Intolerance of uncertainty and symptom-level associations between generalized anxiety and depression in adolescence: A large-scale subgroup network analysis.

BACKGROUND: Intolerance of uncertainty (IU), defined as a dispositional tendency to perceive uncertain situations as distressing and unacceptable, is increasingly recognized as a transdiagnostic risk factor for internalizing psychopathology such as generalized anxiety and depression, particularly during adolescence. However, its role in the organization of symptom-level associations between these conditions remains unclear. This study examined whether generalized anxiety-depression symptom networks differed between adolescents with high versus low levels of IU using a network analytic framework.

METHODS: A large-scale longitudinal sample of 53,872 school-aged youths from southern China (M age-baseline = 13.00 years, SD age-baseline = 1.79, aged 9-19; 46.8% were girls) completed assessments of generalized anxiety and depressive symptoms at two time points over a six-month interval. Participants were categorized into high- and low-IU groups based on their IU scale scores. Cross-sectional symptom networks and cross-lagged panel networks were estimated separately for the two groups to compare symptom-level associations between generalized anxiety and depression across IU-defined subgroups.

RESULTS: Compared with the low-IU group, adolescents with high IU exhibited more densely connected cross-sectional symptom networks and stronger longitudinal associations between generalized anxiety and depressive symptoms. Within the high-IU network, uncontrollable worry demonstrated the strongest outgoing temporal connectivity, whereas excessive worry showed the strongest incoming temporal connectivity.

CONCLUSIONS: These findings suggest that generalized anxiety-depression symptom networks differ across adolescents with high versus low levels of IU. Adolescents with high IU exhibited more strongly interconnected internalizing symptom networks and more pronounced longitudinal symptom associations over time, which highlights IU as a potentially important factor related to the organization of internalizing symptom networks during adolescence. Findings may help inform future prevention and intervention efforts targeting IU and worry-related cognitive processes (e.g., uncontrollable worry).