Academic Edi o : Ch is ian Napoli
Recei ed: 29 Ma ch 2025
Re ised: 25 Ap il 2025
Accep ed: 30 Ap il 2025
Published: 4 May 2025
Ci a ion: Badillo-Sánchez, N.;
Mo gado-Toscano, C.; Allande-Cussó,
R.; Gómez-Salgado, J.; Yıldı ım, M.;
Goniewicz, K.; Macías-To onjo, I.;
Fagundo-Ri e a, J. Assessing
COVID-19-Rela ed Psychological
Dis ess: Valida ion o he AMICO
Scale in Spanish Nu sing Uni e si y
S uden s. Heal hca e 2025,13, 1058.
h ps://doi.o g/10.3390/
heal hca e13091058
Copy igh : © 2025 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
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dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license
(h ps://c ea i ecommons.o g/
licenses/by/4.0/).
A icle
Assessing COVID-19-Rela ed Psychological Dis ess: Valida ion
o he AMICO Scale in Spanish Nu sing Uni e si y S uden s
Nadine Badillo-Sánchez
1
, C is ina Mo gado-Toscano
1,†
, Regina Allande-Cussó
2
, Juan Gómez-Salgado
3,4,
* ,
Mu a Yıldı ım 5,6 , K zysz o Goniewicz 7, Is ael Macías-To onjo 8and Ja ie Fagundo-Ri e a 9,*
1School o Doc o a e, Uni e si y o Huel a, 21007 Huel a, Spain
2Depa men o Nu sing, Uni e si y o Se ille, 41009 Se ille, Spain
3Depa men o Sociology, Social Wo k and Public Heal h, Facul y o Labou Sciences,
Uni e si y o Huel a, 21007 Huel a, Spain
4Sa e y and Heal h Pos g adua e P og amme, Uni e sidad Espí i u San o, Guayaquil 092301, Ecuado
5
Depa men o Psychology, Facul y o Science and Le e s, A˘g ı ˙
Ib ahim Çeçen Uni e si y, 04100 A˘g ı, Tü kiye
6Psychology Resea ch Cen e , Khaza Uni e si y, 1009 Baku, Aze baijan
7Depa men o Secu i y, Polish Ai Fo ce Uni e si y, 08-521 Deblin, Poland
8Depa men o Rehabili a ion, FREMAP Huel a, 21001 Huel a, Spain
9Cen o Uni e si a io de En e me ía C uz Roja, Uni e si y o Se ille, 41009 Se ille, Spain
*Co espondence: [email p o ec ed] (J.G.-S.); ja ie . agundo@c uz oja.es (J.F.-R.);
Tel.: +34-959219700 (J.G.-S.); +34-954350997 (J.F.-R.)
†Cu en add ess: Heal h Sciences Resea ch Uni : Nu sing, Uni e si y o Coimb a,
3004-531 Coimb a, Po ugal.
Abs ac : Backg ound: The COVID-19 pandemic had a signi ican impac on nu sing
s uden s by in e wining academic demands wi h heal h conce ns, a si ua ion ha had
e ec s on hei emo ional well-being and academic engagemen . Fac o s such as sociode-
mog aphic cha ac e is ics and heal h s a us de e mined hei expe iences. Unde s anding
hese dynamics is c ucial, especially in he con ex o he Spanish heal h and educa ion
sys ems. The p esen s udy aimed o adap and assess he psychome ic p ope ies o
he AMICO scale in he con ex o nu sing s uden s in Spain. Me hods: C oss-sec ional
desc ip i e s udy. The s udy was ca ied ou in Uni e si y Nu sing Cen e s in Spain using
a non-p obabilis ic snowball sampling me hod. The o al sample consis ed o 1197 nu sing
s uden s. Sociodemog aphic a iables we e included, as well as ques ions ela ed o gene al
heal h and some mo e speci ic ques ions abou COVID-19. Fo he eliabili y s udy, C on-
bach’s alpha was calcula ed. An explo a o y ac o analysis using p incipal componen s
and a imax o a ion was applied, excluding i ems wi h loadings below 0.05. Resul s:
In his s udy, 1197 nu sing s uden s esiding in Spain pa icipa ed, o whom 85% we e
emale, wi h a mean age o 22.35 yea s. Despi e 73.9% o he s uden s being isola ed due o
exposu e o COVID-19, hey a ed hei gene al heal h posi i ely (7.86). Females epo ed
highe le els o anxie y. The AMICO scale e ealed signi ican di e ences acco ding o
gende , heal h, and accina ion his o y, showing high eliabili y (C onbach’s alpha = 0.913).
Conclusions: The wo- ac o s uc u e o he AMICO scale was alida ed, con i ming i s
sui abili y o assessing anxie y and ea among nu sing s uden s in Spain. The s udy
e ealed signi ican emo ional dis ess du ing he COVID-19 pandemic, pa icula ly among
women, high- isk indi iduals, and hose ully accina ed. These indings accen ua e he
need o highe educa ion ins i u ions o implemen a ge ed men al heal h in e en ions
du ing public heal h eme gencies. Fu u e longi udinal esea ch should examine he e ol -
ing psychological impac o such c ises and he mi iga ing oles o quali y o li e, sleep, and
physical ac i i y.
Heal hca e 2025,13, 1058 h ps://doi.o g/10.3390/heal hca e13091058
Heal hca e 2025,13, 1058 2 o 18
Keywo ds: COVID-19 pandemic; men al heal h; nu sing s uden s; psychological s ess;
emo ional well-being; ea ; anxie y; AMICO scale; alida ion s udy; assessmen ; heal h
s a us; wo kplace s ess; wo king and COVID-19
1. In oduc ion
The COVID-19 pandemic p o oundly ans o med he educa ional landscape, wi h
a pa icula impac on disciplines such as nu sing, whose s uden s a e closely linked o
heal hca e en i onmen s [
1
,
2
]. The con e gence o academic demands and heal h- ela ed
conce ns signi ican ly shaped s uden s’ expe iences du ing he c isis, a ec ing bo h hei
emo ional well-being and academic engagemen [3,4].
Academic engagemen —de ined as s uden s’ ac i e in ol emen , dedica ion, and
sus ained e o in hei s udies—was challenged by ex e nal s esso s, which weakened
mo i a ion and ocus [
5
–
8
]. Pe sonal a iables such as gende , age, place o esidence, and
household composi ion in luenced he pe cep ions o sa e y and isk [
9
], while gene al
heal h s a us and p e ious expe iences wi h COVID-19 u he condi ioned emo ional
s abili y [10,11].
These ac o s o e lapped wi h speci ic academic esponsibili ies [
12
], such as clinical
placemen s, which imposed addi ional bu dens on s uden s in mo e ad anced s ages o
hei p og ams [
13
,
14
]. In hese se ings, pe cei ed sa e y—shaped by p o ec i e measu es
and aining in COVID-19 p e en ion—was c i ical o s uden s’ willingness o engage in
clinical p ac ice [15,16].
The in e play o sociodemog aphic, heal h- ela ed, and academic ac o s c ea ed
a complex amewo k ha in luenced nu sing s uden s’ emo ional esponses, wi h
ea and anxie y a ying acco ding o indi idual ci cums ances and a ailable suppo
sys ems [12,15,17,18]
. Unde s anding his dynamic is essen ial o assessing he pandemic’s
impac on s uden s’ men al heal h and academic pe o mance. Mo eo e , he e ec s o
he COVID-19 pandemic on he educa ional sphe e and academic placemen se ings we e
also obse ed in s uden s in ol ed in o he uni e si y cu icula, bo h wi hin he heal hca e
sec o [19] and in disciplines ou side o i , such as eache educa ion [20].
Despi e he g owing body o in e na ional esea ch, a speci ic gap emains in he li e -
a u e ega ding alida ed ins umen s o measu ing COVID-19- ela ed ea and anxie y in
nu sing s uden s in Spain, a coun y wi h dis inc i e heal hca e and educa ional s uc u es,
as well as a ied egional esponses o he pandemic [9,14,21,22].
Se e al psychome ic ins umen s ha e been de eloped o assess men al heal h du -
ing he pandemic, including he Co ona i us Anxie y Scale (CAS) [
23
], he COVID-19
S ess Scale (CSS) [
24
], and he Fea o COVID-19 Scale (FCV-19S) [
25
], all o which ha e
demons a ed u ili y in uni e si y se ings [
26
–
28
]. Howe e , he AMICO scale [
29
,
30
], a
16-i em ool designed o assess bo h anxie y and ea ela ed o COVID-19, has eme ged as
a pa icula ly obus measu e. The AMICO scale has a C onbach’s alpha alue o 0.92 and
has been shown o be alid and eliable in a ious con ex s, including speci ic subg oups
such as he gene al adul popula ion [
30
], p egnan women [
31
], and olde adul s [
32
]
in Spain.
In his con ex , he p esen s udy aims o adap and alida e he AMICO scale o
use among nu sing s uden s in Spain. A psychome ically sound ins umen is essen ial
o accu a ely measu e he emo ional impac o he pandemic on his g oup, p o iding a
ounda ion o he de elopmen o a ge ed psychological suppo and p e en i e s a egies
wi hin academic se ings.
Heal hca e 2025,13, 1058 3 o 18
2. Ma e ials and Me hods
2.1. Design
A desc ip i e c oss-sec ional s udy was conduc ed o cul u al adap a ion and psycho-
me ic alida ion o he AMICO scale. The He zog e al. classi ica ion [
33
] as well as he
STROBE checklis we e ollowed o design he s udy, epo he assessmen esul s, and
e ise he manusc ip o publica ion [34].
2.2. Pa icipan s and P ocedu e
This s udy was ca ied ou on Spanish nu sing s uden s. In Spain, a o al o
1,333,567 uni e si y
s uden s we e en olled in he 2021–2022 academic yea . O hese,
50,688 we e en olled in he Bachelo ’s deg ee in Nu sing [35].
The sample size was calcula ed on he basis o he popula ion size, i.e., he numbe
o unde g adua e nu sing s uden s in Spain (50,688), wi h a con idence le el o 95%, a
p ecision o 3%, and an expec ed loss a e o 25%. The minimum sample size equi ed
o ensu e s a is ical signi icance was 382 indi iduals; howe e , he inal sample included
1197 nu sing s uden s om a ious p o inces o Spain, 47 in o al, including Alaba, Al-
bace e, Alican e, Alme ia, As u ias, A ila, Badajoz, Balea es, Ba celona, Bu gos, Cace es,
Cadiz, Can ab ia, Cas ellon, Ceu a, Ciudad Real, Communi y o Mad id, Co doba, Cuenca,
G anada, Guadalaja a, Guipuzcoa, and Huel a, among o he s. The inclusion c i e ion was
being en olled in a Bachelo ’s deg ee in Nu sing in Spain. Ques ionnai es ha we e no
ully comple ed we e excluded om he inal sample.
Due o he speci ic cha ac e is ics o he sample and he necessa y condi ions o
da a collec ion, non-p obabilis ic snowball sampling was employed [
36
]. This me hod has
ce ain disad an ages, including he lack o con ol o e he sampling p ocess, which may
lead o sampling bias and limi he gene alizabili y o he esul s o a b oade popula ion
o nu sing s uden s [
37
]. Howe e , i also o e s ad an ages, such as educed cos s and
sho e ec ui men imes when aiming o each a su icien ly la ge popula ion o s udying
a a e cha ac e is ic.
To ec ui he sample, an online ques ionnai e was de eloped using he Google Fo ms©
applica ion. The ques ionnai e included in o ma ion abou he s udy, along wi h i ems
ela ed o he s udy a iables. I was dis ibu ed o nu sing s uden s h ough a co e le e
sen o he Deans o all Facul ies o e ing a Bachelo ’s deg ee in Nu sing in Spain, ia he
Na ional Con e ence o Deans o Nu sing. I was also sha ed wi h he Spanish Gene al
Council o Nu sing and he Spanish Associa ion o Unde g adua e Nu sing S uden s,
he eby eaching pa icipan s h ough o icial and au ho ized channels.
All subjec s we e duly in o med abou he pu pose o he s udy, as well as abou
hei olun a y, anonymous, and con iden ial pa icipa ion, ensu ing hese condi ions.
The ques ionnai e was dis ibu ed be ween Oc obe 28, 2021, and May 31, 2022, eaching
nu sing s uden s ac oss 47 p o inces o Spain.
2.3. Va iables and Ins umen s
The ques ionnai e included sociodemog aphic a iables (such as gende , age, p o ince
o esidence, and numbe o cohabi an s), gene al heal h ques ions, and mo e speci ic
i ems ela ed o COVID-19 (including con agion, isola ion, and accina ion). Addi ionally,
a iables ela ed o anxie y and ea o COVID-19, as well as academic ac o s (such as
cu en academic yea , ype o uni e si y, and wo k expe ience), we e inco po a ed. The
inclusion o hese a iables was in ended o cap u e he na ional di e si y o nu sing
s uden s ac oss Spain, a he han o ensu e ep esen a i eness o all Spanish uni e si ies.
Al hough he sampling s a egy and ec ui men p ocess did no allow o iden i ying he
speci ic ins i u ions in which pa icipan s we e en olled, da a we e collec ed on he ype
Heal hca e 2025,13, 1058 4 o 18
o academic ins i u ion (public, p i a e, o a ilia ed), along wi h p o ince and academic
yea . These a iables se ed as p oxies o ins i u ional and geog aphic di e si y, allow-
ing o b oad na ional co e age while main aining pa icipan anonymi y and a oiding
ins i u ional-le el iden i ica ion.
The AMICO scale (Anxie y and Fea o COVID-19), o iginally de eloped du ing he
hi d wa e o he pandemic, was designed o e alua e psychological esponses ela ed o
he COVID-19 c isis wi hin he Spanish adul popula ion [
25
,
30
]. This ins umen , inspi ed
by he FCV-19S scale, expanded i s scope by explici ly inco po a ing anxie y symp oms
linked o he pandemic. I s ini ial alida ion included a ep esen a i e sample o
1036 adul
pa icipan s esiding in Spain. The inal e sion o he scale comp ises 16 i ems g ouped
in o wo dimensions— ea and anxie y— ha oge he accoun ed o 64% o he o al
a iance (KMO = 0.94; Ba le ’s es p< 0.001). Each i em is a ed on a 10-poin Like
scale, om 1 (lowes pe cei ed in ensi y) o 10 (highes pe cei ed in ensi y), wi h he o al
sco e calcula ed as he a e age sco e o all i em esponses. In e p e a ion h esholds classi y
he esul s in o low (
≤
4.31), mode a e (4.32–6.4), and high (
≥
6.41) le els o anxie y and
ea . The psychome ic e alua ion con i med high in e nal consis ency, wi h a C onbach’s
alpha o 0.92. Fu he mo e, in a subsequen applica ion o he scale among Spanish nu sing
p o essionals, i demons a ed s ong diagnos ic pe o mance, wi h a sensi i i y o 90.48%
and a speci ici y o 76% [38].
2.4. Da a Analysis
Desc ip i e analyses, bo h uni a ia e and bi a ia e, we e conduc ed using SPSS S a is-
ics © 26 so wa e [
39
]. Since he Kolmogo o –Smi no es yielded a p- alue
below 0.05
,
he da a we e conside ed o de ia e signi ican ly om a no mal dis ibu ion. Acco d-
ingly, non-pa ame ic me hods we e employed o hypo hesis es ing, speci ically he
Mann–Whi ney
U and K uskal–Wallis es s, while Kendall’s Tau-b coe icien was used o
assess associa ions be ween pai s o quan i a i e a iables.
The decision o use non-pa ame ic es s was no based solely on he ejec ion o
no mali y. Al hough he sample size was la ge (n= 1197), he AMICO scale sco es o igi-
na ed om a Like - ype esponse o ma , which, despi e being ea ed as con inuous in
some psychome ic con ex s, inhe en ly e lec s an o dinal s uc u e. This challenges key
assump ions o pa ame ic es ing, such as in e al-le el measu emen and homoscedas-
ici y. Mo eo e , in addi ion o he s a is ical es , isual inspec ion o he da a con i med
a skewed dis ibu ion. The e o e, he use o non-pa ame ic me hods was deemed bo h
cau ious and me hodologically app op ia e o he cha ac e is ics o he da a.
To examine he ac o ial s uc u e o he AMICO scale, an explo a o y ac o analysis
(EFA) was pe o med using p incipal axis ac o ing, a me hod ecommended when da a
de ia e om no mali y and a s able ac o solu ion is equi ed [
40
]. P omax o a ion
was applied o allow o co ela ion be ween he ex ac ed ac o s, and he inal ac o
s uc u e was de e mined by selec ing he i ems wi h he highes loadings wi hin each
dimension. The numbe o ac o s e ained was based on he Kaise –Gu man c i e ion,
conside ing only hose wi h eigen alues g ea e han 0.924. Subsequen ly, a con i ma o y
ac o analysis (CFA) was conduc ed o alida e he s uc u e, applying he mos widely
accep ed i indices, including chi-squa ed/d (
χ2
/d < 3.0), he Compa a i e Fi Index
(CFI
≥
0.90), he Tucke –Lewis Index (TLI
≥
0.90), also e e ed o as he Non-No mal Fi
Index (NNFI
≥
0.90), he Inc emen al Fi Index (IFI
≥
0.90), he Roo -Mean-Squa e E o
o App oxima ion (RMSEA
≤
0.08), and he S anda dized Roo -Mean-Squa e Residual
(SRMR ≤0.08) [41].
To e alua e he in e nal consis ency o he scale, C onbach’s alpha was ini ially cal-
cula ed. Addi ionally, ollowing ecen me hodological ecommenda ions o eliabili y
Heal hca e 2025,13, 1058 5 o 18
assessmen , McDonald’s omega coe icien was compu ed, as i p o ides a mo e obus
es ima ion unde he assump ion o au-equi alence. This coe icien was also adjus ed o
accoun o he impac o co ela ed e o s on he eliabili y indices [42]. Fu he mo e, in e -
i em co ela ions we e calcula ed o assess he deg ee o associa ion be ween pai s o i ems
wi hin he scale, o e ing insigh in o in e nal cohe ence. In pa allel, co ec ed i em– o al
co ela ions we e examined o de e mine he indi idual con ibu ion o each i em o he
o e all cons uc . Las ly, C onbach’s alpha i i em dele ed was calcula ed o e alua e whe he
he emo al o any i em would subs an ially imp o e he in e nal consis ency o he scale.
2.5. E hical Aspec s
This esea ch was conduc ed in acco dance wi h he e hical s anda ds desc ibed in
he Decla a ion o Helsinki [
43
]. The pa icipan s we e in o med ha joining he s udy
was comple ely olun a y and ha hey could decide o d op ou o he s udy a any ime
wi hou penal y. They we e also in o med ha hei pa icipa ion would no esul in any
pe sonal gain and ha all da a collec ed would be kep con iden ial and anonymous, would
be used exclusi ely o he s udy, and would no ha e any ad e se e ec s on hem. Thei
accep ance o pa icipa ion in his s udy was documen ed in a w i en in o med consen .
The au ho iza ion o his s udy was ob ained om he Resea ch E hics Commi ee o he
Regional Resea ch Communi y, Regional Go e nmen o Andalusia, on 20 Janua y 2021
(Re e ence code: PI 036/20).
3. Resul s
3.1. Desc ip i e Analysis
The o al s udy sample consis ed o 1197 nu sing s uden s esiding in Spain. As can
be seen in Table 1, o he o al sample, 85% we e emale and 14.6% we e male. Also, 0.1%
decla ed hemsel es o be non-bina y, and he es p e e ed no o espond o his a iable.
The age o he sample anged om 17 o 57 yea s, wi h a mean o 22.35 yea s (SD = 5.783).
Rega ding he place o esidence, mos o he pa icipan s we e om he p o ince o Se ille
(15.7%), wi h Guadalaja a and A ila being he leas ep esen ed (0.1%).
Conside ing he o al sample, 78.2% o he nu sing s uden s we e en olled in pub-
lic uni e si ies o public uni e si y cen e s, and 28.2% we e in hei second yea o he
Bachelo ’s deg ee in Nu sing. The mean sco e o he numbe o cohabi an s in he same
household was 3.48 (SD = 0.979). Wi h ega d o he pe cei ed le el o knowledge du ing
he pandemic, a mean sco e o 7.33 (SD = 1.654) was ob ained. The pa icipan s also a ed
hei gene al heal h wi h a mean sco e o 7.86 (SD = 1.271), e en hough 73.9% had o isola e
hemsel es a some poin due o close con ac wi h in ec ed subjec s o in ec ion, and 46.5%
epo ed ha hey had been diagnosed wi h COVID-19 a some poin . S ill, 72.4% o he
sample epo ed no belonging o high- isk g oups.
In o al, 55.9% o he s uden s s a ed ha hei academic con ac s o e e ence had
p o ided hem wi h he necessa y sel -p o ec ion measu es o a oid con agion, and 65.2%
had ecei ed speci ic aining o a oid con agion. The e o e, only 6.5% o he s uden s
epo ed eeling e y unsa e o no sa e a all du ing hei pe iod o clinical placemen .
The o e all mean sco e on he AMICO scale was 4.06 (SD = 1.547), wi h he obse ed
alues anging be ween 1 and 9.56 (see Table 1). The Kolmogo o –Smi no es indica ed
a signi ican de ia ion om no mali y (p< 0.001), sugges ing ha he dis ibu ion o he
sco es did no con o m o a no mal cu e. As a esul , non-pa ame ic s a is ical me h-
ods we e applied. In he bi a ia e analysis, he AMICO o al sco e showed s a is ically
signi ican di e ences when compa ed ac oss a iables such as gende , p o ince o esi-
dence, household size, pe cei ed gene al heal h, COVID-19 diagnosis, isk g oup s a us,
a ailabili y o p o ec i e measu es du ing clinical placemen s, and accina ion his o y.
Heal hca e 2025,13, 1058 6 o 18
Table 1. Sociodemog aphic cha ac e is ics o he pa icipan s ela ed o he s udy a iables.
Quan i a i e Va iables Mean
SD Range
Age 22.35
5.783
Max = 57
Min = 17
Numbe o cohabi an s 3.48
0.984
Max = 6
Min = 1
Gene al heal h 7.86
1.271
Max = 10
Min = 1
To al AMICO 4.06
1.546
Max = 9.56
Min = 1
Quali a i e Va iables I ems Resul
(N= 1197)
Sex
Male
Female
Non-bina y
Ra he no say
n= 175 (14.6%)
n= 1017 (85%)
n= 1 (0.1%)
n= 4 (0.3%)
Academic yea
1s yea
2nd yea
3 d yea
4 h yea
n= 304 (25.4%)
n= 338 (28.2%)
n= 290 (24.2%)
n= 265 (22.1%)
COVID-19 diagnosis No
Yes
n= 640 (53.5%)
n= 557 (46.5%)
Isola ion No
Yes
n= 313 (26.1%)
n= 884 (73.9%)
High- isk g oup No
Yes
n= 867 (72.4%)
n= 330 (27.6%)
Sel -p o ec ion measu es
No
Yes
O he
n= 487 (40.7%)
n= 669 (55.9%)
n= 41 (3.4%)
Feeling sa e du ing clinical placemen
Somewha sa e
Fai ly sa e
Ve y li le sa e
No, no sa e a all
Yes, comple ely sa e
n= 361 (30.2%)
n= 565 (49.7%)
n= 56 (4.7%)
n= 22 (1.8%)
n= 163 (13.6%)
COVID-19 accine
I do no wish o ge accina ed
Yes, a single dose
Yes, wo doses
Yes, h ee doses
No ye accina ed
n= 7 (0.6%)
n= 42 (3.5%)
n= 368 (30.7%)
n= 778 (65%)
n= 2 (0.2%)
No e. Au ho s’ sel -elabo a ion. SD: s anda d de ia ion; Max: maximum; Min: minimum.
Females showed high le els o ea and anxie y on he AMICO scale (4.15) compa ed
o males (3.54) and conside ing di e ences in he sample p opo ions (Table 1). The le els
o ea and anxie y we e also highe o hose s uden s who had ne e been diagnosed wi h
COVID-19 (4.16), as well as o hose who we e conside ed o be a isk (4.37) and hose
who had no ecei ed sel -p o ec ion measu es du ing hei clinical placemen (4.12).
3.2. Psychome ic Analysis
To assess he dimensional s uc u e o he AMICO scale, an explo a o y ac o analysis
(EFA) was conduc ed. The sampling adequacy was con i med by he Kaise –Meye –Olkin
(KMO) measu e, which yielded a alue o 0.924, while Ba le ’s es o sphe ici y was
signi ican (p< 0.001), indica ing he sui abili y o he da a o ac o analysis. The analysis
esul ed in a wo- ac o s uc u e, co esponding o anxie y and ea , comp ising a o al o
16 i ems (see Table 2), and accoun ing o 88% o he o al a iance. The in e nal consis ency
o he ins umen was high, wi h a C onbach’s alpha o 0.913. Fu he mo e, ollowing
Heal hca e 2025,13, 1058 7 o 18
ecen me hodological ecommenda ions [
44
], McDonald’s Omega was also compu ed,
ob aining a alue o 0.916.
Table 2. Explo a o y ac o analysis o he dimensional s uc u e.
AMICO Scale I ems Componen
Fac o 1 Fac o 2
AMICO 1. I am e y a aid o COVID-19 0.652 0.403
AMICO 2. I eel uneasiness when hinking abou COVID-19 0.607 0.427
AMICO 3. I am e y conce ned abou ge ing COVID-19 0.695 0.338
AMICO 4. The COVID-19 disease may cause dea h, and his wo ies me 0.713 0.166
AMICO 5. My hands swea when I hink abou COVID-19 0.132 0.750
AMICO 6. I eel ne ous o anxious when wa ching news o s o ies
abou COVID-19 in social ne wo ks and o he media 0.549 0.512
AMICO 7. I can’ sleep because I am wo ied abou ge ing COVID-19 0.046 0.833
AMICO 8. My pulse aces when I hink abou ge ing COVID-19 0.241 0.784
AMICO 9. Con adic o y in o ma ion abou co ona i us in social ne wo ks
and he media makes me eel anxious 0.449 0.440
AMICO 10. I ha e nega i e ideas when I hea o ead any news ela ed o he disease 0.505 0.540
AMICO 11. I am a aid a ela i e o iend may ge COVID-19 0.702 0.009
AMICO 12. I am wo ied abou how long he pandemic will las 0.669 0.003
AMICO 13. When someone coughs nea me, o oo close o me,
I am a aid o ge ing in ec ed 0.643 0.321
AMICO 14. I am wo ied abou being close o o assis ing a pe son ha has
o may ha e COVID-19 0.628 0.318
AMICO 15. I eel sad o downcas when I hink abou he disease
and he possibili y o ge ing in ec ed 0.408 0.687
AMICO 16. I eel anxious abou going ou , o conside ing going ou ,
o ul il my daily esponsibili ies (wo k, amily e c.) 0.177 0.701
No e. Au ho s’ sel -elabo a ion.
Subsequen ly, a CFA was ca ied ou o he cons uc alidi y s udy, which yielded he
ollowing alues: CFI = 0.910; TLI = 0.910; IFI = 0.900; RMSEA = 0.078; and
SRMR = 0.06
. To
enhance he psychome ic analysis o he AMICO scale, h ee addi ional ables
a e included
.
Table 3p esen s he model i indices de i ed om he CFA, along wi h hei in e p e-
a ion, o assess he adequacy o he ac o ial s uc u e.
Table 3. Fi indices and in e p e a ion.
Fi Index Value Accep able Th eshold In e p e a ion
χ2/d 2.5 <3.0 Accep able
CFI 0.91 ≥0.90 Good i
TLI 0.91 ≥0.90 Good i
IFI 0.90 ≥0.90 Accep able
RMSEA 0.078 ≤0.08 Accep able
SRMR 0.06 ≤0.08 Good i
χ2
/d (Chi-squa e/d ); CFI (Compa a i e Fi Index); TLI (Tucke –Lewis Index); IFI (Inc emen al Fi Index);
RMSEA (Roo -Mean-Squa e E o o App oxima ion); SRMR (S anda dized Roo -Mean-Squa e Residual).
Table 4p esen s he in e -i em co ela ion ma ix based on Spea man’s ank co ela ion,
p o iding insigh in o he in e nal consis ency and cohe ence among i ems. The ma ix
displays he co ela ions be ween each pai o i ems in he AMICO scale, whe e highe
alues sugges ha he i ems a e likely measu ing simila unde lying cons uc s. O e all,
he in e -i em co ela ions indica ed ha mos i ems we e posi i ely associa ed, suppo ing
he assump ion ha hey e lec ed he ela ed aspec s o anxie y and ea conce ning
COVID-19.
Heal hca e 2025,13, 1058 8 o 18
Table 4. In e -i em co ela ion ma ix (Spea man) o he AMICO scale.
AMICO_1 AMICO_2 AMICO_3 AMICO_4 AMICO_5 AMICO_6 AMICO_7 AMICO_8 AMICO_9
AMICO_10 AMICO_11 AMICO_12 AMICO_13 AMICO_14 AMICO_15 AMICO_16
AMICO_1 1.0 0.64 0.75 0.56 0.4 0.46 0.36 0.48 0.32 0.45 0.34 0.25 0.51 0.5 0.49 0.38
AMICO_2 0.64 1.0 0.59 0.44 0.4 0.57 0.33 0.43 0.47 0.57 0.28 0.36 0.41 0.43 0.51 0.35
AMICO_3 0.75 0.59 1.0 0.59 0.35 0.45 0.31 0.48 0.31 0.45 0.37 0.31 0.51 0.49 0.47 0.36
AMICO_4 0.56 0.44 0.59 1.0 0.28 0.44 0.22 0.33 0.32 0.38 0.47 0.32 0.39 0.39 0.37 0.25
AMICO_5 0.4 0.4 0.35 0.28 1.0 0.4 0.52 0.56 0.32 0.42 0.16 0.13 0.32 0.31 0.5 0.47
AMICO_6 0.46 0.57 0.45 0.44 0.4 1.0 0.36 0.46 0.6 0.66 0.33 0.37 0.42 0.44 0.53 0.41
AMICO_7 0.36 0.33 0.31 0.22 0.52 0.36 1.0 0.64 0.31 0.42 0.09 0.07 0.3 0.27 0.49 0.51
AMICO_8 0.48 0.43 0.48 0.33 0.56 0.46 0.64 1.0 0.38 0.49 0.2 0.16 0.42 0.42 0.57 0.48
AMICO_9 0.32 0.47 0.31 0.32 0.32 0.6 0.31 0.38 1.0 0.62 0.28 0.37 0.34 0.36 0.42 0.33
AMICO_10
0.45 0.57 0.45 0.38 0.42 0.66 0.42 0.49 0.62 1.0 0.31 0.36 0.43 0.42 0.55 0.42
AMICO_11
0.34 0.28 0.37 0.47 0.16 0.33 0.09 0.2 0.28 0.31 1.0 0.41 0.41 0.35 0.25 0.18
AMICO_12
0.25 0.36 0.31 0.32 0.13 0.37 0.07 0.16 0.37 0.36 0.41 1.0 0.34 0.3 0.28 0.16
AMICO_13
0.51 0.41 0.51 0.39 0.32 0.42 0.3 0.42 0.34 0.43 0.41 0.34 1.0 0.67 0.48 0.38
AMICO_14
0.5 0.43 0.49 0.39 0.31 0.44 0.27 0.42 0.36 0.42 0.35 0.3 0.67 1.0 0.52 0.36
AMICO_15
0.49 0.51 0.47 0.37 0.5 0.53 0.49 0.57 0.42 0.55 0.25 0.28 0.48 0.52 1.0 0.6
AMICO_16
0.38 0.35 0.36 0.25 0.47 0.41 0.51 0.48 0.33 0.42 0.18 0.16 0.38 0.36 0.6 1.0
Heal hca e 2025,13, 1058 9 o 18
Table 5displays he co ec ed i em– o al co ela ions and he alues o C onbach’s
alpha i each i em we e dele ed, o e ing u he e idence o he indi idual con ibu ion o
each i em o he o e all eliabili y o he scale.
Table 5. Co ec ed i em– o al co ela ions and C onbach’s alpha i i em dele ed.
I em I em–To al
Co ela ion
C onbach’s Alpha
I I em Dele ed
AMICO_1 0.745 0.904
AMICO_2 0.741 0.904
AMICO_3 0.742 0.904
AMICO_4 0.657 0.908
AMICO_5 0.563 0.91
AMICO_6 0.755 0.904
AMICO_7 0.547 0.911
AMICO_8 0.667 0.908
AMICO_9 0.644 0.909
AMICO_10 0.737 0.904
AMICO_11 0.554 0.911
AMICO_12 0.537 0.912
AMICO_13 0.703 0.906
AMICO_14 0.692 0.907
AMICO_15 0.744 0.904
AMICO_16 0.578 0.91
O e all 0.913
Co ec ed i em– o al co ela ions indica e how well each i em co ela es wi h he o al
sco e o he scale, excluding he i em i sel . Highe alues sugges ha he i em is a s ong
indica o o he o e all cons uc being measu ed. In his s udy, he co ec ed i em- o al
co ela ions we e gene ally high, indica ing ha each i em con ibu ed meaning ully o he
in e nal consis ency o he scale.
C onbach’s alpha measu es he in e nal consis ency o a scale, wi h alues abo e
0.70 ypically conside ed accep able. The o e all C onbach’s alpha ob ained in his s udy
exceeded 0.90, e lec ing excellen eliabili y. Addi ionally, he alues o C onbach’s alpha
i each i em we e dele ed a e epo ed. These alues help iden i y any i em ha may
nega i ely a ec he o e all eliabili y o he scale; howe e , in his case, all i ems appea ed
o suppo he in e nal consis ency.
Figu e 1illus a es he ac o ial s uc u e o he AMICO scale as con i med h ough
he CFA. The model suppo s a wo- ac o solu ion comp ising “Fea ” and “Anxie y”, each
associa ed wi h hei co esponding i ems. The s anda dized ac o loadings indica ed
mode a e o high ela ionships be ween i ems and hei la en cons uc s, suppo ing he
in e nal s uc u e o he scale. The co ela ion be ween he wo la en a iables ( ea and
anxie y) is also shown, sugges ing a s ong posi i e associa ion and concep ual cohe ence
be ween he wo dimensions.
Heal hca e 2025,13, 1058 16 o 18
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