Validation of the Fear of COVID-19 Scale in a Sample of Pakistan’s University Students and Future Directions

Abstract

This study determined the psychometric validation of the English version of the Fear of COVID-19 Scale (FCV-19S). Findings demonstrated robust psychometric properties for the FCV-19S. CFA results showed that the FCV-19S was a good model fit to the data in a sample of 608 university students. The FCV-19S also showed good concurrent validity, as it was significantly and positively related to the Preventive Behaviors related to COVID-19 Scale and the Generalized Anxiety Disorder Scale as well as significantly and negatively related to the Warwick-Edinburgh Mental Well-being Scale. The scale also showed good internal consistency reliability. Further, the association of age with FCV-19S indicated that younger students experienced greater fear of COVID-19. The analyses of mean differences revealed that women as compared to men, bachelor’s and master’s students as compared to post-master’s students, and unemployed students as compared to employed students experienced greater fear of the outbreak. Also, those suffering from severe anxiety experienced greater fear of COVID-19 followed by those suffering from moderate, mild, and minimal anxiety. Moreover, knowing someone suffering from the coronavirus, being afraid that someone close might contract the virus, and believing that the current COVID-19 situation adversely affects academic performance were linked to higher levels of fear of the pandemic. Practice implications, limitations, and avenues for future research are also discussed.

Keywords

COVID-19 FCV-19S psychometric validation generalized anxiety disorders mental well-being COVID-19 preventive behaviors Pakistan’s university students

Introduction

As a complex, multilayered emotion, fear is one of the most crucial factors that could impair mental health and well-being (Kumar & Nayar, 2020). The fear of COVID-19 has led to elevated levels of anxiety (Bitan et al., 2020) predominantly because of its rapid and invisible transmission rate as well as its rate of morbidity and mortality (Ahorsu et al., 2020). Researchers predict that the fear of contracting the virus may exacerbate the existing levels of mental health disorders or trigger extreme anxiety reactions (Colizzi et al., 2020). Studies have also indicated that university students are suffering from anxiety because of the COVID-19 crisis (e.g., Aqeel et al., 2020; Cao et al., 2020; Kaleem et al., 2020; Perz et al., 2020).

Research by Kaleem et al. (2020) revealed that in Pakistan, 44% of the students feel anxious on a daily basis because of the outbreak. They are afraid to leave home (66%) and fret that their health could be severely affected because of the coronavirus (54%). Moreover, 83% have stopped going to prayer places to maintain social distancing. Furthermore, 56% believe that the COVID-19 situation is much worse than it is actually being portrayed. Also, 81% of the students are extremely anxious about their academic future and more than half of them do not want to go to the hospital for treatment of any ailment, as they are afraid of getting infected by the virus. Additionally, Salman et al. (2020) found that the wide spread of the coronavirus, the fear of family members or friends contracting the virus, and the ineffective infection control measures taken by the Government are the main sources of mental distress among university students in Pakistan.

Almost six months since the outbreak in Pakistan (February 26, 2020) and the ever increasing cases and death toll (confirmed cases = 305,031 and deaths = 6,415 as of September 18, 2020), the coronavirus continues to breed fear among most university students. As such, it is pertinent to assess their fear of COVID-19. This contribution reports the validation of the English version of the Fear of COVID-19 Scale (FCV-19S) developed by Ahorsu et al. (2020) in a sample of Pakistan’s university students. Relevant to note here is that it is customary to conduct research in Pakistan based on instruments in the English language. The same holds true for previous scholarly work on students and COVID-19 in Pakistan (e.g., Abbasi et al., 2020; Green, 2020a; Green et al., 2020a, 2020b; Kaleem et al., 2020). Therefore, we considered it important to validate the English version of the fear of COVID-19 scale to predict and control its effect on university students. Moreover, English is the official medium of instruction and communication in Pakistan’s universities and students are expected to possess a good level of English to be eligible for admission. Further, the items in the English version of the scale are terse and flow more naturally as compared to the culturally equivalent scale. The Urdu version of the scale has been validated based on a sample of general public from the Khyber Pakhtunkhwa province by Mahmood et al. (2020). It is more suitable for assessing the fear of the pandemic among individuals who have limited or no knowledge of English.

Specifically, this study aims to confirm the unidimensional structure of the FCV-19S as well as assess its concurrent validity and internal consistency reliability. In addition, it endeavors to gain a comprehensive understanding of the fear of COVID-19 among university students by analyzing the mean differences in FCV-19S as a function of their demographic characteristics, level of generalized anxiety disorder, and responses to epidemiological questions. Previous validation studies pertaining to the FCV-19S have also undertaken the same (e.g., Akdeniz et al., 2020; Bitan et al., 2020; Mahmood et al., 2020; Satici et al., 2020; Zolotov et al., 2020).

Methods

Participants

This study comprised 608 university students—258 (42%) men and 350 (58%) women—studying in three public and three private universities situated in Islamabad and Rawalpindi. Participants were in the 18-33 age group and 77% reported being single. The demographic characteristics of the sample representative of the university student population are reported in Table 1.

Table 1.

Demographic, GAD, and current COVID-19 characteristics of the sample and related mean differences in FCV-19S.

Variable	Freq.	%	Mean differences in FCV-19S
Variable	Freq.	%	M	SD	F-test/t-test
Gender
Male	258	42	15.10	5.88	t (595.02) = −5.43, p < .001
Female	350	58	17.94	6.98	t (595.02) = −5.43, p < .001
Age			24.76	3.52
Education
Bachelor’s	406	67	17.01	6.34	F (2, 157.82) = 5.42, p = .005
Master’s	143	23	16.97	6.93
Post-master’s	59	10	14.09	5.36
Faculty
Social sciences	112	18	15.90	6.22	F (3, 277.73) = 1.78, p = .152
Business administration	248	41	17.17	6.45
Natural & applied sciences	132	22	16.08	6.26
Computer sciences	116	19	17.38	7.91
University
Private	332	55	16.74	6.65	t (606) = 0.041, p = .967
Public	276	45	16.72	6.73	t (606) = 0.041, p = .967
Employment status
Unemployed	386	64	17.29	6.73	t (606) = 2.71, p = .007
Employed	222	36	15.77	6.51	t (606) = 2.71, p = .007
Generalized anxiety disorders
Minimal (0–4)	46	8	10.00	3.46	F (3, 201.44) = 116.79, p < .001
Mild (5–9)	224	37	13.67	4.96
Moderate (10–14)	190	31	17.20	5.08
Severe (15 or higher)	148	24	22.88	6.60
Epidemiological questions
Do you know someone who has the coronavirus?
Yes	160	26	25.78	3.63	t (309.13) = 35.59, p < .001
No	448	74	13.51	4.04	t (309.13) = 35.59, p < .001
Are you afraid that someone close to you might contract the coronavirus?
Yes	250	41	23.16	4.74	t (417.41) = 31.32, p < .001
No	358	59	12.25	3.35	t (417.41) = 31.32, p < .001
Do you believe that the current COVID-19 situation is adversely affecting your academic performance?
Yes	314	52	22.76	5.13	t (427.33) = 27.61, p < .001
No	294	48	12.41	3.62	t (427.33) = 27.61, p < .001

Note. All percentages have been rounded off.

Measures

Demographic and COVID-19 information

Questions about participants’ gender, age, education, faculty, university type, and employment status were asked. Additionally, three dichotomous (yes/no) questions were asked: “Do you know someone who has the coronavirus?” “Are you afraid that someone close to you might contract the coronavirus?” and “Do you believe that the current COVID-19 situation is adversely affecting your academic performance?”

Fear of COVID-19 Scale (FCV-19S)

Developed by Ahorsu et al. (2020), this 7-item self-report measure (e.g., “I am afraid of coronavirus-19” and “My heart races or palpitates when I think about getting coronavirus-19”) reflects emotional fear reactions towards the COVID-19 pandemic. Participants are required to rate each item on a 5-point Likert type scale (1 = strongly disagree; 5 = strongly agree). As reported by the developers, the scale showed good internal consistency (α = .82) as well as acceptable composite reliability (CR; 0.88) and average variance extracted (AVE; 0.51). Furthermore, the scale was positively related to depression and anxiety. The FCV-19S has been validated in several languages, including Urdu (cf. Mahmood et al., 2020).

Preventive Behaviors related to COVID-19 Scale (PBCV-19S)

This 7-item scale was developed by Mahmood et al. (2020) based on the recommendations of the World Health Organization regarding the cautionary measures to be adopted during the pandemic. PBCV-19S uses a 5-point Likert type scale (1 = strongly disagree; 5 = strongly agree) for rating each item. Sample items in the scale are: “I regularly wash my hands for 20 seconds,” “I maintain social physical distance while meeting others,” and “I wear a mask when I go outside.” They reported its internal consistency to be .85. Pilot testing assessed its validity and reliability. Confirmatory Factor Analysis (CFA) indicated that the PBCV-19S was a good model fit, i.e., χ² (10, N = 238) = 11.07, p = .35; χ²/df = 1.11; RMSEA = 0.02; RMSEA 90% CI [.0; .08]; CFI = 0.99; TLI = 0.98; NFI = 0.99; GFI = .99; AGFI = .97; SRMR = 0.02. Factor loadings ranged from 0.58 to 0.82. Higher scores on the PBCV-19S suggest that respondents strictly follow COVID-19 preventive behaviors. Cronbach’s alpha value indicated good internal consistency of the scale (α = 0.84). Pertaining to this study sample, the alpha value of the PBCV-19S calculated to .88.

Generalized Anxiety Disorder Scale (GAD-7S)

Seven items from the GAD-7S were used in this study. Developed by Spitzer et al. (2006), the items in the scale represent essential diagnostic characteristics pertaining to generalized anxiety disorder, such as trouble relaxing, feeling anxious or on edge, becoming easily irritable, and feeling afraid that something awful might happen. The scale uses a 4-point Likert type scale (0 = not at all; 3 = nearly every day). Spitzer et al. (2006) reported excellent internal consistency (α = .92) of the GAD-7S. Generalized anxiety disorder was also treated as a categorical variable and included in the analyses of mean differences based on these levels or categories and associated cut-off points: Minimal (0-4), Mild (5-9), Moderate (10-14), and Severe (15 or higher). Based on the pilot testing, CFA indicated that the GAD-7 was a good model fit, i.e., χ² (7, N = 238) = 12.43, p = .18; χ²/df = 1.78; RMSEA = 0.06; RMSEA 90% CI [.0; .11]; CFI = 0.98; TLI = 0.97; NFI = 0.98; GFI = .98; AGFI = .96; SRMR = 0.02. Factor loadings ranged from 0.49 to 0.88. Higher scores on the GAD-7S suggest greater anxiety experienced by respondents. Further, Cronbach’s alpha value indicated good internal consistency of the scale (α = 0.89). With regard to this study sample, the Cronbach’s alpha value of the GAD-7S amounted to .90.

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

This is a 14-item scale developed by Tennant et al. (2007) for assessing mental well-being through such items as: “I’ve been able to make up my own mind about things,” “I’ve been interested in new things,” and “I’ve been feeling good about myself.” The WEMWBS uses a 5-point Likert type scale (1 = none of the time; 5 = all of the time) for respondents to rate each item. Winter et al. (2020) reported excellent internal consistency (α = .91) of the WEMWBS. Furthermore, based on the pilot testing, CFA demonstrated that WEMWBS was a good model fit, i.e., χ² (19, N = 238) = 45.38, p = .11; χ²/df = 2.39; RMSEA = 0.06; RMSEA 90% CI [.04; .11]; CFI = 0.98; TLI = 0.97; NFI = 0.98; GFI = .97; AGFI = .95; SRMR = 0.04. Factor loadings ranged from 0.46 to 0.86. Higher scores on the WEMWBS suggest greater mental well-being. In addition, Cronbach’s alpha value indicated good internal consistency of the scale (α = 0.83). Relating to this study sample, the Cronbach’s alpha value of the WEMWBS amounted to .89.

Procedure

This study was developed and conducted during August and September, 2020. Data were collected during August 30, 2020 (COVID-19 confirmed cases = 296,149 and deaths = 6,298) and September 10, 2020 (COVID-19 confirmed cases = 300,371 and deaths = 6,370). For this study, the Contemporary Research Initiative at Preston University, Islamabad Campus, formally contacted 10 universities on the Higher Education Commission’s (HEC) list of recognized university campuses in Rawalpindi and Islamabad. The three private and three public universities that consented to participate in the study were sent the link to the online survey developed through Google Forms. The link to the survey was also posted on relevant student groups on social media. The student affairs department at each university liaised with faculty to circulate the link in their class groups on Whatsapp. The researchers also used their contacts at these universities and requested them to forward the survey to students. This study did not impose any restrictions on participation. Participants who had previously contracted the virus were also allowed to participate in the study. All participants participated voluntarily and anonymously. They were clearly explained the objectives of the study and assured of the confidentiality of their responses through a webpage preceding the survey. This page also requested their consent to participate in the study. They could only move to the survey if they chose the “I agree” option. In addition, participants had to complete all the items/questions in the online survey in order for it to be submitted.

Statistical analyses

Except for the CFA, all analyses were performed using the IBM Statistical Package for the Social Sciences (SPSS) version 24. LISREL (Linear Structural Relationships) version 8.80 was used for conducting the CFA. First, descriptive statistics were calculated pertaining to the sample’s demographic characteristics, level of generalized anxiety disorder, and responses to epidemiological questions. Mean, standard deviation (measures of central tendency), skewness, and kurtosis (measures of distribution) were also calculated with regard to each item of the FCV-19S. Second, CFA was used to check whether the FCV-19S showed a good model fit to the sample data based on Absolute Fit Indices and Incremental Fit Indices. Third, for determining the concurrent validity, Pearson’s Correlation Coefficient was calculated to check the relationship of the FCV-19S with the PBCV-19S, the GAD-7S, and the WEMWBS. Also, the adequacy of convergent validity was ascertained by calculating CR and AVE in MS Excel. Fourth, the internal consistency reliability of the FCV-19S entailed determining the values of Cronbach’s alpha if item deleted, corrected-item total correlations, inter-item correlations, and the value of Cronbach’s alpha for the entire scale. Lastly, the mean differences in FCV-19S as a function of the sample’s different characteristics were determined through independent samples t-test and one-way ANOVA based on Bonferroni Post Hoc comparisons.

Results

Preliminary analysis

Table 2 reports the mean and standard deviation for each item of the FCV-19S. Further, the values of Skewness and Kurtosis were well within the -1.5 to +1.5 range. Hence, all seven items were normally distributed (Byrne & Campbell, 1999).

Table 2.

Item properties, CFA factor loadings, and goodness of fit statistics of the FCV-19S.

Item	M	SD	Skewness	Kurtosis	CFA factor loadings
1	2.88	1.25	−0.011	−0.969	0.75
2	2.98	1.38	−0.168	−1.207	0.64
3	1.78	1.06	1.249	0.710	0.76
4	2.38	1.45	0.630	−1.026	0.72
5	3.17	1.38	−0.213	−1.155	0.58
6	1.61	0.99	0.987	1.312	0.80
7	1.95	1.16	1.020	−0.029	0.84
					AVE = 0.54
					CR = 0.89
Goodness of fit statistics				Value	Acceptable threshold levels
Absolute fit indices
Normal theory weighted least squares chi-square (χ²)				10.70	Non-significant, p > .05 (McDonald & Ho, 2002)
Degrees of freedom (df)				5
Relative/normed chi-square (χ²/df)				2.14	<3.00 (Hair et al., 2010)
Root Mean Square Error of Approximation (RMSEA)				0.04	<0.07 (Steiger, 2007)
Standardized Root Mean Square Residual (SRMR)				0.02	<0.05 (Diamantopoulos & Siguaw, 2000)
Goodness of Fit Index (GFI)				0.98	>0.95 (Hooper et al., 2008)
Adjusted Goodness of Fit Index (AGFI)				0.96	>0.95 (Hooper et al., 2008)
Incremental fit indices
Tucker-Lewis Index (TLI)				0.96	≥0.95 (Hu & Bentler, 1999)
Comparative Fit Index (CFI)				0.98	≥0.95 (Hu & Bentler, 1999)
Normed Fit Index (NFI)				0.98	≥0.95 (Hu & Bentler, 1999)

Confirmatory factor analysis

The 7- item unidimensional FCV-19S was entered for CFA using the maximum likelihood estimation method. Table 2 also shows the range of values or the acceptable threshold levels for absolute and incremental fit indices based on which we evaluated the fit of the CFA model. Results showed that the model was a good fit, that is, χ² (5) = 10.70, p = .15; χ²/df = 2.14; RMSEA = .04, RMSEA 90% CI [.0; .07]; CFI = .98; TLI = .96; NFI = .98; GFI = .98; AGFI = .96; SRMR = .02. Furthermore, the factor loadings ranged from .58 to .84 and were within the acceptable threshold of > .50 as presented in Table 2. Higher scores on the scale suggest that respondents possess higher levels of fear of COVID-19. Thus, CFA results confirm the unidimensional structure of the scale.

Concurrent validity

The FCV-19S (M = 16.74, SD = 6.68) was correlated with the PBCV-19S (M = 26.62, SD = 6.29), the GAD-7S (M = 11.09, SD = 4.73), and the WEMWBS (M = 55.07, SD = 7.93) to determine its concurrent validity. The FCV-19S demonstrated good concurrent validity. It was positively related to the PBCV-19S (r = 0.38, p < 0.001) and the GAD-7S (r = 0.59, p < 0.001). Also, the FCV-19S was negatively related to the WEMWBS (r = -0.33, p < 0.001) suggesting that respondents who had higher FCV-19S scores had lower scores on the WEMWBS.

Convergent validity

According to Z. W. Lee et al. (2015), convergent validity is the extent to which the items of a scale appear to reflect/indicate a single underlying construct. Wu et al. (2015) suggest that convergent validity is deemed adequate when AVE of the latent variable is ≥ 0.50 and CR is ≥ 0.70. As reported in Table 2, the value of AVE for the FCV-19S was adequate (0.54) and that of CR was much higher than the desired threshold (0.89).

Internal consistency reliability

Table 3 presents the internal consistency reliability of the FCV-19S. The internal consistency of FCV-19S was good, i.e., α = 0.88. In addition, the Cronbach’s alpha value did not increase if an item was deleted from the seven items. In addition, the corrected-item total correlations for the FCV-19S were strong, ranging from 0.60 to 0.75. Lastly, the inter-item correlations ranged from 0.35 to 0.70. Thus, results suggest that the FCV-19S has good internal consistency reliability.

Table 3.

Internal consistency reliability of the FCV-19S.

FCV-19S item	Cronbach’s alpha if item deleted	Corrected-item total correlations	Inter-item correlations
FCV-19S item	Cronbach’s alpha if item deleted	Corrected-item total correlations	1	2	3	4	5	6	7
1	0.86	0.70	–	0.69	0.56	0.58	0.46	0.35	0.56
2	0.87	0.67		–	0.46	0.55	0.58	0.29	0.50
3	0.86	0.69			–	0.55	0.42	0.63	0.65
4	0.86	0.70				–	0.45	0.52	0.59
5	0.88	0.60					–	0.44	0.49
6	0.87	0.61						–	0.70
7	0.85	0.75							–
Reliability		Value	Acceptable threshold levels
Reliability (Cronbach’s α)		0.88	> 0.70

Note: All correlations are significant at p < .001.

Demographic characteristics and FCV-19S

Age was not treated as a categorical variable and therefore we determined its relationship with the fear of COVID-19. Pearson’s correlation showed that age was negatively related to the FCV-19S (r = -.17, p < .001). In addition, we calculated the mean differences in the FCV-19S as a function of the sample’s other demographic characteristics (cf. Table 1).

Results of independent samples t-test indicated that there was a significant difference in gender and employment status with regard to the scores obtained on the FCV-19S, i.e., women and unemployed students had higher scores on the FCV-19S. There was however no significant difference between students studying in private and public universities.

Results of One-way ANOVA revealed that there was no significant difference in the scores on the FCV-19S among students studying in the four faculties. Additionally, results indicated a significant difference in the scores on the FCV-19S among bachelor’s, master’s, and post-master’s students. Bachelor’s students scored the highest on the scale followed by master’s students and post-master’s students. The Post Hoc Bonferroni comparisons however indicated that the bachelor’s group and the master’s group scored almost similar on the scale. Further, these showed that the bachelor’s group scored significantly different (p < .001) on the FCV-19S than the post-master’s group (M_difference = 2.92) and the master’s group scored significantly different (p < .001) than the post-master’s group (M_difference = 2.88).

GAD and FCV-19S

Next, we determined the mean differences in the FCV-19S as a function of the sample’s level of generalized anxiety disorder based on One-way ANOVA (cf. Table 1). Results showed a significant difference in the scores on the FCV-19S among students in the four GAD categories. Students in the severe anxiety group scored highest on the FCV-19S followed by those in the moderate anxiety group, the mild anxiety group, and the minimal anxiety group. Post Hoc Bonferroni comparisons indicated that the minimal anxiety group scored significantly different (p < .001) on the FCV-19S than the mild anxiety group (M_difference = -3.67), the moderate anxiety group (M_difference = -7.20), and the severe anxiety group (M_difference = -12.88). Further, the comparisons showed that the mild anxiety group scored significantly different (p < .001) on the FCV-19S than the moderate anxiety group (M_difference = -3.53) and the severe anxiety group (M_difference = -9.21). The comparisons also showed that the moderate anxiety group scored significantly different (p < .001) on the FCV-19S than the severe anxiety group (M_difference = -5.68).

Current COVID-19 characteristics and FCV-19S

Lastly, we determined the mean differences in the FCV-19S as a function of the sample’s current COVID-19 characteristics. Results of independent samples t-test suggested that students who (a) knew someone suffering from coronavirus, (b) were afraid that someone close to them might contract the coronavirus, and (c) believed that the current COVID-19 situation is adversely affecting their academic performance scored higher on the FCV-19S.

Discussion

This study demonstrated the validation of the English version of FCV-19S (Ahorsu et al., 2020) in a sample of Pakistan’s public and private university students. In addition, the study analyzed the association of university students’ demographic characteristics, level of generalized anxiety disorder, and responses to epidemiological questions with their fear of COVID-19. Results of the study are discussed in the following paragraphs.

Psychometric integrity of the FCV-19S

Results demonstrated robust psychometric properties for the English version of the FCV-19S. CFA results showed that the scale has good construct validity. These support the CFA results of the Urdu version of the scale (Mahmood et al., 2020). Most importantly, CFA confirmed the single-factor structure of the FCV-19S, which is in line with previous validation studies (e.g., Ahorsu et al., 2020; Mahmood et al., 2020; Perz et al., 2020; Satici et al., 2020).

The FCV-19S also showed good concurrent validity. It was significantly and positively related to the PBCV-19S and the GAD-7S as well as significantly and negatively related to the WEMWBS. Winter et al. (2020) also used the WEMWBS as one of the instruments to determine the concurrent validity of the English version of the FCV-19S. They also reported a negative relationship between the FCV-19S and the WEMWBS. Mahmood et al. (2020) used the PBCV-19S and the GAD-7S to determine the concurrent validity of the Urdu version of the FCV-19S. They also reported that the FCV-19S was positively related to the PBCV-19S and the GAD-7S. Further, as indicated by the values of AVE (0.54) and CR (0.89), the scale showed adequate convergent validity. These values are greater than those reported by previous validation studies (e.g., Ahorsu et al., 2020; Satici et al., 2020). The internal consistency of the scale calculated to 0.88, which is also greater than that reported by previous studies (cf. Mahmood et al., 2020).

Demographic characteristics

Age

Results suggested that the younger the university students are, the greater is their fear of COVID-19. This finding is in line with that of a study by Koçak et al. (2021). Younger students may experience greater fear because of three major reasons. First, younger students (i.e., between 18 and 24 years, irrespective of academic status) tend to be more angst about their academic future as well as their ability to pay for their university/college education as compared to older students (Aristovnik et al., 2020). Second, due to the bombardment of COVID-19 news, younger students—who are constantly glued to social media—may be more exposed to risk-elevating messages than older students (Huckins et al., 2020). As such, students relying on social media may not have adequate or correct knowledge about the pandemic (Khasawneh et al., 2020) because they may misinterpret the seriousness of the outbreak (Baloran, 2020). Rodríguez-Hidalgo et al. (2020) assert that ignorance or disinformation is a breeding ground for the fear of COVID-19 among younger university students. Third, the emotional maturity that comes with age may act as a buffer against mental health problems during the pandemic. According to Wang and Zhao (2020), maturity enables students to better handle fluctuant emotions. Moreover, research has shown that older students are less likely to experience psychological distress amid the pandemic as compared to younger students (Saravanan et al., 2020).

Gender

Results indicated that women experience greater fear of the pandemic than men. Previous research has also indicated the same (e.g., Bitan et al., 2020; Mahmood et al., 2020; Qiu et al., 2020; Zolotov et al., 2020). This is possibly because women tend to take health risks more seriously than men (Broche-Pérez et al., 2020). Moreover, women as compared to men have shown greater vulnerability to the COVID-19 pandemic in terms of experiencing higher levels of anxiety, depression, stress, insomnia, and adjustment disorder (Rossi et al., 2020; Wang, Pan, et al., 2020). For instance, the female gender has been shown to predict higher levels of risk perception of COVID-19 (Dryhurst et al., 2020). Women have also reported higher levels of post-traumatic stress symptoms than men during the outbreak. One of the major reasons for this is that they show more reactivity than men in neural networks related to fear (Liu et al., 2020). Furthermore, women’s mental health has been adversely affected due to insignificant domestic and emotional support during lockdown (Thibaut & van Wijngaarden-Cremers, 2020). In Pakistan’s patriarchal society, a sense of stigma—attached with being infected with the virus—experienced by women from male members of the society may also contribute to the fear of COVID-19 among them.

Education

Bachelor’s and master’s students scored almost the same on the FCV-19S, but higher than the post-master’s students. This is likely because bachelor’s and master’s students are at a higher level of risk of exposure than the post-master’s students. Many universities in Pakistan have started offering blended learning from the first week of September 2020. To observe social distancing, students in each semester are divided into two groups. When the first group studies online, the second attends university in-person. Each group therefore attends face to face classes every alternate week. Amid the threat of the virus, bachelor’s and master’s students attend in-person classes five or six days a week, whereas, the post-master’s students two days a week. The fear of COVID-19 is also greater among the bachelor’s and master’s students probably because many live away from home in student hostels where living conditions are less healthy and safe. Using the public transportation system to attend university in-person may also contribute to the fear of COVID-19 among many students. Hostel accommodation is also availed by those students whose universities only offer the online mode of education. This is because they face internet connectivity issues as they live in remote areas and as such are unable to attend online classes from home. Most post-master’s students who are away from home are employed and can therefore afford a decent place to reside than the bachelor’s and master’s students.

Further, findings of this study indicated that there is no significant difference in the fear of COVID-19 experienced by students studying in different faculties or in public or private universities. Wang and Zhao (2020) also found no significant differences between students majoring in arts and sciences. However, a significant difference in FCV-19S scores was found between medical and social work students (Zolotov et al., 2020), i.e., medical students scored lower on the FCV-19S than social work students. Studies have demonstrated that as medical students have more knowledge about the pandemic, therefore, they experience lower levels of fear than those studying in other disciplines (e.g., Saddik et al., 2020; Saravanan et al., 2020).

Employment status

According to the results, unemployed students fear the pandemic more than those who are employed. This is possibly due to the economic instability as well as the anxiety of future employability caused by the uncertainty of the COVID-19 crisis (Wang, Horby, et al., 2020). Previous research has also indicated that unemployed individuals score higher on the FCV-19S than those who are employed (e.g., Mahmood et al., 2020).

Generalized anxiety disorders

Results suggested that students suffering from severe anxiety score higher on the FCV-19S followed by those suffering from moderate, mild, and minimal anxiety. Perz et al. (2020) also found that students who score higher on the GAD-7 have significantly higher scores on the FCV-19S. Our findings suggest that students experiencing any form of generalized anxiety disorder (i.e., not necessarily related to COVID-19) may experience greater fear of the pandemic. This is in all likelihood because people with higher levels of anxiety are not able to think rationally to counter the fear of COVID-19 (Ahorsu et al., 2020; S. A. Lee, 2020).

Epidemiological questions

Findings of the study indicated that university students who know someone suffering from the coronavirus experience greater fear of COVID-19 as compared to those who don’t. The same is true for those who are afraid that someone close to them might contract the coronavirus. Previous research has also demonstrated the existence of such fears among study participants (e.g., Akdeniz et al., 2020; Bitan et al., 2020; Perz et al., 2020). These fears may be directly associated with the unpredictable and ever-evolving nature of the coronavirus (Lippi et al., 2020), its rapid and invisible transmission rate, and its rate of morbidity and mortality (Ahorsu et al., 2020). Moreover, it is human instinct to act in irrational ways to protect loved ones (Akdeniz et al., 2020). Our findings also indicated that students who believe that the current COVID-19 situation is adversely affecting their academic performance experience greater fear of COVID-19 as compared to those who don’t. This fear is possibly because of the rapid and unsettling transition to online learning caused by the sudden emergence of the pandemic (Akdeniz et al., 2020; Bao, 2020) as well as the gradual distances created by the absence of interpersonal communication (Xiao, 2020).

Practice implications

Results of the study have implications for education administrators, university counselors, faculty members, student affairs practitioners, mental health professionals, positive psychologists, and interventionists to work in collaboration to devise strategies for addressing the fear of COVID-19 among university students.

First, it may be vital for universities to implement a mechanism for effectively monitoring students’ fear of COVID-19. In this regard, the FCV-19S may be used to identify those who are at a greater risk of developing mental health issues because of the fear of COVID-19 so that educational interventions may be developed and implemented accordingly. Educational interventions may be based on the emotionalized learning experiences (ELE) format, which makes use of affective outcomes to increase learner engagement and motivation to learn (Patel, 2010). Affective outcomes are based on relevant, current, and thought-provoking intervention content imparted through experiential activities (cf. Green, 2019a, 2019b, 2019c; Green & Batool, 2017). Offering positive emotional experiences to learners, these educational interventions may be offered through an intelligent mix of online learning and offline personal/collaborative learning phases (cf. Bao, 2020) by student affairs practitioners in collaboration with mental health professionals, positive psychologists, and online interventionists or facilitators. It is pertinent to note that nurturing positive emotions among students may enable them to identify, adapt, and share effective coping strategies to develop resilience against the persistent negative effects of the pandemic (Tugade & Frederickson, 2004). In line with the Broaden-and-Build theory by Fredrickson (2013), positive emotions have two major roles. First, positive emotions have the power to expand horizons based on novel and creative thoughts and actions in the short-term (Broadening effect). Second, these positive emotions lead to the development of essential personal resources (e.g., physical, intellectual, psychological, and social) in the long run (Building effect) to foster self-improvement, greater well-being (Fredrickson, 2004), enhanced learning capabilities (Reschly et al., 2008), and most importantly post-epidemic growth (Fredrickson et al., 2003). Relevant educational interventions based on online and offline phases that may be used for addressing the fear of COVID-19 as well as associated negative emotions (e.g., anxiety, stress, and depression) include: building inner strength and fortitude, the art-of-living, fostering proactivity and career adaptability, dimensions of wellness, advancing well-being in the PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) dimensions; character strengths for promoting personal growth and environmental mastery, enhancing self-insight, cultivating a positive outlook on life, promoting the joy of living, practicing gratitude for greater happiness, and unlocking the winner within (cf. Alameda, 2009; Bryant et al., 2011; Emmons & McCullough, 2003; Green, 2020a, 2020b; Green & Batool, 2018; Green et al., 2015a, 2015b, 2015c, 2015d, 2020b; Lang & Schmitz, 2016; Seligman, 2011; Shonin et al., 2013).

Second, education administrators may need to motivate faculty members to be a mentor to their students during these trying times. In this regard, faculty may teach students to be optimistic and how to embrace the new normal instead of spending excessive time on social media reading about COVID-19. Faculty may encourage students to create a Whatsapp chat group in which reliable information and facts about the coronavirus may be shared and discussed. Additionally, faculty members may schedule virtual office hours to address students’ issues related to their online studies. This study indicates that students were worried about their academic performance due to the pandemic. Therefore, faculty members may need to revisit their teaching practices to prevent academic stress and anxiety among students. It is also recommended to encourage stronger partnerships between mental health resources and faculty. Further, organizing training sessions to enable faculty to identify and help students in distress may be particularly worthwhile. Alleviating the fear of COVID-19 among younger students and women must be given special consideration. They may be encouraged to discuss their fears and associated feelings with the university counselors or mental health professionals.

Third, to assuage the fear of the coronavirus among students, education administrators in collaboration with university counselors and administrative staff may need to implement various strategies to encourage behaviors that contain its spread. Major strategies may include: (a) actively encouraging students, faculty, and staff—who are sick or have been in close contact with an infected person—to stay at home or self-isolate; (b) recommending and reinforcing hand hygiene and respiratory etiquette; (c) recommending and reinforcing the use of masks among students, faculty, and staff both on and off campus; (d) posting signs in highly visible locations that promote everyday protective measures as well as describe how to stop the spread of germs; (e) cleaning and disinfecting frequently touched surfaces and shared objects before use; and (f) improving the ventilation system to increase the flow of clean air (cf. Centers for Disease Control and Prevention, 2020). Additionally, measures may be taken to monitor the health of students, faculty, and staff on a regular basis including more testing of students on campus. Furthermore, information about COVID-19, preventive measures, and practicing wellness behaviors during the outbreak may be disseminated through a dedicated website developed for this purpose. The website may also be used to promote a safe and healthy environment in the campus (Green et al., 2020a).

Fourth, this study indicates that 24% university students suffer from severe and 31% from moderate anxiety, which may aggravate their fear of COVID-19. Therefore, education administrators may require the services of mental health professionals and university counsellors to offer online counseling and therapy sessions, as prolonged anxiety may be detrimental to students’ mental and physical health. Additionally, online question and answer sessions may be scheduled on a regular basis to help students clarify their doubts about the pandemic, address their anxiety and fear of COVID-19 (Saravanan et al., 2020), and accept the new normal way of life. Combining these sessions with a discussion board may allow students to post their questions in advance. This may give mental health professionals or facilitators ample time to prepare to answer the questions effectively during the scheduled session. It is recommended that separate Q&A sessions may be scheduled for female students to enable them to participate without inhibitions. Furthermore, student affairs professionals may liaise with positive psychologists, mental health professionals, and faculty to organize online lecturettes on such topics as mental well-being, living the new normal, positive aspects of the pandemic, and optimal functioning throughout the year to promote mindful living (Green et al., 2020a).

Limitations and future research

This study is based on a fairly large sample size as well as a relatively heterogeneous and representative sample of the general university student population in Pakistan. However, this study has certain limitations. First, the study used an online survey method and as such those not having Internet access may not have been able to participate in it. Second, future studies could improve the study design by recruiting students from public and private universities in other cities of Pakistan. Third, this is a cross-sectional study, which does not evaluate the changes in fear and other variables among students over time. Longitudinal studies may therefore be conducted to study the changes in variables over time.

In the future, qualitative research may be used to gain insights into how the fear of the pandemic (based on emotional fear reactions and symptomatic expressions of fear) impacts students’ mental health, as they may have different levels of resilience and coping mechanisms. Future research may also focus on identifying the mental health and psychological predictors of FCV-19S so that interventions may be designed to counter their effect to address the fear of the pandemic. Additionally, future research may consider FCV-19S as a mediator between GAD and academic self-efficacy or career competencies as well as between anxiety of COVID-19 and preventive behaviors.

As the pandemic has affected almost all aspects of human life, therefore, researchers and specialists from different disciplines may help in bringing their unique insights, expertise, and resources to better understand the fear of COVID-19 and its effect on mental health. Research may also focus on the development, validation, and adoption of instruments that may provide a more accurate assessment of mental health and psychological constructs during the pandemic so that the FCV-19S may be used to ascertain how the fear of the outbreak may influence these constructs.

Overall, findings of this study support the significance and utility of the English version of the FCV-19S and at the same time underscore its potential in research related to mental health and educational interventions. It is hoped that the FCV-19S will lead to pertinent new findings to enable university students to effectively cope with these unprecedented times.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

The research protocol was submitted for consideration, comment, guidance and approval to the university’s research ethics committee. All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

ORCID iD

Zane Asher Green

Notes

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