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Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study
  1. Olivia Remes,
  2. Nicholas 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 Generalised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.

Design Large, population study.

Setting UK population-based cohort.

Participants 30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.

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

Results In this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).

Conclusion People with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.

  • epidemiology
  • mental health
  • public health

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  • Contributors OR had the idea for and conducted the analysis, and wrote the article. CB critically reviewed drafts of the manuscript. K-TK edited versions of the paper. PS and NW provided feedback into the analysis. All authors contributed to the interpretation of data for the work, agreed to be accountable for all aspects of the work, gave final approval of the version to be published and made substantial contributions to the analysis and interpretation of data. All authors have seen and approved the final version. All 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 guarantor of the study.

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

  • Competing interests OR received a PhD studentship from the National Institute for Health Research.

  • Patient consent Obtained.

  • Ethics approval Norfolk Ethics Committee (Rec Ref: 98CN01).

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

  • Data sharing statement No additional data available.