Skip to main content

Development and validation of the Post-Pandemic Fear of Viral Disease scale and its relationship with general anxiety disorder: a cross-sectional survey from Pakistan



Given the worldwide reach of COVID-19, media coverage has amplified the psychological and social effects of this pandemic causing a widespread fear. Despite substantial research on the short-term psychological impact of COVID-19, its long-term consequences on mental health remain relatively unexplored. This research aims to develop and validate a Post-Pandemic Fear of Viral Disease (PPFVD) scale and to see its relationship with general anxiety disorder among the Pakistani population.


A cross-sectional online-based survey was conducted with 457 respondents in August and September 2022. We adopted the modified fear of coronavirus scale (FCV-19 S) consisting of seven items and the Generalized Anxiety Disorder (GAD) questionnaire to measure anxiety disorder. Confirmatory factor analysis was applied using the maximum likelihood estimation method. Scale dimensions and item reliability were tested for their validity and goodness of fit. SPSS and AMOS were used for data management and analyses.


All inter-item correlations were found to be significant and ranged between 0.30 and 0.70. The value of Cronbach’s alpha was 0.887, indicating good reliability. Corrected item-total correlations ranged between 0.632 and 0.754. Factor loadings ranged from 0.664 to 0.810, indicating a good internal consistency. Overall, these results clearly demonstrate that the one-factor solution model for PPFVD presents a good fit to the data. The composite reliability (CR = 0.747) was also good.


The COVID-19 pandemic has negatively affected the mental health of people globally. This measurement scale can be trusted and used to test the PPFVD in the post-pandemic situation. Prospective research might validate this instrument in newly emerging scenarios and test it with diverse ethnic groups.

Peer Review reports


Pandemics and epidemics have been known to generate an environment of uncertainty – followed by panic, fear, and anxiety. The recent COVID-19 pandemic has posed large challenges to mental health and enforced anxiety [1]. It reformed the global lifestyle with an increased preference for virtual social interaction and individuals spending more time within their respective households (e.g., due to the ability and necessity to work from home). In addition, behavioral changes have been observed in terms of hygiene, saving money, and buying health insurance [2]. Unwanted and prolonged fear-based stay in houses and restricted mobility with constant fear of catching the virus has increased the likelihood of developing a post-pandemic fear of viral disease (PPFVD) and generalized anxiety disorder [3].

Previous research has confirmed that the COVID-19 pandemic evoked a range of reactions from both infected and uninfected people around the world [4]. Among the psychological effects of the pandemic are post-traumatic stress disorders, confusion, anxiety, frustration, fear of infection, insomnia, and a sense of helplessness [5]. Research from previous pandemics like Ebola revealed that the survivors experienced different multiple mental health issues such as obsession-compulsion, anxiety and paranoid ideation [6]. Similarly, research demonstrated that the Zika pandemic instilled anxiety in the public [7]. Empirical evidence confirmed the incidence of pandemic fear and anxiety since the outbreak of COVID-19 [8,9,10].

The COVID-19 pandemic has led to several social challenges and disruptions which presumably will remain for many years. While the enormous (financial) costs of the pandemic will only be known ex post, COVID-19 induced perpetual changes in human lives at individual, local/regional, and global levels. Many people lost their own lives or lives of their loved ones, many lost their employment or business, while many other were pauperized due to steady decline in world economy. Business at all levels had to suffer an irreparable loss. Strained economic conditions impacted all aspects of life which crumbled intimate relationships and family life. All of these challenges may be associated with psychological distress [4]. Individuals had to undergo extreme psychological distress that led to the awakening of fear. People showed fear of the viral infection, but also fear of touching other individuals, surfaces or things [11]. Fear is a distressing emotion, that occurs in the presence of a danger and is often accompanied by emotional distress and behavioral avoidance. Like any other event that touches human senses and is in our context of experience, we react to fear symbolically, by arbitrarily relating it to other objects and events through derived verbal relations [12]. Human beings react cognitively to every known event. Therefore, pandemics are not simply biological diseases confined to health specialists. Instead, they also influence individuals and society more generally through symbolic relations. Fear is not simply the evaluation of a threatening situation but the way we perceive our sense of impotence against a threat. According to Porcelli [13], fear involves a combination of subjective incompetence (“I am not able to cope with it.”), hopelessness (“I can do nothing about it.”), helplessness (“No one can help me.”), and catastrophizing (“Imminent death is coming closer.”).

Consistently, previous research has illustrated the emergence of fear as one of the behavioral responses to the pandemic on the one side and its implications for mental wellbeing, morbidity, and comorbidity on the other side. Improving our understanding of the experience of fear related to COVID-19 may have substantial clinical and societal implications, both during and after the pandemic [14]. In order to understand the anticipated fall outs of COVID-19, particularly the long-lasting effects of the pandemic on the mental health and wellbeing of the current generation need to be focused [15]. Understanding the dynamic post-pandemic risk factors is essential for policymakers and therapeutic interventions [16].

Already published literature on fear of disease demonstrates that fear of COVID-19 has also been studied in comparison to the fear of other infections [17]. Similarly, the pandemic fear was reported to have increased due to the misinformation on social media [18]. The COVID-19 pandemic has lasted for several years and brought significant changes to our daily lives [19], particularly induced by social restrictions, which in turn may have long-lasting impacts on the individual and collective life leading for example to sleep disturbance and anxiety. However, this situation causes a vicious circle [20]: Whether you suffered from social anxiety before or you have slowly developed social anxiety since being isolated and distanced from others, returning to post-pandemic “normal” life can seem more daunting than the onset of the pandemic itself.

These mental health effects are not limited to experiences during the pandemic, but they are long-lasting and can change the mental health of people for years to come. Although it is evident that the COVID-19 pandemic has a profound effect on mental health in the short-term, there is a lack of literature on how its psychological impact might translate to long-term negative outcomes in a post-pandemic world [10]. Furthermore, evidence suggests that some people have developed what has been termed COVID-19 stress syndrome, characterized by fear of infection, touching surfaces or objects that might be contaminated, xenophobia (fear that foreigners might be infected), and traumatic stress symptoms (e.g., COVID-19 related intrusive thoughts and nightmares) [21]. Previous studies (e.g., [22]) reported that fear is related to a higher level of health compliance but at the same time it also contributes to a higher level of distress and lower mental health in general.

In the light of the above-mentioned facts, there is a need for tools to assess the post-pandemic fear of viral disease. Thus, the present study has been conducted to investigate the aftershocks of COVID-19 with particular reference to fear produced. The major objective of this study was to develop and validate the Post-Pandemic Fear of Viral Disease Scale (PPFVD). We aimed to investigate the presence of fear of viral disease and its association with general anxiety disorder among Pakistani population.


Participants and procedures

We used a cross-sectional online survey to collect data from people living in Punjab, Pakistan. Punjab is the most populous province in Pakistan. Any person who had access to the internet, was above 15 years of age, and could read and write in the national language was eligible to participate in this study. The researchers developed the questionnaire at Google Forms and generated a hyperlink. In this online questionnaire, the respondents were informed about the objectives of the study and the anonymity of the data. The respondents were not offered any incentive to participate in this study. The respondents were asked to provide consent before providing the answers to the questionnaire. The respondents had to answer every question in this questionnaire before its submission. The data was collected through non-list-based random sampling, a sampling technique used in online surveys [23]. The hyperlink to this questionnaire was shared with people through social media platforms such as Facebook, LinkedIn, and WhatsApp. The data was collected from August 20, 2022, to September 4, 2022. The estimated sample size for this study was 450 using the table by Sekaran and Bougie [24]. In total, there were 457 respondents who successfully completed this survey.


Socio-demographic characteristics

The researchers asked the respondents to provide personal information regarding to age, gender, educational status, current place of residence, income and marital status.

Post-pandemic fear of viral diseases (PPFVD)

Various scales were available to measure the fear of the Coronavirus during the pandemic. However, there is a need to develop a scale to understand the fear of viral diseases among the people after the pandemic. For this purpose, we selected the Fear of Coronavirus Scale (FCV-19 S) for adaptation. This scale consisted of 7 items (e.g., “It makes me uncomfortable to think about Corona” and “I cannot sleep because I’m worrying about getting Corona”). These items were measured on a 5-point Likert scale [8]. However, this scale could not be utilized after the pandemic. The researchers decided to modify these items for a post-pandemic situation. Out of seven items, six items were modified to measure post-pandemic fear of viral diseases. A comparison of both original and modified items is provided in Table 1. These items were measured on a 4-point Likert Scale (from “great extent” to “not at all”).

Table 1 Items of the Post-Pandemic Fear of Viral Diseases (PPFVD) scale

Generalized anxiety disorder

We used seven items from the Generalized Anxiety Disorder (GAD-7) questionnaire [25] to measure anxiety disorders among respondents. The seven items used from the scale describe a number of the most salient diagnostic features of GAD (i.e., feeling nervous, anxious, or on edge and worrying too much about various things). Items were rated on a 4-point Likert-type scale (1 = “not at all” to 4 = “nearly every day”). The Cronbach’s alpha of this scale was 0.892, indicating good internal consistency.

Statistical analyses

IBM SPSS Statistics 21 and AMOS have been used for the statistical analyses. Descriptive statistics were used to report the sample characteristics. Measures of central tendency (mean and standard deviation) and measures of distribution (skewness and kurtosis) were calculated with respect to each item. To assess internal consistency of the PPFVD, we computed Cronbach’s alpha coefficient, inter-item correlations, and corrected item-total correlations. Explorative factor analysis (EFA) was performed to assess unidimensional factor structure of the PPFVD. Confirmatory factor analysis (CFA) was conducted to check construct and predictive validity. For this purpose, PPFVD was taken as a predictor to explain the variance of GAD. Confirmatory factor analysis was performed using the maximum likelihood estimation (MLE) method. AMOS software was used for this purpose. Goodness of fit was assessed according to the following criteria: goodness of fit index (GFI < 0.90); adjusted goodness of fit index (AGFI < 0.90); comparative fit index (CFI > 0.90); and root mean square error of approximation (RMSEA ≤ 0.08).


Characteristics of participants

Of the 457 respondents, 294 (64.3%) were female and 163 (35.7%) male, with approximately 74.2% living in urban areas. The majority of participants (86.2%) belonged to the age group up to 30 years, followed by 12.0% who were aged between 31 and 45 years. Most of the respondents were either graduates (70.2%) or postgraduates (22.5%). The majority was unmarried (79.6%) (Table 2).

Table 2 Socio-demographic characteristics of sample (N = 457)

The results regarding central tendency, skewness, and kurtosis of each item indicate that people had agreement with items 1 and 2, whereas they disagreed with items 3, 4, 5 and 6. A distribution of items can be considered normal if values of skewness and kurtosis range between ± 1.5. Our findings show that all of the items were normally distributed because no item had a higher or lesser value than ± 1.5 for skewness and kurtosis (Table 3).

Table 3 Item properties of the PPFVD

The results of the inter-item correlations are presented in Table 4. All inter-item correlations were found to be significant and ranged between 0.30 and 0.70, which is considered as a medium to strong association. The value of Cronbach’s alpha was 0.887, indicating good reliability. Corrected item-total correlations ranged between 0.632 and 0.754 (Table 5).

Table 4 Inter-item correlation matrix
Table 5 Factor loadings and Cronbach’s alpha results

Explorative factor analysis

EFA was performed to see the factor structure of PPFVD. The result of the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.856, which showed that the sample was adequate for factor analysis. One factor structure emerged, as its eigenvalue was 3.834 and explained 63.9% of the variance of the construct. Factor loadings ranged from 0.838 to 0.736 and communalities ranged from 0.703 to 0.552 (Table 6). These statistics indicate that PFFVD showed a good internal consistency.

Table 6 Results of the explorative factor analysis

Construct validity

Confirmatory factor analysis was run on the six items of the PPFVD to test one-factor solution of the post pandemic fear of viral diseases. The analysis revealed that model fit indices (CFI = 0.997, RMSEA = 0.035) showed a good fit in the overall sample. The other fit indices (GFI = 0.992, AGFI = 0.976, and RMR = 0.019) also showed a good fit of the sample. In addition, squared multiple correlations for each item were all statistically significant and ranged from 0.34 to 0.70. Overall, these results clearly demonstrate that the one-factor solution model for PPFVD presents a good fit to the data (Fig. 1). The composite reliability (CR = 0.747) was also good and acceptable.

Fig. 1
figure 1

Construct validity

Criterion validity

Criterion validation was performed through a structured equation modelling analysis. As proposed in this study, PPFVD was taken as the predictor of GAD in the structural model. The findings revealed an excellent fit to the data (RMR = 0.044; RMSEA = 0.057; GFI = 0.946; AGFI = 0.920; TLI = 0.967; CFI = 0.974). A further inspection to the correlation coefficient provided additional support for the PPFVD’s criterion validity (r = 0.54, R2 = 0.29, p < 0.001, 99.9%) (Fig. 2).

Fig. 2
figure 2

Criterion validity


The COVID-19 pandemic has a widespread impact on people’s actions and well-being worldwide. The majority still believes that they should be precautious to avoid COVID-19. These preventative measures are now considered the new norm. Because of the severity and magnitude of this pandemic, the threat of a novel viral disease outbreak will persist in the coming years. The findings indicate that the PPFVD has (i) a strong internal consistency, as shown by the good Cronbach alpha results; (ii) a good concurrent validity, as demonstrated by significant positive correlation with general anxiety disorder; and (iii) an acceptable construct validity, as demonstrated by CFA results.

The findings of this study reflect that this trend is predominantly prevailing among the people. We now recommend longitudinal studies in order to identify the prevalence of post-pandemic fear. In addition, there is a need to train healthcare practitioners, government officers, legal authorities, media, civilians, and the online community in helping to reduce fear and anxiety in the public. As a result, academics may use this tool to assess the situation in diverse socio-cultural settings. Similar studies have indicated that the anxiety sensitivity has risen due to staying in dwellings during the COVID-19 outbreak [26]. Similarly, positive impact of social media usage on mental health during the pandemic has been observed, which should also be analyzed in post-pandemic circumstances [27].

Another scale, the Fear of Coronavirus Questionnaire (FCV-19 S), developed by Mertens and colleagues [28] demonstrated that pandemic fear has slowly decreased since April 2020. Our adapted instrument, the PPFVD, can highlight an increase or decrease in the pandemic fear. There is a dire need to assess the population’s mental health following the pandemic. This scale can assist healthcare practitioners and mental health professionals in determining the prevalence of fear of viral diseases. Most people may believe that COVID-19 is over and that there is no need to worry because this situation will never arise again. Population level of estimation would be required in this regard as it is associated with the preparedness for future pandemics. However, we know that the world may face a similar situation again if a new variant of COVID-19 or another novel virus outbreak occurs. Some other studies have indicated fear attached with flu and cough leading to similar anxiety [29]. However, it is important to distinguish between the utilitarian precautionary behavior from excessive and abnormal fear [30]. Previous research has assessed fear of pandemic among difference populations such as pregnant women [31], students [32], workforce [33], patients [34], and medical staff [35]. The ones who have been economically impacted by the pandemic experienced largest amounts of post-pandemic fear [36].

This study is subject to certain limitations which are linked to the data collection via an online-based survey with a non-random sample of heterogeneous and diverse respondents. Secondly, the validation is based on data collected in the Pakistani context which might raise questions on the external validity. The strength of this study lies in the fact that post-pandemic fear of viral diseases has not yet been investigated internationally. Future researchers are encouraged to test the scale in diverse social contexts. More studies are required to validate the results of this study as well.


In conclusion, the PPFVD is a reliable and valid tool to measure the post-pandemic fear of viral diseases. This measurement scale can be trusted and used to test the PPFVD in post-pandemic situations. The findings of this study have relevance to social and health policy. Moreover, this study contributes to the emerging literature on post-pandemic fear of viral diseases.

Availability of data and materials

Data are available from corresponding author upon reasonable request.



Adjusted goodness of fit index


Composite fit index


Coronavirus disease 2019


Composite reliability


Fear of Coronavirus Scale


Generalized anxiety disorder


Goodness of fit index


Post-pandemic dear of virus disease


Root mean square residual


Root mean square error of approximation


Tucker-Lewis index


  1. May T, Aughterson H, Fancourt D, Burton A. Stressed, uncomfortable, vulnerable, neglected’: a qualitative study of the psychological and social impact of the COVID-19 pandemic on UK frontline keyworkers. BMJ Open. 2021;11(11):e050945.

    Article  PubMed  Google Scholar 

  2. Saladino V, Algeri D, Auriemma V. The psychological and social impact of Covid-19: new perspectives of well-being. Front Psychol. 2020;11:2550.

    Article  Google Scholar 

  3. Zakeri MA, Rafsanjanipoor SMH, Kahnooji M, Heidari FG, Dehghan M. Generalized anxiety disorder during the COVID-19 outbreak in Iran: the role of social dysfunction. J Nerv Ment Dis. 2021;209(7):491–6.

    Article  PubMed  Google Scholar 

  4. Nazari N, Zekiy AO, Feng LS, Griffiths MD. Psychometric validation of the Persian version of the COVID-19-Related psychological distress scale and association with COVID-19 fear, COVID-19 anxiety, optimism, and lack of resilience. Int J Mental Health Addict. 2022;20(5):2665–80.

    Article  Google Scholar 

  5. Dey N, Mishra R, Fong SJ, Santosh KC, Tan S, Crespo RG. COVID-19: psychological and psychosocial impact, fear, and passion. Digit Gov Res Pract. 2020;2(1):1–4.

    Article  Google Scholar 

  6. Acharibasam JW, Chireh B, Menegesha HA. Assessing anxiety, depression and insomnia symptoms among Ebola survivors in Africa: a meta-analysis. PLoS One. 2021;16(2):e0246515.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Blakey SM, Abramowitz JS. Psychological predictors of health anxiety in response to the Zika virus. J Clin Psychol Med Settings. 2017;24(3–4):270–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. 2022;20(3):1537–45.

    Article  PubMed  Google Scholar 

  9. Fitzpatrick KM, Harris C, Drawve G. Fear of COVID-19 and the mental health consequences in America. Psychol Trauma. 2020;12(S1):S17–21.

    Article  PubMed  Google Scholar 

  10. Wasim A, Truong J, Bakshi S, Majid U. A systematic review of fear, stigma, and mental health outcomes of pandemics. J Mental Health. 2022.

  11. Taylor S, Asmundson GJ. Life in a post-pandemic world: what to expect of anxiety-related conditions and their treatment. J Anxiety Disord. 2020;72:102231.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Presti G, McHugh L, Gloster A, Karekla M, Hayes SC. The dynamics of fear at the time of COVID-19: a contextual behavioral science perspective. Clin Neuropsychiatry. 2020;17(2):65.

    PubMed  PubMed Central  Google Scholar 

  13. Porcelli P. Fear, anxiety and health-related consequences after the COVID-19 epidemic. Clin Neuropsychiatry. 2020;17(2):103.

    PubMed  PubMed Central  Google Scholar 

  14. Heeren A. On the distinction between fear and anxiety in a (Post) Pandemic world: a commentary on. Clin Neuropsychiatry. 2020;17(3):189.

    PubMed  PubMed Central  Google Scholar 

  15. Paluszek MM, Landry CA, Taylor S, Asmundson GJ. The psychological sequelae of the COVID-19 pandemic: psychological processes, current research ventures, and preparing for a postpandemic world. Behav Ther. 2020;43(5):158–65.

    Google Scholar 

  16. Das N. Psychiatrist in post-COVID-19 era – are we prepared? Asian J Psychiatry. 2020;51:102082.

    Article  Google Scholar 

  17. Erfidan G, Şimşek ÖÖ, Aksay AK, Üstündağ G, Çamlar SA, Mutlubaş F, Çiftdoğan DY, Demir BK, Alaygut D. Are we losing awareness of other infections due to the fear of coronavirus disease-2019 and MIS-C? Germs. 2021;11(4):617–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Su Z, McDonnell D, Wen J, Kozak M, Abbas J, Šegalo S, et al. Mental health consequences of COVID-19 media coverage: the need for effective crisis communication practices. Glob Health. 2021;17:4.

    Article  Google Scholar 

  19. Hu R, Ye M, Lai B, Luo F, Yang M, Yuan J, Tao Q. Fear of COVID-19, internet addiction, learning burnout, and psychological health on teenagers in China at post-pandemic era: a serial mediation model. Preprint,

  20. Duan H, Gong M, Zhang Q, Huang X, Wan B. Research on sleep status, body mass index, anxiety and depression of college students during the post-pandemic era in Wuhan, China. J Affect Disord. 2022;301:189–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bacon AM, Krupić D, Caki N, Corr PJ. Emotional and behavioral responses to COVID-19. Eur Psychol. 2021;26(4):334–47.

    Article  Google Scholar 

  22. Taylor S. The psychology of pandemics. Ann Rev Clin Psychol. 2022;18:581–609.

    Article  Google Scholar 

  23. Fricker RD. Sampling methods for web and e-mail surveys. The SAGE handbook of online research methods. London: SAGE Publications Ltd; 2008.

    Google Scholar 

  24. Sekaran U, Bougie R. Research methods for business: a skill building approach. Hoboken: Wiley; 2016.

    Google Scholar 

  25. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.

    Article  PubMed  Google Scholar 

  26. Mayorga NA, Garey L, Viana A, Cardoso JB, Schmidt NB, Zvolensky MJ. Psychological distress and physical health symptoms in the Latinx population during the COVID-19 pandemic: exploring the role of anxiety sensitivity. Cogn Therapy Res. 2022;46(1):20–30.

    Article  Google Scholar 

  27. Sarangi A, Amor W, Javed S, Usmani S, Rashid A. Social media reinvented: can social media help tackle the post-pandemic mental health onslaught? Cureus. 2022;14(1):e21070.

    PubMed  PubMed Central  Google Scholar 

  28. Mertens G, Lodder P, Smeets T, Duijndam S. Pandemic panic? Results of a 14-month longitudinal study on fear of COVID-19. J Affect Disord. 2023;322:15–23.

    Article  PubMed  Google Scholar 

  29. Asmundson GJG, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: what all decision-makers, health authorities, and health care professionals need to know. J Anxiety Disord. 2020;71:102211.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bianchi D, Lonigro A, Norcia AD, Tata DD, Pompili S, Zammuto M, Cannoni E, Longobardi E, Laghi F. A model to understand COVID-19 preventive behaviors in young adults: health locus of control and pandemic-related fear. J Health Psychol. 2022;27(14):3148–63.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Giesbrecht GF, Rojas L, Patel S, Kuret V, MacKinnon AL, Tomfohr-Madsen L, Lebel C. Fear of COVID-19, mental health, and pregnancy outcomes in the pregnancy during the COVID-19 pandemic study: fear of COVID-19 and pregnancy outcomes. J Affect Disord. 2022;299:483–91.

    Article  CAS  PubMed  Google Scholar 

  32. Spatafora F, Matos Fialho PM, Busse H, Helmer SM, Zeeb H, Stock C, Wendt C, Pischke CR. Fear of infection and depressive symptoms among German university students during the COVID-19 pandemic: results of COVID-19 international student well-being study. Int J Environ Res Public Health. 2022;19(3):1659.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ke GN, Grajfoner D, Carter S, DeLima N, Khairudin R, Lau WY, Kamal KA, Lee SC. Psychological wellbeing and employability of retrenched workforce during COVID-19: a qualitative study exploring the mitigations for post pandemic recovery phase. Front Public Health. 2022;10:907797.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sanwald S, Widenhorn-Müller K, GenEmo Research Group, Montag C, Kiefer M. Primary emotions as predictors for fear of COVID-19 in former inpatients with major depressive disorder and healthy control participants. BMC Psychiatry. 2022;22:94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Alnazly E, Khraisat OM, Al-Bashaireh AM, Bryant CL. Anxiety, depression, stress, fear and social support during COVID-19 pandemic among Jordanian healthcare workers. PLoS One. 2021;16(3):e0247679.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Posel D, Oyenubi A, Kollamparambil U. Job loss and mental health during the COVID-19 lockdown: evidence from South Africa. PLoS One. 2021;16(3):e0249352.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references





Author information

Authors and Affiliations



QKM conceptualized the study. QKM was responsible for data collection and data analysis. QKM drafted the first version of the manuscript. AJ, MF, MSA and FF revised it critically for important intellectual content. All authors read and approved the final version of this manuscript.

Corresponding author

Correspondence to Florian Fischer.

Ethics declarations

Ethics approval and consent to participate

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Participants provided informed consent before the study started. This procedure was reviewed and approved by the Ethical Review Committee, University of the Punjab.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests. FF serves as Academic Editor for BMC Public Health.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahmood, Q.K., Jalil, A., Farooq, M. et al. Development and validation of the Post-Pandemic Fear of Viral Disease scale and its relationship with general anxiety disorder: a cross-sectional survey from Pakistan. BMC Public Health 23, 1739 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: