Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Overall r = 0.47 (medium-large effect); r = 0.37 with child-friendly measures

• Primary Outcome: Association between intolerance of uncertainty and depression symptoms

• Nnt Or Sensitivity: Inhibitory IU subscale showed stronger association with depression than prospective IU

• Confidence Interval: Not reported in abstract

Clinical Application

IU assessment could be incorporated into routine youth mental health screening, though requires age-appropriate measurement tools Relevant to RACGP guidelines on youth depression screening and early intervention programs. Could inform headspace and school-based mental health initiatives across Australia Children and adolescents in general population settings, applicable to Australian primary care and school-based mental health programs

Abstract

BACKGROUND: Intolerance of uncertainty (IU) is a development and maintenance factor for depression and anxiety. Previous reviews found that it associated with anxiety in children and adolescents. However, there was insufficient evidence at the time to review its association with depression in this population. METHOD: 20 studies investigating the relationship between IU and depression in children and adolescents were identified. Random effects meta-analysis was used to aggregate cross-sectional associations, with age, gender, and measure as moderators. A narrative review of longitudinal findings from relevant studies (K = 6) was also conducted. RESULTS: Meta-analysis of cross-sectional associations found an overall effect size of r = 0.47. There was limited evidence that age or gender moderated the effect, however there was a significant moderating effect of measure. Namely, when including studies using 'child-friendly' measures (i.e., developed and normed with children as opposed to adults), the effect size was r = 0.37. Another analysis revealed that the inhibitory IU subscale was more strongly associated with depression than prospective IU. Longitudinal findings suggested that the association between IU and depression persists over time. LIMITATIONS: Studies were limited to those published in English and including general population samples (e.g., typically developing, without significant medical needs). CONCLUSIONS: There is a medium-strong association between IU and depression symptoms in children and adolescents. However, it may be overestimated by the use of IU measures that are not child-friendly. Future research can further extend the evidence-base through careful measure selection, as well as longitudinal and experimental designs.

References

1. 1.Mares, L., & Fuller, M. (2026). Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis. Journal of Affective Disorders, 121288. https://doi.org/10.1016/j.jad.2026.121288