Is intolerance of uncertainty a necessary condition for anxiety symptoms in adolescents? A necessary condition analysis study

Background: Intolerance of uncertainty (IU) is a well-established risk factor for anxiety disorders, as higher levels of IU increase the likelihood of future maladaptive outcomes. However, the presence of low levels of IU does not imply that maladaptive outcomes will not occur, as other risk factors can still lead to the onset of anxiety symptoms. Currently, it is unknown whether IU also serves as a necessary cause for anxiety symptoms, meaning that its absence would ensure the absence of these symptoms. Methods: A sample of 186 adolescents (58.6 % boys) between 14 and 18 years of age (M = 16.58 ± 1.01) was followed for six months, with evaluations every three months. Several self-reports were administered to measure IU and general anxiety problems, derived from the Youth Self Report 11–18, and anxiety-specific symptoms, derived from the Self-Administered Psychiatric Scales for Children and Adolescents. The Necessary Condition Analysis approach was applied to determine the extent to which IU is a necessary condition for anxiety. Findings: The analyses revealed that IU is a necessary condition for anxiety problems (d =.23 −.24), generalized anxiety disorder symptoms (d =.18 −.19), social anxiety disorder symptoms (d =.19 −.29), and school-related anxiety symptoms (d =.19 −.23) after three and six months. However, IU was not a statistically significant necessary condition for separation anxiety disorder symptoms. At baseline, between 29 % and 70 % of the sample exhibited the necessary levels of IU to potentially experience subclinical anxiety symptoms at subsequent follow-ups. Discussion: IU is a necessary condition for the potential development of anxiety symptoms during adolescence. Recognizing necessary conditions for anxiety symptoms and mental disorders, in general, could lead to substantial progress, given its impact on enhancing our theoretical understanding and improving prevention strategies and clinical treatments.