From Death Anxiety to Generalized Anxietyin the Time of COVID-19: The Worsening Role of Intolerance of Uncertainty

Introduction: The life-threatening Covid-19 (C19) has challenged people’s physical and mental health (e.g., anxiety, worry). C19 has potentially fatal outcomes and could intensify the specific Anxiety of Death (DA) that, in turn, could heighten the levels of pervasive Generalized Anxiety (GA) also in not-lifethreatening situations. The unprecedented C19 pandemic still has an unpredictable course, involving substantial uncertainty - about short- and long-term future - able to trigger anxious reactions. To note, people with high levels of dispositional Intolerance of Uncertainty (IU) are more prone to experience high GA. Despite both DA and IU can trigger or worsen GA, literature about it is still scarce. Hence, this study aimed to test the literature-driven hypothesis that the relationship between DA and GA may depend on IU levels in the context of C19. Methods: In a sample (N = 1034; mean age 49.9±16.2; females 51%) representative of the Italian general population, DA, GA, and IU were respectively assessed with the: Death Anxiety Inventory (17 items); Generalized Anxiety Disorder-7 (7 items); Intolerance of Uncertainty Scale (12 items). A moderation model tested whether IU would be a moderator strengthening the path between DA and GA. Results: Both DA (b = .56,) and IU (b = 1.55, p < .001) predicted higher GA (both p<.001). The significant interaction of IU and DA (b =.124, p < .001) confirmed the moderating role of IU. In other words, at different increasing values of IU (moderator), DA has a larger effect (b) on GA. Conclusions: The IU moderator strengthens the effect of DA on GA in relation to the context, predicting a generalized and pervasive anxiety state, thus worsening psychological distress. The implications of these findings are useful for both clinical and research fields. First, psychological interventions in life-threatening situations (e.g., illness) could target DA and IU. Second, further research may deepen the intriguing relationship between DA and I