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Cited by 22Maternal Mental Health During Pregnancy and PostpartumCOVID-19 and Mental HealthMindfulness and Compassion Interventions

The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19

Open access
Sbrilli, Marissa D., Haigler, Katherine, Laurent, Heidemarie K.·2021·Mindfulness
DOI 10.1007/s12671-021-01657-xPMC PMC8171361
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Abstract

Objectives: The COVID-19 pandemic is associated with mental health difficulties, especially during pregnancy and early postpartum. Intolerance of uncertainty (IU) and reduced capacity for mindfulness—a protective factor for child-bearers—may be particularly relevant factors driving mental health problems given the unpredictable nature of the pandemic. The current study aims to shed light on modifiable paths to perinatal psychological distress by testing whether there is an indirect effect of IU on psychological symptoms through a perceived reduction in mindfulness during the pandemic. Methods: Pregnant individuals (67%, n = 133) and new mothers within 6 months postpartum (33%, n = 66) participated in a cross-sectional online survey assessing IU, current and retrospective pre-pandemic mindfulness (FFMQ), and psychological symptoms (anxiety, depression, somatization; BSI). Perceived change in mindfulness was captured by including retrospective mindfulness as a covariate in the PROCESS macro used for analyses. Results: Tests of the direct association between mindfulness, IU, and psychological symptoms showed significant effects of IU (b = 0.46, SE = 0.064; p <.001) and perceived decrease in mindfulness during the pandemic (b = − 0.72, SE = 0.08, p <.001) on psychological symptoms (R2 =.21–.34; F[2, 197] = 51.13–52.81, p <.001). The indirect effect of IU on symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043, 95%CI [.060,.226]) was significant (R2 =.41, F[3, 195] = 45.08, p <.001). Conclusions: Results suggest that mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to perceived reduction in mindfulness during the pandemic. Future research should examine whether IU is a screening risk marker and target for mindfulness-based interventions to improve maternal well-being and family outcomes. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Integrity signals

Registry

Crossref · 10.1007/s12671-021-01657-x

Cites

84 of 84 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 24 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The COVID-19 pandemic is linked to mental health problems, particularly in pregnancy and the early postpartum period.

    “The COVID-19 pandemic is associated with mental health difficulties, especially during pregnancy and early postpartum.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites American Psychological Association, 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Ceulemans et al., 2020 source
    • cites Lebel et al., 2020 source

      The Conclusions report elevated anxiety and depression symptoms among pregnant individuals during the COVID-19 pandemic. The Discussion mentions postpartum depression only as a potential consequence of prenatal distress; the study does not establish mental health difficulties during the early postpartum period. Page numbers are unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    In the full model, IU had a significant direct effect on symptoms (b = 0.29, SE = 0.063; 95% CI [0.16, 0.41]).

    “The full model revealed a significant, though smaller, direct effect IU (b = 0.29, SE = 0.063; 95% CI [0.16, 0.41]) on symptoms along with a significant indirect effect via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043; 95% CI [0.060, 0.226]).”
    Quote in the paperSubstantial claim
  • Findingown data

    The indirect effect of IU on symptoms was significant through the acting with awareness facet (b = 0.07, SE = 0.030; 95% CI [0.023, 0.141]).

    “The indirect effect of IU on symptoms was significant through three subscales: acting with awareness (b = 0.07, SE = 0.030; 95% CI [0.023, 0.141]), nonreactivity (b = 0.07, SE = 0.036; 95% CI [0.01, 0.15]), and describing (b = 0.07, SE = 0.032; 95% CI [0.01 to 0.14])”
    Quote in the paperSubstantial claim
  • Findingown data

    With depression as the outcome, IU had a significant direct effect on depression symptoms (b = 0.28, SE = 0.064; 95% CI [0.15, 0.40]).

    “With depression as an outcome, a significant direct effect of IU (b = 0.28, SE = 0.064; 95% CI [0.15, 0.40]) on depression symptoms was found in addition to a significant indirect effect via decreased pandemic FFMQ ratings (b = 0.13, SE = 0.04; 95% CI [0.061, 0.220]; R2 = 0.38; F[3, 195] = 39.98, p < 0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    IU had a significant indirect effect on psychological symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043; 95% CI [.060, .226]).

    “The indirect effect of IU on symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043, 95%CI [.060, .226]) was significant (R2 = .41, F[3, 195] = 45.08, p < .001).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 12

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Meta-analytic evidence supports the effectiveness of online mindfulness-based interventions for mental health.

    “meta-analytic evidence supports the effectiveness of online mindfulness-based interventions for mental health (Spijkerman et al., 2016).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Spijkerman et al., 2016 source

  • May combine two claims.

    Premisecitation

    During the perinatal period, high IU in pregnancy is associated with pregnancy-related anxiety, predicts increased postpartum psychological symptoms, and is implicated in parent-infant transmission of mental illness.

    “During the perinatal period, IU may be a particularly salient familial risk factor as evidence suggests that high IU in pregnancy is associated with pregnancy-related anxiety (Treleaven, 2020), predicts increased psychological symptoms postpartum (Furtado et al., 2019), and is implicated in parent–infant transmission of mental illness as a cognitive bias learned nonverbally through social Referenc”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Treleaven, 2020
    • cites Furtado et al., 2019 source
    • cites Aktar et al., 2017 source

      The 'Nonspecific pathways' section describes social referencing as nonverbal learning from parents’ anxious reactions and links it to infants’ fear and avoidance. The 'Specific pathways' section proposes that parents may model intolerance of uncertainty, but says its parent-to-child transmission remains to be investigated. The paper does not establish that infants learn intolerance of uncertainty nonverbally or that this process transmits mental illness. The pregnancy and postpartum findings are attributed to other citations in the sentence. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In COVID-19, IU has shown indirect effects on distress through avoidant, maladaptive coping.

    “Specifically in COVID-19, IU has similarly shown indirect effects on distress through avoidant, maladaptive coping (e.g., self-distraction; Rettie & Daniels, 2020).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Rettie & Daniels, 2020 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    IU is strongly implicated in the etiology of generalized anxiety disorder and is a transdiagnostic risk and maintenance factor across mental health concerns and an intervention target.

    “IU is strongly implicated in the etiology of generalized anxiety disorder (GAD; Dugas et al., 1998), but more recently has been included in transdiagnostic models as a central risk and maintenance factor across mental health concerns and an important transdiagnostic intervention target (Boswell et al., 2013; Carleton, 2016; Einstein, 2014; McEvoy & Mahoney, 2012) in COVID-19 (Freeston et al., 2020”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Dugas et al., 1998 source
    • cites Boswell et al., 2013 source

      The Abstract Results and Discussion (page not provided) report that IU was associated with symptoms across diagnostic categories, decreased during transdiagnostic treatment, and may be a shared factor in emotional disorders. The paper does not establish IU as a central risk and maintenance factor across mental health concerns generally; its Discussion calls for further research on IU’s role in etiology and maintenance. The GAD-etiology clause is attributed to Dugas et al., not Boswell et al. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Carleton, 2016 source

  • May combine two claims.

    Premisecitation

    IU is associated with lower mindfulness and higher psychological symptoms in undergraduate samples.

    “In undergraduate samples, IU has been shown to relate to both lower mindfulness and higher psychological symptoms, in particular anxiety symptoms such as worry (Kraemer et al., 2016; Papenfuss et al., 2021).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Kraemer et al., 2016 source
    • cites Papenfuss et al., 2021 source

  • May combine two claims.

    Premisecitation

    Mindfulness-based interventions affect processes by which IU leads to distress by decreasing worry and rumination, increasing distress tolerance, and fostering acceptance and nonreactivity.

    “Mindfulness-based interventions have further been shown to impact processes by which IU leads to distress—that is, by decreasing worry and rumination (Deyo et al., 2009; Ma & Teasdale, 2004), increasing distress tolerance (Lotan et al., 2013), and fostering acceptance and nonreactivity in the face of negative situations and emotions (Lindsay, Chin, et al., 2018; Lindsay, Young, et al., 2018).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Deyo et al., 2009 source
    • cites Ma & Teasdale, 2004 source
    • cites Lotan et al., 2013 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A post hoc power analysis indicated adequate power (0.847) to detect indirect effects.

    “A post hoc power analysis conducted using MedPower (Kenny, 2017) based on the sample size of 199, effects for each path, and an alpha of 0.05 indicated adequate power (0.847) to detect indirect effects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kenny, 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductreasoning

    The cross-sectional design restricted the ability to infer causal relationships, measure change over time, and draw conclusions for clinical use.

    “These limitations restricted our ability to infer causal relationships, measure change over time, and draw conclusions that could inform clinical use on the basis of the current findings.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent work suggests that the effects of COVID-19 concerns on psychological symptoms in the general population may be mediated by reduced mindfulness.

    “Recent work suggests that the effects of COVID-19 concerns on psychological symptoms in the general population may be mediated by reduced mindfulness (Belen, 2021).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Belen, 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Mothers who are less able to tolerate uncertainty experience more psychological symptoms, partly because of a perceived reduction in mindfulness during the pandemic.

    “Results suggest that mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to perceived reduction in mindfulness during the pandemic.”
    • Also stated in: § Discussion · hedged
      “In line with indications from previous research outside a pandemic and/or perinatal context (Nekić & Mamić, 2019), these results suggest mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to a sense of diminished mindfulness during the pandemic.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    As a result, mothers may perceive aversive emotional states as less threatening and more bearable, interrupting the cycle of worry, rumination, and prolonged negative affect that maintain anxiety and depression symptoms.

    “As a result, they may perceive these aversive emotional states as less threatening and more bearable, interrupting the cycle of worry, rumination, and prolonged negative affect that maintain both anxiety and depression symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    IU may make it harder to use adaptive coping or emotion regulation strategies such as mindfulness, thereby increasing sensitivity to stress and likelihood of distress in an uncertain climate.

    “IU may make it more difficult to engage in adaptive coping/emotion regulation strategies such as mindfulness, thereby increasing sensitivity to stress and likelihood of distress in a climate of uncertainty.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Mothers who can tolerate uncertainty may have greater access to mindfulness as an emotion regulation strategy in unpredictable circumstances, helping them view negative emotional reactions from a decentered, accepting, nonreactive perspective.

    “suggesting that mothers who are able to tolerate uncertainty may have more access to mindfulness as an emotion regulation strategy in the face of unpredictable and potentially overwhelming circumstances, helping them to view negative emotional reactions from a decentered, accepting, and nonreactive perspective.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    IU is a modifiable risk factor for parental distress during the pandemic, and mindfulness is a mechanism that could be targeted to improve family outcomes.

    “This finding points to IU as a modifiable risk factor for parental distress in the face of the pandemic and mindfulness as a mechanism that could be targeted to improve family outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The sample was relatively privileged and homogenous in race, socioeconomic status, and education, which may limit generalizability.

    “Second, our sample was relatively privileged and homogenous in race, socioeconomic status, and education.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Meta-analyses suggest repetitive negative thinking may be a shared mechanism underlying the relationship between IU and anxiety and depression.

    “Meta-analyses suggest that repetitive negative thinking (worry and rumination) may be a shared mechanism underlying the relationship between IU and anxiety and depression (Gentes & Ruscio, 2011; McEvoy et al., 2019).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Gentes & Ruscio, 2011 source
    • cites McEvoy et al., 2019 source

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisereasoning

    Intolerance of uncertainty and reduced mindfulness capacity are relevant factors that may drive mental health problems during the pandemic's unpredictability.

    “Intolerance of uncertainty (IU) and reduced capacity for mindfulness—a protective factor for child-bearers—may be particularly relevant factors driving mental health problems given the unpredictable nature of the pandemic.”
    Quote in the paperNot a substantial claim
17 of 17

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract says F[2, 197] for the direct model but elsewhere F[1, 201]

    Minor

    The abstract describes the direct association model as using F[2, 197], while the Results section states the total effect of IU was tested with F[1, 201]. These are different degrees of freedom for what is presented as the same total-effect model.

  • Abstract assigns the wrong degrees of freedom to one F statistic

    Minor

    The abstract places 52.81 in a range labeled F[2, 197], but the detailed results report 52.81 as F[1, 201].

  • IU total-effect test implies a larger sample than reported

    Minor

    The paper reports 199 participants, but F[1, 201] implies 203 observations in a regression with one predictor. The stated sample size cannot produce those degrees of freedom.

  • Mindfulness test implies 200 observations

    Minor

    F[2, 197] implies 200 observations in a regression with two predictors, whereas the reported study sample contains 199 participants.

4 of 4

Cites

Flagged first, then by citations

5 of the 89 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. American Psychological Association. (2020). Stress in AmericaTM 2020: Stress in the Time of COVID-19 (Vol. 1). https://www.apa.org/news/press/releases/stress/2020/stress-in-america-covid.pdf
  2. Shaddix, C. (2014). An interpretative phenomenological study of the experience of parents who attended a mindfulness-based childbirth and parenting program [Unpublished doctoral dissertation]. The Wright Institute.

Cited by

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Related

Authors
Sbrilli, M. D., Haigler, K., & Laurent, H. K.
Affiliations
University of Illinois Urbana-Champaign (US)
Corresponding author
Sbrilli, Marissa D.
ORCID
Venue
Mindfulness
Publisher
Springer Science and Business Media LLC
Published
2021-06-02
Volume
12
Issue
8
Pages
1999-2008
ISSN
  • 1868-8527 (ISSN-L)
  • 1868-8535
DOI
10.1007/s12671-021-01657-x
PMC
PMC8171361
OpenAlex
W3170493289
Cited by
19
References
89
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 2 · 2021: 2
FWCI
3.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Mindfulness (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
intolerance of uncertainty, perinatal mental health, COVID-19 pandemic, maternal anxiety, maternal depression, somatization, pregnancy, postpartum period, indirect effects, maternal well-being

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