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A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study
  1. Olivia Remes1,
  2. Nicholas W J Wainwright2,
  3. Paul Surtees1,
  4. Louise Lafortune1,
  5. Kay-Tee Khaw2,
  6. Carol Brayne1
  1. 1 Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
  2. 2 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to Olivia Remes; or260{at}


Objective Many patients receiving medical treatment for anxiety relapse or do not improve. Research has therefore been turning to coping mechanisms as a way to decrease anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of anxiety in women, but not in men. The objective of this study is to assess whether sense of coherence (coping mechanism) buffers the influence of area deprivation on women’s risk of generalised anxiety disorder using data from the European Prospective Investigation of Cancer-Norfolk.

Design Large, population study.

Setting UK population-based cohort.

Participants 30 445 people over the age of 40 years were recruited through general practice registers in England. Of these, 20 919 completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder and sense of coherence. Area deprivation was measured using 1991 Census data, and sense of coherence and anxiety were examined in 1996–2000. 10 183 women had data on all variables.

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

Results In this study, 2.6% (260/10 183) of women had generalised anxiety disorder. In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety (OR 1.29, 95% CI 0.77 to 2.17). However, among women with a weak sense of coherence, those living in deprived areas were almost twice as likely to have generalised anxiety disorder compared with those living in more affluent areas (OR 1.99, 95% CI 1.37 to 2.91).

Conclusion The number of women living in deprived conditions is large worldwide, and significant numbers are affected by generalised anxiety disorder. Sense of coherence moderates the association between area deprivation and anxiety in women; therefore, interventions targeting coping mechanisms may need to be considered for people with anxiety.

  • anxiety
  • anxiety disorders
  • risk factors
  • gender

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  • Contributors OR (corresponding author) had the idea for and conducted the analysis, and wrote the article. CB critically reviewed drafts of the manuscript and provided input into the analysis, K-TK edited versions of the paper; PS and NW provided feedback into the analysis and reviewed the final draft of the paper. OR, CB, K-TK, LL, PS and NWJW 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. OR, CB, K-TK, LL, PS and NW have seen and approved the final version. OR, CB, K-TK, LL, PS and NW 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 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 available.

  • Author note Nick Wainwright is a retired author.