A recent article published in the Journal of Mental Health explores the relationship between uncertainty and mental health. Specifically, the authors looked at data from medical settings, disaster and conflict settings, and occupational and university settings. They found a positive relationship between uncertainty—especially around medical issues—and worsened mental health, particularly depression, anxiety, PTSD, stress, and general psychological distress.
“Climate change, the rise in armed conflict and natural hazards, displacement and large flows of refugees, and austerity, are all believed to contribute to triggering widespread uncertainty at the individual, communal, and societal levels. Currently, the COVID-19 pandemic has further exacerbated pre-existing uncertainties and generated new ones, with media outlets going as far as talking of a ‘pandemic of uncertainty,’” the authors write.
“Never before has the link between uncertainty and mental health been more central in public and academic discourses. Yet, there is little systematic evidence concerning the link between uncertainty and mental health.”
Research shows that crises in our social and ecological environments can increase mental distress. From the COVID-19 pandemic to climate change, studies support the notion that chaotic, destructive forces in the broader world can impact individuals’ mental health.
From a big picture perspective, uncertainty may be at the root of much of this distress, as pandemics and uncertain futures can increase anxiety. Research does suggest, for example, that uncertainty around economic policies can increase suicidality in men. Another study points to “existential insecurity” as a significant factor in the mental health of Palestinian children living in the Gaza Strip.
The current study is a comprehensive review of research literature examining the relationship between uncertainty and mental health. The authors, based out of London and Palestine, examined 101 papers “addressing the association between uncertainty and mental.”
The study was a “scoping review,” which typically consists of: “exploratory projects that systematically map the literature available on a topic, identifying key concepts, theories, sources of evidence, and gaps in the research.”
The authors were selective with the included studies, screening out, for example, studies on related topics like insecurity and risk, studies that did not focus on mental health or the association between uncertainty and mental health, studies that were not peer-reviewed, and studies published before the year 2000.
A “narrative review” approach was chosen to synthesize and report the study’s findings. This included descriptive statistics for numerical outcomes and the generation of narrative themes for qualitative aspects.
The authors do acknowledge that uncertainty is not always a bad thing: “uncertainty can be appraised not only as a threat but also as an opportunity,” depending on contextual factors.
The majority of studies (91%) were original research papers, with review articles (6%), papers using secondary datasets, and theoretical papers/commentaries making up the rest.
Most of the research was cross-sectional (67%) and came from fields such as medicine and nursing (59%), followed by psychology/psychiatry/neuroscience (11%) and other related fields.
The United States was the location for most of the studies, with 61 of the 101 studies. However, some of the studies also came from countries such as the UK and Taiwan, as well as a few others.
Uncertainty was examined in three different settings:
- Medical settings (n=92)
- Disaster and conflict settings (n=4)
- Occupational and university settings (n=4)
In medical settings, which made up the vast majority of the studies, uncertainty was often investigated in relation to medical issues such as “cancer, other non-communicable diseases, infectious diseases, high-risk pregnancies, undergoing genetic counseling, organ transplants, and receiving implanted devices.” Uncertainty in this context centered around the illness itself and treatment and prognosis.
Uncertainty itself was most commonly measured using the Mishel Uncertainty in Illness Scale (MUIS), at 45%, but others such as the Parental Perceptions of Uncertainty Scale and things like questionnaires also showed up in the studies.
In terms of mental health categories analyzed, the most common were depression (23%), anxiety (19%), psychological distress (15%), PTSD (10%), and stress (10%). This data was collected using a variety of instruments across the studies.
Most of the studies (79%) did find a positive association between uncertainty and mental health issues. Some studies (15%), however, found mixed results, meaning that specific mental health outcomes had a positive association with uncertainty while others did not. 6% found no significant statistical relationship at all.
Motivating this research was a concern around the Israel-Palestine conflict, with the authors stating that in occupied Palestinian territory:
“…uncertainty is a chronic, pervasive, and structural experience, given ongoing Israeli military occupation, movement restrictions, siege conditions, land confiscation, the building of Israeli settlements on Palestinian land, periodic invasions, exposure to political violence, and medical shortages.”
The authors mention several limitations to the study and the research literature more broadly.
Because the majority of the data were cross-sectional, it is difficult to establish causation. Additionally, because of how different the standards of analysis were across the studies (such as type of study and instruments used), the authors were forced to do a “scoping review” instead of a conventional meta-analysis. Not including studies on “insecurity” or “risk” may have left out important insights.
Another significant limitation noted by the authors is that despite qualitative research showing that individuals and communities can shift their relationship to uncertainty through coping mechanisms, rather than being passive, little research has explored this in statistical detail.
Additionally, they state that looking at qualitative studies could add more nuance to the relationship between uncertainty and mental health and offer insight into effective coping mechanisms.
The authors did perform a separate review examining qualitative studies, which will be published separately.
“Recent years have seen a shift away from addressing mental health through a purely biomedical model and towards a more holistic understanding of mental health as a bio-psycho-social phenomenon intimately linked with social, economic, and political factors. The current review points towards the importance of investigating how uncertainty around key social determinants can impact mental health.”
Massazza, A., Kienzler, H., Al-Mitwalli, S., Tamimi, N., & Giacaman, R. (2022). The association between uncertainty and mental health: A scoping review of the quantitative literature. Journal of Mental Health, 1–12. (Link)
Bad things happen, and they can drive your crazy. I don’t like to say “I told you so,” but: