Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies

Autoři: Vivian Huang aff001;  Mabel Yu aff002;  R. Nicholas Carleton aff002;  Shadi Beshai aff002
Působiště autorů: Department of Psychology, Ryerson University, Toronto, Ontario, Canada aff001;  Department of Psychology, University of Regina, Regina, Saskatchewan, Canada aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224865


The current study replicated and extended previous studies by examining the mediating and moderating role of rumination in the relationship between intolerance of uncertainty (IU) and depression in a community sample using both cross-sectional (n = 494; 56.9% female) and a two-months longitudinal (n = 321; 48.4% female) designs. Participants in each study were recruited through online crowdsourcing websites and completed study questionnaires. Results from Study 1 suggested that, while rumination did not appear to moderate the relationship between IU and depression, rumination appeared to partially mediates such relationship. Results from Study 2 supported rumination as fully mediating the relationship between IU and depression over two months. The brooding and reflection rumination subtypes exerted a significant indirect, but not moderating, effect on the relationship between IU and depression. Brooding exhibited a stronger mediation effect than did reflection. Overall, current results suggest that high levels of IU fuel the development of depression symptoms over time through engagement in heightened rumination. The IU-depression association appeared fully explained through rumination as it is a passive and contextually-dependent coping response that may enhance individuals’ emotion and facilitate the development of depressive symptoms.

Klíčová slova:

Anxiety – Cross-sectional studies – Depression – Emotions – Longitudinal studies – Questionnaires – Reflection – Undergraduates


1. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119–38. doi: 10.1146/annurev-publhealth-031912-114409 23514317

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Publication; 2013.

3. Friedrich MJ. Depression is the leading cause of disability around the world. J Am Med Assoc. 2017;15:1517.

4. Hong RY. From dispositional traits to psychopathological symptoms: Social-cognitive vulnerabilities as intervening mechanisms. J Psychopathol Behav Assess. 2013;35(4):407–20.

5. Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100(4):569–82. doi: 10.1037//0021-843x.100.4.569 1757671

6. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 2008;3(5):400–24. doi: 10.1111/j.1745-6924.2008.00088.x 26158958

7. Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504–11. 11016119

8. Abela JRZ, Hankin BL. Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study. J Abnorm Psychol. 2011;120(2):259–71. doi: 10.1037/a0022796 21553940

9. Lyubomirsky S, Nolen-Hoeksema S. Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995;69(1):176–90. doi: 10.1037//0022-3514.69.1.176 7643299

10. Watkins E, Brown RG. Rumination and executive function in depression: an experimental study. J Neurol Neurosurg Psychiatry [Internet]. 2002;72(3):400–2. 11861707

11. Watkins E, Teasdale JD. Rumination and overgeneral memory in depression: effects of self-focus and analytic thinking. J Abnorm Psychol. 2004;110(2):353–7.

12. Lyubomirsky S, Tkach C. The consequences of dysphoric rumination. In: Papageorgious C, Wells A, editors. Rumination: Nature, theory, and treatment of negative thinking in depression. Chichester, England: John Wiley & Sons; 2003. p. 21–41.

13. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev [Internet]. 2010;30(2):217–37. 20015584

14. Dickson KS, Ciesla JA, Reilly LC. Rumination, Worry, Cognitive Avoidance, and Behavioral Avoidance: Examination of Temporal Effects. Behav Ther [Internet]. 2012;43(3):629–40. 22697450

15. Lyubomirsky S, Nolen-Hoeksema S. Self-perpetuating properties of dysphoric rumination. J Pers Soc Psychol. 1993;65(2):339–49. doi: 10.1037//0022-3514.65.2.339 8366423

16. Bagby RM, Parker JD. Relation of rumination and distraction with neuroticism and extraversion in a sample of patients with major depression. Cognit Ther Res. 2001;25(1):91–102.

17. Cox S, Funasaki K, Smith L, Mezulis AH. A prospective study of brooding and reflection as moderators of the relationship between stress and depressive symptoms in adolescence. Cognit Ther Res. 2012;36(4):290–9.

18. Crane C, Barnhofer T, Williams JMG. Reflection, brooding, and suicidality: A preliminary study of different types of rumination in individuals with a history of major depression. Br J Clin Psychol. 2007;46(4):497–504.

19. Watkins E. Appraisals and strategies associated with rumination and worry. Pers Individ Dif. 2004;37(4):679–94.

20. Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of rumination in anxiety and depression: A multimodal meta-analysis. Clin Psychol Sci Pract. 2013;20(3):225–57.

21. Burwell RA, Shirk SR. Subtypes of rumination in adolescence: Associations between brooding, reflection, depressive symptoms, and coping. J Clin Child Adolesc Psychol. 2007;36(1):56–65. doi: 10.1080/15374410709336568 17206881

22. Schoofs H, Hermans D, Raes F. Brooding and reflection as subtypes of rumination: Evidence from confirmatory factor analysis in nonclinical samples using the dutch Ruminative Response Scale. J Psychopathol Behav Assess. 2010;32(4):609–17.

23. Raes F, Hermans D. On the mediating role of subtypes of rumination in the relationship between childhood emotional abuse and depressed mood: Brooding versus reflection. Depress A2nxiety. 2008;25(12):1067–70.

24. Marroquín BM, Fontes M, Scilletta A, Miranda R. Ruminative subtypes and coping responses: Active and passive pathways to depressive symptoms. Cogn Emot. 2010;24(8):1446–55.

25. Ciesla J a, Roberts JE. Rumination, negative cognition, and their interactive effects on depressed mood. Emotion. 2007;7(3):555–65. doi: 10.1037/1528-3542.7.3.555 17683212

26. Kuyken W, Watkins E, Holden E, Cook W. Rumination in adolescents at risk for depression. J Affect Disord. 2006;96(1–2):39–47. doi: 10.1016/j.jad.2006.05.017 16837053

27. Lo CSL, Ho SMY, Hollon SD. The effects of rumination and negative cognitive styles on depression: A mediation analysis. Behav Res Ther. 2008;46(4):487–95. doi: 10.1016/j.brat.2008.01.013 18316063

28. Mezulis A, Simonson J, McCauley E, Vander Stoep A. the association between temperament and depressive symptoms in adolescence: Brooding and reflection as potential mediators. Cogn Emot. 2011;25(8):1460–70. doi: 10.1080/02699931.2010.543642 21432637

29. Carleton RN. Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30–43. doi: 10.1016/j.janxdis.2016.02.007 26945765

30. Carleton RN. The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Rev Neurother. 2012;12(8):937–47. doi: 10.1586/ern.12.82 23002938

31. Carleton RN. Fear of the unknown: One fear to rule them all? J Anxiety Disord. 2016;41:5–21. doi: 10.1016/j.janxdis.2016.03.011 27067453

32. Dugas MJ, Schwartz A, Francis K. Intolerance of uncertainty, worry, and depression. Cognit Ther Res. 2004;28(6):835–42.

33. McEvoy PM, Mahoney AEJ. To Be Sure, To Be Sure: Intolerance of Uncertainty Mediates Symptoms of Various Anxiety Disorders and Depression. Behav Ther [Internet]. 2012;43(3):533–45. 22697442

34. Carleton NR, Mulvogue MK, Thibodeau MA, McCabe RE, Antony MM, Asmundson GJG. Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. J Anxiety Disord [Internet]. 2012;26(3):468–79. 22366534

35. Mahoney AEJ, McEvoy PM. A Transdiagnostic Examination of Intolerance of Uncertainty Across Anxiety and Depressive Disorders. Cogn Behav Ther. 2012;41(3):212–22. doi: 10.1080/16506073.2011.622130 22032195

36. Watkins E, Baracaia S. Rumination and social problem-solving in depression. Behav Res Ther. 2002;40(10):1179–89. doi: 10.1016/s0005-7967(01)00098-5 12375726

37. Ward A, Lyubomirsky S, Sousa L, Nolen-Hoeksema S. Can’t quite commit: Rumination and uncertainty. Personal Soc Psychol Bull. 2003;29(1):96–107.

38. de Jong-Meyer R, Beck B, Riede K. Relationships between rumination, worry, intolerance of uncertainty and metacognitive beliefs. Pers Individ Dif [Internet]. 2009;46(4):547–51.

39. Liao KYH, Wei M. Intolerance of uncertainty, depression, and anxiety: The moderating and mediating roles of rumination. J Clin Psychol. 2011;67(12):1220–39. doi: 10.1002/jclp.20846 22052621

40. Yook K, Kim KH, Suh SY, Lee KS. Intolerance of uncertainty, worry, and rumination in major depressive disorder and generalized anxiety disorder. J Anxiety Disord [Internet]. 2010;24(6):623–8. 20439149

41. Chandler J, Shapiro D. Conducting Clinical Research Using Crowdsourced Convenience Samples. Annu Rev Clin Psychol. 2016;12:53–81. doi: 10.1146/annurev-clinpsy-021815-093623 26772208

42. Le J, Edmonds A, Hester V, Biewald L. Ensuring Quality in Crowdsourced Search Relevance Evaluation: The Effects of Training Question Distribution. In: The SIGIR 2010 Workshop on crowdsourcing for search evaluation. 2010.

43. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief Depression Severity Measure. J Gen Intern Med. 2001;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x 11556941

44. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition—Text Revision. Washington D.C.: American Psychiatric Publishing; 2000.

45. Lee PW, Schulberg HC, Raue PJ, Kroenke K. Concordance between the PHQ- 9 and the HSCL-20 in depressed primary care patients. J Affect Disord. 2007;99(1):139–45.

46. Nakai Y, Inoue T, Toda H, Toyomaki A, Nakato Y, Nakagawa S, et al. The influence of childhood abuse, adult stressful life events and temperaments on depressive symptoms in the nonclinical general adult population. J Affect Disord. 2014;158:101–7. doi: 10.1016/j.jad.2014.02.004 24655773

47. Beck AT, Steer RA, Brown G. The Beck Depression Inventory–Second Edition Manual (BDI-II). San Antonio, TX: The Psychological Corporation; 1996.

48. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

49. Kung S, Alarcon RD, Williams MD, Poppe KA, Moore MJ, Frye MA. Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire (PHQ-9) Depression Measures in an integrated mood disorders practice. J Affect Disord [Internet]. 2013;143:341–3.

50. Pilkonis PA, Yu L, Dodds NE, Johnston KL, Maihoefer CC, Lawrence SM. Validation of the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS®) in a three-month observational study. J Psychiatr Res. 2014;56:112–9. doi: 10.1016/j.jpsychires.2014.05.010 24931848

51. Nolen-Hoeksema S, Morrow J, Fredrickson BL. Response styles and the duration of episodes of depressed mood. J Abnorm Psychol. 1993;102(1):20–8. doi: 10.1037//0021-843x.102.1.20 8436695

52. Spasojević J, Alloy LB. Rumination as a Common Mechanism Relating Depressive Risk Factors to Depression. Emotion. 2001;1(1):25–37. doi: 10.1037/1528-3542.1.1.25 12894809

53. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination Reconsidered: A Psychometric Analysis. Cognit Ther Res [Internet]. 2003;27(3):247–59.

54. Carleton RN, Norton MAPJ, Asmundson GJG. Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. J Anxiety Disord. 2007;21(1):105–17. doi: 10.1016/j.janxdis.2006.03.014 16647833

55. Freeston MH, Rhéaume J, Letarte H, Dugas MJ, Ladouceur R. Why do people worry? Personal Individ Differ. 1994;17(6):791–802.

56. Khawaja NG, Yu LNH. A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clin Psychol. 2010;14(3):97‐106.

57. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression- based approach. New York, NY: Guildford Press; 2013.

58. Hayes AF. Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Commun Monogr. 2009;76(4):408–20.

59. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91. doi: 10.3758/brm.40.3.879 18697684

60. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing [Internet]. Vienna, Austria; 2018.

61. Pinheiro J, Bates D, DebRoy S, Sarkar D, R Core Team. nlme: Linear and Nonlinear Mixed Effects Model. 2019.

62. Long JA. Comprehensive, User-Friendly Toolkit for Probing Interactions. 2019.

63. Maxwell SE, Cole DA, Mitchell MA. Bias in cross-sectional analyses of longitudinal mediation: Partial and complete mediation under an autoregressive model. Multivariate Behav Res. 2011;46(5):816–41. doi: 10.1080/00273171.2011.606716 26736047

64. O’Laughlin KD, Martin MJ, Ferrer E. Cross-Sectional Analysis of Longitudinal Mediation Processes. Multivariate Behav Res [Internet]. 2018;53(3):375–402. 29624079

65. Thoemmes F. Reversing Arrows in Mediation Models Does Not Distinguish Plausible Models. Basic Appl Soc Psych [Internet]. 2015;37(4):226–34.

66. McIntosh WD, Martin LL. The cybernetics of happiness: the relation of goal attainment, rumination, and affect. Rev Personal Soc Psychol. 1992;14:222–46.

67. Van Randenborgh A, De Jong-Meyer R, Hüffmeier J. Decision making in depression: Differences in decisional confl ict between healthy and depressed individuals. Clin Psychol Psychother. 2010;17(4):285–98. doi: 10.1002/cpp.651 19844960

68. Takano K, Tanno Y. Self-rumination, self-reflection, and depression: Self-rumination counteracts the adaptive effect of self-reflection. Behav Res Ther [Internet]. 2009;47(3):260–4. 19181307

69. Dugas MJ, Hedayati M, Karavidas A, Buhr K, Francis K, Phillips NA. Intolerance of uncertainty and information processing: Evidence of biased recall and interpretations. Cognit Ther Res. 2005;29(1):57–70.

Článek vyšel v časopise


2019 Číslo 11