Currently, the COVID–19 pandemic is arguably the most significant health problem we are facing globally. Most of the efforts that have been made in research to date, by both public and private organizations, have explored the pathophysiological effects of the virus on health or sought therapeutic alternatives so that the health personnel at the forefront of the epidemic have the best tools to face the problem. The effects of the virus on the mental health of our workers should not be overlooked, yet comparatively few authors have addressed the problem that the pandemic represents for public health and the mental health of our workers.
Ahorsu et al. developed a scale to evaluate fear towards the COVID–19 pandemic and its effects on the psychological mental state of the Iranian population. As this inventory showed a good internal consistency, it was used in multiple studies to explore fear in different cultures and countries (Ahorsu et al., 2020; Reznik et al., 2020; Sakib et al., 2020; Satici, Gocet-Tekin, Deniz, & Satici, 2020; Soraci et al., 2020), although the problem has not yet been addressed in Mexico.
Soraci et al.’s online survey in Italy, one of the most affected countries, administered the Italian versions of the FCV–19S, the Hospital Anxiety and Depression Scale (HADS), and the Severity Measure for Specific Phobia–Adult (SMSP-A) to 249 participants (Soraci et al., 2020). Our results differ considerably from Soraci et al.’s; however, Soraci et al.’s sample did not represent an equal distribution of population—92% (229 out of 249) of their participants were female—while our sample comprised 57.4% (1,641) females and 42.6% (1,219) males. Although no formal diagnoses concerning mood disorders were obtained in Soraci et al.’s study, scores on the FCV–19S were significantly and positively related to scores assessing depression and anxiety (HADS) and the severity of the specific phobia (SMSP-A). The validity of the FCV–19S was supported by significant and positive correlations with the HADS and SMSP-A (Soraci et al., 2020).
Like Soraci et al., Satici et al. adapted the FCV–19S to Turkish and applied it to 1,304 participants using online surveys. Data analysis revealed significant positive correlations between the FCV–19S and depression, anxiety, and stress. The fear of COVID–19 was found to be associated with psychological distress and life satisfaction (Satici et al., 2020). Correspondingly, Reznik et al. (2020) applied the FCV–19S to a sample of 850 participants from Russia and Belarus. Their reported mean fear score was lower than in our sample (17.2 vs. 19.2), but both studies reported higher levels of fear in female than male participants.
Our study had the second biggest population, with a total sample of 2,860 participants, and as far as we know, this is the first time the FCV–19S has been applied in a hospital setting and as a direct personal questionnaire, unlike other studies where online-based surveys were used. Furthermore, we decided to analyze the relationship between the different job categories and their levels of fear. Reznik et al. (2020) proposed a division of factors within the scale, and found items 3, 6, and 7 were highly correlated and could represent the physiological responses to COVID–19, while items 1, 2, 4, and 5 described the emotional responses to COVID–19. We found slightly different correlations within factors: Items 3, 5, 6, and 7 showed higher correlation values, which could represent the physiological responses to fear as described by Reznik, and items 1, 2, and 4 were highly correlated, representing the emotional responses to fear. The single factor model proves that the inventory is useful when exploring the fear prevalence in the general and medical population. Our analysis presented similar fitness to the overall fitness described by Sakib et al. (2020) and Satici et al. (2020). However, our proposed 2-factor model analysis, although presenting a lower model of fitness than the single-factor model, showed higher item loadings. We recommend that further studies be conducted to explore this model utility.
Fear can alter the cognitive function of those who suffer it, by affecting memory, focus, attention, and decision making (McEwen & Morrison, 2013). After the SARS pandemic of 2003, reports show that survivors were diagnosed with post-traumatic stress disorder, depression, anxiety disorders, and in some cases, obsessive-compulsive disorder up to four years later (Lam et al., 2009). In the COVID–19 crisis, health care professionals are expected to perceive a high amount of stress due to the overall lack of preparation, infrastructure, and personal protective equipment (Chua et al., 2004; Maunder et al., 2003; Pfefferbaum & North, 2020). In 2003, the stress of the pandemic caused abandonment of work and a staff deficit in many hospitals. Many health care professionals opted not to stay in their houses, so they did not transmit the disease to their families and loved ones, or in some extreme cases, their families physically blocked them from leaving their houses (Chan, 2003; Tzeng, 2003).
It is interesting to note that the hospitals’ administrative personnel, while not interacting directly with COVID–19 patients, still presented higher scores than medical staff and other personnel who interacted directly with infected patients. It could be theorized that medical personnel have a more in-depth knowledge of the disease and the outcomes than the general population. These results are similar to those found by Li et al., where there were higher levels of vicarious traumatization in the general population than in front-line nursing personnel (Li et al., 2020).
As expected, the nursing personnel presented the highest scores of fear of COVID–19, as their role as primary front-line personnel includes direct interaction with patients in a wide range of activities and areas. Nonetheless, our medical and nursing staff still did not present high scores in the FCV–19S. This could be due to a low incidence of COVID–19 in our region (Secretaría de Salud, 2020).
Although the country has 78,023 confirmed cases, the study’s region had registered 1,355 cases. (Mapa Interactivo COVID–19 en México, 2020). However, if the number of confirmed cases increases, the health care staff could start to show a higher prevalence of depression, suicide ideation, suicide attempts, substance abuse, and burnout syndrome (Lai et al., 2020; Lam et al., 2009; Pfefferbaum & North, 2020).
One of the study limitations is that there were no other studies on the prevalence of fear in health care professionals using this scale, so comparison was not possible. This may also be a strength, as this study may now provide a stepping stone for further studies on how fear in hospital staff changes in response to pandemic changes, and for the development of coping and prevention tools to keep health care personnel physically and mentally healthy.