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Validation of the collaborative outcomes study on health and functioning during infection times (COH-FIT) questionnaire for adults

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Marco Solmi, Trevor Thompson, Andres Estrade Vaz, Agorastos Agorastos, Joaquim Radua, Elena Dragioti, Friedrich Leisch, Davy Vancampfort, Lau Caspar Thygesen, Harald Aschauer, Monika Schloegelhofer, Elena Aschauer, Andres Schneeberger, Christian G. Huber, Gregor Hasler, Philippe Conus, Kim Q. Do Cuénod, Roland von Känel, Gonzalo Arrondo, Paolo Fusar-Poli & 82 more Philip Gorwood, Pierre-Michel Llorca, Marie-Odile Krebs, Elisabetta Scanferla, Taishiro Kishimoto, Golam Rabbani, Karolina Skonieczna-żydecka, Paolo Brambilla, Angela Favaro, Akihiro Takamiya, Leonardo Zoccante, Marco Colizzi, Julie Bourgin, Karol Kamiński, Maryam Moghadasin, Soraya Seedat, Evan Matthews, Anthea Tinker, Emilia Vassilopoulou, Ary Gadelha, Kuan-Pin Su, Jun Soo Kwon, Minah Kim, Tae Young Lee, Oleg Papsuev, Denisa Manková, Andrea Boscutti, Cristiano Gerunda, Diego Saccon, Elena Righi, Francesco Monaco, Giovanni Croatto, Guido Cereda, Jacopo Demurtas, Nicola Veronese, Paolo Enrico, Pierluigi Politi, Valentina Ciappolino, Andrea Pfennig, Andreas Bechdolf, Andreas Meyer-Lindenberg, Kai G Kahl, Katharina Domschke, Michael Bauer, Nikolaos Koutsouleris, Sibylle Winter, Stefan Borgwardt, Istvan Bitter, Judit Balazs, Pal Czobor, Zsolt Unoka, Dimitris Mavridis, Konstantinos Tsamakis, Vasilios P. Bozikas, Chavit Tunvirachaisakul, Michael Maes, Teerayuth Rungnirundorn, Thitiporn Supasitthumrong, Ariful Haque, Andre R. Brunoni, Carlos Gustavo Costardi, Felipe Barreto Schuch, Guilherme Vanoni Polanczyk, Jhoanne Merlyn Luiz, Lais Fonseca, Luana V. Aparicio, Samira Valvassori, Merete Nordentoft, Per Vendsborg, Sofie Have Hoffmann, Jihed Sehli, Norman Sartorius, Sabina Heuss, Daniel Guinart, Jane Hamilton, John M. Kane, José M. Rubio, Michael Sand, Ai Koyanagi, Aleix Solanes, Alvaro Andreu-Bernabeu, Antonia San José Cáceres

Original languageEnglish
JournalJournal of affective disorders
Early online date28 Dec 2022
Accepted/In press7 Dec 2022
E-pub ahead of print28 Dec 2022


King's Authors


The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; is an anonymous and global online survey measuring health and functioning during COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology “P-score”.
The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1–4 items (“COH-FIT items”) were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed.
From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex.

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