific to COVID-19 (Bernardo et al., 2020). Further,
Bernardo and colleagues developed ‘Coronavirus pandemic
anxiety scale’ aimed to assess the anxiety specific to COVID-
19 (Bernardo et al., 2020). On further scrutiny of items, it was
found that items used in the scale were generic and may not
tap the anxiety specifically related to COVID-19. For
example, items in the scale ‘felt faster heat-beat’, ‘felt restless
or agitated’, ‘had difficulty breathing’ etc. do tap anxiety but
that anxiety could be because of various generic reasons.
Another scale was developed by Chandu and colleagues to
assess anxiety specific to COVID-19 (Chandu et al., 2020).
The seven-item scale has used only principal component
analysis and provided only preliminary evidence, and thus
not robust enough (Hair et al., 2010). Moreover, the second
factor ‘illness anxiety’ has just two items, which are not
usually recommended (Hair et al., 2010). Considering the
same, the authors themselves advised future researchers to
add more relevant items (Chandu et al., 2020).
To summarise, it can be safely said that there are tools to
assess anxiety but a more specific tool to assess anxiety
because of COVID-19 is hampering the growth of the subject
and its effective management. Moreover, to the best of our
knowledge no study has compared the scales with each other.
Therefore, the present research is a modest attempt to fill this
gap in the literature by developing a more specific and more
robust COVID-19 anxiety scale.
Development of a New COVID-19 Anxiety
Scale (NCAS)
After thorough review of literature on anxiety as well as on
COVID-19 manifestations, the authors had rounds of
discussion, which resulted in the development of 25 items. A
committee of five senior psychiatrists and psychologists
reviewed these items. Five items were dropped on the
recommendation of the committee, as they tend to assess
phobia or fear rather than anxiety. Three independent studies
were undertaken to develop a robust and new COVID-19
anxiety scale (NCAS). Study 1 focused on exploratory factor
analysis (EFA). Study 2 was undertaken to confirm the factor
structure and to assess the test–retest reliability of NCAS.
Study 3 was done to compare the NCAS with two most
widely used measures (FCV-19S and CAS scale) and their
effect was assessed on outcome variables.
Ethics
The study was approved by the Institutional Ethics
Committee, Faculty of Social Sciences, Jamia Millia Islamia,
New Delhi, India. Ethical standards in the 2013 Declaration
of Helsinki followed. Written informed consent were
obtained from all the participants after briefing them about
the nature of the study.
Study 1
The study aimed at exploring the factor structure of NCAS by
exploratory factor analysis.
Rehman et al. 3
Method
Sample
The sample comprised of 260 Indian respondents.
Convenience sampling technique was used to collect data
electronically with the help of google forms in English. Out
of 260 research participants, 92 were males, 160 were females
and eight (8) preferred not to disclose their gender. Ages
ranged from 18 to 72 years with a mean of 28.47 (SD = 9.89).
About 145 of the participants self-identified as students, 97
were working professionals and the remaining 18 were
unemployed or laid off during lockdown.
Measure
The authors as mentioned above developed the new
COVID-19 anxiety scale (NCAS). The scale comprised of 20
statements scored on a 5-point scale ranging from never (0) to
always (4). The remaining three options were: rarely (1),
sometimes (2) and often (3).
Results and Interpretation
The data was analysed with the help of SPSS V-21. Skewness
and kurtosis were found to be ranging from −1.57 to 0.18 and
−1.30 to 2.57 respectively, indicating the normality of the
data. Inter-item correlations were found be in the range of
0.3–0.7 indicating the appropriateness of data for factor
analysis. EFA was done to extract the inherent factor structure
of the new COVID-19 Anxiety Scale. KMO and Bartlett’s
test of sphericity, both showed that the data was appropriate
for factor analysis with values of 0.90 and 1320.23 (p < 0.001)
respectively. The maximum likelihood extraction method
with promax rotation was used. Items with low factor loading
and cross loadings were deleted one by one and EFA resulted
in a 3-factor solution with 12 items (Table 1). These three
factors explained 61% of the variance within the analysis.
The inter-correlations among the three factors were in the
range of 0.54–0.69.
A close scrutiny of the factors and the items under each
factor reveal that factor 1 encompasses apprehension related
to lack of medicine, being isolated/quarantined, the threat of
COVID-19 to health, and therefore, was named as Anxiety
pertaining to the threat posed by COVID-19. The second
factor was related to items pertaining to policies and
governance, and therefore was called Anxiety pertaining to
public policies related to COVID-19. The third factor was
related to watching news about coronavirus disease, how
infection spreads, how dead bodies were cremated or buried,
and people committing suicide because of coronavirus
disease. Therefore, the third factor was called Anxiety related
to societal consequences of COVID-19. Cronbach’s alpha for
the three factors of NCAS were found to be 0.79, 0.76 and
0.72 respectively.
Study 2
Confirmatory factor analysis was conducted to confirm the
factor structure of the NCAS as obtained in study 1. Test–
retest reliability was also assessed with a time gap of 6–7
weeks after the first phase of data collection.
Method
Sample
Study 2 comprised of 240 participants. Convenience sampling
technique was used to collect data with the help of google
forms in English. The data comprised of 91 males and 149
females. The age of the participants ranged from 16 to 57 (M
= 27.73, SD = 7.00). Of the participants, 147 were single, 62
were married and 31 were in other categories of relationship
(committed, long distance, etc.).
For test–retest reliability, the participants who gave their
consent in the first phase of data, were contacted with the help
of their email Ids/WhatsApp after 6–7 weeks. Out of 260
respondents, only 158 respondents filled the forms again.
Measure
New COVID-19 anxiety scale (NCAS): 12 items NCAS
developed in Study 1 was used to collect data.
Analysis of Data
Before doing CFA, skewness and kurtosis were obtained for
all the 12 items. The values were within the prescribed range
of plus or minus two. Confirmatory factor analysis (CFA)
was done using AMOS 21 maximum likelihood procedure to
examine the validity of the 3-factor structure of NCAS. A
single factor competing model tested the validity of the model
(Garson, 2015; Rehman & Shahnawaz, 2019; Shahnawaz &
Rehman, 2020). Factor loadings, average variance extracted
(AVE) and composite reliability were also used to test the
convergent validity of NCAS. Further, a second-order factor
structure of NCAS was also tested. Correlation coefficients
were used to assess the test–retest reliability of this scale.
Results and Interpretation
Multiple criteria were used for evaluating model fit. The
obtained fit indices for the 3-factor model of NCAS were as
follows: Chi Square = 146.78 (p < 0.001), DF = 52, CMIN/
DF = 2.82, GFI = 0.91, CFI = 0.93, RMSEA = 0.08 and
SRMR = 0.05. The model fit indices for single factor
competing model were: Chi Square = 223.20 (p < 0.001),
CMIN/DF = 4.13, GFI = 0.87, CFI = 0.87, RMSEA = 0.11
and SRMR = 0.06. These fit indices clearly suggested a good
fit for the 3-factor model NCAS as compared to single-factor
model (Hair et al., 2010). Moreover, the chi-Square difference
4 Journal of Health Management

Table 1. Showing Pattern Matrix.

Factor 1 Factor 2 Factor 3
Items (Factor Loadings) (Factor Loadings) (Factor Loadings)
3. I am worried that the medical supplies will fall short of the demand 0.60
11. Lack of clear-cut policies/coordination among various government 0.73
agencies related to COVID-19 makes me stressful
14. I feel stressed as there is contradiction between what agencies say 0.53
and what the reality on the ground is
5. I am anxious because till date how exactly the COVID-19 spreads is 0.57
still not known
6.Thinking/hearing/watching people who were infected and died make 0.75
me frightened and distressed
7. The way dead bodies are cremated/buried is disturbing for me 0.66
12. I feel tense when I watch/hear COVID-19 related news/stories 0.59
13. I feel disturbed to see people committing suicide due to the current 0.67
scenario
17.Watching and hearing information regarding COVID-19 makes me 0.64
feel fatigued
18. I am unable to relax due to the constant threat that COVID-19 0.79
poses to our health
19. I worry over being infected since there is no drug that can treat 0.75
the COVID-19 virus
20. I fear being lonely due to the quarantine and isolation mandated 0.57
if I were to be infected with COVID-19

between the two models was 79.40 (p < 0.05), which further
showed that the 3-factor model is significantly better than a
single-factor model. The inter-factor correlations were 0.83
(factor 1 & factor 3), 0.78 (factor 2 & factor 3) and 0.75
(factor 1 & factor 2). This 3-factor model is presented in
Figure 1.
As shown in Table 2, factor loadings of all 12 items were
significant and above 0.50. Eight of these loadings are above
0.70. Average variance explained for all the three factors were
more than 0.50. Composite reliabilities for the three factors
are also above 0.70. These three indicators of convergent
validity showed that the respective items of the three factors
of the NCAS loaded well on their respective latent factors and
therefore provided convergent validity evidence for NCAS
(Hair et al., 2010).
Furthermore, a second order CFA was also run to test the
higher order conceptualisation of NCAS. The resultant model
is shown in the Figure 2. All the model fit indices such as Chi
Square = 146.784, DF = 51, CMIN/DF = 2.87, GFI = 0.914,
CFI = 0.93, RMSEA = 0.089 and SRMR = 0.047 suggested a
good fit for the higher order framework of NCAS (Hair et al.,
2010). Factor loadings ranged from 0.61 to 0.83. Scrutiny of
the fit indices of first order 3-factor NCAS and that of the
higher order revealed that there are not many differences
between the two set of fit indices. This is not unusual and has
been found in the past as well by other researchers in the case
of 3-factor constructs (Ahmad et al., 2014; Smith et al., 2006).
Correlation technique was used to calculate the test–retest
reliability of NCAS. Correlation coefficients were found to
be 0.81, 0.76 and 0.85 for ‘anxiety pertaining to the threat
posed by COVID-19’, ‘anxiety pertaining to public policies’
and ‘anxiety related to societal consequences of COVID-19’,
respectively. The test–retest reliability for the whole scale
was found to be 0.91. All four reliability coefficients indicated
good reliability for the new scale.
Study 3
The aim of the study was to compare NCAS with two most
widely used measures related to COVID-19 and to establish
the unique contribution of NCAS over and above these
two. For the same, fear of COVID-19 scale (FCV-19S) and
Coronavirus anxiety scale (CAS) were chosen along with
variables such as mental health and life satisfaction. FCV-
19S and CAS are the most widely used measures and have
been translated and validated in many cultural contexts
and languages.
Rehman et al. 5

Method

Figure 1. Three-factor Structure of the New COVID-19 Anxiety
Scale (NCAS).
Sample
Data was collected from 273 adult Indian nationals. The age
range was found to be 18–58 years, with a mean of 23.43.
There were 141 males, 130 females and 2 preferred not to
disclose their sex. As far as their relationship status is
concerned, 236 reported to be single while the remaining 37
were from various relationship categories. As far as their
work status was concerned, 230 were students and 43 were
working professionals.
Measures
Fear of COVID-19 Scale (FCV-19S): FCV-19S developed by
Ahorsu and colleagues is a seven-item scale, rated on a 5-point
Likert scale ranging from strongly disagree (1) to strongly
agree (5) (Ahorsu et al., 2020). The higher score on the scale
indicates greater fear of COVID-19. Cronbach Alpha of FCV-
19S on the current sample was found to be 0.89.
Coronavirus anxiety scale (CAS): CAS was developed by
Lee (2020). It is a five-item scale, rated on a 5-point Likert
scale ranging from not at all (0) to nearly every day over the
last two weeks (4). The higher score on CAS indicates more
anxiety related to coronavirus. Cronbach alpha of CAS on the
current sample was found to be 0.87.

Table 2. Showing Items, Factors, Factor Loadings, AVE and Composite Reliability.
Factor Composite
Items Factor Loadings AVE Reliability
3. I am worried that the medical supplies will fall short of Anxiety pertaining to public 0.66
the demand. policies
11. Lack of clear-cut policies/coordination among various Anxiety pertaining to public 0.73 0.53 0.82
government agencies related to COVID-19 makes me policies
stressful
14. I feel stressed as there is contradiction between what Anxiety pertaining to public 0.79
agencies say and what the reality on the ground is policies
5. I am anxious because till date how exactly the Anxiety related to societal 0.69
COVID-19 spreads is still not known consequences
6.Thinking/hearing/watching people who were infected Anxiety related to societal 0.79 0.51 0.72
and died make me frightened and distressed consequences
7. The way dead bodies are cremated/buried is disturbing Anxiety related to societal 0.68
for me consequences
12. I feel tense when I watch/hear COVID-19-related Anxiety related to societal 0.80
news/stories consequences
13. I feel disturbed to see people committing suicide due Anxiety related to societal 0.60
to the current scenario consequences
17. Watching and hearing information Anxiety pertaining to threat 0.71
regarding COVID-19 makes me feel fatigued posed by Covid-19
18. I am unable to relax due to the constant threat that Anxiety pertaining to threat 0.85 0.54 0.83
COVID-19 poses to our health posed by Covid-19
19. I worry over being infected since there is no drug that Anxiety pertaining to threat 0.75
can treat the COVID-19 virus posed by Covid-19
20. I fear being lonely due to the quarantine and isolation Anxiety pertaining to threat 0.59
mandated if I were to be infected with COVID-19 posed by Covid-19
6 Journal of Health Management

Analysis of Data
Correlational analysis was run to assess the relationships
between the variables. Hierarchical regression analysis was
used to establish the incremental validity of NCAS over FCV-
19S and CAS in predicting mental health and life satisfaction.
Results and Interpretation
The results show that NCAS is significantly related to
FCV-19S, CAS, mental health as well as with life satisfaction.
However, NCAS shared only 48% of variance with FCV-19S
and 27% with CAS. It suggests that NCAS measures something
unique, which has not been tapped by these two scales (Table 3).
It is evident from Table 4 that the NCAS has produced
significant effect on SRMH beyond FCV-19S and CAS.
As can be seen from Table 5, the NCAS has produced
significant effect on life satisfaction beyond FCV-19S and CAS.

Table 3. Showing Correlations among the Variables.

Self-reported
CAS NCAS Mental Health Life Satisfaction
FCV-19S 0.620** 0.699** –0.536** –0.171**
CAS 0.525** –0.371** –0.210**
Figure 2. New COVID-19 Anxiety Scale (NCAS) as a Second-
NCAS –0.536** –0.240**
order Construct.
SRMH 0.384**
Note: ** correlation was significant at .01 level
New COVID-19 anxiety scale (NCAS): The scale was
developed by the present researchers. There are 12 items in
the scale, rated on a 5-point Likert scale ranging from never
Table 4. Showing Hierarchical Multiple Regression Analysis for
(0) to always (4). A higher score on this scale indicates more Self-reported Mental Health (SRMH) as the Criterion Variable
anxiety related to COVID-19. Cronbach Alpha on the current
sample was found to be 0.91. R Std. R square F Significant
Model R square Error Change Change F Change
Mental Health: Mental health was assessed using self-
reported mental health (SRMH) single-item scale (Ahmad 1 0.536a 0.287 0.9685 0.287 109.196 0.000
et al., 2014). Participants were asked, ‘In general, would you 2 0.538b 0.290 0.9687 0.002 0.897 0.345
say that your mental health during the current pandemic 3 0.582c 0.338 0.9365 0.049 19.891 0.000
(COVID-19) is?’ The participants had to choose from the
Notes: a. Predictors: (Constant), FCV-19S total.
following options. Excellent (1), Very Good (2), Good (3), b. Predictors: (Constant), FCV-19S total, CAS total.
Fair (4) and Poor (5). Lower scores indicate better mental c. Predictors: (Constant), FCV-19S total, CAS total, NCAS total.
health. SRMH has been found to be associated with multi-
item measures of mental health, self-rated health and health
problems in many researches (Ahmad et al., 2014). Table 5. Showing Hierarchical Multiple Regression Analysis for
Life satisfaction: It was assessed by a one-item scale Life Satisfaction as the Criterion Variable.
developed by Cheung and Lucas to measure life satisfaction
(Cheung & Lucas, 2014). Participants were asked, ‘In general, R Std. R square Significant
Model R square Error Change F Change F Change
how satisfied are you with your life’ on a scale of 1 (Very
dissatisfied) to 4 (Very satisfied). Higher scores on this single- 1 0.171a 0.029 0.7328 0.029 8.204 0.005
item life satisfaction measure indicate greater satisfaction 2 0.217b 0.047 0.7275 0.018 4.974 0.027
with life. There is substantial evidence that single-item 3 0.263c 0.069 0.7203 0.022 6.370 0.012
measure of life satisfaction not only correlated significantly Notes: a. Predictors: (Constant), FCV-19S total.
with the longer version satisfaction with life scale but also b. Predictors: (Constant), FCV-19S total, CAS total.
with theoretically relevant variables (Milman et al., 2020). c. Predictors: (Constant), FCV-19S total, CAS total, NCAS total.
Rehman et al. 7

General Discussion COVID-19 is a higher order construct, although, it would be

prudent to use three facets for effective anxiety management.
Coronavirus pandemic brought uncertainties to people’s It is also evident that COVID-19 anxiety will have long-term
lives worldwide. Clearly, the impact on mental health of implications as shown by test–retest reliability evidence
COVID-19 is likely to last for many years that necessitates after six to seven weeks. The long-term effects of COVID-19
the development of a measure of anxiety specific to COVID- will also unfold in the coming months and years, and
19, so that appropriate interventions can be done. The present therefore, assessment of the magnitude of COVID-19
study aimed at achieving this goal by conducting three anxiety, may go a long way in providing the much-needed
independent studies. counselling help to clients.
The results revealed that coronavirus disease (COVID-19)
anxiety is a higher order construct having three first-order
dimensions. The first dimension or factor is ‘anxiety
pertaining to the threat posed by COVID-19’ that refers to Limitations
anxiety about lack of a medicine, being isolated/quarantined
In the present study, three independent studies were undertaken
and the threat of COVID-19 to our health. Crucially, there is
successfully to develop a new COVID-19 anxiety scale
evidence that quarantined individuals experienced a range of
(NCAS). However, there are few limitations of the present
both immediate and short-term psychological consequences
research. The result of the present study is limited because of
(Ehrlich et al., 2020).
convenience sampling method, small sample sizes, more
The second factor has been termed as ‘Anxiety pertaining
women than men, and data collected through online medium
to public policies related to COVID-19’ and it measures
is only in English language. The biggest limitation was the
concerns like whether we have adequate medical facilities to
reliance on a self-report method to collect data, which are
cater to the needs of so many people. As many frontline health
known to suffer from social desirability and other common
care providers tested positive for coronavirus the world over
method biases. However, test–retest reliability shows that
(Ehrlich et al., 2020), anxiety pertaining to quality health care
results are consistent even after 6–7 weeks. The present study
is a reality that is worrisome. The situation becomes even
is also limited because of the fact that illness history (physical
more complicated for developing countries where the
and mental) of the participants was not considered in the
healthcare infrastructure is not great (Roy et al., 2020).
research. The research has been conducted in India, however,
Finally, the third dimension, ‘Anxiety related to societal
the specific manifestations of COVID-19 anxiety (e.g. the fear
consequences of COVID-19’ pertains to information related
that medical supplies will fall short of the demand, lack of
to the disease, spread of infection, manner of cremation or
clear cut policies/coordination among agencies, how exactly
burial of people who succumb to the disease and incidences
COVID-19 spreads, watching/hearing information regarding
of suicide due to the virus. It is argued that the increasing
COVID-19, issue of isolation/quarantine and so on), may not
barrage of information and misinformation on COVID-19
vary across countries. However, cross-cultural validity would
transmitted through print, electronic and social media fuels
provide external validity evidence for the NCAS. As all the
stress and hysteria among the public (Sallam et al., 2020) and
three studies of the present research have been done on non-
hence, confounds people. During COVID-19 pandemic there
clinical sample, it will be desirable that the NCAS would be
was a plethora of misinformation on social media related to
administered in the real clinical and counselling settings to
COVID-19 virus that it became difficult to find reliable
establish the clinical validity of the scale.
information (Taylor, 2020). Perhaps confusion prevailed over
the accuracy of information about the disease, that in turn, led
to anxiety and even distress.
Furthermore, the results also revealed that NCAS was Author Contributions
related to FCV-19S and CAS, but NCAS shared only 48% of
variance with FCV-19S and 27% variance with CAS. Thus, All the authors have equally contributed to the study.
NCAS has the potential to contribute uniquely in the
measurement of fear and anxiety related to COVID-19.
Moreover, NCAS has incremental validity over FCV-19S and Declaration of Conflicting Interests
CAS in predicting self-reported mental health as well as life
satisfaction. The authors declared no potential conflicts of interest with
Thus, it can be concluded that NCAS displayed good respect to the research, authorship and/or publication of this
psychometric properties. Moreover, anxiety resulting from article.
8 Journal of Health Management
Funding
The authors received no financial support for the research,
authorship and/or publication of this article.
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