Normal fear is defined as a reaction to a real or imagined threat and is considered an integral and adaptive feature related to the primary function of survival. Nevertheless, when fear is intense and maladaptive, it may lose its role for survival and may progress in a phobic disorder with a negative impact for the individual who suffers it. According to some researchers, childhood and adolescence are the main life periods where phobias and other anxiety disorders develop. It is estimated that up to 50% of children and adolescents report one or more intense fears and more than 20% of these meet diagnostic criteria for specific phobias, frequently related to the development of future mental disorders during adulthood. In the assessment of fear, it is important to consider the evaluation of its intensity as well as its frequency among three main dimensions: the subjective dimension (including feelings and thoughts), the physical dimension (e.g., tachycardia and paleness) and the behavioral dimension (e.g., avoidant behaviors). So far, the main fear assessment methods include self-reports, observation and psychophysiological registers. In the area of mental health, the Fear Survey Schedule for Children II (FSSC-II) is the most widely used instrument for the assessment of fears in youth population. The cultural adaptation of an internationally instrument such as the FSSC-II brings the opportunity for subsequent comparison of investigation findings with other populations. The FSSC-II is an updated version of the original instrument as it includes other type of fears such as fear of war and/or AIDS designed to both children and adolescents. Since it is possible that some mental disorders in adulthood are conditioned by the presence of fears in early stages of life, it is important to have an objective characterization of the main fears in our culture. On this basis, adequate psychopathology prevention programs and treatment strategies can be designed and tested. In general, psychopathology is influenced by the cultural context and fears are not the exception as they tend to manifest differently from one cultural context to another. Therefore, the aim of the present work was to translate, culturally adapt and examine the psychometric properties of the FSSC-II in a Mexican sample of high school students. Method A total of 5030 high school students who accepted to participate in the study were recruited. Age ranged between 14 and 24 years old. The FSSC-II is composed of 78 items scored in a three-point Likert scale that assess frequency and intensity of different fears classified in five main dimensions: fear of death and danger, fear of the unknown, fear of failure or criticism, fear of animals and physical stress-medical fears. Before the enrollment procedure, the FSSC-II was adapted for Mexican population. First, translation-back translation was performed by two independent translators. Some items of the instrument were culturally adapted by consensus to reach the final version of the instrument. A principal component analysis with varimax rotation was performed to determine the construct validity of the instrument in Mexican population. Cronbach's alpha was used to determine the internal consistency of each domain and total score of the FSSC-II. All analyses were performed with the 10th version of the SPSS-X. Results A total of 2992 women and 2038 men participated. Mean age was of 16.43±1.2 years old. For the Mexican adaptation of the FSSC-II, 1 1.53% of the items (n=18) were culturally adapted. Factor analysis showed five factors for the instrument. These factors were consistent with those described in the original version: fear of death and danger, fear of animals or injuries, fear of failure or criticism, fear of the unknown and medical fears. Internal consistency of the FSSC-II was .96. Alpha coefficients for four dimensions were above .80, except the "medical fears" dimension (.70). Discussion The Spanish version of the FSSC-II among Mexican high school students showed adequate psychometric properties. The adaptation process implicated the modification of some items of the original instruments in order to reach a correct assessment of the proposed constructs of the instrument according to the predominant cultural patterns of Mexico. On the other hand, some items were not modified and were taken literally from either U.S. or Australian versions. Although more than 10% of the items were adjusted, the factor structure of the instrument remained congruent with the original version and the U.S version of the FSSC-II. The Mexican version was totally compatible with the five constructs found in the U.S. version; nevertheless it is important to remark that the content of the Mexican version was more compatible with the content of the items of the Australian version. Some of the inconsistencies found between the three versions may be the result of the subjects' age in the studies. The U.S. study included subjects with ages between 8 and 11 years, the Australian study included subjects between 7 and 18 years old, while our study included subjects with ages between 14 and 24 years old. The way children experience reality is not the same as that of adolescents or adults. It is possible to assume that the fears of children are more related to immediate, concrete stimuli, while the ones of adolescents and young adults are related to anticipatory or abstract stimuli. For example, the item of "Fear of being scolded by the principal" can be experienced by a child as something extremely dangerous and, therefore, the item will classify in the dimension "fear of death and danger" and not in the dimension of "fear of failure or criticism" where the answer of an adolescent or a young adult is most likely to be classified. Despite the disparities between the three versions, the FSSC-II showed high internal consistency values and an adequate percentage of explained variance in our sample. These results highlight the utility of the FSSC-II for the assessment of the frequency and intensity of fears in both adolescents and young adults in Mexico. It would be desirable to perform future studies among children.
El miedo es una emoción que se experimenta a lo largo de la vida y en ocasiones posibilita la adaptación. No obstante, el miedo puede tornarse desadaptativo y evolucionar hacia un trastorno fóbico que impacta negativamente en el individuo que lo padece. La infancia y la adolescencia son las etapas en las que típicamente inician las fobias, las cuales se han asociado al desarrollo de otros trastornos mentales en la vida adulta. En la evaluación del miedo es necesario evaluar tanto su intensidad como su frecuencia en tres dimensiones principales: la subjetiva, la física y la conductual. Los principales métodos de valoración del miedo han sido los autoinformes, la observación externa y los registros psicofisiológicos. En el área de la salud mental, la escala más utilizada para la evaluación de miedos en población juvenil es el Inventario de Miedos para Niños II (Fear Survey Schedule for Children II, FSSC-II). La adaptación cultural de un instrumento internacionalmente utilizado como éste brinda la oportunidad de realizar comparaciones subsecuentes de los hallazgos de investigación con otras poblaciones. Dado el impacto del miedo en el futuro desarrollo de trastornos mentales, es importante contar con una caracterización de los principales miedos en nuestra población para la elaboración de futuros programas preventivos y de tratamiento efectivos. De esta forma, el objetivo del presente estudio fue traducir al español, adaptar culturalmente y evaluar psicométricamente el Inventario de Miedos para Niños FSSC-II en una muestra de adolescentes y adultos jóvenes mexicanos. Método La muestra estuvo conformada por estudiantes de preparatoria de ambos sexos, entre 14 y 24 años de edad, que aceptaron participar en el estudio de manera anónima. Dos traductores independientes realizaron la traducción-retraducción y adaptación cultural del FSSC-II y posteriormente fue aplicado a los estudiantes. Se obtuvo la consistencia interna del instrumento mediante el alpha de Cronbach y la validez de constructo mediante un análisis de componentes principales. Resultados Se incluyeron 2992 mujeres y 2038 hombres, con una edad promedio de 16.43 años. El 11.53% de los reactivos de la versión original del FSSC-II se adaptaron para su uso en población mexicana. El análisis factorial mostró cinco factores agrupados de acuerdo con lo teóricamente esperado: miedo a la muerte o peligro, miedo a los animales o lesiones, miedo al fracaso escolar o a la crítica, miedo a lo desconocido y miedos médicos. Todos los factores del FSSC-II mostraron elevados valores de consistencia interna (>.80) con excepción del área de miedos médicos (.70). El alpha de la puntuación total de la escala fue de .96. Discusión La estructura de cinco factores del instrumento resultó congruente con la versión australiana original y la estadounidense, siendo compatible en su totalidad con la versión de Estados Unidos. No obstante, en cuanto al contenido de los reactivos, la versión mexicana del FSSC-II fue más similar a la versión australiana del instrumento. Estas inconsistencias pueden deberse a las diferencias de edades de las muestras sujetas a estudio, siendo distintas las realidades que vive un niño a las que vive un adolescente o un adulto joven. A pesar de estas divergencias, la alta consistencia interna y varianza explicada del instrumento muestran su utilidad para evaluar la frecuencia e intensidad de miedos en adolescentes y adultos jóvenes en nuestro país. Es deseable dirigir futuros estudios para evaluar a niños de menores edades.
