*2.5. Impact of Event (COVID-19 Pandemic) Scale (R) (IES)*

Daniel Weiss and Charles Marmar developed the first draft of the impact of event scale (IES) in 1997 [12] to parallel the DSM-IV criteria, subscale with hyperarousal items were included into IES and renamed as IES-R [13]. This scale comprises of total 22 items measured on a 5-point Likert scale rated from 0 to 4 (0 = not at all, 1 = a little, 2 = moderately, 3 = quite a bit and 4 = extremely) based on the extent to which 22 items described in the scale has caused distress to the participants in the last 7 days with reference to COVID-19. The consistency of the items was found to have Cronbach's alpha of 0.94. The cutoff score reported in earlier literature ranges from 25 to 40, with a score of more than cutoff indicate a person at high risk for psychological problems [14]. Since this study was done during the time of the event, the investigators decided on a mean score of 35 as the cutoff point to validate the impact of COVID-19 in the participants. Intrusion (items 1, 2, 3, 6, 9, 14, 16 and 20), avoidance (items 5, 7, 8, 11, 12, 13, 17 and 22) and hyperarousal (items 4, 10, 15, 18, 19, 21) are three subscales to this questionnaire.
