See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/341413029

Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by

Rumination and Fear of COVID-19

Article  in  International Journal of Mental Health and Addiction · May 2020

DOI: 10.1007/s11469-020-00305-0

CITATIONS READS

0 3

6 authors, including:

Mark D Griffiths
Nottingham Trent University
1,270 PUBLICATIONS   45,294 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Excessive smartphone use View project

mustafa ercengiz View project

All content following this page was uploaded by Mark D Griffiths on 15 May 2020.

The user has requested enhancement of the downloaded file.

International Journal of Mental Health and Addiction
https://doi.org/10.1007/s11469-020-00305-0

ORIGINAL ARTICLE

Intolerance of Uncertainty and Mental Wellbeing: Serial

Mediation by Rumination and Fear of COVID-19

Begum Satici 1 & Mehmet Saricali

2
& Seydi Ahmet Satici
1
& Mark D. Griffiths
3

# The Author(s) 2020

Abstract
The novel coronavirus-2019 (COVID-19) pandemic has become globally widespread
with millions of confirmed cases and many countries implementing various levels of
quarantine. Therefore, it is important to investigate the psychological consequences of
this process, given the unique situation that has been experienced globally. Therefore, the
present study examined whether intolerance of uncertainty was related to mental
wellbeing and whether this relationship was mediated by rumination and fear of
COVID-19. The sample comprised 1772 Turkish individuals (aged between 18 and
73 years) from 79 of 81 cities in Turkey, who completed measures of mental wellbeing,
intolerance of uncertainty, rumination, and fear of COVID-19. Results of serial mediation
analyses showed that intolerance of uncertainty had a significant direct effect on mental
wellbeing. Rumination and fear of COVID-19, in combination, serially mediated the
association between intolerance of uncertainty and mental wellbeing. The findings are
discussed within the framework of the psychological consequences of the COVID-19
pandemic and related literature.

Keywords COVID-19 . Mental wellbeing . Intolerance of uncertainty . Rumination . Fear of

COVID-19 . Turkey

The recent novel coronavirus-2019 (COVID-19) worldwide pandemic has completely

changed how individuals are living their day-to-day lives due to the quarantining and spatial
distancing measures implemented by most governments to minimize the spread of the virus

* Mark D. Griffiths
[email protected]
Begum Satici
[email protected]

Mehmet Saricali
[email protected]
Seydi Ahmet Satici
[email protected]

Extended author information available on the last page of the article

 International Journal of Mental Health and Addiction

(Pakpour and Griffiths 2020). The COVID-19 pandemic has also affected individuals psycho-
logically and there have been reports of possible collective trauma (Garfin et al. 2020).
Outbreaks such as the COVID-19 pandemic threaten many indices of psychological wellbeing
in the general population. For example, in a study conducted after mass isolation concerning
the severe acute respiratory syndrome (SARS) outbreak, it was reported that almost half of the
participants experienced psychological disorders (Mihashi et al. 2009). Another study with
hospitalized patients during the SARS outbreak reported four latent clusters, in which two of
them indicated psychological dysfunction (chronic dysfunction and delayed dysfunction) and
the other two related to strength (recovery and resilience) (Bonanno et al. 2008). One study
also found a positive relationship between a SARS-related stressor check list and the Psycho-
logical Symptoms Check List (Main et al. 2011).
During epidemics, individuals may experience maladaptive psychological consequences by
just being in proximity to those whom they consider as in a potential risk group in terms of a virus
outbreak. For instance, during the Ebola epidemic, which occurred intensely in Africa, it was
found that individuals with African-born foreigner neighbors experienced somatization, anxiety,
and Ebola-related worry (Jose et al. 2017). Suicide cases can also occur as a result of stress
intensity during epidemics. Yip et al. (2010) indicated that older people are afraid of burdening
their families as infected during the epidemic which triggers suicidal ideation in them.
As with other epidemics, the COVID-19 pandemic is also currently causing global anxiety
and heightened stress (Garfin et al. 2020). In this regard, it was reported that individuals with
increased the fear of COVID-19 have committed suicide because they thought they were
infected, even though autopsies showed they were not (Goyal et al. 2020; Mamun and
Griffiths 2020). It has also been stressed that the psychological effects of the current pandemic
may be quite profound, and that the fear of COVID-19 is high in some countries such as Iran
(Pakpour and Griffiths 2020). The fear of COVID-19 is rooted in four basic pillars: fear of the
body, significant others, uncertainty, and action/inaction (Schimmenti et al. 2020). Therefore,
the global COVID-19 pandemic has arguably resulted in a psychologically chaotic and
gloomy environment. This time of heightened uncertainty has led to radical changes in
individuals’ daily routines. Individuals’ psychological wellbeing may fluctuate daily as a
consequence of increasing existential threat, highlighted mortality salience, and impaired
routine. Therefore, in the present study, the predictive role of uncertainty during the pandemic
on the psychological wellbeing of individuals was investigated.
Over the past two decades, different dimensions of wellbeing have been defined and
researched operationally. Wellbeing research has developed in two main camps, primarily
hedonic (e.g., Bastian et al. 2014) and eudaimonic (e.g., Waterman et al. 2010). However, the
synthesis of these two main approaches has become prominent in recent years (Disabato et al.
2016; Lambert et al. 2015). Mental wellbeing is conceptualized as a concise psychological
construct covering these two schools of wellbeing (Stewart-Brown et al. 2009). Mental
wellbeing includes psychological functioning, as well as cognitive and emotional dimensions
of wellbeing (Tennant et al. 2007). In the present study, it was predicted that intolerance to
uncertainty, which is an important in the context of a pandemic, is an important determinant of
psychological wellbeing.
Certainty and uncertainty is a fundamental dichotomy that reflects the basic dilemma of
being human. For example, the vast majority of individuals do not want to know the negative
events they will experience in the future, and Gigerenzer and Garcia-Retamero (2017) called
this situation the regret of knowing. In fact, individuals do not want to feel future threat in the
present moment. However, individuals want to fully realize the current threatening situation
International Journal of Mental Health and Addiction

completely and have some sense of control. Therefore, the uncertainty in the current situation
can be considered as an important risk factor for affecting psychological wellbeing.
Intolerance to uncertainty is defined as the dispositional fear underlying emotional diffi-
culties and resulting in anxiety in cases where the unknown is perceived intensely (Fergus
2013). Intolerance to uncertainty encapsulates a negative reaction irrespective of a rational
possibility of realization of a phenomenon in case of uncertainty (Hong and Lee 2015). In this
respect, intolerance towards uncertainty is considered as the main component underlying
anxiety disorders (Morriss et al. 2016). Apart from anxiety disorder, intolerance to uncertainty
may increase the effect of posttraumatic stress disorder on depression (Hollingsworth et al.
2018). Considering the aforementioned postulations, it is expected that inability to tolerate
uncertainty may negatively predict wellbeing. However, identifying the mediators of this
predictive relationship is of great utility.

The Present Study

The present authors first envisaged the mediation of rumination in relation to uncertainty and
wellbeing. One of the main postulations that informs an individual’s vulnerability to depression is
the theory of response styles (Nolen-Hoeksema 1991; Nolen-Hoeksema et al. 2008). In this theory,
rumination broadly describes repetitive speculations as the cause and consequences of an individ-
ual’s current psychological symptoms (Nolen-Hoeksema 1991). Therefore, rumination is considered
as a way of thinking that deepens and maintains depression (Pössel 2011). A possible reason for this
is the retrieval of negatively charged emotional experiences from autobiographical memory with
rumination (Lyubomirsky et al. 1998). Another factor is that when individuals think about bad
situations or memories, they may ruminate more than when thinking about good ones (Zullow et al.
1988). Research has demonstrated that rumination may threaten mental health (e.g., Bravo et al.
2020) and increase negative moods (Genet and Siemer 2012), including depression (Ciesla and
Roberts 2007). Moreover, intrusive rumination can trigger posttraumatic stress disorder when faced
with a traumatic event (Wozniak et al. 2020).
In addition, rumination can facilitate negative emotions that can negatively affect the
wellbeing of the individual during the trauma process. Consequently, rumination may strength-
en anger when experiencing something traumatic (Christ et al. 2020). Additionally, rumination
may weaken an individual’s sense of mastery, reinforce the perception of loss of control, and
cause depressive emotions to be prolonged Nolen-Hoeksema et al. 1999). Therefore, in the
present research study, it was hypothesized that rumination fed by uncertainty may negatively
affect wellbeing through fear of COVID-19 because the prominent feature of rumination is the
focus on negative emotions (Nolen-Hoeksema 1991). The media plays an important role in the
dissemination of information in the pandemic, and continuous exposure to COVID-19 pan-
demic-related information can keep the sense of threat alive (Garfin et al. 2020). The rapid
flow of information in both traditional and social media leads to confusion and increases
uncertainty. At this this current time of information overload concerning COVID-19, individ-
uals who ruminate more may inflate the perception of threat and experience more fear of the
COVID-19 pandemic. Consequently, psychological wellbeing can deteriorate beyond the
inherent negativities of the pandemic. In line with these data and based on previous findings
in the literature, the present study proposes the following hypotheses (Hs):

H1. Intolerance of uncertainty will be negatively related to mental wellbeing.

 International Journal of Mental Health and Addiction

H2. The relationship between intolerance of uncertainty and mental wellbeing will be
mediated by rumination.
H3. The relationship between intolerance of uncertainty and mental wellbeing will be
mediated by fear of COVID-19.
H4. The relationship between intolerance of uncertainty and mental wellbeing will be
serially mediated by rumination and fear of COVID-19.

Method

Participant and Procedure

The sample comprised 1772 Turkish individuals (1244 [70%] females and 528 [30%] males)
from 79 of 81 cities in Turkey, aged 18–73 years (M = 24.42, SD = 8.29). They were recruited via
a web-based questionnaire, and participated voluntarily. Participants were asked to provide
answers to measures assessing mental wellbeing, intolerance of uncertainty, rumination, and fear
of COVID-19, as well as basic information (e.g., gender, age, questions related to COVID-19).
The education levels of the sample were as follows: 3% had a primary school degree (n = 53),
2.4% had a middle school degree (n = 43), 19.7% had a high school degree (n = 349), 16.9% had
an associate degree (n = 299), 54.9% had a bachelor’s degree (n = 972), and the remainder
(n = 56) had a master’s degree or above (3.2%). The sample’s characteristics are shown in Table 1.

Measures

Mental Wellbeing Participants’ mental wellbeing was assessed using the Warwick-Edinburgh
Mental Well-Being Scale (WEMWBS; Tennant et al. 2007). Participants assess 14 items (e.g.,
“I’ve been feeling good about myself”) on a 5-point Likert-type scale ranging from 1 (none of
the time) to 5 (all of the time), with higher scores indicating higher levels of mental wellbeing.
In the present study, the Turkish version of the WEMWBS (Keldal 2015) was used. It has been
shown to have excellent internal consistency reliability (α = .92), as well as excellent construct
validity (NFI = .94, RFI = .93, IFI = .96, CFI = .96, NNFI = .95, and RMR = .054; Keldal
2015). The Cronbach’s α in the present study was excellent (.91).

Fear of COVID-19 Participants’ fear of coronavirus-19 was assessed using the Fear of
COVID-19 Scale (FCV-19S; Ahorsu et al. 2020). Participants assess seven items (e.g., “It
makes me uncomfortable to think about coronavirus-19”) on a 5-point Likert-type scale
ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating higher
levels of fear of coronavirus-19. In the present study, the Turkish version of the FCV-19S
(Satici et al. 2020) was used. It has been shown to have very good internal consistency
reliability (α = .85 and ω = .85), as well as excellent construct validity (SRMR = .061; GFI =
.936; NFI = .912; IFI = .915; CFI = .915; Satici et al. 2020). The Cronbach’s α in the present
study was very good (.87).

Intolerance of Uncertainty Participants’ intolerance of uncertainty was assessed using the

Short Version of the Intolerance of Uncertainty Scale (IUS12; Carleton et al. 2007). Participants
assess 12 items (e.g., “It frustrates me not having all the information I need”) on a 5-point Likert-
type scale ranging from 1 (not at all characteristic of me) to 5 (entirely characteristic of me),
International Journal of Mental Health and Addiction

Table 1 Sample characteristics

Variable Frequency (n) %

Gender
Female 1244 70.2
Male 528 29.8
Educational status
Primary school 53 3.0
Middle school 43 2.4
High school 349 19.7
Associate degree 299 16.9
Undergraduate 972 54.9
Master’s/doctorate 56 3.2
Occupational status
Student 1182 66.7
Government employee 148 8.4
Private employee 210 11.9
Unemployed 232 13.1
Perceived social-economic status
Low 230 13
Moderate 1408 79.5
High 134 7.5
Marital status
Single 1463 82.6
Married 309 17.4
Child status
Have children 259 14.6
No children 1513 85.4
COVID-19 symptoms to date
Yes 42 2.4
Partially 192 10.8
No 1538 86.8
Chronic disease state
Yes 181 10.2
No 1591 89.8
Have you had any relatives diagnosed with COVID-19?
Yes 375 21.2
No 1397 78.8
Have you had any relatives who lost their lives due to COVID-19?
Yes 112 6.3
No 1660 93.7

with higher scores indicating higher levels of intolerance of uncertainty. In the present study, the
Turkish version of the IUS12 (Sarıcam et al. 2014) was used. It has been shown to have very
good internal consistency reliability (α = .88), as well as very good construct validity
(RMSEA = .073, CFI = .95, IFI = .95, GFI = .94, and SRMR = .046; Sarıcam et al. 2014). The
Cronbach’s α in the present study was very good (.87).

Rumination Participants’ rumination was assessed using the Ruminative Response Scale
(RRS; Treynor et al. 2003). Participants assess 10 items (e.g., “Think ‘What am I doing to
deserve this?’”) on a 4-point Likert-type scale ranging from 1 (almost never) to 4 (almost
always), with higher scores indicating higher levels of rumination. In the present study, the
Turkish version of the RRS (Erdur-Baker and Bugay 2012) was used. It has been shown
to have good internal consistency reliability (α > .75), as well as excellent construct validity
 International Journal of Mental Health and Addiction

(χ2/df = 2.68; TLI = .94, CFI = .97, RMSEA = .06 and SRMR = .04; Erdur-Baker and Bugay
2012). The Cronbach’s α in the present study was very good (.85).

Data Analysis

Mediation analysis was conducted using the PROCESS macro for SPSS (Model 6, Hayes
2018) to test the mediation effects of how intolerance of uncertainty affects rumination, how
rumination affects fear of COVID-19, and how fear of COVID-19 affects mental wellbeing,
with rumination and fear of COVID-19 as mediators. Gender and age were controlled for as
covariates. The advantage of this procedure, as noted by Van Jaarsveld, Walker, and Skarlicki
(2010), is that it enables isolation of each mediator’s indirect effect: rumination (H2) and fear
of COVID-19 (H3). Furthermore, this approach also allows investigation of “the indirect effect
passing through both of these mediators in a series” (Van Jaarsveld et al. 2010, p. 1496) (H4).
The statistical significance of the mediating variable was investigated using 5000 bootstrap
samples. This method generated 95% confidence intervals (CI) of the indirect effects.
Bootstrapped 95% CIs not straddling zero were considered statistically significant (Hayes
2018). All data analyses were conducted using IBM SPSS Statistics 22 and JASP 0.11.1.

Ethics

The study was approved by the research team’s university ethics committee (REF: 78646441-
050.01.04-E.5372). All procedures performed in studies involving human participants were in
accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical
standards. The study was carried out only with volunteers. It was stated to the participants that
they could withdraw from the research at any time. Informed consent was obtained before
participating in the study.

Results

Preliminary Analyses

Descriptive statistics, correlations, and reliabilities for the study variables are displayed in Table 2. As
expected, mental wellbeing was negatively associated with intolerance of uncertainty (r = − .23,
p < .001), rumination (r = − .28, p < .001), and fear of COVID-19 (r = − .24, p < .001). Fear of
COVID-19 was positively associated with intolerance of uncertainty (r = .48, p < .001) and

Table 2 Descriptive statistics and correlations among study variables (N = 1772)

Variable 1 2 3 α ω M SD Skewness Kurtosis

1. Fear of COVID-19 – .87 .87 18.83 6.01 .175 − .293

2. Mental wellbeing − .24** – .91 .91 51.07 9.46 − .511 .737
3. Intolerance of uncertainty .48** − .23** – .87 .87 38.86 9.00 − .188 − .034
4. Rumination .42** − .28** .54** .85 .86 22.25 5.73 .401 .216

**p < .001

International Journal of Mental Health and Addiction

rumination (r = .42, p < .001). Intolerance of uncertainty was positively associated with rumination
(r = .54, p < .001).

Statistical Assumption Tests

The results indicated that the skewness ranged from − .51 to .40 and kurtosis ranged from − .29 to
.74 and were within the normality criteria. It was found that all reliability coefficients were highly
above .70 and therefore acceptable. The entire Mahalanobis distance was below 15. The variance
inflation factor values were 1.37–1.59, the tolerance values were .63–.73, and the Durbin Watson
value was 1.82, which indicates that there was no multicollinearity and residuals problem. As a
result, all assumptions were met in accordance with Field’s (2016) suggestions.

Serial Multiple Mediational Analyses

Results of the serial mediation analyses are presented in Fig. 1. Confirming Hypothesis 1, the
study found a negative direct effect of intolerance of uncertainty on mental wellbeing (total
effect; B = − .226, p < .001). When the mediators were included in the analysis, this coefficient
was reduced but was still statistically significant (direct effect, B = − .069, p < .05]. Intolerance
of uncertainty was also found to be a positive predictor of rumination (B = .334, p < .001) and
fear of COVID-19 (B = .238, p < .001).
Confirming Hypothesis 2, the study found a significant indirect effect of intolerance of
uncertainty on mental wellbeing via rumination (B = − .092, SE = .02, 95% CI = [− .124,
− .061]). In addition, the indirect effect of intolerance of uncertainty on mental wellbeing via
fear of COVID-19 was also significant (B = − .049, SE = .01, 95% CI = [− .073, − .028]),
confirming Hypothesis 3. Finally, the study tested the indirect effect of intolerance of uncer-
tainty on mental wellbeing via both rumination and fear of COVID-19. The relationship was

Covariates
Gender
Age

Ruminaon ** Fear of COVID-19

(M1) d21 = .225 (M2)

**
a1 = .334 a2 = .238
** **
b1 = -.276
**
b2 = -.209

Intolerance of
c' = -.226** Mental wellbeing
uncertainty *
c = -.069 (Y)
(X)
Fig. 1 The result of serial multiple mediational model, *p < .05, **p < .001. Values shown are unstandardized
coefficients
 International Journal of Mental Health and Addiction

significant with a point estimate of 0.016 (testing serial multiple mediation; SE = .01, 95%
CI = − .024, − .009). Therefore, Hypothesis 4 was also confirmed (see Table 3).
To summarize, results from the study showed that there was an indirect relationship
between high intolerance of uncertainty and low mental wellbeing. This association was
partially mediated by higher levels of rumination and higher levels of fear of COVID-19.

Discussion

At the time of writing, the COVID-19 pandemic has become a global crisis. Consequently, the
negative psychological outcomes of the pandemic have become important to investigate.
Therefore, in the present study, the relationships between intolerance of uncertainty, rumina-
tion, fear of COVID-19, and mental wellbeing were investigated. The findings indicated that
rumination and fear of COVID-19 mediated the relationship between intolerance of uncer-
tainty and mental wellbeing. As a result of the analysis, the hypothesis concerning the
relationship between intolerance of uncertainty and wellbeing was confirmed. This result
overlaps with findings indicating an increase in negative psychological consequences during
epidemics (e.g., Jose et al. 2017; Mihashi et al. 2009; Yip et al. 2010). Wellbeing is threatened
by direct and indirect trauma as well as potential risk perception. Uncertainty may have also
been triggered by disruption of daily routine and interaction social support mechanisms, as
well as feelings concerning perceived loss of control.
In accordance with another hypothesis, the mediating role of rumination in the rela-
tionship between intolerance of uncertainty and mental wellbeing was tested and the
hypothesis was confirmed. The findings of the study indicated the mediating role of
rumination in the relationship between intolerance of uncertainty and wellbeing concurs
with research showing the moderating role of rumination in the relationship between daily
activities and negative mood (Genet and Siemer 2012). Similarly, intrusive rumination has
been found to mediate in the relationship between traumatic experiences and posttraumatic
disorder (Wozniak et al. 2020). A study that examined the relationship between rumination
and depressive mood showed that negative cognitions mediated this relationship (Ciesla
and Roberts 2007). Therefore, within the framework of all these empirical findings, it can
be concluded that rumination increases negative cognition and bad mood as well as
negative psychological wellbeing in traumatic and uncertain situations.

Table 3 Indirect effect of intolerance of uncertainty on mental wellbeing via rumination and fear of COVID-19

Path Coefficient 95% CI

LL UL

Intolerance of uncertainty ➔ Rumination ➔ Mental wellbeing − .092 − .124 − .060

Intolerance of uncertainty ➔ Fear of COVID-19 ➔ Mental wellbeing − .049 − .073 − .028
Intolerance of uncertainty ➔ Rumination ➔ Fear of COVID-19 ➔Mental − .016 − .024 − .009
wellbeing
Total effect − .226 − .274 − .179
Direct effect − .068 − .127 − .010
Total indirect effect − .157 − .195 − .121

CI confidence interval, LL lower limit, UL upper limit

International Journal of Mental Health and Addiction

The main hypothesis was confirmed because findings demonstrated the serial mediation
roles of rumination and fear of COVID-19 in the relationship between intolerance of uncertainty
and wellbeing. In line with this hypothesis, it was shown that rumination inflates COVID-19
fear and disrupts wellbeing. This finding is similar to findings that rumination in traumatic
events may increase anger (Christ et al. 2020), and speed up the recall of negative memories
(Lyubomirsky et al. 1998). Therefore, it can be speculated that rumination may increase fear in
the COVID-19 pandemic because it increases negative affect in other traumatic situations.

Limitations and Future Research

The present study was self-report and correlational in nature. In future research, daily
experiences concerning COVID-19 and other variables in the study could be researched
through different methods such as the dairy method and/or carrying out a longitudinal study
to overcome the correlational nature of the findings. The limitation due to the correlational
nature of the research may be eradicated by using stress-priming studies in a laboratory
environment. In this way, emotional consequences of rumination used in case of stress can
be observed. Although the present study was carried out among a relatively large sample, the
use of cross-sectional data collection is a limitation. Consequently, more valid findings would
be generated by testing the associations reported here utilizing a longitudinal research design.
In addition, this research was conducted in a non-clinical sample. Practitioners working with
the clinical population need to be careful when applying the findings of the study.
In the present study, it was found that rumination negatively predicted wellbeing by
increasing fear in the pandemic. In further studies, potential mediating variables such
as psychological need frustration, existential loneliness, and meaninglessness may also
be tested in the relationship between rumination and mental wellbeing. In addition,
beyond the theoretical presumptions, it may be fruitful to explore real experiences
through qualitative research methods such as phenomenology and grounded theory.

Conclusion

Overall, in the present study, it was shown with a nationwide participant sample that the
inability to tolerate uncertainty in the current pandemic might provoke fear of COVID-19 via
rumination, and consequently impacting negatively on psychological wellbeing. In line with
these findings, counselors could develop programs to reduce intolerance to uncertainty and
implement it online. In this context, the attachment-based intolerance to uncertainty reduction
program in Turkey for adolescents has been developed and implemented (Yildiz and Iskender
2019). Similar programs may be implemented in online settings, especially targeting risk
groups. In addition, audio and visual materials in which internal dialogues with and without
rumination are played can be prepared and shared by counselors. Moreover, to deal with
uncertainty caused by pseudo-science and information, accurate and filtered knowledge about
the COVID-19 pandemic can be shared with clients and the general community through social
media channels.

Acknowledgments Sources of funding are acknowledged.

 International Journal of Mental Health and Addiction

Compliance with Ethical Standards

Conflict of Interest The authors declare that they have no conflict of interest.

Ethical Approval All procedures performed in this study involving human participants were in accordance
with the ethical standards of University’s Research Ethics Board and with the 1975 Helsinki Declaration.

Informed Consent Informed consent was obtained from all participants.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and
indicate if changes were made. The images or other third party material in this article are included in the article's
Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or
exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy
of this licence, visit http://creativecommons.org/licenses/by/4.0/.

References

Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The Fear of COVID-
19 Scale: development and initial validation. International Journal of Mental Health and Addiction.
https://doi.org/10.1007/s11469-020-00270-8.
Bastian, B., Kuppens, P., De Roover, K., & Diener, E. (2014). Is valuing positive emotion associated with life
satisfaction? Emotion, 14(4), 639–645. https://doi.org/10.1037/a0036466.
Bonanno, G. A., Ho, S. M. Y., Chan, J. C. K., Kwong, R. S. Y., Cheung, C. K. Y., Wong, C. P. Y., & Wong, V. C.
W. (2008). Psychological resilience and dysfunction among hospitalized survivors of the SARS epidemic in
Hong Kong: A latent class approach. Health Psychology, 27(5), 659–667. https://doi.org/10.1037/0278-
6133.27.5.659.
Bravo, A. J., Kelley, M. L., Mason, R., Ehlke, S. J., Vinci, C., & Redman, J. C. (2020). Rumination as a mediator
of the associations between moral injury and mental health problems in combat-wounded veterans.
Traumatology, 26(1), 52–60. https://doi.org/10.1037/trm0000198.
Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the
Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117. https://doi.org/10.1016/j.
janxdis.2006.03.014.
Christ, N. M., Contractor, A. A., Wang, X., & Elhai, J. D. (2020). The mediating effect of rumination between
posttraumatic stress disorder symptoms and anger reactions. Psychological Trauma: Theory, Research,
Practice and Policy. https://doi.org/10.1037/tra0000579
Ciesla, J. A., & Roberts, J. E. (2007). Rumination, negative cognition, and their interactive effects on depressed
mood. Emotion, 7(3), 555–565. https://doi.org/10.1037/1528-3542.7.3.555.
Disabato, D. J., Goodman, F. R., Kashdan, T. B., Short, J. L., & Jarden, A. (2016). Different types of well-being?
A cross-cultural examination of hedonic and eudaimonic well-being. Psychological Assessment, 28(5), 471–
482. https://doi.org/10.1037/pas0000209.
Erdur-Baker, O., & Bugay, A. (2012). The Turkish version of the Ruminative Response Scale: An examination of
its reliability and validity. International Journal of Educational and Psychological Assessment, 10(2), 1–16.
Fergus, T. A. (2013). A comparison of three self-report measures of intolerance of uncertainty: An examination of
structure and incremental explanatory power in a community sample. Psychological Assessment, 25(4),
1322–1331. https://doi.org/10.1037/a0034103.
Field, A. (2016). Discovering statistics using IBM SPSS Statistics. London: Sage.
Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). The novel coronavirus (COVID-2019) outbreak:
Amplification of public health consequences by media exposure. Health Psychology, 39(5), 355–357.
https://doi.org/10.1037/hea0000875.
Genet, J. J., & Siemer, M. (2012). Rumination moderates the effects of daily events on negative mood: Results
from a diary study. Emotion, 12(6), 1329–1339. https://doi.org/10.1037/a0028070.
International Journal of Mental Health and Addiction

Gigerenzer, G., & Garcia-Retamero, R. (2017). Cassandra’s regret: The psychology of not wanting to know.
Psychological Review, 124(2), 179–196. https://doi.org/10.1037/rev0000055.
Goyal, K., Chauhan, P., Chhikara, K., Gupta, P., & Singh, M. P. (2020). Fear of COVID 2019: First suicidal case
in India! Asian Journal of Psychiatry, 49, 101989. https://doi.org/10.1016/j.ajp.2020.101989.
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: a regression-
based approach. New York: Guilford Publications.
Hollingsworth, D. W., Gauthier, J. M., McGuire, A. P., Peck, K. R., Hahn, K. S., & Connolly, K. M. (2018).
Intolerance of uncertainty mediates symptoms of PTSD and depression in African American veterans with
comorbid PTSD and substance use disorders. Journal of Black Psychology, 44(7), 667–688. https://doi.
org/10.1177/0095798418809201.
Hong, R. Y., & Lee, S. S. M. (2015). Further clarifying prospective and inhibitory intolerance of uncertainty:
Factorial and construct validity of test scores from the intolerance of uncertainty scale. Psychological
Assessment, 27(2), 605–620. https://doi.org/10.1037/pas0000074.
Jose, R., Alison Holman, E., & Silver, R. C. (2017). The importance of the neighborhood in the 2014 Ebola
outbreak in the United States: Distress, worry, and functioning. Health Psychology, 36(12), 1181–1185.
https://doi.org/10.1037/hea0000518.
Keldal, G. (2015). Turkish version of the Warwick-Edinburgh Mental Well-Being Scale: A validity and reliability
study. Journal of Happiness & Well-Being, 3(1), 103–115.
Lambert, L., Passmore, H.-A., & Holder, M. D. (2015). Foundational frameworks of positive psychology:
Mapping well-being orientations. Canadian Psychology, 56(3), 311–321. https://doi.org/10.1037
/cap0000033.
Lyubomirsky, S., Caldwell, N. D., & Nolen-Hoeksema, S. (1998). Effects of ruminative and distracting responses
to depressed mood on retrieval of autobiographical memories. Journal of Personality and Social Psychology,
75(1), 166–177. https://doi.org/10.1037/0022-3514.75.1.166.
Main, A., Zhou, Q., Ma, Y., Luecken, L. J., & Liu, X. (2011). Relations of SARS-related stressors and coping to
Chinese college students’ psychological adjustment during the 2003 Beijing SARS epidemic. Journal of
Counseling Psychology, 58(3), 410–423. https://doi.org/10.1037/a0023632.
Mamun, M. A., & Griffiths, M. D. (2020). First COVID-19 suicide case in Bangladesh due to fear of COVID-19
and xenophobia: Possible suicide prevention strategies. Asian Journal of Psychiatry, 51, 102073. https://doi.
org/10.1016/j.ajp.2020.102073.
Mihashi, M., Otsubo, Y., Yinjuan, X., Nagatomi, K., Hoshiko, M., & Ishitake, T. (2009). Predictive factors of
psychological disorder development during recovery following SARS outbreak. Health Psychology, 28(1),
91–100. https://doi.org/10.1037/a0013674.
Morriss, J., Christakou, A., & van Reekum, C. M. (2016). Nothing is safe: Intolerance of uncertainty is associated
with compromised fear extinction learning. Biological Psychology, 121(Pt B), 187–193. https://doi.
org/10.1016/j.biopsycho.2016.05.001.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes.
Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569.
Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive
symptoms. Journal of Personality and Social Psychology, 77(5), 1061–1072. https://doi.org/10.1037
//0022-3514.77.5.1061.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on
Psychological Science, 3(5), 400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x.
Pakpour, A., & Griffiths, M. (2020). The fear of COVID-19 and its role in preventive behaviors. Journal of
Concurrent Disorders, 2(1), 58–63.
Pössel, P. (2011). Can Beck’s theory of depression and the response style theory be integrated? Journal of
Counseling Psychology, 58(4), 618–629. https://doi.org/10.1037/a0025092.
Sarıcam, H., Erguvan, F. M., Akın, A., & Akça, M. Ş. (2014). The Turkish short version of the Intolerance of
Uncertainty (IUS-12) Scale: The study of validity and reliability. Route Educational and Social Science
Journal, 1(3), 148–157.
Satici, B., Gocet-Tekin, E., Deniz, M. E., & Satici, S. A. (2020). Adaptation of the Fear of COVID-19 Scale: Its
association with psychological distress and life satisfaction in Turkey. International Journal of Mental
Health and Addiction. https://doi.org/10.1007/s11469-020-00294-0.
Schimmenti, A., Billieux, J., & Starcevic, V. (2020). The four horsemen of fear: An integrated model of
understanding fear experiences during the COVID-19 pandemic. Clinical Neuropsychiatry, 17(2), 41–45.
Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J., & Weich, S. (2009). Internal construct
validity of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): A Rasch analysis using data
from the Scottish Health Education Population Survey. Health and Quality of Life Outcomes, 7(1), 15–15.
https://doi.org/10.1186/1477-7525-7-15.
 International Journal of Mental Health and Addiction

Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J., Secker, J., & Stewart-Brown,
S. (2007). The Warwick-Edinburgh mental well-being scale (WEMWBS): Development and UK validation.
Health and Quality of Life Outcomes, 5(1), 63. https://doi.org/10.1186/1477-7525-5-63.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis.
Cognitive Therapy and Research, 27(3), 247–259. https://doi.org/10.1023/A:1023910315561.
Van Jaarsveld, D. D., Walker, D. D., & Skarlicki, D. P. (2010). The role of job demands and emotional exhaustion
in the relationship between customer and employee incivility. Journal of Management, 36(6), 1486–1504.
https://doi.org/10.1177/0149206310368998.
Waterman, A. S., Schwartz, S. J., Zamboanga, B. L., Ravert, R. D., Williams, M. K., Bede Agocha, V., Yeong
Kim, S., & Brent Donnellan, M. (2010). The Questionnaire for Eudaimonic Well-Being: psychometric
properties, demographic comparisons, and evidence of validity. Journal of Positive Psychology, 5(1), 41–61.
https://doi.org/10.1080/17439760903435208.
Wozniak, J. D., Caudle, H. E., Harding, K., Vieselmeyer, J., & Mezulis, A. H. (2020). The effect of trauma
proximity and ruminative response styles on posttraumatic stress and posttraumatic growth following a
university shooting. Psychological Trauma Theory Research Practice and Policy, 12(3), 227–234.
https://doi.org/10.1037/tra0000505.
Yildiz, B., & Iskender, M. (2019). The secure attachment style oriented psycho-educational program for reducing
intolerance of uncertainty and academic procrastination. Current Psychology. https://doi.org/10.1007/s12144-
018-0112-4.
Yip, P. S. F., Cheung, Y. T., Chau, P. H., & Law, Y. W. (2010). The impact of epidemic outbreak: The case of
severe acute respiratory syndrome (SARS) and suicide among older adults in Hong Kong. Crisis, 31(2), 86–
92. https://doi.org/10.1027/0227-5910/a000015.
Zullow, H. M., Oettingen, G., Peterson, C., & Seligman, M. E. P. (1988). Pessimistic explanatory style in the
historical record: CAVing LBJ, presidential candidates, and east versus West Berlin. American Psychologist,
43(9), 673–682. https://doi.org/10.1037/0003-066X.43.9.673.

Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and
institutional affiliations.

Affiliations

Begum Satici 1 & Mehmet Saricali 2 & Seydi Ahmet Satici 1 & Mark D. Griffiths 3
1
Department of Psychological Counselling, Artvin Coruh University, Artvin, Turkey
2
Department of Psychological Counselling, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
3
International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham,
UK

View publication stats