Sense of coherence as a coping mechanism for women with anxiety living in deprivation: a cohort study in the British population

Abstract

BackgroundTargeting people's coping mechanisms may represent a method of reducing anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of generalised anxiety disorder in women, but not in men. The aim of this study was to assess whether sense of coherence (coping mechanism) mitigates the influence of area deprivation on women's risk of generalised anxiety disorder. MethodsWe used data from the EPIC-Norfolk study. 30 445 men and women over the age of 40 were recruited through general practice registers in England. Of these, 11 820 women and 9101 men completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and sense of coherence. Scores of sense of coherence component constructs were summed to create a final measure ranging from 1 to 6, where scores lower than 2 represent a strong sense of coherence. Census data for 1991 were used to measure area deprivation, and sense of coherence and anxiety were assessed in 1996–2000. 10 185 women had complete data on covariates. Logistic regression was used to assess the association between area deprivation and generalised anxiety disorder, and stratification by (and interaction with) sense of coherence was performed. The study was approved by the Norfolk Ethics Committee (98CN01); participants gave written informed consent. Findings261 (2·6%) of 10 185 women had generalised anxiety disorder. There was no interaction between sense of coherence and generalised anxiety disorder (p=0·23). In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety after controlling for sociodemographics, and medical and psychiatric history (odds ratio 1·29, 95% CI 0·77–2·18; p=0·34). However, among women with a weak sense of coherence, those living in deprived areas had a 98% higher likelihood of having generalised anxiety disorder than those living in more affluent areas, in a fully-adjusted model (1·98, 1·35–2·92; p=0·0005). InterpretationMany women live in deprived conditions worldwide, and substantial numbers are affected by generalised anxiety disorder. A key message is that deprivation needs to be addressed worldwide for many reasons. Understanding and strengthening coping mechanisms as a way to reduce anxiety is an important area for attention—both in research and in public health practice. Our findings might not be generalisable to extremely deprived areas. FundingThis work was supported by the UK Medical Research Council (grant number SP2024-0201 and SP2024-0204) and Cancer Research UK (grant number G9502233). OR received a PhD studentship from the National Institute for Health Research.