The Intolerance of Uncertainty Inventory: Validity and Comparison of Scoring Methods to Assess Individuals Screening Positive for Anxiety and Depression

Clarifying the Factor structure of the Intolerance of Uncertainty Inventory: Measurement Invariance and Validity in Predicting Clinical Outcomes

The Intolerance of Uncertainty Inventory (IUI) is a two-part inventory assessing the general unacceptability of uncertainty in terms of generalized maladaptive beliefs (IUI-A) and specific individuals’ reactions to uncertainty, such as avoidance, doubt, overestimation of threat, worry, control of uncertainty, and seeking reassurance (IUI-B). Previous research has examined the factor structure of both parts with mixed results, especially for IUI-A. The present study took advantage of the Farsi-language version to clarify the IUI factor structure, assess measurement invariance between clinical and nonclinical samples, and examine the criterion-related and incremental validity of IUI-A and IUI-B. We administered the IUI to a mixed psychiatric sample of patients who met DSM-IV criteria for affective disorders (N = 198) and community participants in relatively good health (N = 427). Exploratory structural equation modeling analyses were used to test alternative factor models and determine whether IUI factors predicted depression and anxiety symptoms. A bifactor model was found to be the best fit for IUI-A and IUI-B, and reliability analyses supported the use of the total scores for both parts. The IUI-A and IUI-B were scalar invariant. The general factors of each part and the IUI-B worry factor were higher in patients with affective disorders than in community participants. Validity analyses showed that the two general factors tapped into the same variance in depression and anxiety symptoms as the competing instruments, although not superior in predictive performance to the Intolerance of Uncertainty scale (IUS-12) and the Disorder Specific Intolerance of Uncertainty (DSIU) scale. The present study clarified the factorial structure of the IUI and provided evidence that IUI total scores are reliable and valid for assessing the Intolerance of Uncertainty construct and predicting clinical outcomes.

The assessment of Intolerance of uncertainty in youth: An examination of the Intolerance of Uncertainty Scale-Revised in Italian nonclinical boys and girls

Intolerance of Uncertainty (IU) is a transdiagnostic factor involved in several psychological disorders. Adolescence is characterized by elevated uncertainty and psychopathological vulnerability, but insufficient attention has been paid to IU at this age. This study aimed to investigate the factor structure and psychometric properties of the Intolerance of Uncertainty Scale-Revised (IUS-R) in Italian preadolescents and adolescents. 862 Italian students (57.3% girls) aged 11-17 (M = 14.8 ± 1.91) completed the IUS-R and measures of internalizing and externalizing symptoms, and psychological well-being. To test the factor structure of the IUS-R, one-factor, two-factor, and bifactor models were compared; measurement invariance, reliability, and validity were also addressed. Results showed that the bifactor model outperformed alternative factor models, and a general factor was needed to model the IUS-R. Bifactor model indices supported using the total score to assess IU reliably. Configural and metric invariance by age and sex were fully supported, while the IUS-R achieved partial scalar invariance. Significant correlations emerged for the IUS-R total score with psychopathological constructs, while no relationships with psychological well-being were found. Compared to adult normative data, higher total IUS-R scores were detected, suggesting that IU may be a phase-specific characteristic of adolescence. Our findings support using the IUS-R to measure IU across the lifespan. The recommended use of the total score and its associations with psychopathological dimensions highlight the transdiagnostic nature of IU in adolescence. Therefore, including IU when implementing interventions to prevent maladaptive outcomes in teenagers would be beneficial.

Coping with COVID Stress: Maladaptive and Adaptive Response Styles Predicting College Student Internalizing Symptom Dimensions

The COVID-19 pandemic significantly disrupted daily life for undergraduates and introduced new stressors (e.g., campus closures). How individuals respond to stressors can interact with stress to increase disorder risk in both unique and transdiagnostic ways. The current study examined how maladaptive and adaptive stress response styles moderated the perceived severity of COVID-related stressors effect on general and specific internalizing dimensions at the beginning of the COVID-19 pandemic in a combined undergraduate sample across two universities (N = 451) using latent bifactor modeling and LASSO modeling to identify optimal predictors. Results showed that perceived stress severity and maladaptive response styles (not adaptive response styles or interactions between stress and response styles) were associated with both common and specific internalizing dimensions. Results suggest additive associations of stress severity and maladaptive coping with internalizing symptoms during the pandemic’s beginning, and provide important insights for screening, prevention, and intervention during future public health crises.

Graduate training during the COVID-19 pandemic: North American genetic counseling students' challenges, intolerance of uncertainty, and psychological well-being

The COVID-19 pandemic has upended genetic counseling (GC) graduate students' lives, as they have been forced to transition, manage, and acclimate to life during a pandemic. The current study is a first step in understanding their lived experiences during this historic, global event. We investigated academic and personal challenges, intolerance of uncertainty, and psychological well-being of GC students (n = 248) who trained during the pandemic (GC-COV cohort) and those who did not (GC-NoCOV cohort). Participants completed an online survey (July-September 2020) that used validated measures of Intolerance of Uncertainty and Psychological Well-Being. To assess the academic and personal challenges students experienced during GC graduate training, we developed a 43-item measure. Principal axis factoring of the items revealed categories of challenges related to the following: Academic & Professional Development, Self-Regulation & Resilience, Institutional & Program Leadership, and Financial Stability. There was no cohort difference in Psychological Well-Being. Linear mixed-effects modeling showed significant cohort differences in challenges. Multiple linear regression analyses revealed that the GC-COV cohort's Psychological Well-Being was statistically significantly predicted by Institutional & Program Leadership challenges (p = .029), Self-Regulation & Resilience challenges (p = .013), and Intolerance of Uncertainty (p = .010). For the GC-NoCOV cohort, the statistically significant predictor of Psychological Well-Being was Self-Regulation & Resilience challenges (p = .029). Our findings demonstrate that GC students training during the COVID-19 pandemic have experienced various personal, academic, and psychological disruptions and highlight a need to develop resources and implement interventions supporting students' academic development and psychological well-being.

The relations between different components of intolerance of uncertainty and symptoms of generalized anxiety disorder: a network analysis

BACKGROUND

Intolerance of uncertainty (IU) is considered as a specific risk factor in the development and maintenance of generalized anxiety disorder (GAD). Yet, researches have investigated the relations between IU and GAD (or worry) using total scores on self-report measures. This ignores that there are different components exist in IU and the heterogeneity of GAD symptoms. In the present study, we explored the relations among different components of IU and symptoms of GAD.

METHODS

A dimensional approach which take individual differences into consideration in different components of IU along a full range of normal to abnormal symptom severity levels of GAD were used in this study. Components of IU were measured by 12-item Intolerance of Uncertainty Scale and symptoms of GAD were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Regularized partial-correlation network was estimated using cross-sectional data from 624 university students.

RESULTS

Four strongest edges are between components of IU, like "Unforeseen events upset me greatly" and "It frustrates me not having all the information I need". Two strongest edges are between symptoms of GAD, like "Being so restless that it is hard to sit still" and "Feeling afraid as if something awful might happen". Symptom "Worrying too much about different things" and component "It frustrates me not having all the information I need" have the highest expected influences in the present network. In the community of IU, component "It frustrates me not having all the information I need" has the highest bridge expected influence. And in the community of GAD, symptoms "Worrying too much about different things" and "Not being able to stop or control worrying" have the highest bridge expected influence.

CONCLUSIONS

This study reveals potential pathways between different components of IU and various symptoms of GAD. Understanding how putative risk factors such as different components of IU are related to symptoms of GAD may provide some references for related preventions and interventions, such as targeting component "It frustrates me not having all the information I need" may be more effective at reducing symptoms of GAD than targeting other components of IU.

Resilient Coping Types in People With Spinal Cord Injury: Latent Class Analysis

Resilience is central to living well with a spinal cord injury (SCI). To provide a timely, targeted, and individualized intervention supporting resilience, it is necessary to assess an individual’s resilience level and characteristics of resilience on an ongoing basis. We aimed to validate the different types of resilient coping among people with SCI (PwSCI), using the Connor–Davidson resilience scale, and to identify the relationships between resilience and other psychosocial factors among the types of resilient coping. We recruited 93 PwSCI, who took the self-report measures of resilience, depression, life satisfaction, and spirituality. Using latent class analysis, we found three types: (a) goal-pursuing, bouncing-back, and persevering, named GP; (b) uncertainty about coping with setbacks, named UC; and (c) loss of resilient coping, named LOSS. The multivariate tests indicated that the three types differed on a linear combination of resilience, depression, and life satisfaction, with a large effect size. We discussed the three types of resilient coping and the implications for psychosocial interventions. We also recommended that rehabilitation clinicians examine PwSCI’s resilience levels and types of resilience during initial and follow-up visits. In doing so, PwSCI will have timely, targeted supports for developing and/or re-building their resilience.

What is the internal structure of intolerance of uncertainty? A network analysis approach

Intolerance of uncertainty (IU) is a transdiagnostic vulnerability factor spanning psychological disorders. Although IU has been extensively studied, its internal structure is still not fully understood. In the current study, we applied network analysis to investigate IU - as measured by the Intolerance of Uncertainty Scale-Revised (IUS-R) - in two large non-clinical samples, consisting of undergraduates (N = 1172) and community individuals (N = 1759). Network analysis revealed that feeling a general internal uncertainty aversion and the belief that things have to be planned in advance are the most central nodes in both samples. Moreover, the community analysis revealed that, in both samples, the network of IU consists of three communities referring to negative beliefs about uncertainty, behavioral reactions to uncertainty, and emotional reactions to uncertainty. Lastly, the network was highly similar in undergraduates and community individuals in terms of network similarity, global connectivity, and structure and items mean levels; only minimal-to-negligible differences were found. The way current findings expand our knowledge of the internal structure of IU, along with theoretical and clinical implications, are discussed.

Psychometric Properties of the Chinese Version of the Intolerance of Uncertainty Inventory in Chinese College Students

BACKGROUND

Intolerance of uncertainty (IU) is considered to be associated with emotional disorders, such as generalized anxiety disorder (GAD), depression, obsessive compulsive disorder (OCD), and social anxiety. Therefore, a comprehensive instrument to measure IU is needed. The purposes of the present study were as follows: 1) developing a Chinese version of the Intolerance of Uncertainty Inventory (CIUI) and 2) measuring the reliability and validity of CIUI.

METHODS

We translated the Intolerance of Uncertainty Inventory (IUI) into Chinese. A sample consisting of Chinese college students from three universities was used to evaluate the internal consistency, test-retest reliability, and validity of the CIUI. Participants answered the CIUI, IUS-12, GAD-7, BDI-II, and PSWQ. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were run to explore the factor structure of CIUI.

RESULTS

The results demonstrated an acceptable internal consistency for CIUI (Part A of CIUI [CIUIA]: α = 0.920; Part B of CIUI [CIUIB]: α = 0.947) and test-retest reliability (CIUIA: ICC = 0.788; CIUIB: ICC = 0.859). The results of EFA and CFA all supported a two-factor structure for CIUIA (Intolerance of the unexpected and difficulty waiting in an uncertain situation and Intolerance of uncertainty and of uncertain situations) and a four-factor structure for CIUIB (Overestimation, Control, Uncertainty makes one feel stressful, and Reassurance), and acceptable validity was obtained.

CONCLUSION

The CIUI is an appropriate instrument for measuring IU in Chinese populations. Future studies should confirm the psychometric properties using a comprehensive sample.

The Effects of Dynamic Work Environments on Entrepreneurs' Humble Leader Behaviors: Based on Uncertainty Reduction Theory

Although it is widely acknowledged that the environments faced by entrepreneurs now are more dynamic than ever, little is known about the effect of dynamic work environments on entrepreneurs' leader behaviors. Based on the uncertainty reduction theory and the data from 197 entrepreneurs and their subordinates, this research found a positive relationship between dynamic work environments and entrepreneurs' humble leader behaviors. Moreover, this positive relationship can be mediated by entrepreneurs' feedback-seeking behavior. And the relationship between dynamic work environments and entrepreneurs' humble leader behaviors (via feedback-seeking) can be moderated by entrepreneurs' intolerance of uncertainty. The contributions and implications of this study are discussed.

The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis

Intolerance of uncertainty is a dispositional trait associated with a range of psychological disorders, but the influence of methodological factors on theses associations remains unknown. The first aim of this meta-analysis was to quantify the strengths of the association between IU and symptoms of generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive compulsive disorder, depression, and eating disorders. The second aim was to assess the influence of methodological factors on these relationships, including clinical (vs. non-clinical) status, age group, sex, IU measure, and symptom measure. We extracted 181 studies (N participants = 52,402) reporting 335 independent effect sizes (Pearson's r). Overall, there was a moderate association between IU and symptoms (r = 0.51, 95% CI = 0.50-0.52), although heterogeneity was high (I² = 83.50, p < .001). Some small but significant moderator effects emerged between and within disorders. Effect sizes were not impacted by sample size. The results indicate that IU has robust, moderate associations with a range of disorder symptoms, providing definitive evidence for the transdiagnostic nature of IU.

A Correlational Analysis of the Relationships among Intolerance of Uncertainty, Anxiety Sensitivity, Subjective Sleep Quality, and Insomnia Symptoms

In this study, we used structural equation modeling to investigate the interplay among Intolerance of Uncertainty (IU), Anxiety Sensitivity (AS), and sleep problems. Three hundred undergraduate students completed the Intolerance of Uncertainty Scale, the Intolerance of Uncertainty Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. 68% and 40% of the students reported poor sleep quality or sub-threshold insomnia problems, respectively. Depression and anxiety levels were above the cut-off for about one-fourth of the participants. Structural equation modeling revealed that IU was strongly associated with AS, in turn influencing both insomnia severity and sleep quality via depression and anxiety. Significant indirect effects revealed that an anxious pathway was more strongly associated with insomnia severity, while a depression pathway was more relevant for worsening the quality of sleep. We discussed the results in the frameworks of cognitive models of insomnia. Viewing AS and IU as antecedents of sleep problems and assigning to AS a pivotal role, our study suggested indications for clinical interventions on a population at risk for sleep disorders.

Intolerance of Uncertainty and Anxiety-Related Dispositions Predict Pain During Upper Endoscopy

Although sedatives can defuse anxiety and relieve pain, Esophagogastroduodenoscopy (EGD) still is uncomfortable and threatening for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. Using a prospective design and a multimodal assessment of pain, the present study evaluated how anxiety-related variables predicted subsequent pain outcomes. Sixty-two consecutive patients referred for elective EGD were assessed for intolerance of uncertainty (IU), procedure-related worries, anxiety sensitivity and health distress before endoscopy. During endoscopy, a doctor rated patients’ pain behavior. After complete recovery from sedation, the patients retrospectively rated endoscopy pain and situation specific catastrophizing thoughts. Descriptive analyses showed that patients undergoing EGD for the first time were more distressed and anxious than patients accustomed to the procedure and needed a higher sedative dose. Notwithstanding sedation, the behavioral rating of pain was above the cut-off value for probable pain for more than half of the patients. IU assessed before endoscopy predicted situational pain catastrophizing (PC) and self-reported pain after endoscopy through procedure related worries. Situational PC not only mediated the effect of worry, but also female gender and younger age were associated with self-reported pain through increased catastrophizing thoughts. Health distress and anxiety sensitivity predicted PC only for women, younger patients, and those not accustomed to the procedure. Our study showed that psychological preparation before sedation is needed especially for first-timers, women, and younger patients, addressing maladaptive cognitive beliefs and acquainting patients with the somatic sensations that they might experience during the procedure.

Biological and psychosocial predictors of anxiety worsening in the postpartum period: A longitudinal study

BACKGROUND

As many as 20% of women will experience an anxiety disorder during the perinatal period. Women with pre-existing anxiety disorders are at increased risk of worsening during this time, yet little is known about its predictors.

STUDY AIM

To investigate the psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders.

METHODS

Thirty-five (n = 35) pregnant women with pre-existing DSM-5 anxiety disorders were enrolled in this prospective study investigating the psychosocial (e.g., childhood trauma, intolerance of uncertainty, depression) and biological risk factors (e.g. C-reactive protein, interleukin-6, tumor necrosis factor-α) for anxiety worsening in the postpartum period. Anxiety worsening was defined as an increase of ≥50% or greater on Hamilton Anxiety Rating Scale scores from the third trimester of pregnancy (32.94 ± 3.35 weeks) to six weeks postpartum.

RESULTS

Intolerance of uncertainty, depressive symptom severity, and obsessive-compulsive disorder symptoms present in pregnancy were significant predictors of anxiety worsening in the postpartum.

LIMITATIONS

Sample heterogeneity and limited sample size may affect study generalizability.

CONCLUSIONS

To our knowledge, this is the first longitudinal study to investigate psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. Continued research investigating these risk factors is needed to elucidate whether they differ from women experiencing new-onset anxiety disorders in the perinatal period, and those in non-puerperal groups. Identifying these risk factors can guide the development of screening measures for early and accurate symptom detection. This can lead to the implementation of appropriate interventions aimed at decreasing the risk of perinatal anxiety worsening.

Does Human Experimental Endotoxemia Impact Negative Cognitions Related to the Self?

A role of inflammatory processes in the pathophysiology of depression is increasingly recognized. Experimental endotoxemia offers an established model to induce transient systemic inflammation in healthy humans, and has been proposed as an experimental paradigm of depression. Indeed, different symptoms of depression can be observed during experimental endotoxemia, including negative mood or dysthymia as key symptoms of depression. Hopelessness and low self-esteem constitute common cognitive symptoms in depression, but have not been specifically assessed during endotoxemia. Thus, we pooled data from healthy volunteers who received low-dose endotoxin (i.e., 0.4 or 0.8 ng/kg lipopolysaccharide, LPS) or placebo in three randomized, controlled studies to investigate the effects of LPS on cognitive schemata related to depression. Validated questionnaires were used to assess self-esteem, hopelessness and the vulnerability factor intolerance of uncertainty after intravenous injection of LPS or placebo. Plasma tumor necrosis factor (TNF)-α and interleukin (IL)-6 were repeatedly assessed, along with self-reported mood. Because not all questionnaires were available from primary studies, data were analyzed in two separate data sets: In data set 1, self-esteem and intolerance of uncertainty were assessed in N = 87 healthy volunteers, who randomly received either 0.4 or 0.8 ng/kg LPS or placebo. In data set 2, hopelessness was measured in N = 59 volunteers who randomly received either LPS (0.8 ng/kg) or placebo. In both data sets, LPS-application led to significant increases in TNF-α and IL-6, reflecting systemic inflammation. Positive mood was significantly decreased in response to LPS, in line with inflammation-induced mood impairment. General self-esteem, intolerance of uncertainty and hopelessness did not differ between LPS- and placebo groups, suggesting that these negative cognitive schemata are not responsive to acute LPS-induced systemic inflammation. Interestingly, LPS-treated volunteers reported significantly lower body-related self-esteem, which was associated with increased TNF-α concentration. Thus, certain aspects of self-esteem related to physical attractiveness and sportiness were reduced. It is conceivable that this effect is primarily related to physical sickness symptoms and reduced physical ability during experimental endotoxemia. With respect to cognitive symptoms of depression, it is conceivable that LPS affects cognitive processes, but not negative cognitive schemata, which are rather based on learning and repeated experiences.