Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing

Cho Eulah,Hong Jihoon,Kim Harin,Park C. Hyung Keun,Hong Youjin,Park Jangho,Jun Jin Yong,Chung Seockhoon 대한의학회 2023 Journal of Korean medical science Vol.38 No.36

Background: This study investigated the relationship between preoccupation with coronavirus disease 2019 (COVID-19), reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing among frontline nursing professionals working in COVID-19 inpatient wards. Additionally, the study aimed to determine whether the commitment to physical distancing mediates the influence of intolerance of uncertainty on viral anxiety. Methods: Frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals in Korea were surveyed between April 7 and 26, 2022. The survey included scales—such as the Obsession with COVID-19 Scale, Coronavirus Reassurance-Seeking Behaviors Scale, Fear of COVID-19 Scale, and Intolerance of Uncertainty Scale-12 and a questionnaire on adherence to physical distancing. A total of 256 responses were analyzed after excluding inappropriate or incomplete responses. Results: Pearson’s correlation analysis found that age was significantly associated with the Obsession with COVID-19 Scale (r = −0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). Linear regression analysis ascertained that age (β = −0.07, P = 0.002), Coronavirus Reassurance-Seeking Behaviors Scale (β = 0.35, P < 0.001), and Fear of COVID-19 Scale (β = 0.24, P < 0.001) were predictors of obsession with COVID-19 (Adjusted R2 = 0.60, F = 78.1, P < 0.001). The indirect pathway by mediation analysis showed that reassurance-seeking and viral anxiety mediated the effect of intolerance of uncertainty on the preoccupation with COVID-19. Conclusion: During the pandemic, there may be a strong association between reassuranceseeking behavior, viral anxiety, and a heightened preoccupation with COVID-19 among frontline healthcare workers. Thus, from the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups.

Intolerance of Uncertainty Mediates the Influence of Viral Anxiety on Social Distancing Phobia Among the General Korean Population During the Coronavirus Disease 2019 Pandemic

Cho Inn-Kyu,Ahmed Oli,Lee Dongin,Cho Eulah,Chung Seockhoon,Günlü Aykut 대한신경정신의학회 2022 PSYCHIATRY INVESTIGATION Vol.19 No.9

Objective We aimed to examined the reliability and validity of Korean version of Social Distancing Phobia scale, and whether intolerance of uncertainty mediates the association of the general population’s social distancing phobia with viral anxiety and depression.Methods Through this anonymous online survey, we collected responses from 400 individuals in the general Korean population. Participants’ demographic information and rating scales scores, including the Social Distancing Phobia scale, Stress and Anxiety to Viral Epidemics-6 items, Patient Health Questionnaire-9, and Intolerance of Uncertainty-12 items.Results Confirmatory factor analysis showed a good model fit, and the Korean version of Social Distancing Phobia scale showed good internal consistency. Social distancing phobia was significantly correlated with age (r=0.213, p<0.001), viral anxiety (r=0.390, p<0.001), depression (r=0.244, p<0.001), and intolerance of uncertainty (r=0.323, p<0.001). A linear regression analysis showed that age (β=0.235, p<0.001), viral anxiety (β=0.281, p<0.001), depression (β=0.121, p=0.009), and intolerance of uncertainty (β=0.200, p<0.001; adjusted R²=0.246, F=33.6, p<0.001) predicted social distancing phobia. Mediation analysis revealed that viral anxiety directly influenced social distancing phobia (z=6.48, p<0.001), and intolerance of uncertainty partially mediated this association (z=2.92, p=0.003).Conclusion Social distancing phobia may cause psychological stress but may also increase adherence to physical distancing measures and prevent the spread of viruses.

Insomnia Mediate the Influence of Reassurance-Seeking Behavior and Viral Anxiety on Preoccupation With COVID-19 Among the General Population

Cho Eulah,Lee Dongin,Cho Inn-Kyu,Lee Joohee,Ahn Junseok,Bang Young Rong 대한수면학회 2022 sleep medicine research Vol.13 No.2

Background and Objective We explored in this study whether insomnia, viral anxiety, reassurance- seeking behavior, and preoccupation with coronavirus disease (COVID-19) are related among the general population. As well, we explored the possibility that insomnia may mediate the association between COVID-19 viral anxiety and preoccupation.Methods During November 9–15, 2021, 400 participants voluntarily completed this survey, and participants’ age, sex, living location, and marital status were collected. Responses to questions about COVID-19 were also gathered, and their symptoms were rated using the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Fear of COVID-19 scale (FCV-19S), and Insomnia Severity Index (ISI).Results Preoccupation with COVID-19 was predicted by young age (β = -0.08, p = 0.012), CRBS (β = 0.52, p < 0.001), FCV-19S (β = 0.30, p < 0.001), and ISI (β = 0.07, p = 0.029) (adjusted R2 = 0.62, F = 163.6, p < 0.001). Mediation analysis showed that insomnia partially mediates the influence of reassurance seeking behavior and viral anxiety on preoccupation with COVID-19.Conclusions Sleep disturbances can contribute to a vicious cycle of hypochondriacal preoccupation with COVID-19. In order to reduce an individual’s viral anxiety, insomnia symptoms must be addressed.

Assessing Stress and Anxiety in Firefighters During the Coronavirus Disease-2019 Pandemic: A Comparative Adaptation of the Stress and Anxiety in the Viral Epidemic–9 Items and Stress and Anxiety in the Viral Epidemics–6 Items Scales

Inn-Kyu Cho,Han Sung Lee,Kayoung Song,Oli Ahmed,Dongin Lee,Jiyoung Kim,Eulah Cho,Soomin Jang,Jeong-Hyun Kim,Seockhoon Chung 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.11

Objective This study assessed the reliability and validity of the Stress and Anxiety to Viral Epidemics–9 items (SAVE-9) and Stress and Anxiety to Viral Epidemics–6 items (SAVE-6) scales for measuring viral anxiety among firefighters during the coronavirus disease-2019 pandemic.Methods An online survey was conducted among 304 firefighters assigned in Gyeonggi-do. The SAVE-9 scale, initially developed for healthcare workers, was adapted for firefighters. We compared it with the SAVE-6 scale designed for the general population among the firefighters sample. The confirmatory factor analysis (CFA) was conducted to explore the factor structure of both scales. Internal consistency reliability was checked using Cronbach’s alpha and McDonald’s omega. Convergent validity was assessed in accordance with the Patient Health Questionnaire–9 and Generalized Anxiety Disorder–7 scales.Results The SAVE-9 scale demonstrated a Cronbach alpha of 0.880, while the SAVE-6 scale yielded an alpha of 0.874. CFA indicated good model fits for both SAVE-9 and SAVE-6 scales among firefighters sample. The SAVE-9 and SAVE-6 comparably measures viral anxiety of firefighters.Conclusion Both of the SAVE-9 and SAVE-6 scales are reliable and valid instruments for assessing viral anxiety among firefighters during the pandemic.

Does Viral Anxiety Influence the Insomnia Severity Among Patients With Insomnia Disorder During COVID-19 Pandemic?

Sleiman Jana,Cho Eulah,Lee Dongin,Cho Inn-Kyu,Chung Seockhoon,Uygur Omer Faruk 대한수면학회 2023 sleep medicine research Vol.14 No.1

Background and Objective We aimed to investigate whether viral anxiety affects insomnia severity in patients with insomnia disorder during the coronavirus disease 2019 (COVID-19) pandemic. In addition, we examined whether viral anxiety mediates the influence of dysfunctional beliefs about sleep on insomnia severity.Methods The medical records of 111 patients who visit the sleep clinic from September 2021 to May 2022 were reviewed. Patients’ symptoms were rated with rating scales including Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), Patient Health Questionnaire-9 items (PHQ-9), Epworth Sleepiness Scale, and discrepancy between desired time in bed and desired total sleep time (the DBST index).Results The SAVE-6 score was not significantly correlated with ISI score among insomnia patients. Linear regression analysis showed that the ISI score was expected by PHQ-9 (β = 0.21, p = 0.038) and DBAS-16 (β = 0.42, p < 0.001). Mediation analysis showed that viral anxiety did not mediate the influence of dysfunctional beliefs about sleep on insomnia severity.Conclusions We could not observe the mediating effect of viral anxiety on the association between dysfunctional beliefs about sleep on insomnia severity. Though COVID-somnia was one of big issues in this COVID-19 pandemic, the influence of virus on the severity of insomnia among insomnia patients needs to be interpreted cautiously.

Effect of Cancer-Related Dysfunctional Beliefs About Sleep on Fear of Cancer Progression in the Coronavirus Pandemic

Kim Harin,Cho Inn-Kyu,Lee Dongin,Kim Kyumin,Lee Joohee,Cho Eulah,Park C. Hyung Keun,Chung Seockhoon 대한의학회 2022 Journal of Korean medical science Vol.37 No.36

Background: This study aimed to explore clinical correlates of fear of progression (FoP) among patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic and examine the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS). Methods: Medical charts of patients with cancer who visited a psycho-oncology clinic between July and November 2021 were reviewed. Baseline socio-demographic and cancer-related variables were collected. Patients’ self-report questionnaires, regarding FoP, depression (Patient Health Questionnaire-9 items; PHQ-9), viral anxiety (Stress and Anxiety to Viral Epidemics-6 items; SAVE-6), C-DBS, and other distress, were investigated. Pearson’s correlation and linear regression were performed to examine the risk factors of FoP. Mediation effect analysis with the bootstrap method with 2,000 resamples was implemented. Results: A total of 231 patients were included in the analysis. Linear regression revealed that FoP was predicted by age (β = −0.14, P = 0.003), PHQ-9 (β = 0.48, P < 0.001), SAVE-6 (β = 0.34, P < 0.001), and C-DBS (β = 0.15, P = 0.005). FoP was directly influenced by SAVE-6 and mediated by C-DBS, while it was directly influenced by PHQ-9 with no mediation effect. Conclusion: During the COVID-19 pandemic, the FoP of patients with cancer was associated with younger age, depression, viral anxiety, and C-DBS. Depression and viral anxiety directly influenced FoP, while C-DBS mediated the association between viral anxiety and FoP. Therefore, oncology healthcare professionals are recommended to assess C-DBS of their patients when they are highly distressed from FoP.

Mediating Effect of Intolerance of Uncertainty and Cancer-Related Dysfunctional Beliefs About Sleep on Psychological Symptoms and Fear of Progression Among Cancer Patients

Jaeeun Song,Eulah Cho,Inn-Kyu Cho,Dongin Lee,Jiyoung Kim,Harin Kim,Seockhoon Chung 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.10

Objective This study aimed to explore the mediating effects of cancer-related dysfunctional beliefs regarding sleep and intolerance of uncertainty on the effect of depression, insomnia, and anxiety on fear of progression (FoP). Methods We retrospectively reviewed medical records of patients with cancer who visited the Sleep Clinic for cancer patients in Asan Medical Center for the first time between December 2021 and March 2022. Data collected included age, sex, types of cancer, staging, current treatment modalities, and history of surgical procedures. In addition, psychological symptoms were rated using the Insomnia Severity Scale (ISI), Patient Health Questionnaire-9 items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Short form of Fear of Progression Questionnaire, Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), single item of pain and fatigue, Connor Davidson Resilience Scale 2-item (CD-RISC2), and Intolerance of Uncertainty-12 (IUS-12). The predictive variables for FoP were determined by linear regression analysis. Results The FoP was significantly correlated with age (r=-0.289), ISI (r=0.178), PHQ-9 (r=0.703), STAI-S (r=0.377), fatigue (r=0.452), CD-RISC2 (r=-0.270), IUS-12 (r=0.585), and C-DBS (r=0.427, all p<0.01). A mediation analysis showed that intolerance of uncertainty and dysfunctional beliefs about sleep mediated the relationship of FoP with insomnia, depression, or anxiety. Conclusion Psychological support for intolerance of uncertainty and cancer-related dysfunctional beliefs about sleep in patients with cancer may be beneficial to reduce their FoP.

Psychometric Properties of the Insomnia Severity Index and Its Comparison With the Shortened Versions Among the General Population

Seockhoon Chung,Oli Ahmed,Eulah Cho,Young Rong Bang,Junseok Ahn,Hayun Choi,Yoo Hyun Um,Jae-Won Choi,Seong Jae Kim,Hong Jun Jeon 대한신경정신의학회 2024 PSYCHIATRY INVESTIGATION Vol.21 No.1

Objective The aim of this study was to explore the psychometric properties of the Insomnia Severity Index (ISI) based on modern test theory, such as item response theory (IRT) and Rasch analysis, with shortened versions of the ISI among the general population.Methods We conducted two studies to evaluate the reliability and validity of the shortened versions of the ISI in a Korean population. In Study I, conducted via online survey, we performed an exploratory factor analysis (n=400). In Study II, confirmatory factor analysis (CFA) was conducted (n=400). IRT and Rasch analysis were performed on all samples. Participants symptoms were rated using the ISI, Dysfunctional Beliefs and Attitudes about Sleep–16 items, Dysfunctional Beliefs about Sleep–2 items, Patient Health Questionnaire–9 items, and discrepancy between desired time in bed and desired total sleep time.Results CFA showed a good fit for the 2-factor model of the ISI (comparative fit index=0.994, Tucker–Lewis index=0.990, root-meansquare-error of approximation=0.039, and standardized root-mean-square residual=0.046). The 3-item versions also showed a good fit for the model. All scales showed good internal consistency reliability. The scale information curve of the 2-item scale was similar to that of the full-scale ISI. The Rasch analysis outputs suggested a good model fit.Conclusion The shortened 2-factor ISI is a reliable and valid model for assessing the severity of insomnia in the Korean population. The results are needed to be explored further among the clinical sample of insomnia.

Reliability and Validity of Dysfunctional Beliefs About Sleep-2 (DBS-2), an Ultra-brief Rating Scale for Assessing Dysfunctional Thoughts About Sleep

Kim Kyumin,Chung Seockhoon,Cho Eulah,Choi Jung Mun,Lee Dongin,Cho Inn-Kyu 대한수면학회 2022 sleep medicine research Vol.13 No.3

Background and Objective It is important to consider dysfunctional beliefs about sleep when conducting cognitive-behavioral therapy for insomnia. The purpose of this study was to examine the reliability and validity of a Dysfunctional Beliefs about Sleep-2 items (DBS-2) scale in a general population and clinical sample.Methods Our study examined the reliability and validity of the DBS-2 scale in the general population (group I, n = 374) and in a clinical sample of subjects with insomnia disorders (group II, n = 105). An online survey targeting the general population was conducted over the course of January 10–18, 2022, and a retrospective study of medical records was conducted among a clinical sample of insomnia patients who visited the Asan Medical Center Sleep Clinic for the first time between September of 2021 and May of 2022. The internal consistency reliability of the DBS-2 scale was measured using split-half coefficients, and factor analysis was used to determine its validity. Using the Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), convergence validity was explored.Results Split-half coefficients for the DBS-2 were 0.862 and 0.855 in the general population and a clinical sample of insomnia disorder. DBS-2 overall report score was significantly correlated with ISI (r = 0.26, p < 0.001) and DBAS-16 (r = 0.43, p < 0.001) in the general population, and correlated with ISI (r = 0.45, p < 0.001) and DBAS-16 (r = 0.50, p < 0.001) in the clinical sample. Both groups of subjects had an optimal cut-off score of 13 for the DBS-2 scale.Conclusions We found that the DBS-2 scale, a two-item ultra-brief rating scale, could accurately measure dysfunctional beliefs about sleep in the general population and a clinical sample of insomnia patients.

Validation of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale and Relationship With Insomnia or Depression Among Healthcare Workers Who Witnessed Patient’s Death in COVID-19 Pandemic

Lee Dongin,Kamaleddine Issa,Cho Inn-Kyu,Ahmed Oli,Cho Eulah 대한수면학회 2022 sleep medicine research Vol.13 No.3

Background and Objective We tested the psychometric properties of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale among healthcare workers who experienced patients’ deaths.Methods From June 2nd to 10th, 2022, an anonymous, online survey was administered to medical doctors and nursing professionals who witnessed the deaths of patients they cared for during the last two years. Participants demographic characteristics and responses to the SAVE-9, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI) were collected.Results A total of 267 responses were collected in this survey. The two-factor model of the SAVE-9 fits well among healthcare workers who witnessed patients’ death (CFI = 1.000, GFI = 0.996, RMSEA = 0.000, RSMR = 0.040). The SAVE-9 scale showed good reliability of internal consistency and convergent validity with the GAD-7 (r = 0.429, p = 0.001), PHQ-9 score (r = 0.414, p = 0.001), and ISI (r = 0.368, p = 0.001).Conclusions We observed that the SAVE-9 and its two subscales were valid and reliable tools for measuring work-related stress and viral anxiety among healthcare workers who witnessed the death of their patients.