The first Brazilian diagnosed with COVID-19 was identified on February 25th, resulting in a series of governmental actions to prepare the population for the effects of the pandemic. Nevertheless, geographic and socioeconomic characteristics of the country, and the strategies adopted may have contributed to generating a widespread feeling of uncertainty in the population; uncertainty about the disease, how to prevent it, its severity, and its impact on political and economic issues. This study was designed to investigate the relationship between intol­erance of uncertainty and common mental health disorders. Participants were contacted via social media messages and encouraged to fill out an online questionnaire with socioeconomic questions, a short measure of intol­erance of uncertainty (IUS-12), and a measure of mental health indicator (DASS-21). With a sample of 924 participants from Sergipe, Brazil, three binomial logistic regressions were performed, one for each DASS-21 outcome, categorized by a median. The women in the sample showed a higher probability of having stress, anxiety and depression scores above the median. Over the entire sample, both subscales of IUS-12 were significantly and positively related to all three DASS-21 subscales. These findings are discussed in the context of mental health during a pandemic, and future directions for research are also presented.

Keywords:
Intolerance of uncertainty, depression, anxiety, stress, COVID-19, pandemic

Apóstolo, J. L. A., Mendes, A. C., & Azeredo, Z. A. (2006). Adaptação para a língua portuguesa da Depression, Anxiety and Stress Scale (DASS). Revista Latino Americana de Enfermagem, 14(6), 863–871.

Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The Fear of COVID-19 Scale: Development and Initial Validation. International Journal of Mental Health and Addiction, 1–9. Advance online publication. https://doi.org/10.1007/s11469-020-00270-8

Baillon, A., Cabantous, L., & Wakker, P. (2012). Aggregating imprecise or conflicting beliefs: An experimental investigation using modern ambiguity theories. Journal of Risk and Uncertainty, 44, 115–147. https://doi.org/10.1007/s11166-012-9140-x

Bakioğlu, F., Korkmaz, O., Ercan, H. (2020). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-020-00331-y

Berenbaum, H., Bredemeier, K., & Thompson, R. J. (2008). Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. Journal of Anxiety Disorders, 22(1), 117–125. https://doi.org/10.1016/j.janxdis.2007.01.004

Bottesi, G., Noventa, S., Freeston, M. H., & Ghisi, M. (2019). Seeking certainty about intolerance of uncertainty: Addressing old and new issues through the Intolerance of Uncertainty Scale – revised. PLOS ONE, 14(2), e0211929. https://doi.org/10.1371/journal.pone.0211929

BRASIL (2018). Estatísticas de gênero: Indicadores sociais das mulheres no Brasil. (Estudos e pesquisa, informação demográfica e socioeconômica, n.38). Brasília: Instituto Brasileiro de Geografia e Estatística. Retrieved from https://biblioteca.ibge.gov.br/visualizacao/livros/liv101551_informativo.pdf in June, 15.

Carleton, R. N., Collimore, K. C., & Asmundson, G. J. G. (2010). “It’s not just the judgements—It’s that I don’t know”: Intolerance of uncertainty as a predictor of social anxiety. Journal of Anxiety Disorders, 24(2), 189–195. https://doi.org/10.1016/j.janxdis.2009.10.007

Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117. https://doi.org/10.1016/j.janxdis.2006.03.014

Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007

Croda, J. H. R., & Garcia, L. P. (2020). Resposta imediata da vigilância em saúde à epidemia da COVID-19. Epidemiologia e Serviços de Saúde, 29(1), e2020002. https://doi.org/10.5123/S1679-49742020000100021

Croda, J. O., Wanderson K., Frutuoso, R. L., Mandetta, L. H., Baia-da-Silva, D. C., Brito-Sousa, J. D., Monteiro, W. M., & Lacerda, M. V. G. (2020). COVID-19 in Brazil: advantages of a socialized unified health system and preparation to contain cases. Revista da Sociedade Brasileira de Medicina Tropical, 53, e20200167. Epub April 17, 2020. https://dx.doi.org/10.1590/0037-8682-0167-2020

De Groot, K., & Thurik, R. (2018). Disentangling risk and uncertainty: When risk-taking measures are not about risk. Frontiers in Psychology, 9(Article 2194). https://doi.org/10.3389/fpsyg.2018.02194

Decreto 40560 de 16 de março, Pub. L. No. Diário Oficial do Estado de Sergipe (2020). https://segrase.se.gov.br/ver-flip/3350/#/e:3350/p:1?find=coronavirus

Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research, 25(5), 551–558. https://doi.org/10.1023/A:1005553414688

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226. https://doi.org/10.1016/S0005-7967(97)00070-3

Elledge, B. L., Brand, M., Regens, J. L., & Boatright, D. T. (2008). Implications of public understanding of avian influenza for fostering effective risk communication. Health Promotion Practice, 9(4_suppl), 54S-59S. https://doi.org/10.1177/1524839908319089

Field, A. (2009).  Discovering Statistics Using SPSS. 3rd Edition, Sage Publications Ltd., London.

Flint, A. J., Peasley-Miklus, C., Papademetriou, E., Meyers, B. S., Mulsant, B. H., Rothschild, A. J., Whyte, E. M., & STOP-PD Study Group (2010). Effect of age on the frequency of anxiety disorders in major depression with psychotic features. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 18(5), 404–412. https://doi.org/10.1097/jgp.0b013e3181c294ac

Gardner, P. J., & Moallef, P. (2015). Psychological impact on SARS survivors: Critical review of the English language literature. Canadian Psychology/Psychologie canadienne, 56(1), 123-135. http://dx.doi.org/10.1037/a0037973

Gomes, L. A. de V., Mello, A. M. de, & Rodrigues, A. C. de A. (2020). Vencendo as incertezas para superar a pandemia do vírus. Jornal Da USP. https://jornal.usp.br/?p=312817

Gosselin, P., Ladouceur, R., Evers, A., Laverdière, A., Routhier, S., & Tremblay-Picard, M. (2008). Evaluation of intolerance of uncertainty: Development and validation of a new self-report measure. Journal of Anxiety Disorders, 22(8), 1427–1439. https://doi.org/10.1016/j.janxdis.2008.02.005

Greco, V., & Roger, D. (2001). Coping with uncertainty: The construction and validation of a new measure. Personality and Individual Differences, 31(4), 519–534. https://doi.org/10.1016/S0191-8869(00)00156-2

Greco, V., & Roger, D. (2003). Uncertainty, stress, and health. Personality and Individual Differences, 34(6), 1057–1068. https://doi.org/10.1016/S0191-8869(02)00091-0

Hong, R. Y., & Lee, S. S. M. (2015). Further clarifying prospective and inhibitory intolerance of uncertainty: Factorial and construct validity of test scores from the Intolerance of Uncertainty Scale. Psychological Assessment, 27(2), 605–620. https://doi.org/10.1037/pas0000074

Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006). A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 20(2), 158–174. https://doi.org/10.1016/j.janxdis.2005.01.002

Huang, Y., & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Research, 288, 112954. https://doi.org/10.1016/j.psychres.2020.112954

Jiang, F., Deng, L., Liangqing, Z., Yin, C., Chi Wai, C., & Zhengyuan, X. (2020). Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). Journal of General Internal Medicine, 35, 1545-1549. https://doi.org/10.1007/s11606-020-05762-w

Knight, F. H. (1921). Risk, Uncertainty and Profit. Sentry Press.

Kretzmann, R. P. (2018). Intolerance of Uncertainty Scale (IUS-12) para uso no Brasil: Adaptação Transcultural e Propriedades Psicométricas (Issue 2) [(dissertação de mestrado) Universidade Federal do Rio Grande do Sul].

Kuehner, C. (2017). Why is depression more common among women than among men? The Lancet Psychiatry, 4(2), 146–158. https://doi.org/10.1016/S2215-0366(16)30263-2

Lipsitch, M., Phil, D., Swerdlow, D. L., & Finelli, L. (2020). Defining the epidemiology of Covid-19 – studies needed. The New England Journal of Medicine, 1–3.

Liu, C. H., Zhang, E., Wong, G. T. F., Hyun, S., & Hahm, H. “Chris.” (2020). Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health. Psychiatry Research, 290(May). https://doi.org/10.1016/j.psychres.2020.113172

McEvoy, P. M., & Erceg-Hurn, D. M. (2016). The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty. Journal of Anxiety Disorders, 41, 96–107. https://doi.org/10.1016/j.janxdis.2016.02.002

McEvoy, P. M., & Mahoney, A. E. J. (2011). Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. Journal of Anxiety Disorders, 25, 112–122. https://doi.org/10.1016/j.janxdis.2010.08.010

Novais, A., Monteiro, S., Roque, S., Correia-Neves, M., & Sousa, N. (2016). How age, sex and genotype shape the stress response. Neurobiology of Stress, 6, 44–56. https://doi.org/10.1016/j.ynstr.2016.11.004

Oliveira, W. K. de, Duarte, E., França, G. V. A. de, & Garcia, L. P. (2020). Como o Brasil pode deter a COVID-19. Epidemiologia e Serviços de Saúde, 29(2), e2020044. https://doi.org/10.5123/S1679-49742020000200023

Orth, U., & Robins, R. W. (2014). The development of self-esteem. Current Directions in Psychological Science, 23(5), 381–387. https://doi.org/10.1177/0963721414547414

Phua, J., Weng, L., Ling, L., Egi, M., Lim, C.-M., Divatia, J. V.,… Du, B. (2020). Intensive care management of coronavirus disease 2019 (COVID-19): Challenges and recommendations. The Lancet Respiratory Medicine, 8(5), 506–517. https://doi.org/10.1016/S2213-2600(20)30161-2

Rincón-Cortés, M., Herman, J. P., Lupien, S., Maguire, J., & Shansky, R. M. (2019). Stress: Influence of sex, reproductive status and gender. Neurobiology of Stress, 10, 100155. https://doi.org/10.1016/j.ynstr.2019.100155

Roma, V. G., & Hope, D. A. (2017). Are we certain about which measure of intolerance of uncertainty to use yet? Cognitive Behaviour Therapy, 46(4), 327–338. https://doi.org/10.1080/16506073.2016.1252792

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102

Satici, B., Saricali, M., Satici, S.A., Griffiths, M.D. (2020). Intolerance of uncertainty and mental wellbeing: Serial mediation by rumination and fear of COVID-19. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-020-00305-0

Slovic, P. (2010). The psychology of risk. Saúde e Sociedade, 19(4), 731-747. https://dx.doi.org/10.1590/S0104-12902010000400002

Taha, S., Matheson, K., Cronin, T., & Anisman, H. (2014). Intolerance of Uncertainty, appraisals, coping, and anxiety: The case of the 2009 H1N1 pandemic. British Journal of Health Psychology, 19(3), 592–605. https://doi.org/10.1111/bjhp.12058

Tavares Lima, C. K., de Medeiros Carvalho, P. M., Silva Lima, I. A. A., de Oliveira Nunes, J. V. A., Saraiva, J. S., de Souza, R. I.,…Rolim Neto, M. L. (2020). The emotional impact of coronavirus 2019-nCoV (new coronavirus disease). Psychiatry Research, 287, 112915. https://doi.org/10.1016/j.psychres.2020.112915

Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph S., Weich, S.,…Stewart-Brown, S.  (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes 5, 63. https://doi.org/10.1186/1477-7525-5-63

Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of Uncertainty in obsessive–compulsive disorder. Journal of Anxiety Disorders, 17, 233-242.

Vignola, R. C. B., & Tucci, A. M. (2014). Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese. Journal of Affective Disorders, 155(1), 104–109. https://doi.org/10.1016/j.jad.2013.10.031

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S.,…Ho, R. C.  (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17, 17– 29. https://doi.org/10.3390/ijerph17051729

World Health Organization. Coronavirus disease (COVID-19): Situation report—126. Accessed May 30, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200525-covid-19-sitrep-126.pdf?sfvrsn=887dbd66_2

Xiang, Y., Yang, Y., Li, W., Zhang, L., Zhang, Q., Cheung, T., & Ng, C. H. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry, 7(3), 228–229. https://doi.org/10.1016/S2215-0366(20)30046-8