Area deprivation and generalised anxiety disorder in a British community cohort: findings from the EPIC-Norfolk study

Abstract

BackgroundGeneralised anxiety disorder, one of the most common anxiety disorders in the general population, has been associated with disability, impairment, and high health service use. Whereas the effect of individual-level socioeconomic status on generalised anxiety disorder has been well researched, an understanding of the links between area-level (contextual) measures of deprivation and this disorder is less clear. Deprivation has been shown to be a determinant of general mental distress, depression, and a range of physical health outcomes; however, its association with generalised anxiety disorder is unknown. We aimed to examine whether area-level deprivation is associated with generalised anxiety disorder over and above individual-level circumstances in a British community cohort. MethodsWe used data from the EPIC-Norfolk study, a British population-based cohort study. 11 456 women and 8888 men over the age of 40 years were recruited between 1993 and 1997 through general practice age–sex registers in Norfolk, UK. Individual-level data were captured on sociodemographics, medical histories, disability level, and psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) with detailed health and lifestyle questionnaires. We used the Townsend Index and the Index of Multiple Deprivation to examine area-level deprivation. To account for the intracluster correlation, we constructed a population-average model using generalised estimating equations. FindingsWe found that 301 women (2·6%) and 157 men (1·8%) had generalised anxiety disorder in the previous year. Women living in deprived areas had a significantly higher risk than women living in areas that were not deprived (odds ratio 1·75, 95% CI 1·33–2·30), and this association persisted after adjustment for individual-level covariates. By contrast, no association was observed for men (1·09, 0·70–1·68). InterpretationArea-level characteristics should inform mental health policy. In particular, in deprived areas mental health services should target actions to address generalised anxiety disorder in women. Additional studies are needed to assess the specific dimensions of deprivation that are associated with generalised anxiety disorder in women. FundingOR received a studentship from the National Institute for Health Research (NIHR). The NIHR had no role in the writing of the manuscript or the decision to submit for publication.