Intolerance of Uncertainty and Health-Related Anxiety in Youth amid the COVID-19 Pandemic: Understanding and Weathering the Continuing Storm
Open accessAbstract
The COVID-19 pandemic is a public health crisis that continues to impact individuals worldwide. While children may be less susceptible to severe medical complications, they are nonetheless vulnerable to stress and anxiety associated with the pandemic. However, current understanding of psychological functioning and potential strategies to mitigate distress amid a pandemic is naturally limited. Consequently, this article is an attempt to fill that gap. Existing literature on pandemics, health-related anxieties, intolerance of uncertainty, and psychopathological sequelae is summarized within the context of the COVID-19 outbreak. Conclusions from the empirical data and emerging theoretical models are reviewed and synthesized. Finally, several potentially engaging and effective examples of developmentally appropriate interventions targeting intolerance of uncertainty and health-related anxieties in pediatric patients during the peri- and post-pandemic periods are described. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Claims the paper makes
21 of 50 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Emphasis on personal hygiene and handwashing as COVID-19 prevention may increase OCD-related symptoms in children.
“The emphasis on personal hygiene and handwashing as preventative measures for the spread of the virus may also increase OCD-related symptoms in children (Imran et al., 2020).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Imran et al., 2020 source
In the Introduction section “Children with Pre-existing Mental Illnesses” (page unavailable), the paper says stress may worsen obsessions and compulsions in children with OCD and that disease-mitigation measures can be traumatic. Its “Specific Interventions” section recommends frequent handwashing, but it does not say that emphasis on hygiene or handwashing increases OCD-related symptoms. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premisecitation
Radanovic et al. (2021) found that children's worries increased with greater exposure to threat messages from parents and outside sources.
“Further, Radanovic et al. (2021) found that children’s worries increased with greater exposure to threat messages originating from parents as well as from outside sources (e.g., peers, news reports, internet, social media, etc.).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Radanovic et al., 2021 source
- Premisecitation
Children with chronic illnesses appear especially vulnerable to IU's adverse effects.
“Children with chronic illnesses appear especially vulnerable to IU’s adverse effects (Mertens et al., 2020).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Mertens et al., 2020 source
The Introduction (page unavailable) describes intolerance of uncertainty (IU) as a general vulnerability factor for anxiety-related disorders, and the Discussion (page unavailable) reports a trend linking IU to greater fear of coronavirus. Neither passage establishes that children with chronic illnesses are especially vulnerable to IU’s effects; the Discussion’s mention of chronic diseases concerns coronavirus risk, not IU. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Premisecitation
Osmanağaoğlu et al. (2018) attributed nearly 40% of adolescents' variation in worry to IU.
“Osmanağaoğlu et al. (2018) attributed nearly 40% of adolescents’ variation in worry to IU.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Osmanağaoğlu et al., 2018 source
Section 3.2 reports that IU was associated with approximately 39.69% of the variance in worry, supporting the nearly 40% figure. However, the meta-analysis covered children and adolescents, not adolescents separately. The Discussion also cautions that its largely cross-sectional evidence cannot establish the direction of the association, so “attributed” should not imply causation. (LLM, conf=0.87)
Experimental — accuracy not yet measured
- Premisecitation
IU propels worry.
“Clearly, IU propels worry (Dugas et al., 1998; Carleton, 2016; Osmanağaoğlu et al., 2018; Evans et al., 2020; Rifkin & Kendall, 2020b).”
Quote in the paperSubstantial claim2 of 3 sources checked- cites Dugas et al., 1998 source
- cites Carleton, 2016 source
- cites Osmanağaoğlu et al., 2018 source
The Introduction describes models in which IU sets off a chain of worry, and section 3.2 finds a strong association between IU and worry. But the Discussion says that nearly all eligible studies were cross-sectional, so little can be concluded about the direction of that association; the unqualified causal wording “propels” overstates the evidence for children and adolescents. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Premisecitation
Anxiety spectrum disorders in pediatric populations are expected to rise dramatically during the peri- and post-pandemic periods.
“During the peri- and post-pandemic periods, anxiety spectrum disorders in pediatric populations are expected to rise dramatically (Czeisler et al., 2020).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Czeisler et al., 2020 source
The Discussion (page unavailable) reports that symptoms of anxiety disorder were about three times as prevalent among U.S. adults in June 2020 as in the second quarter of 2019, while cautioning that the surveys might not be directly comparable. The study surveyed people aged 18 and older; it does not establish a rise in diagnosed anxiety disorders among pediatric populations or predict a post-pandemic rise. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Premisecitation
In that population, distress symptoms positively correlated with perceiving the virus as threatening or stigmatizing.
“Symptoms of distress within this population positively correlated with perceptions of the virus as threatening or stigmatizing.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Liu et al., 2020 source
The Comment section discusses possible mental-health effects of quarantine and separation on children, but does not report a correlation between distress symptoms and perceptions of the virus as threatening or stigmatizing. Searches for that correlation and for stigma and perceived threat found no passage addressing it. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Premisecitation
Contamination fears and worries about becoming ill are exacerbated by the uncertainty accompanying the pandemic.
“Contamination fears and worries about becoming ill are exacerbated by the uncertainty accompanying the pandemic (Tanir et al, 2020).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Tanir et al, 2020 source
The Results report increased contamination obsessions during the pandemic among children and adolescents with OCD. The Introduction mentions uncertainty about the disease as a possible source of stress, but the paper does not establish that uncertainty exacerbated contamination fears or worries about becoming ill. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Premisecitation
The digital divide disproportionately negatively impacts marginalized populations.
“However, the digital divide disproportionately negatively impacts marginalized populations (Fegert et al., 2020; Stancin, 2020).”
Quote in the paperSubstantial claim1 of 2 sources checked- cites Fegert et al., 2020 source
In “Focus on high risk children” (page unavailable), the review says telemedicine and telepsychiatry may be less accessible to children in low-income families because they may lack resources or a confidential space. That supports a digital-access disadvantage for one marginalized group, but the claim extends it to marginalized populations generally and states the impact more definitively than the review does. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites Stancin, 2020 source
- Interpretationreasoning
IU appears transdiagnostically connected to various anxieties.
“Perhaps, this is a reason IU appears to be transdiagnostically connected to various anxieties.”
Quote in the paperSubstantial claim - Premisecitation
Fear is transmitted through verbal threat messaging.
“These findings are consistent with Rachman’s (1977) seminal work stating that fear is transmitted through verbal threat messaging.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rachman, 1977 source
- Interpretationreasoning
Health-related anxieties and IU appear connected.
“For instance, health-related anxieties and IU appear connected.”
Quote in the paperSubstantial claim - Premisecitation
Health-related worries increase distress in response to a perceived threat to physical well-being.
“Health-related worries increase individuals’ distress in response to a perceived threat to physical well-being (Taylor & Asmundson, 2004; Asmundson et al., 2010).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Taylor & Asmundson, 2004
- cites Asmundson et al., 2010 source
- Premisecitation
Contemporary CBT spectrum approaches offer procedures for combatting IU and its clinical sequelae, especially health-related anxiety and OCD.
“Fortunately, contemporary Cognitive Behavior Therapy (CBT) spectrum approaches offer a full cache of procedures for combatting IU and its clinical sequelae especially health-related anxiety (Higa-McMillan et al., 2016; Palitz et al., 2019a) and OCD (Storch et al., 2018).”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
Children with comorbid mental health disorders and medical conditions are more at risk for developing health-related anxieties during a pandemic due to contamination fears and worries about exacerbating their illnesses.
“Therefore, it seems reasonable to suspect that children with comorbid mental health disorders and medical conditions are more at risk for developing health-related anxieties during a pandemic due to contamination fears and worries about exacerbating their illnesses.”
Quote in the paperSubstantial claim - Interpretationcitation
Elevated IU may underlie panic disorder.
“Elevated IU may also underlie panic disorder (PD).”
Quote in the paperNot a substantial claim - Interpretationreasoning
The pandemic serves as a stressor and triggers IU because of its characteristic properties.
“As Fig. 1 graphically illustrates, the pandemic serves as a stressor and triggers IU due to its characteristic properties.”
Quote in the paperSubstantial claim - Premisecitation
The COVID-19 pandemic and increased media coverage likely act as critical incidents that accelerate health-related anxieties in children.
“The COVID-19 pandemic and the increased media coverage likely serve as “critical incidents” for accelerating health-related anxieties (Haig-Ferguson et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Haig-Ferguson et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
The multiple uncertainties accompanying the COVID-19 pandemic likely accelerate greater IU and worries about health.
“The multiple uncertainties that accompany the COVID-19 pandemic likely accelerate greater IU and worries about health.”
Quote in the paperNot a substantial claim - Premisecitation
Hearn et al. (2017a, b) found significantly higher IU among children and adolescents with SAD and GAD than in cohorts without anxiety disorders.
“Hearn et al., (2017a, b) found significantly higher IU among children and adolescents with SAD and GAD than cohorts without anxiety disorders.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hearn et al., 2017a, b source
- Interpretationreasoning
Because IU is considered a dispositional variable, it likely serves as a diathesis.
“Since IU is considered a dispositional variable, the construct likely serves as a diathesis.”
Quote in the paperSubstantial claim - Premisenone given
In novel situations marked by uncertainty and ambiguity, children are especially vulnerable to maladaptive stress reactions.
“In novel situations where uncertainty and ambiguity are rampant, children are especially vulnerable to developing maladaptive reactions to stress.”
Quote in the paperSubstantial claim - Interpretationreasoning
The COVID-19 pandemic and its sequelae contribute to multiple adverse circumstances, leading to likely surges in pediatric health-related anxieties.
“The COVID-19 pandemic and its sequelae are contributing to multiple adverse circumstances, which in turn, leads to likely surges in pediatric health-related anxieties.”
Quote in the paperSubstantial claim - Premisecitation
IU jeopardizes fear extinction.
“Further, IU jeopardizes fear extinction (Pincotti et al., 2021).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pincotti et al., 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- May combine two claims. 20
- Classified as probably not a substantial claim. 11
May combine two claims.
InterpretationcitationPsychoeducational strategies are especially valuable for treating youth with pandemic-related worries because they empower pediatric patients and initially modify IU.
“Consequently, psychoeducational strategies are especially valuable for treating youth with pandemic-related worries because they empower pediatric patients and serve to initially modify IU (Radanovic et al, 2021).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Radanovic et al, 2021 source
The Discussion > Implications recommends talking with children about the pandemic in ways that help them understand it and reduce their worries. It does not describe psychoeducation as a treatment for pediatric patients, claim that it empowers them, or discuss initially modifying intolerance of uncertainty (IU). (LLM, conf=0.83)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationIndividuals with high IU find ambiguity unbearable and experience difficulty functioning in uncertain situations.
“Individuals with high IU find ambiguity unbearable and experience difficulty functioning in uncertain situations (Comer et al., 2009).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Comer et al., 2009 source
May combine two claims.
PremisecitationStudies show elevated anxiety levels in pediatric populations diagnosed with diabetes, functional abdominal pain, coronary heart disease, and asthma.
“More specifically, studies show elevated anxiety levels in pediatric populations diagnosed with diabetes (Ducat et al., 2014), functional abdominal pain (Shelby et al., 2013), coronary heart disease (Oliver et al., 2020), and asthma (Pateraki et al., 2018).”
Quote in the paperNot a substantial claim1 of 3 sources checkedMay combine two claims.
PremisecitationDoubt and IU are core features of OCD.
“Doubt and IU are seen as core features of OCD (Gillett et al., 2018; Cervin et al., 2020).”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites Gillett et al., 2018 source
- cites Cervin et al., 2020 source
The Discussion describes doubt as central to OCD, and the study finds doubting/checking central in youth symptom networks. It mentions uncertainty alongside doubt but does not identify intolerance of uncertainty (IU) as a core feature. The source therefore supports the doubt portion, not the IU portion. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationExperts predict a surge in young people seeking clinical care for behavioral health concerns during the peri- and post-pandemic periods.
“Experts predict a surging number of young people-seeking clinical care for various behavioral health concerns during the peri- and post-pandemic period (Fegert et al., 2020; Golberstein et al., 2020; Loades et al., 2020; Marques de Miranda et al., 2020; Sanderson et al., 2020; Simon et al., 2020; Abbott, 2021).”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites Fegert et al., 2020 source
- cites Golberstein et al., 2020 source
- cites Loades et al., 2020 source
The paper's discussion of policy and practice says COVID-19 containment-related loneliness could lead to subsequent mental health problems in young people. Its Results section also reports that, after earlier infectious-disease outbreaks, some children affected by containment measures needed mental health services. Neither passage predicts a surge in young people seeking clinical care during or after COVID-19. (LLM, conf=0.83)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationIU contributes to avoidance, reassurance seeking, planning for worst-case scenarios, and excessive caution.
“Moreover, IU contributes to avoidance, seeking reassurance, planning for worst-case scenarios, and excessive caution (Beesdo‐Baum et al., 2012).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Beesdo‐Baum et al., 2012 source
The Assessments section lists avoidance, reassurance seeking, making plans in case worries come true, and acting carefully as behaviors assessed in patients with generalized anxiety disorder. The Introduction also describes reassurance seeking as a way to reduce uncertainty. But the paper does not establish that intolerance of uncertainty (IU) causes or contributes to those behaviors; it assesses them as responses to worry. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationLiu et al. (2020) found elevated PTSD and GAD rates among Chinese children and adolescents after the COVID-19 outbreak.
“For instance, Liu et al. (2020) found elevated PTSD and GAD rates among Chinese children and adolescents after the COVID-19 outbreak.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Liu et al., 2020 source
The Comment section reports that 30% of children isolated or quarantined during earlier pandemic diseases met clinical criteria for PTSD, citing Sprang and colleagues. It does not report PTSD rates among Chinese children after the COVID-19 outbreak or any GAD rates; it discusses those children’s potential mental-health risks instead. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationCBT approaches to anxiety are empirically supported and widely applicable to diverse pediatric populations.
“While CBT approaches to anxiety are empirically supported and widely applicable to diverse pediatric populations (Norris & Kendall, 2020), traditionally marginalized populations are often disadvantaged by a lack of access to proper behavioral health care.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Norris & Kendall, 2020 source
The Introduction identifies CBT as a well-established treatment for youth anxiety and reports that most studies found equivalent outcomes across racial and ethnic groups. But it also emphasizes that few studies tested race or ethnicity and that trial samples often lacked diversity, so broad applicability to diverse pediatric populations is not firmly established. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTanir et al. (2020) claimed that cleanliness and handwashing obsessions and compulsions have increased during the viral outbreak.
“More specifically, Tanir et al. (2020) claimed cleanliness as well as handwashing obsessions and compulsions have increased during the viral outbreak.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Tanir et al., 2020 source
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningIU may be a key variable for conceptualizing young people's health-related concerns during a viral outbreak, and CBT interventions targeting this pathway are potentially good treatment options.
“Accordingly, IU may be a key variable for conceptualizing young people’s health-related concerns during a viral outbreak and cognitive-behavioral interventions targeting this pathway are potentially good treatment options.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationHealth pandemics tend to be singular widespread traumatic events, occur in waves, appear indefinite to the public, and have ambiguous endpoints.
“Taylor (2019) suggested health pandemics share certain features including being singular widespread traumatic events, often marked by waves, apparently indefinite to the public, and characterized by ambiguous endpoints.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Taylor, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningPsychoeducation, cognitive restructuring procedures, and exposure/behavioral experiments are likely suitable treatment options.
“In particular, psychoeducation, cognitive restructuring procedures, and exposure/behavioral experiments are likely suitable treatment options.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe coronavirus poses a behavioral health emergency as well as a public health crisis.
“Thus, the coronavirus poses not only a potential crisis for public health services but a behavioral health emergency as well.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationIU manifests as worry, emotional distress, ineffective problem solving, and uncertainty avoidance.
“IU manifests as worry, emotional distress, ineffective problem solving, and uncertainty avoidance (Dugas et al., 1998; Read et al., 2013; Rifkin & Kendall, 2020a, b).”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationLack of information and misinformation are major catalysts to children's pandemic-related anxieties.
“A recent study noted that lack of information as well as misinformation are major catalysts to children’s pandemic-related anxieties (Shahrbabaki et al., 2021).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Shahrbabaki et al., 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationHealth-related anxieties in young patients are relatively common, though care providers are often unfamiliar with them.
“Although care providers are often unfamiliar with health-related anxieties in young patients, these worries are nonetheless relatively common (Villadsen et al., 2017; Haig-Ferguson et al., 2020).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Villadsen et al., 2017 source
- cites Haig-Ferguson et al., 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningThe reviewed literature suggests that a diathesis-stress model could be a useful clinical heuristic for conceptualizing and treating youth distress during the pandemic.
“The reviewed literature suggests a diathesis-stress model could be a useful clinical heuristic for conceptualizing and treating youth experiencing distress during the pandemic.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationUncertainty and health-related anxieties increase during the peri- and post-pandemic periods.
“Uncertainty and health-related anxieties grow organically in the peri- and post-pandemic periods.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Taylor, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationAlthough IU serves as a mechanism of action in multiple disorders, its specific function is currently unclear.
“In sum, although IU serves as a mechanism of action in multiple disorders, the specific function is currently unclear (Palitz et al., 2019b).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Palitz et al., 2019b source
May combine two claims.
InterpretationreasoningHeightened IU propels catastrophizing, magnification of threat, hypervigilance, rumination, worry, reassurance-seeking/checking, fears of loss or lack of control, and avoidance.
“Heightened IU then propels catastrophizing, magnification of threat, hypervigilance, rumination, worry, reassurance-seeking/checking, fears of loss/lack of control, and avoidance.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningIU acts as both a causal factor that increases vulnerability to anxiety spectrum symptoms and a maintaining factor that is negatively reinforced through safety-seeking behaviors.
“Finally, IU acts as both a causal factor by increasing vulnerability to anxiety spectrum symptoms and a maintaining factor by being negatively reinforced via various safety-seeking behaviors (e.g., checking or avoidance).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningA CBT-oriented approach to treatment seems a promising strategy to combat the array of symptoms and potential comorbidities.
“A CBT-oriented approach to treatment seems a promising strategy to combat the array of symptoms and potential comorbidities.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationChildren's anxiogenic beliefs during the pandemic include thoughts such as fear of dying from COVID-19, anxiety from watching the news, fear of spreading the virus, and worry about being infected.
“More specifically, children’s anxiogenic beliefs during the pandemic include thoughts such as “I am afraid I am going to die because of COVID-19,” “I get anxious or nervous from watching the news,” “I am afraid I am going to spread the virus to others,” and “I worry about being infected (Shahrbabaki et al., 2021).””
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Shahrbabaki et al., 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationCatastrophic predictions, overestimations of danger or threat, and what-if thinking are common in anxious youth.
“Catastrophic predictions, overestimations of danger/threat, and what if thinking are common in anxious youth (Friedberg & McClure, 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Friedberg & McClure, 2015
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
PremisecitationExposure-based techniques are ways children and adolescents can show they can tolerate uncertainty and approach previously dreaded experiences.
“These procedures are ways children and adolescents can “show they can” tolerate uncertainty and approach heretofore dreaded experiences (Kendall et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kendall et al., 2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningIU likely represents a diathesis for anxiety-related symptoms and a logical transdiagnostic target for intervention.
“IU likely represents a diathesis for anxiety-related symptoms and a logical transdiagnostic target for intervention.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone givenBetter integration of accessible services into macro-systems such as schools, primary care settings, and community organizations holds potential to improve clinical outcomes and reduce behavioral health inequities in the peri- and post-pandemic periods.
“Better integration of accessible services into macro-systems such as schools, primary care settings, and community organizations, holds the potential to improve clinical and reduce behavioral health inequities in the peri- as well as post-pandemic periods.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningIdentifying and treating IU potentially helps ameliorate young people's emotional and behavioral responses to the COVID-19 pandemic.
“Identifying and treating IU potentially helps ameliorate young peoples’ emotional and behavioral responses to the COVID-19 pandemic.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Current understanding of psychological functioning and potential strategies to mitigate distress during a pandemic is limited.
“However, current understanding of psychological functioning and potential strategies to mitigate distress amid a pandemic is naturally limited.”
The paper relies on this without support.
Models for understanding psychological sequelae associated with global pandemics are under-developed.
“Models for understanding psychological sequelae associated with global pandemics are under-developed.”
The paper relies on this without support.
Treatment approaches to mitigate distress in the peri- and post-pandemic periods are incipient.
“Unsurprisingly, treatment approaches to mitigate distress in the peri- and post-pandemic periods are similarly incipient.”
The paper relies on this without support.
The last pandemic hitting the United States occurred over 100 years ago, so theoretical concepts and treatment methods have not been examined in the current viral outbreak context.
“However, the last pandemic hitting the United States occurred over 100 years ago. Therefore, these theoretical concepts and treatment methods have not been examined in the current context of the viral outbreak.”
The paper relies on this without support.
Understanding of health-related anxieties in young patients is limited but expanding.
“As the pre-pandemic literature review indicates, the understanding of health-related anxieties in young patients is limited but expanding.”
The paper relies on this without support.
Conceptualization of the psychological mechanisms associated with health-related anxieties is somewhat rudimentary.
“However, the conceptualization of the psychological mechanisms associated health-related anxieties is somewhat rudimentary.”
The paper relies on this without support.
The state of the science and clinical practice were somewhat caught unprepared because of the unprecedented and sudden nature of the pandemic.
“However, due to the unprecedented and sudden nature of the pandemic, the state of the science and clinical practice were somewhat caught unprepared.”
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“Clearly, IU propels worry (Dugas et al., 1998; Carleton, 2016; Osmanağaoğlu et al., 2018; Evans et al., 2020; Rifkin & Kendall, 2020b).”
BackgroundGeneralized anxiety disorder: A preliminary test of a conceptual model
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“High levels of IU are associated with rumination and catastrophizing (Read et al., 2013; Satici et al., 2020).”
BackgroundEvidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety
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BackgroundRacial and Ethnic Disparities in Pediatric Mental Health
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BackgroundThe rise of adverse childhood experiences during the COVID-19 pandemic.
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“The COVID-19 viral pandemic is a historic global health crisis that continues to wreak havoc on millions of lives.”
BackgroundInfluentialIntolerance of uncertainty and obsessive-compulsive disorder dimensions
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COVID-19 and OCD: Potential impact of exposure and response prevention therapy
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Moderators of Outcome for Youth Anxiety Treatments: Current Findings and Future Directions
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The barriers, benefits and training needs of clinicians delivering psychological therapy via video
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Commentary: Reflections on the COVID-19 Pandemic and Health Disparities in Pediatric Psychology
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Don't Think That Kids Aren't Noticing: Indirect Pathways to Children's Fear of COVID-19
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“Consequently, psychoeducational strategies are especially valuable for treating youth with pandemic-related worries because they empower pediatric patients and serve to initially modify IU (Radanovic et al, 2021).”
BackgroundPalitz, S. A., Rifkin, L. S., Norris, L. A., Knepley, M., Fleischer, N. J., Steinberg, L., & Kendall, P. C. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.102146 · Cited by 26 · see citing works
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Fear and anxiety in girls aged 7 to 11 years old and related factors during the coronavirus pandemic
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“Virtual service delivery facilitates convenience and ecological validity (Comer & Timmons, 2019).”
BackgroundReflections on Changing Times for Pediatric Integrated Primary Care During COVID-19 Pandemic
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“However, the digital divide disproportionately negatively impacts marginalized populations (Fegert et al., 2020; Stancin, 2020).”
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Self-citationHealth anxiety symptoms in children and adolescents diagnosed with OCD
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Stress and Coping in Pediatric Asthma: The Experiences of Low-SES Latinx Families
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Sorted by citations
Temsah, M.-H. A., Alenezi, S., Alarabi, M., Aljamaan, F., Alhasan, K. A., Assiri, R., Bassrawi, R. K., Alshahrani, F. S., Alhaboob, A. A. N., Alaraj, A., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19041944 · Cited by 50 · see citing works
Wang, T., Jiang, L., Li, T., Zhang, X., & Xiao, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1136084 · Cited by 48 · see citing works
Cognition and Mental Health in Pediatric Patients Following COVID-19
Avittan, H., & Kustovs, D. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20065061 · Cited by 35 · see citing works
“A diagnosis of any serious illness may elicit significant anxiety in children [36].”
BackgroundInfluentialIn their own words: Child and adolescent perceptions of caregiver stress during early COVID-19
He, Y., Ortiz, R., Kishton, R. E., Wood, J. N., Fingerman, M., Jacobs, L., & Šinko, L. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105452 · Cited by 26 · see citing works
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Bredemeier, K., Church, L. D., Bounoua, N., Feler, B., & Spielberg, J. M. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102660 · Cited by 18 · see citing works
“Indeed, the consistency of rapidly emerging findings in the past year supporting the role of IU in health anxiety during the pandemic seems to highlight the robustness of this relationship (see also Korte et al., 2021).”
Sun, C., Li, Y., Kwok, S. Y. C. L., & Mu, W. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192214924 · Cited by 22 · see citing works
Levine, R. S., Lim, R. J., & Bintliff, A. V. (2023) · Education Sciences · doi:10.3390/educsci13040411 · Cited by 17 · see citing works
Adolescent coping and social media use moderated anxiety change during the COVID‐19 pandemic
Myruski, S., Pérez‐Edgar, K. E., & Buss, K. A. (2023) · Journal of Adolescence · doi:10.1002/jad.12267 · Cited by 18 · see citing works
Iannattone, S., Spaggiari, S., Riso, D. D., & Bottesi, G. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.108 · Cited by 16 · see citing works
Frye, W. S., Feldman, M. A., Katzenstein, J. M., & Gardner, L. M. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09839-4 · Cited by 12 · see citing works
Graffeo, M. T., Albano, G., Salerno, L., Blasi, M. D., & Coco, G. L. (2022) · Psych · doi:10.3390/psych4020023 · Cited by 12 · see citing works
“Many authors suggest that the construct of IU can be explained as a transdiagnostic factor contributing to negative affects [2,47,48] and our results seem to potentially corroborate this claim.”
BackgroundResultGevers‐Montoro, C., Liew, B. X. W., Deldar, Z., Conesa‐Buendía, F. M., Ortega, A., Falla, D., & Khatibi, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-31054-4 · Cited by 12 · see citing works
The mental condition of Polish adolescents during the COVID-19 pandemic and war in Ukraine
Wójtowicz-Dacka, M., Grzankowska, I., & Deja, M. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1257384 · Cited by 10 · see citing works
The role of personal identity as a resource for college students during COVID-19
Schwartz, S. J., Ertanir, B., Harkness, A., Zamboanga, B. L., Bessaha, M. L., Bartholomew, J. B., Meca, A., Michikyan, M., Duque, M., Montero‐Zamora, P., et al. (2023) · Journal of American College Health · doi:10.1080/07448481.2023.2214244 · Cited by 12 · see citing works
Effects of COVID-19 on School Nurse Mental Health Intervention Practices
Hoskote, A. R., Rolin, D. G., Rew, L., & Johnson, K. E. (2023) · The Journal of School Nursing · doi:10.1177/10598405231172758 · Cited by 8 · see citing works
“Similar to the qualitative fi ndings of Lee et al. (2021) in which they describe school nurses “ navigating the school through the pandemic ” (p. 404), school nurses in our study reported an increased leadership role during the pandemic and also served as role models and provided guidance in their…”
Wang, S., Chu, Y., & Dai, H. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1015433 · Cited by 8 · see citing works
“Individuals are unable to live a normal life in this special period and would frequently experience intolerance of uncertainty and impermanence (Korte et al., 2022).”
BackgroundNavigating Identity Uncertainty: Identity Distress During the COVID-19 Pandemic
Meca, A., Allison, K. K., Passini, J., Veniegas, T. K., Cruz, B., Castillo, L. G., Schwartz, S. J., Zamboanga, B. L., Michikyan, M., Bessaha, M. L., et al. (2023) · Emerging Adulthood · doi:10.1177/21676968231203031 · Cited by 7 · see citing works
“…have had a profound impact on the lives of college-attending emerging adults (Regan et al., 2023; Tasso et al., 2021), resulting in unprecedented uncertainty, anxiety, and worries tied to COVID-19 that negatively impacted young people ’ s mental health and future plans (Korte et al., 2022).”
BackgroundResultInfluentialFriedberg, R. D., Thomas, J., Tiller-Ormord, J., Korte, C., Brown, K., Mendez, E., Mohavedi, Y., & Zelcer, H. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231156346 · Cited by 7 · see citing works
“The current data is consistent with previous literature asserting that youth who are excessively intolerant of uncertainty are much more likely to develop maladaptive coping strategies (Haig-Ferguson et al., 2020; Korte et al., 2022).”
Self-citationMatsopoulos, A., & Theron, L. C. (2023) · School Psychology International · doi:10.1177/01430343231151591 · Cited by 6 · see citing works
“…to how gender, developmental stage, and situational/cultural context play into student resilience, practitioners, need to distinguish between the levels of risk (high, medium, or low) that students are exposed to and tailor interventions to students’ unique needs (Korte et al., 2021; Ungar, 2019).”
BackgroundWang, S., Zhang, Y., Zhang, Y., & Sun, Y. (2024) · Current Psychology · doi:10.1007/s12144-024-05655-9 · Cited by 7 · see citing works
“It is also associated with various types of anxious psychological problems, such as social anxiety, health anxiety, and test anxiety, even among normal individuals (Gillett et al., 2018; Korte et al., 2022).”
Malerba, A., Iannattone, S., Casano, G., Lauriola, M., & Bottesi, G. (2022) · Children · doi:10.3390/children9111631 · Cited by 7 · see citing works
“Extant research has chiefly examined the role of IU in buffering health-related anxiety in adults during COVID-19 [32], while, to our knowledge, no study has yet tapped into the relationship between adolescent IU and internalizing symptoms during this pandemic.”
BackgroundSarbazi, E., Masoudi, N., Mehri, A., Esfanjani, R. M., Azizi, H., Soleimanpour, M., Pouraghaei, M., & Soleimanpour, H. (2024) · BMC Pediatrics · doi:10.1186/s12887-024-04816-w · Cited by 5 · see citing works
“…contribute to parental hesitancy in accepting COVID-19 vaccines for their children, including safety [30], effectiveness [30], lack of long-term data [31], risk–benefit analysis [32], trust in the healthcare system [33], fear of unknown consequences [34], and personal beliefs and values [35].”
BackgroundThe inflexible mind: A critical factor in understanding and addressing COVID-19 vaccine hesitancy
Pellegrini, L., Clarke, A., Fineberg, N. A., & Laws, K. R. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.09.028 · Cited by 6 · see citing works
Anxiety in Early Adolescents During the Covid-19 Pandemic
Dorčić, T. M., Živčić–Bećirević, I., & Smojver‐Ažić, S. (2023) · European Journal of Psychology Open · doi:10.1024/2673-8627/a000035 · Cited by 5 · see citing works
Friedberg, R. D., Neelley, M., Zucker, J., Hanna, A., Mendelsohn, A., Greenberger, A., & Dunevich, N. (2024) · Journal of Exploratory Research in Pharmacology · doi:10.14218/jerp.2023.00008 · Cited by 3 · see citing works
Self-citationA Toolbox for Use During the Post-Pandemic Era: Preparing Youth for Re-entry
Barnowski, A., Brown, K., Movahedi, Y., & Friedberg, R. D. (2024) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-023-09599-2 · Cited by 2 · see citing works
Self-citationGhouri, M. W. A., Wang, G., Hussain, M. A., Li, Z., & Chin, T. (2024) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2024.044759 · Cited by 2 · see citing works
Forte, G., Favieri, F., Corbo, I., Troisi, G., Marselli, G., Blasutto, B., Ponce, R., Pace, E. D., Langher, V., Tambelli, R., et al. (2024) · Brain Sciences · doi:10.3390/brainsci14070711 · Cited by 2 · see citing works
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“The pandemic was so novel that people even experts had no experience with it [43].”
BackgroundElgendi, M. M., Stewart, S. H., Sherry, S., & Deacon, S. H. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122168
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Multimodal assessment of the role of intolerance of uncertainty in fear acquisition and extinction
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INTOLERANCE OF UNCERTAINTY AND WORRY DURING THE COVID-19 PANDEMIC
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“…found that increased social isolation, loneliness, family stress and the loss of loved ones brought on by the pandemic contributed to significant anxiety and depressive symptoms among students and instructors (Bryant, Oo, and Damian 2020; Korte et al. 2022; Meade 2021; Walcott and Chambers 2022).”
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“Individuals find it difficult to function in uncertain situations (Korte, 2022).”
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“Moreover, adolescents with high intolerance of uncertainty often overemphasize worrying as a problem-solving strategy (Korte et al., 2021 ), potentially impacting their flexible thinking abilities.”
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- Authors
- Korte, C., Friedberg, R. D., Wilgenbusch, T., Paternostro, J. K., Brown, K., Kakolu, A., Tiller-Ormord, J., Baweja, R., Cassar, M., Barnowski, A., Movahedi, Y., Kohl, K., Martinez, W., Trafalis, S., & Leykin, Y.
- Affiliations
- Palo Alto University (US)
- University of Iowa (US)
- Pennsylvania State University (US)
- Corresponding author
- Friedberg, Robert D.
- ORCID
- Venue
- Journal of Clinical Psychology in Medical Settings
- Published
- 2021-09-03
- Volume
- 29
- Issue
- 3
- Pages
- 645-653
- ISSN
- 1068-9583 (ISSN-L)
- 1573-3572
- PMC
- PMC8414950
- OpenAlex
- W3198672189
- Cited by
- 54
- References
- 80
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 12 · 2023: 19 · 2022: 9 · 2021: 2
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Clinical Psychology in Medical Settings (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- intolerance of uncertainty, youth, children, anxiety, stress, child mental health
- MeSH terms
- COVID-19, Adolescent, Anxiety, Anxiety Disorders, Child, Humans, Uncertainty, Pandemics
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