Interplay between Intolerance of Uncertainty and Anxiety Sensitivity in University Students: A Systematic Review

Abstract

Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are recognized as interconnected vulnerability factors affecting university students’ mental health. This systematic review (2014–2024) followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251036590). Seven databases across psychology, education and health were searched, yielding 664 records; 11 studies met inclusion criteria after screening. The evidence consistently shows a strong positive relationship between IU and AS. Students who struggle with uncertainty tend to also fear anxiety sensations, compounding their risk for psychological distress. In most studies, high IU exacerbated the effects of AS on anxiety-related outcomes (e.g. health anxiety), and conversely AS often mediated the impact of IU on overall anxiety levels. The included research—primarily cross-sectional studies from North America with student/young adult samples—indicates that IU and AS together fuel avoidance behaviors, help-seeking barriers, and academic difficulties, undermining inclusive participation in campus life. However, longitudinal data are scarce, and cultural diversity is limited, leaving causality and generalizability uncertain. This review synthesizes a decade of findings to highlight the intertwined roles of IU and AS in student anxiety, and it discusses implications for targeted interventions in higher education. Reducing IU and AS via cognitive-behavioral strategies and supportive educational practices is recommended to improve student resilience and inclusion.