ISSN: 2226-6348
Open access
Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are recognized as interconnected vulnerability factors affecting university students’ mental health. This systematic review (2014–2024) followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251036590). Seven databases across psychology, education and health were searched, yielding 664 records; 11 studies met inclusion criteria after screening. The evidence consistently shows a strong positive relationship between IU and AS. Students who struggle with uncertainty tend to also fear anxiety sensations, compounding their risk for psychological distress. In most studies, high IU exacerbated the effects of AS on anxiety-related outcomes (e.g. health anxiety), and conversely AS often mediated the impact of IU on overall anxiety levels. The included research—primarily cross-sectional studies from North America with student/young adult samples—indicates that IU and AS together fuel avoidance behaviors, help-seeking barriers, and academic difficulties, undermining inclusive participation in campus life. However, longitudinal data are scarce, and cultural diversity is limited, leaving causality and generalizability uncertain. This review synthesizes a decade of findings to highlight the intertwined roles of IU and AS in student anxiety, and it discusses implications for targeted interventions in higher education. Reducing IU and AS via cognitive-behavioral strategies and supportive educational practices is recommended to improve student resilience and inclusion.
Allan, N. P., Macatee, R. J., Norr, A. M., & Schmidt, N. B. (2014). Direct and interactive effects of distress tolerance and anxiety sensitivity on generalized anxiety and depression. Cognitive Therapy and Research, 38(5), 530–540. https://doi.org/10.1007/s10608-014-9623-y
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford Press.
Bottesi, G., Iannattone, S., Carraro, E., & Lauriola, M. (2023). The assessment of intolerance of uncertainty in youth: An examination of the Intolerance of Uncertainty Scale–Revised in Italian nonclinical boys and girls. Research on Child and Adolescent Psychopathology, 51(2), 209–222. https://doi.org/10.1007/s10802-022-00944-y
Bredemeier, K., Church, L. D., Bounoua, N., Feler, B., & Spielberg, J. M. (2023). Intolerance of uncertainty, anxiety sensitivity, and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis. Journal of Anxiety Disorders, 93, 102660. https://doi.org/10.1016/j.janxdis.2022.102660
Byrne, K. A., Winterlind, E. L., Roth, S., Jeffries, C. K., Campbell, H., & Pericot-Valverde, I. (2024). Anxiety sensitivity is associated with heightened intolerance of uncertainty in individuals with alcohol use disorder. Experimental and Clinical Psychopharmacology, 32(6), 693–705. https://doi.org/10.1037/pha0000730
Carleton, R. N. (2016). Fear of the unknown: One fear to rule them all? Journal of Anxiety Disorders, 41, 5–21. https://doi.org/10.1016/j.janxdis.2016.03.011
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
Çelik, E., Biçener, E., Bay?n, Ü., & Erol U?ur, H. (2022). Mediation role of anxiety sensitivity on the relationship between intolerance of uncertainty and fear of COVID-19. Anales de Psicología, 38(1), e1–e6. https://doi.org/10.6018/analesps.469511
Charbonnier, E., Montalescot, L., Puechlong, C., Goncalves, A., & Le Vigouroux, S. (2023). Relationship between fear of COVID-19, intolerance of uncertainty, and coping strategies on university students’ mental health. Nutrients, 15(23), 4938. https://doi.org/10.3390/nu15234938
Chu, T., Liu, X., Takayanagi, S., Matsushita, T., & Kishimoto, H. (2023). Association between mental health and academic performance among university undergraduates: The interacting role of lifestyle behaviors. International Journal of Methods in Psychiatric Research, 32(1), e1938. https://doi.org/10.1002/mpr.1938
Lafontaine, M., Turcotte, S., Denis, I., & Foldes-Busque, G. (2023). Investigating the relationship between the five-factor model of distress tolerance, anxiety, and anxiety sensitivity. Anxiety, Stress, & Coping, 36(3), 353–365. https://doi.org/10.1080/10615806.2022.2077929
Dean, K. E., Long, A. C. J., Matthews, R. A., & Buckner, J. D. (2018). Willingness to seek treatment among Black students with anxiety or depression: The synergistic effect of sociocultural factors with symptom severity and intolerance of uncertainty. Behavior Therapy, 49(5), 691–701. https://doi.org/10.1016/j.beth.2017.12.008
Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268.
Evans, T. M., Bira, L., Gastelum, J. B., Weiss, L. T., & Vanderford, N. L. (2018). Evidence for a mental health crisis in graduate education. Nature Biotechnology, 36(3), 282–284. https://doi.org/10.1038/nbt.4089
Fetzner, M. G., Asmundson, G. J. G., Carey, C., Thibodeau, M. A., Brandt, C. P., Zvolensky, M. J., & Carleton, R. N. (2014). How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cognitive Behaviour Therapy, 43(3), 262–274. https://doi.org/10.1080/16506073.2014.929170
Fitzgerald, H. E., Hoyt, D. L., Kredlow, M. A., Smits, J. A. J., Schmidt, N. B., Edmondson, D., & Otto, M. W. (2021). Anxiety sensitivity as a malleable mechanistic target for prevention interventions: A meta-analysis of the efficacy of brief treatment interventions. Clinical Psychology: Science and Practice, 28(4), 323–337. https://doi.org/10.1037/cps0000038
Gellisch, M., et al. (2024). Unraveling psychological burden: The interplay of socio-economic status, anxiety sensitivity, intolerance of uncertainty, and stress in first-year medical students. BMC Medical Education, 24, Article 5924. https://doi.org/10.1186/s12909-024-05924-y
Gu, Y., Gu, S., Lei, Y., & Li, H. (2020). From uncertainty to anxiety: How uncertainty fuels anxiety in a process mediated by intolerance of uncertainty. Neural Plasticity, 2020, Article 8866386. https://doi.org/10.1155/2020/8866386
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113. https://doi.org/10.1186/1471-244X-10-113
Horenstein, A., Rogers, A., Bakhshaie, J., Zvolensky, M. J., & Heimberg, R. G. (2019). Examining the role of anxiety sensitivity and intolerance of uncertainty in the relationship between health anxiety and likelihood of medical care utilization. Cognitive Therapy and Research, 43(1), 55–65. https://doi.org/10.1007/s10608-018-9980-z
Knowles, K. A., & Olatunji, B. O. (2023). Intolerance of uncertainty as a cognitive vulnerability for obsessive-compulsive disorder: A qualitative review. Clinical Psychology: Science and Practice, 30(3), 317–330. https://doi.org/10.1037/cps0000150
Lauriola, M., Carleton, R. N., Tempesta, D., Calanna, P., Socci, V., Mosca, O., Salfi, F., De Gennaro, L., & Ferrara, M. (2019). A correlational analysis of the relationships among intolerance of uncertainty, anxiety sensitivity, subjective sleep quality, and insomnia symptoms. International Journal of Environmental Research and Public Health, 16(18), 3253. https://doi.org/10.3390/ijerph16183253
Levecque, K., Anseel, F., De Beuckelaer, A., Van der Heyden, J., & Gisle, L. (2017). Work organization and mental health problems in PhD students. Research Policy, 46(4), 868–879. https://doi.org/10.1016/j.respol.2017.02.008
McEvoy, P. M., & Mahoney, A. E. J. (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behaviour Therapy, 43(3), 533–545. https://doi.org/10.1016/j.beth.2011.02.007
Norr, A. M., Capron, D. W., & Schmidt, N. B. (2014). Medical information seeking: Impact on risk for anxiety psychopathology. Journal of Behavior Therapy and Experimental Psychiatry, 45(3), 402–407. https://doi.org/10.1016/j.jbtep.2014.04.003
O’Bryan, E. M., Stevens, K. T., Bimstein, J., Jean, A., Mammo, L., & Tolin, D. F. (2022). Intolerance of uncertainty and anxiety symptoms: Examining the indirect effect through anxiety sensitivity among adults with anxiety-related disorders. Journal of Psychopathology and Behavioral Assessment, 44(2), 353–363. https://doi.org/10.1007/s10862-021-09912-0
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Paralkar, U., & Knutson, D. (2023). Coping with academic stress: Ambiguity and uncertainty tolerance in college students. Journal of American College Health, 71(7), 2208–2216. https://doi.org/10.1080/07448481.2021.1965148
Partovi Pirooz, L., Jomehri, F., Seadatee Shamir, A., & Hasani, J. (2022). Structural model of health anxiety based on intolerance of uncertainty and anxiety sensitivity with the mediating role of rumination in college students. Journal of Adolescent and Youth Psychological Studies, 3(2), 278–290. https://doi.org/10.52547/jspnay.3.2.278
Pintrich, P. R., & De Groot, E. V. (1990). Motivational and self-regulated learning components of classroom academic performance. Journal of Educational Psychology, 82(1), 33–40. https://doi.org/10.1037/0022-0663.82.1.33
Qiang, J., He, X., Xia, Z., Huang, J., & Xu, C. (2024). The association between intolerance of uncertainty and academic burnout among university students: The role of self-regulatory fatigue and self-compassion. Frontiers in Public Health, 12, 1441465. https://doi.org/10.3389/fpubh.2024.1441465
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24(1), 1–8. https://doi.org/10.1016/0005-7967(86)90143-9
Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s help-seeking for mental health problems. Australian E-Journal for the Advancement of Mental Health, 4(3), 218–251. https://doi.org/10.5172/jamh.4.3.218
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68
Saulnier, K. G., Koscinski, B., Volarov, M., Accorso, C., Austin, M. J., Suhr, J. A., Allan, D. M., et al. (2022). Anxiety sensitivity and intolerance of uncertainty are unique and interactive risk factors for COVID-19 safety behaviors and worries. Cognitive Behaviour Therapy, 51(3), 217–228. https://doi.org/10.1080/16506073.2021.1976819
Shihata, S., McEvoy, P. M., Mullan, B. A., & Carleton, R. N. (2016). Intolerance of uncertainty in emotional disorders: What uncertainties remain? Journal of Anxiety Disorders, 41, 115–124. https://doi.org/10.1016/j.janxdis.2016.05.001
Sinval, J., Oliveira, P., Novais, F., Almeida, C. M., & Telles-Correia, D. (2025). Exploring the impact of depression, anxiety, stress, academic engagement, and dropout intention on medical students’ academic performance: A prospective study. Journal of Affective Disorders, 368, 665–673. https://doi.org/10.1016/j.jad.2024.09.116
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., Abramowitz, J. S., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176–188. https://doi.org/10.1037/1040-3590.19.2.176
Toro Tobar, R. A., Avendaño-Prieto, B. L., & Vargas Espinosa, N. M. (2020). Transdiagnostic model of anxiety and depression according to the relationship with affect, intolerance of uncertainty, and anxiety sensitivity. Revista CES Psicología, 13(1), 140–152. https://doi.org/10.21615/cesp.13.1.9
van Kessel, G., Ryan, C., Paras, L., Johnson, N., Zariff, R. Z., & Stallman, H. M. (2025). Relationship between university belonging and student outcomes: A systematic review and meta-analysis. The Australian Educational Researcher, 52, 2511–2534. https://doi.org/10.1007/s13384-025-00822-8
Wright, K. D., Lebell, M. A. N. A., & Carleton, R. N. (2016). Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. Journal of Anxiety Disorders, 41, 35–42. https://doi.org/10.1016/j.janxdis.2016.04.011
Zhao, R., Amanvermez, Y., Pei, J., Castro-Ramírez, F., Rapsey, C., Garcia, C., & Cuijpers, P. (2025). Research Review: Help-seeking intentions, behaviors, and barriers in college students: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 66(10), 1593–1605. https://doi.org/10.1111/jcpp.14145
Zhuo, L., Wu, Q., Le, H., Li, H., Zheng, L, Ma, G., & Tao, H. (2021). COVID-19-related intolerance of uncertainty and mental health among back-to-school students in Wuhan: The moderation effect of social support. International Journal of Environmental Research and Public Health, 18(3), 981. https://doi.org/10.3390/ijerph18030981
Zimmerman, B. J. (2002). Becoming a self-regulated learner: An overview. Theory Into Practice, 41(2), 64–70. https://doi.org/10.1207/s15430421tip4102_2
Wang, Y., Yeo, K. J., & Lee, S. (2026). Interplay between Intolerance of Uncertainty and Anxiety Sensitivity in University Students: A Systematic Review. International Journal of Academic Research in Progressive Education and Development, 15(1), 28-49.
Copyright: © 2026 The Author(s)
Published by HRMARS (www.hrmars.com)
This article is published under the Creative Commons Attribution (CC BY 4.0) license. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this license may be seen at: http://creativecommons.org/licences/by/4.0/legalcode