Why uncertainty causes stress

So, when there is great uncertainty around some major aspect of our lives, we go into a state of heightened awareness and arousal. In the short term this can actually be very helpful. It helps to keep us safe and to react quickly, if we need to. It is only when the uncertainty persists for a long time that it can become a problem.

Not all uncertainty causes us stress. There are many things about which we are uncertain — Will it rain tomorrow? Who will win the Eurovision song contest next year? The issue of mental health among college students is of increasing concern Karatekin, The college years are a peak period for the onset of mental disorder in which young people experience a unique stage of psycho-social development and transition from late adolescence to emerging adulthood Wu et al. College students are an important population segment in determining the economic growth and success of a country Auerbach et al.

The adverse effects of mental disorders during this period are profound including dropping out of college, poor academic performance, strained relationships, and reduced emotional functioning. Together, these effects can have a negative impact on physical health and future professional career potential Cuijpers et al. Mental health problem in this population should be a key public health priority.

However, most research on mental disorders among students has focused on the primary and secondary school years Auerbach et al.

Not enough attention has been paid to identify mental disorders among college students Auerbach et al. It is well known that college students experience high levels of stress Holland, There is strong evidence that the cumulative impact of stress has been associated with mental health problems, which are prevalent in the college population Lee et al. The general strain theory argues that individuals who are stressed are more likely to experience negative affective states such as anger, fear, and frustration.

These affective states, in turn, create an internal pressure, which can lead to the strain outcomes Agnew, The social stress theory also points out that stressful life events play an important role in producing emotional and behavior outcomes for individuals, which could raise the risk of mental disorder Aneshensel, Mental health problems can cause life stress.

On the other hand, the causal link can also operate in the opposite direction, with life stress leading to mental health problems Aneshensel, ; Silver and Teasdale, The more the occurrence of negative events, the greater the likelihood that a disorder will develop Dohrenwend, The relationship between stress and poor mental health has been demonstrated in both prospective and retrospective studies from multiple countries Kitzrow, ; Lee et al.

Study stress and general life stress are very common types of stress among college students Misra and McKean, ; Holland, Study stress is specific to students and measures the amount of stress students experience related to such events as curriculum changes, exams, papers, grade competition, and so forth Misra and McKean, Life stress focuses more on the major life events that impact an individual and the resulting stress from these life events, such as a poor living situation, health conditions, interpersonal relationships, and others Yang et al.

Both life stress and study stress tend to be fairly predictable and are considered to be certainty stressors. In contrast to certainty stress, uncertainty stress is persistent experiences that require more psychological readjustments Peng et al. However, the mechanism between uncertainty stress and mental disorder was still unknown. In the past decades, researchers have paid increased attention to uncertainty Mishel, ; Greco and Roger, ; McEvoy and Mahoney, ; Peters et al.

Uncertainty is a major cognitive and psychological stressor Greco and Roger, Individuals who are intolerant of uncertainty tend to perceive it as stressful and then respond negatively on emotional, cognitive, and behavioral levels McEvoy and Mahoney, Uncertainty constitutes a stressful condition that arouses a stress response that then contributes to ill health Monat et al.

The literature on uncertainty initially focused on clinical settings Mishel, ; Carleton et al. There is a large number of studies from countries outside China that demonstrate that uncertainty plays a significant role in explaining various illness outcomes, especially in cancer patients, psychiatric patients, and chronic disease patients Kang, ; Sammarco and Konecny, ; Jiang and He, Uncertainty has a negative impact on quality of life in breast cancer survivors and is related to health and functioning, socioeconomic status, and psychological and spiritual well being Sammarco and Konecny, The phenomenon of uncertainty has also been associated with a range of psychological maladies including depression, anxiety, and psychiatric symptoms among children with chronic illness Stewart and Mishel, Evidence is accumulating that intolerance of uncertainty may be a transdiagnostic maintaining factor across anxiety disorders and depression McEvoy and Mahoney, Uncertainty has also been found to explain the unique variance with neuroticism as well as with symptoms related to various anxiety disorders and depression McEvoy and Mahoney, Despite the growing literature relating uncertainty to increased psychological distress in the context of illness and hospitalization, it remains unclear how this association and mechanism impacts the general population Carleton et al.

To address this research gap, Yang and his colleagues in China have broadened the emphasis of uncertainty. They proposed a conceptual framework for uncertainty stress, and defined uncertainty stress as anxiety in facing ambiguous situations and problematic environments Yang et al.

It not only includes future uncertainty but also current uncertainty Peng et al. Yang et al. Drawing on theories of stress diathesis and theories of control and defense mechanisms Mirowsky and Ross, , they have shown that uncertainty stress and certainty stress like life stress or study stress, although related, are distinct components of stress Wu et al.

Some studies have provided empirical evidence that uncertainty stress, in particular, was associated with a range of negative health outcomes, including self-reported short- and long-term illness, alcohol abuse, unintentional injuries, deliberate self-harm, and suicidal ideation among Chinese college students Wu et al.

However, no studies hitherto have examined uncertainty stress, in concert with other types of stress, and their relative impact upon mental health. While a plethora of studies on uncertainty stress and its impact on psychological maladies with clinical patients have been conducted in western countries, these theoretical frameworks might not be directly transferable to the Chinese general population because of the complex Chinese social structure and the focus on traditional culture.

The paucity of empirical research examining the association between uncertainty stress and mental disorders was justification for this study. The purpose of this study was to distinguish the effects of different stressors on mental health problems and explore the important role of uncertainty stress on the development of mental disorders.

Given that the studies using a population-based sampling method with nationwide representativeness were limited globally, the present nationwide survey could add stronger empirical evidence to the association of stress especially uncertainty stress and mental health problems. Building upon the literature mentioned above, two hypotheses were developed for this study: 1 uncertainty stress would be negatively associated with the mental health of college students Greco and Roger, ; Lee et al.

The Chinese GHPSS Extended version included additional health-related information on perceived stress and mental health compared to the original version Warren et al. A multistage sampling strategy was utilized to recruit participants by geographic areas, university, and specific classes within each university. In stage 2, the sampling strategy involved the selection of levels within each university.

All levels that had health professional courses were selected in each university. In stage 3, one-third of health-focused classes were randomly selected from each level. In stage 4, all students enrolled in those classes were recruited as study participants. The survey was conducted in class, where the principal investigators of each university explained the study to the students and obtained their informed consent before administering the survey in the classrooms.

The questionnaires were collected by trained researchers after the participants completed them in class. Very few students refused to participate; thus, the response rate was very high. A detailed description on sampling, recruitment, and procedure can be found in Yang et al. The ethics committee at the Medical Center of Zhejiang University approved the study protocol reference number: PJ The CHQ version utilized in the current study was the Mandarin version, which was revised and adapted by Yang et al.

It also has an acceptable reliability and validity and has been widely used to assess mental health status in community and primary care settings across China Qiu et al. Items in this questionnaire were rated on a four-point scale. The summed score was calculated to measure the severity of mental disorders. Following previous practice, a cut-off score of 3 or more signified a mental disorder.

This cut-off score was classified by the performance of the receiver operating characteristic curve using final clinical diagnosis as the gold standard in determining a mental disorder. It demonstrated both good sensitivity and specificity Chong and Wilkinson, ; Yang et al. Information on several sociodemographic characteristics was collected including age, gender, ethnicity, grade, major, parental occupation, monthly expenditure, and family residence location.

University type was determined using the China university ranking system high, middle, and low level as established by the National Ministry of Education. University location was geographically divided into west, middle, and east region of China. The life stress consisted of five items and included questions on financial, health, interpersonal relationships, family, and other issues of daily life. Study stress was assessed by three items that included heavy academic responsibilities, uninteresting professional curricula, and study environment.

The uncertainty stress questionnaire consisted of four items, including current status uncertainty, social change uncertainty, goal uncertainty, and social value uncertainty Yang et al. Items were rated on a five-point scale ranging from 0 no stress to 4 excessive stress. Item scores were summed to attain a total stress score. The higher the total score, the greater is the perceived level of stress. These values suggested that the questionnaires had an acceptable reliability.

Descriptive statistics were calculated to determine the prevalence of mental disorders across different sociodemographic characteristics and stressors. All variables were categorical. We conducted unconditional logistic regression analysis to test hypotheses about associations between the independent variables and dependent variable. Both unadjusted and adjusted models were established to examine and confirm these associations.

A nested hierarchical multilevel modeling technique was utilized, which has substantial advantages over a single-level regression procedure. Ecologic and atomistic fallacies were precluded by modeling random variation at both individual and university levels, thus providing the capacity to differentiate individual and contextual effects upon mental disorder outcomes Wang et al.

Several models were built in this study. We started with the Null Model a two-level individual and university model with random intercepts, which only included a constant in accounting for variation in mental disorder across 50 universities.

From this base model, we entered all individual- and university-level variables as fixed main effects, which were significantly associated with mental disorder from the unadjusted models, to construct four further models for evaluating the impact of variables on mental disorders.

First, we constructed a model, which included study stress and life stress Model 1. Notice when you start to feel anxious and fearful about a situation, begin to worry about what-ifs, or feel like a situation is far worse than it actually is. You might notice the tension in your neck or shoulders, shortness of breath, the onset of a headache, or an empty feeling in your stomach.

Allow yourself to feel the uncertainty. Instead of engaging in futile efforts to gain control over the uncontrollable, let yourself experience the discomfort of uncertainty. Like all emotions, if you allow yourself to feel fear and uncertainty, they will eventually pass.

Take some slow, deep breaths or try a meditation to keep you anchored in the present. Let go. All you can do is let go and accept the uncertainty as part of life.

Shift your attention. Focus on solvable worries, taking action on those aspects of a problem that you can control, or simply go back to what you were doing. When your mind wanders back to worrying or the feelings of uncertainty return, refocus your mind on the present moment and your own breathing.

Life is simply too random and unpredictable. Uncertainty is often centered on worries about the future and all the bad things you can anticipate happening.

It can leave you feeling hopeless and depressed about the days ahead, exaggerate the scope of the problems you face, and even paralyze you from taking action to overcome a problem. One of the surest ways to avoid worrying about the future is to focus on the present.

By being fully connected to the present, you can interrupt the negative assumptions and catastrophic predictions running through your mind. You can learn to purposely focus your attention on the present through mindfulness.

With regular practice, mindfulness can help change your preoccupation with future worries to a stronger appreciation of the present moment—as well as help calm your mind, ease stress, and boost your overall mood. You can start a mindfulness practice by following an audio meditation or incorporating it into an exercise program, such as walking.

Using mindfulness to stay focused on the present can take perseverance. Initially, you may find that your focus keeps wandering back to your future fears and worries—but keep at it. Taking steps to reduce your overall stress and anxiety levels can help you interrupt the downward spiral of negative thoughts, find inner calm, and better cope with the uncertainty in your life.

Get moving. Exercise is a natural and effective stress-reliever and anti-anxiety treatment. Try adding a mindfulness element and focusing on how your body feels as you move.

Pay attention to the sensation of your feet hitting the ground as you walk, run, or dance, for example, or the rhythm of your breathing, or the feeling of the sun or wind on your skin. Make time for relaxation. Choose a relaxation technique such as meditation, yoga, or deep breathing exercises and try to set aside time each day for regular practice.

Get plenty of sleep. Excessive worry and uncertainty can disturb your sleep—just as a lack of quality sleep can fuel anxiety and stress. Unexpected events will occur, and when they do, there are a few ways you can prepare to face uncertainty:. It's healthier to accept uncertainty during big changes, just like we do in our normal day-to-day lives. And even though life's unexpected twists and turns may not always seem positive, it's important to be realistic about how much control you really have.

Acceptance is saying 'I'm willing to experience this uncertainty and accept it as part of my life,' not that I like it. Moreover, Lyons emphasises that acceptance doesn't mean giving up — and it can even help you move forward during scary events like the coronavirus pandemic. Acceptance of the pandemic and social isolation for an unknown period of time as my current reality allows me to more effectively ascertain the options available to me.

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