Pandemic illnesses, such as the H1N1 influenza (swine flu) are often highly publicized in the mass media and can be associated with high levels of anxiety and compensatory behavior (e.g., using hand sanitizers). The present research sought to investigate the psychological processes associated with swine-flu related anxiety during the H1N1 influenza pandemic of 2009–2010. Participants were 315 college students who completed survey measures between September 25th 2009 and February 16th 2010, which encompassed the peak of flu season and a time of intense media attention to this particular outbreak. Data revealed that anxiety in response to the swine flu was common in the sample. Regression analysis indicated that health anxiety, contamination fears and disgust sensitivity were significant predictors of swine flu-related anxiety. Implications for how concerns over pandemic illnesses such as the swine flu can be conceptualized and clinically managed are discussed.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
In order to test the dimensionality of the SFI we submitted the nine retained items to a principal axis factor analysis with oblique (promax) rotation to allow the factors to be correlated. The first three eigenvalues from this analysis were 4.16, 1.44 and 0.77 and examination of the scree plot suggested retaining a two-factor solution. In the promax-rotated solution, five items (# 1, 7–10) saliently loaded on the first factor, three items (#3–5) saliently loaded on the second factor and one item (#2) loaded on both factors. The factors were correlated (r = .55). Importantly, the statements in three items saliently loading on the second factor all began with the question “how” while all of the other items began differently, indicating that question wording may have influenced the separation of these items from the others (e.g., a method factor). Recommendations for factor analysis have suggested that factors defined by three or fewer items may be less reliable and replicable, and four or more items are generally recommended to retain a factor (Guadagnoli and Velicer 1988). As such we opted to consider the SFI as a unidimensional measure and used the total score in all analyses.
Abramowitz, J. S., & Braddock, A. E. (2008). Psychological treatment of hypochondriasis and health anxiety: A biopsychosocial approach. Cambridge, MA: Hogrefe & Huber.
Abramowitz, J. S., Deacon, B., Olatunji, B., Wheaton, M. G., Berman, N., Losardo, D., et al. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22, 180–198.
Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007). The Short Health Anxiety Inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31, 871–883.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Vol. 4 text revision). Washington, DC: Author.
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176–181.
Centers for Disease Control and Prevention. (2010, June 16). The 2009 H1N1 Pandemic: Summary Highlights, April 2009–April 2010. Retrieved from: http://www.cdc.gov/h1n1flu/cdcresponse.htm.
Chan, M. (2009). World now at the start of 2009 influenza pandemic. Retrieved from http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html.
Coles, M. E., Cook, L. M., & Blake, T. R. (2006). Assessing obsessive compulsive symptoms and cognitions on the internet: Evidence for the comparability of paper and Internet administration. Behaviour Research and Therapy, 45, 2232–2240.
Cox, B., Borger, S., & Enns, M. (1999). Anxiety sensitivity and emotional disorders: Psychometric studies and their theoretical implications. In S. Taylor (Ed.), Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 115–148). Mahwah, NJ: Erlbaum.
Daubs, K. (2009, October 27). H1N1 clinics to open early in wake of teen’s death. Retrieved from http://www.healthzone.ca/health/newsfeatures/swineflu/article/716657–teen-treated-for-flu-symptoms-before-death?bn=1.
Deacon, B., & Maack, D. J. (2008). The effects of safety behaviors on the fear of contamination: An experimental investigation. Behaviour Research and Therapy, 46, 537–547.
Deacon, B., & Olatunji, B. O. (2007). Specificity of disgust sensitivity in the prediction of behavioral avoidance in contamination fear. Behaviour Research and Therapy, 45, 2110–2120.
DeVellis, R. F. (1991). Scale development: Theory and applications. Newbury Park: Sage.
Guadagnoli, E., & Velicer, W. F. (1988). Relation of sample size to the stability of component patterns. Psychological Bulletin, 103, 265–275.
Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual Differences, 16, 701–713.
Henry, J. D., & Crawford, J. R. (2005). The 21-item version of the Depression Anxiety Stress Scales (DASS–21): Normative data and psychometric evaluation in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.
Izard, C. E. (1993). Organizational and motivational functions of discrete emotions. In M. Lewis & J. M. Haviland (Eds.), Handbook of emotions. New York: Guilford Press.
Johnson, N. P. A. S., & Mueller, J. (2002). Updating the accounts: Global Mortality of the 1918–1920 “Spanish” influenza pandemic. Bulletin of the History of Medicine, 76, 105–115.
Lacey, M. & Jacobs, A. (2009, May 4). Even as fears of flu ebb, Mexicans feel stigma. The New York Times. Retrieved from http://www.nytimes.com/2009/05/05/world/asia/05china.html.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.
Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New York: McGraw-Hill.
Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Valentiner, D. P. (2007a). Body vigilance in nonclinical and anxiety disorder samples: Structure, correlates, and prediction of health concerns. Behavior Therapy, 38, 392–401.
Olatunji, B. O., & Sawchuk, C. N. (2005). Disgust: Characteristic features, social implications, and clinical manifestations. Journal of Social and Clinical Psychology, 24, 932–962.
Olatunji, B. O., Sawchuk, C. N., Lohr, J. M., & de Jong, P. J. (2004). Disgust domains in the prediction of contamination fear. Behaviour Research and Therapy, 42, 93–104.
Olatunji, B. O., Williams, N. L., Tolin, D. F., Sawchuck, C. N., Abramowitz, J. S., Lohr, J. M., et al. (2007b). The Disgust Scale: Item analysis, factor structure, and suggestions for refinement. Psychological Assessment, 19, 281–297.
Page, A. C., Hooke, G. R., & Morrison, D. L. (2007). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in depressed clinical samples. British Journal of Clinical Psychology, 46, 283–297.
Rachman, S. (2004). Fear of contamination. Behaviour Research and Therapy, 42, 1227–1255.
Reiss, S., Peterson, R., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.
Rubin, G. J., Amlot, R., Page, L., & Wessely, S. (2009). Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: Cross sectional telephone survey. BMJ, 339, b2651.
Salkovskis, P. M., Rimes, K. A., Warwick, H. M., & Clark, D. M. (2002). The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853.
Sandman, P. M. (2009). Pandemics: Good hygiene is not enough. Nature, 459, 322–323.
Schmidt, N. B., Lerew, D. R., & Trakowski, J. H. (1997). Body vigilance in panic disorder: Evaluating attention to bodily perturbations. Journal of Consulting and Clinical Psychology, 65, 214–220.
Taylor, S., & Asmundson, G. (2004). Treating health anxiety: A cognitive-behavioral approach. New York: Guilford.
Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19, 176–188.
University of North Carolina at Chapel Hill. (2009, August 19). Back-to-School Fact Sheet. Retrieved from: http://uncnews.unc.edu/content/view/2790/107.
Van den Bulck, J., & Custers, K. (2009). Television exposure is related to fear of avian flu, an ecological study across 23 member states of the European Union. European Journal of Public Health, 19, 370–374.
Wheaton, M. G., Berman, N. C., Franklin, J. C., & Abramowitz, J. S. (2010). Health anxiety: Latent structure and associations with anxiety-related psychological processes. Journal of Psychopathology and Behavioral Assessment, 32, 565–574.
About this article
Cite this article
Wheaton, M.G., Abramowitz, J.S., Berman, N.C. et al. Psychological Predictors of Anxiety in Response to the H1N1 (Swine Flu) Pandemic. Cogn Ther Res 36, 210–218 (2012). https://doi.org/10.1007/s10608-011-9353-3
- Swine Flu
- Health anxiety
- Contamination fear
- Disgust sensitivity