Article Text

Download PDFPDF

Sex differences in the association between area deprivation and generalised anxiety disorder: British population study
  1. Olivia Remes,
  2. Nick Wainwright,
  3. Paul Surtees,
  4. Louise Lafortune,
  5. Kay-Tee Khaw,
  6. Carol Brayne
  1. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to Olivia Remes; or260{at}


Objective Studies have shown that area-level deprivation measured by factors, such as non-home ownership, non-car ownership and household overcrowding, can increase the risk for mental disorders over and above individual-level circumstances, such as education and social class. Whether area-level deprivation is associated with generalised anxiety disorder (GAD) independent of personal circumstances, and whether this association is different between British women and men is unknown.

Design Large, population study.

Setting UK population-based cohort.

Participants 30 445 people from the general population aged 40 years and older and living in England consented to participate at study baseline, and of these, 21 921 participants completed a structured health and lifestyle questionnaire used to capture GAD. Area deprivation was measured in 1991 using Census data, and GAD was assessed in 1996–2000. 10 275 women and 8219 men had complete data on all covariates.

Main outcome measure Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

Results In this study, 2.5% (261/10 275) of women and 1.8% (145/8219) of men had GAD. Women living in the most deprived areas were over 60% more likely to develop anxiety than those living in areas that were not deprived (OR=1.63, 95% CI 1.21 to 2.21; p=0.001), but this association between deprivation and GAD was not apparent in men (OR=1.13, 95% CI 0.72 to 1.77; p=0.598).

Conclusions The absolute numbers of people living in deprived conditions are large worldwide. This, combined with a growing mental health burden, means that the findings obtained in this study remain highly relevant. The WHO has emphasised the need to reduce social and health inequalities. Our findings provide a strong evidence base to this call, showing that the environment needs to be taken into account when developing mental health policy; gender is important when it comes to assessing the influence of the environment on our mental health.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter Follow Olivia Remes @oliviaroxann

  • Contributors OR (corresponding author) had the idea for and conducted the analysis, and wrote the article, along with CB, K-TK, LL, PS and NW. All authors provided feedback into the analysis and critically reviewed drafts of the manuscript. All authors have seen and approved the final version. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. OR acts as the guarantor of the study.

  • Funding This work was supported by the Medical Research Council UK (grant number G9502233) and Cancer Research UK (grant number SP2024-0201 and SP2024-0204).

  • Competing interests None declared.

  • Ethics approval The study has ethics committee approval from Norfolk Ethics Committee (Rec Ref: 98CN01).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.