{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:12:15Z","timestamp":1789398735678,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The current wave and future trend of the novel coronavirus disease 2019 (COVID-19) has triggered public uncertainty, causing unbearable psychological pressure on people. A cross-sectional online questionnaire was conducted among back-to-school students in Wuhan from 31 August 2020, to 14 September 2020, by using convenience sampling. A total of 1017 participants voluntarily provided sociodemographic characteristics and accomplished the following scales: the Intolerance of Uncertainty Scale (IUS-12), the Social Support Scale (SSQ), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Insomnia Severity Index-7 (ISI-7). Results revealed that the levels of anxiety, depression, and insomnia were moderate, moderate and subthreshold, respectively. A one-way multivariate analysis of variance indicated that those with different attitudes toward the trajectory of the COVID-19 epidemic in China showed significantly different results in anxiety and depression (p &lt; 0.001). Moderation modeling implicated that social support significantly moderated the predictive relationship between intolerance of uncertainty and mental health variables including anxiety and depression, but failed on insomnia. Findings indicate that back-to-school students in Wuhan experience mental health problems and improving social support measures could buffer the effect of intolerance of uncertainty with respect to COVID-19 on mental health.<\/jats:p>","DOI":"10.3390\/ijerph18030981","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T02:07:00Z","timestamp":1611540420000},"page":"981","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["COVID-19-Related Intolerance of Uncertainty and Mental Health among Back-To-School Students in Wuhan: The Moderation Effect of Social Support"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7282-1655","authenticated-orcid":false,"given":"Lijun","family":"Zhuo","sequence":"first","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Le","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5744-3465","authenticated-orcid":false,"given":"Ling","family":"Zheng","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqing","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbing","family":"Tao","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020, September 01). WHO Timeline\u2014COVID-19. Available online: https:\/\/www.who.int\/news-room\/detail\/27-04-2020-who-timeline---covid-19."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1037\/a0037973","article-title":"Psychological impact on SARS survivors: Critical review of the English language literature","volume":"56","author":"Gardner","year":"2015","journal-title":"Can. Psychol. Psychol. Can."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/S0140-6736(20)30185-9","article-title":"A novel coronavirus outbreak of global health concern","volume":"395","author":"Wang","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"109392","DOI":"10.1016\/j.econlet.2020.109392","article-title":"The global effects of Covid-19-induced uncertainty","volume":"194","author":"Caggiano","year":"2020","journal-title":"Econ. Lett."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0929-6646(10)60087-3","article-title":"Population-based Post-crisis Psychological Distress: An Example From the SARS Outbreak in Taiwan","volume":"109","author":"Peng","year":"2010","journal-title":"J. Formos. Med Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Gu, J., Zhong, Y., Hao, Y., Zhou, D., Tsui, H.Y., Hao, C., Gao, Q., Ling, W., and Lau, J. (2015). Preventive Behaviors and Mental Distress in Response to H1N1 Among University Students in Guangzhou, China. Asia Pac. J. Public Health, 27.","DOI":"10.1177\/1010539512443699"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jad.2020.06.029","article-title":"An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19","volume":"275","author":"Duan","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e203976","DOI":"10.1001\/jamanetworkopen.2020.3976","article-title":"Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019","volume":"3","author":"Lai","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Liu, D., Baumeister, R.F., Veilleux, J.C., Chen, C., Liu, W., Yue, Y., and Zhang, S. (2020). Risk factors associated with mental illness in hospital discharged patients infected with COVID-19 in Wuhan, China. Psychiatry Res., 292.","DOI":"10.1016\/j.psychres.2020.113297"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., and Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res., 287.","DOI":"10.1016\/j.psychres.2020.112934"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"251","DOI":"10.24869\/psyd.2020.251","article-title":"Public Mental Health in Post-COVID-19 Era","volume":"32","author":"Ren","year":"2020","journal-title":"Psychiatr. Danub."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"110113","DOI":"10.1016\/j.jpsychores.2020.110113","article-title":"Curating evidence on mental health during COVID-19: A living systematic review","volume":"133","author":"Thombs","year":"2020","journal-title":"J. Psychosom. Res."},{"key":"ref_14","first-page":"1013","article-title":"The Effects of Post-traumatic Stress of College Students on Suicidal Behavior: The Mediating Effect and Gender Differences of Mental Health","volume":"10","author":"Hwang","year":"2019","journal-title":"J. Humanit. Soc. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/0191-8869(94)90048-5","article-title":"Why do people worry","volume":"17","author":"Freeston","year":"1994","journal-title":"Personal. Individ. Differ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.janxdis.2016.02.007","article-title":"Into the unknown: A review and synthesis of contemporary models involving uncertainty","volume":"39","author":"Carleton","year":"2016","journal-title":"J. Anxiety Disord."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Parlapani, E., Holeva, V., Nikopoulou, V.A., Sereslis, K., Athanasiadou, M., Godosidis, A., Stephanou, T., and Diakogiannis, I. (2020). Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.00842"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Mertens, G., Gerritsen, L., Duijndam, S., Salemink, E., and Engelhard, I.M. (2020). Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. J. Anxiety Disord., 74.","DOI":"10.1016\/j.janxdis.2020.102258"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cai, R.Y., Uljarevic, M., and Leekam, S.R. (2020). Predicting Mental Health and Psychological Wellbeing in Mothers of Children with Autism Spectrum Disorder: Roles of Intolerance of Uncertainty and Coping. Autism Res.","DOI":"10.1002\/aur.2341"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s10608-020-10107-2","article-title":"The Impact of Intolerance of Uncertainty and Anxiety Sensitivity on Mental Health Among Public Safety Personnel: When the Uncertain is Unavoidable","volume":"44","author":"Angehrn","year":"2020","journal-title":"Cognit. Ther. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1002\/pon.4975","article-title":"Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer","volume":"28","author":"Hill","year":"2019","journal-title":"Psychooncology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1080\/14767058.2018.1564030","article-title":"The relationship between separation anxiety and intolerance of uncertainty in pregnant women","volume":"33","author":"Kosger","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1016\/j.juro.2016.01.108","article-title":"The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer","volume":"195","author":"Tan","year":"2016","journal-title":"J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Satici, B., Saricali, M., Satici, S.A., and Griffiths, M.D. (2020). Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19. Int. J. Ment. Health Addict., 1\u201312.","DOI":"10.1007\/s11469-020-00305-0"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science","volume":"7","author":"Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Rettie, H., and Daniels, J. (2020). Coping and tolerance of uncertainty: Predictors and mediators of mental health during the COVID-19 pandemic. Am. Psychol.","DOI":"10.1037\/amp0000710"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Voitsidis, P., Nikopoulou, V.A., Holeva, V., Parlapani, E., Sereslis, K., Tsipropoulou, V., Karamouzi, P., Giazkoulidou, A., Tsopaneli, N., and Diakogiannis, I. (2020). The mediating role of fear of COVID-19 in the relationship between intolerance of uncertainty and depression. Psychol. Psychother. Theory Res. Pract.","DOI":"10.1111\/papt.12315"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.nedt.2019.01.029","article-title":"Relationship between mental health of nursing students and coping, self-esteem and social support","volume":"76","author":"Karaca","year":"2019","journal-title":"Nurse Educ. Today"},{"key":"ref_29","first-page":"977","article-title":"Single Parents in Germany: The Interrelation Between Social Support and Mental Health","volume":"81","author":"Borgmann","year":"2019","journal-title":"Gesundheitswesen"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1080\/13548506.2018.1549744","article-title":"Perceived social support and mental health for college students in mainland China: The mediating effects of self-concept","volume":"24","author":"Xu","year":"2019","journal-title":"Psychol. Health Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.beth.2006.10.001","article-title":"A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms","volume":"38","author":"Tull","year":"2007","journal-title":"Behav. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Friedman, H.S. (2011). Social support: A review. The Oxford Handbook of Health Psychology, Oxford University Press. Oxford Library of Psychology.","DOI":"10.1093\/oxfordhb\/9780195342819.001.0001"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1093\/geronb\/gbx084","article-title":"Direct and Indirect Pathways From Social Support to Health?","volume":"74","author":"Kim","year":"2019","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.sbspro.2012.06.603","article-title":"A Survey on the Relation Between Social Support and Mental Health in Students Shahid Rajaee University","volume":"47","author":"Tahmasbipour","year":"2012","journal-title":"Procedia Soc. Behav. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hou, T., Zhang, T., Cai, W., Song, X., Chen, A., Deng, G., and Ni, C. (2020). Social support and mental health among health care workers during Coronavirus Disease 2019 outbreak: A moderated mediation model. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233831"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1752-4458-8-41","article-title":"Social support moderates stress effects on depression","volume":"8","author":"Wang","year":"2014","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Li, J., Liang, W., Yuan, B., and Zeng, G. (2020). Internalized Stigmatization, Social Support, and Individual Mental Health Problems in the Public Health Crisis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124507"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: A critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J. Appl. Psychol."},{"key":"ref_39","unstructured":"INSRV (2010). Introduction to Statistical Analysis Using SPSS, Stata Press."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.janxdis.2006.03.014","article-title":"Fearing the unknown: A short version of the Intolerance of Uncertainty Scale","volume":"21","author":"Carleton","year":"2007","journal-title":"J. Anxiety Disord."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1177\/0265407587044007","article-title":"A Brief Measure of Social Support: Practical and Theoretical Implications","volume":"4","author":"Sarason","year":"2016","journal-title":"J. Soc. Pers. Relatsh."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Seo, J.-G., and Park, S.-P. (2015). Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine. J. Headache Pain, 16.","DOI":"10.1186\/s10194-015-0583-8"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Li, X., Lu, P., Hu, L., Huang, T., and Lu, L. (2020). Factors Associated with Mental Health Results among Workers with Income Losses Exposed to COVID-19 in China. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155627"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"100350","DOI":"10.1016\/j.invent.2020.100350","article-title":"Different impacts of COVID-19-related information sources on public worry: An online survey through social media","volume":"22","author":"Ho","year":"2020","journal-title":"Internet Interv."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/bjhp.12058","article-title":"Intolerance of uncertainty, appraisals, coping, and anxiety: The case of the 2009 H1N1 pandemic","volume":"19","author":"Taha","year":"2014","journal-title":"Br. J. Health Psychol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Hebert, E., and Dugas, M. (2018). Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder. Cogn. Behav. Pract., 26.","DOI":"10.1016\/j.cbpra.2018.07.007"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, Social Support, and the Buffering Hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol. Bull."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2174\/1874434601812010171","article-title":"Persistent (Anxiety and Depression) Affected Academic Achievement and Absenteeism in Nursing Students","volume":"12","author":"Jarrah","year":"2018","journal-title":"Open Nurs. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/jsr.12172","article-title":"The role of vulnerability in stress-related insomnia, social support and coping styles on incidence and persistence of insomnia","volume":"23","author":"Jarrin","year":"2014","journal-title":"J. Sleep Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jsmc.2013.04.005","article-title":"The Role of Genes in the Insomnia Phenotype","volume":"8","author":"Gehrman","year":"2013","journal-title":"Sleep Med. Clin."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.smrv.2009.10.007","article-title":"Sleep and emotions: A focus on insomnia","volume":"14","author":"Baglioni","year":"2010","journal-title":"Sleep Med. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.sleep.2020.06.001","article-title":"Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic","volume":"74","author":"Zhou","year":"2020","journal-title":"Sleep Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/3\/981\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:14:18Z","timestamp":1760159658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/3\/981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":53,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["ijerph18030981"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18030981","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,22]]}}}