Research Snapshot: Coronavirus Anxiety Scale: A five-item mental health screener

What you need to know

The Coronavirus Anxiety Scale (CAS) is a brief mental health screener that can be used by health professionals and researchers, to reliably identify dysfunctional anxiety associated with COVID-19 and symptom severity. Higher CAS scores are associated with COVID-19 diagnosis, impairment, alcohol/drug coping, negative religious coping, extreme hopelessness, suicidal ideation as well as negative attitudes toward President Trump and Chinese products. Further research is needed to ensure that the CAS reflects the full psychological impact of the COVID-19 pandemic as it was developed in the United States at the beginning of the pandemic.


This Research Snapshot looks at the article, "Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety,” which was published in Death Studies in 2020. Read it below or download the PDF

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What is this research about? 

Many new public health measures have been implemented to contain the spread of COVID-19 and the increasing death toll from the pandemic. These measures are disrupting and rapidly changing behaviour and daily life across the globe.

Research on psychological well-being from previous infectious disease outbreaks shows clear links between pandemic-related anxiety and elevated symptoms of fear, stress, contamination concerns, health anxiety, post-traumatic stress and suicidality. The purpose of this study was to develop and evaluate a brief mental health screener to respond to mental health needs resulting from COVID-19.

What did the researchers do?

The author collected online survey data from 775 adults in the United States between March 11–13, 2020. Participants must have spent at least one hour during the past two weeks thinking about and/or watching media about COVID-19, along with experiencing significant anxiety, fear or worry about the disease outbreak. The survey asked participants to provide the following information:

  • Background information – demographic, coronavirus diagnosis and history of anxiety
  • Validity item – used to eliminate participants who may threaten the integrity of the study’s results
  • Social attitudes – five-point scale on their satisfaction with President Trump’s responses to COVID-19; their likelihood of avoiding Chinese food/purchasing Chinese products because of COVID-19; and their likelihood of changing future plans, including travel, vacation or shopping plans because of COVID-19
  • Psychological effects – five-point time-anchored scale (ranging from “not at all” to “nearly every day over the last two weeks”) on how often they have experienced psychological effects from the COVID-19 outbreak, such as extreme hopelessness and passive suicidal ideation
  • Maladaptive coping – five-point time-anchored scale on how often they have engaged in maladaptive coping with COVID-19, such as negative religious coping and alcohol/drug coping
  • Functional impairment – nine-point severity scale on how much impairment they have experienced because of their fear or anxiety over COVID-19.

The researcher selected 20 potential items based on the psychology of fear and anxiety literature. Each item was rated on a five-point scale to reflect the frequency of the symptom over the preceding two weeks, ranging from 0 (not at all) to 4 (nearly every day).  The selected items in the pool included:

  • Cognitive –  repetitive thinking, worry, processing biases, dreaming and planning
  • Behavioural – dysfunctional activities, avoidance and compulsive behaviours
  • Emotional – fear, anxiety and anger
  • Physiological – sleep disturbances, somatic distress, tonic immobility (i.e., motor inhibition) and dimensions of COVID-19 anxiety.

What did the researchers find?

The following five items were included in the final version of the CAS:

  • Dizziness – a major symptom of panic attacks and an associated feature of generalized anxiety disorder
  • Sleep disturbance – a common symptom of generalized anxiety disorder and post-traumatic stress disorder
  • Tonic immobility (i.e., motor inhibition) – an involuntary response to extreme fear and the perception of inescapability, typically experienced by victims of highly traumatic situations
  • Appetite loss – a common symptom of major depressive disorder, a condition that often co-occurs with panic disorder
  • Nausea or abdominal distress – digestive changes associated with a fear response, major symptoms of panic attacks that are associated with generalized anxiety disorder

Results from this study show that the CAS has good discrimination ability and solid diagnostic accuracy, suggesting that it is suitable as a mental health evaluation tool.

CAS scores were also strongly positively associated with functional impairment, alcohol or drug coping, negative religious coping, extreme hopelessness and passive suicidal ideation, demonstrating clinically significant disturbances attributed to fear and anxiety related to COVID-19.

How can you use this research?

The CAS is the first published tool examining anxiety related to COVID-19 that has been validated with a large sample of adults, including a significant sample of people infected with the disease. Mental health screeners like the CAS can be used during the COVID-19 pandemic to help identify and treat people with appropriate mental health services before they overwhelm emergency resources.

About the researchers

Dr. Sherman A. Lee is an associate professor in the Department of Psychology at the Christopher Newport University, Virginia, USA.


COVID-19; coronavirus; mental health; anxiety; screener

This Research Snapshot is based on the article, “Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety,” which was published in Death Studies in 2020.