Abstract
Anxiety and stress-related disorders are both common and disabling psychiatric conditions. There are a number of hypotheses suggesting the underlying pathophysiology of these disorders, however, the exact mechanism is unknown. Inflammation has previously been linked with depression and has more recently been suggested as a possible link to anxiety aetiology. The objectives of this study are to assess the relationship between different anxiety/stress-related disorders and inflammation (measured by C-reactive protein) using the UK Biobank, and also determine whether any relationship between anxiety/stress disorders and inflammation is explained by depressive symptoms and other social and health-related factors. We utilised the UK Biobank for the sample of this study. Our sample included 353,136 participants of which 12,759 (3.61%) had a history of an anxiety (phobic, obsessive-compulsive, or other anxiety disorder including generalised anxiety and panic disorders) or stress-related disorder (including acute stress reaction, post-traumatic stress disorder and adjustment disorders). Four logistic regression models were calculated in which we tested the association between anxiety/stress disorders and C-reactive protein (CRP) >3 mg/L, adjusting for covariates (including age, sex, ethnicity, education level, socioeconomic deprivation, depressive symptoms, body mass index (BMI) and multimorbidity). An association was observed between other anxiety disorders (including panic and generalised anxiety disorders) and CRP (OR: 1.164 [95% CI: 1.096–1.236]). This was attenuated in models after the addition of BMI, multimorbidity and depressive symptoms. Stress/adjustment disorders followed a similar pattern of results (OR: 1.107 [95% CI: 1.040, 1.178]), with the association attenuated with the addition of BMI and multimorbidity). Phobic anxiety disorders (OR: 1.059 [95% CI: 0.896, 1.251]) and obsessive-compulsive disorders (OR: 1.299 [95% CI: 0.973, 1.733]) both showed no statistically significant results in any of the models. Our results support the hypothesis that some anxiety and stress-related disorders may be associated with high levels of inflammatory markers, as measured by CRP. Further studies are required to untangle the potential causal relationships involved.
Highlights
Anxiety and stress-related disorders are some of the most common and disabling types of psychiatric conditions (Kessler et al, 2005; Vos et al, 2017)
Anxiety and stress-related disorders are associated with worsened physical health including increased risk of cardiovascular disease (Batelaan et al, 2016; Emdin et al, 2016; Song et al, 2019b), which may be independent of depression (Batelaan et al, 2016)
The anxiety/stress group had a significantly higher average PHQ-4; they presented with a higher number of depressive symptoms on average compared to the control group
Summary
Anxiety and stress-related disorders are some of the most common and disabling types of psychiatric conditions (Kessler et al, 2005; Vos et al, 2017) They are estimated to have a 12-month prevalence of 7.3% globally as well as a pooled-lifetime prevalence of around 12.9% (Baxter et al, 2013; Steel et al, 2014). Anxiety and stress-related disorders are associated with worsened physical health including increased risk of cardiovascular disease (Batelaan et al, 2016; Emdin et al, 2016; Song et al, 2019b), which may be independent of depression (Batelaan et al, 2016).
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