Anxiety and Chronic Illness

Anxiety Disorders Closely Linked to Physical Conditions, Study Finds
From Cathleen Henning,Your Guide to Anxiety & Panic Disorders. www.panicdisorder.about.com

People with anxiety disorders have an increased chance of developing physical conditions, particularly thyroid diseases, respiratory diseases, gastrointestinal diseases, arthritis, allergies, and migraine disease, researchers report in the October 23, 2006 Archives of Internal Medicine. Additionally, the presence of a physical condition along with an anxiety disorder increases the chance for disability and poor quality of life.

Researchers at the University of Manitoba in Winnipeg, Canada, led by Dr. Jitender Sareen, decided to explore the connection between anxiety disorders and physical conditions. Although depression has been linked to physical illness for quite some time, the association between anxiety and illness is much more recent. Additionally, according to the researchers, a number of the existing studies were limited in different ways, thus possibly affecting the outcomes.

Sareen and his colleagues decided to use the results of the German Health Survey (GHS), a survey of 4181 adults ages 18 to 65, conducted between 1997 and 1999, to assess the association between anxiety and illness. The survey used several tools to assess physical health, psychological health, and quality of life. These questionnaires and interviews were conducted by physicians and psychologists; additionally, medical tests were conducted to evaluate participants for illnesses.

The GHS showed that 8.4 percent of the participants had an anxiety disorder. This is consistent with the National Institute of Mental Health's finding that approximately 8 percent of the population has an anxiety disorder. Using the GHS, Sareen and his colleagues discovered several significant associations between anxiety disorders and physical illnesses:

Anxiety disorders were associated significantly with physical conditions. Below are the percentage of people with each physical illness who also had an anxiety disorder:
Respiratory diseases - 15.2
Gastrointestinal diseases - 18.8
Arthritis - 10.7
Allergic conditions - 12.0
Migraine disease - 20.3
Thyroid diseases - 14.8

Of the individuals with both anxiety disorders and physical conditions, the majority developed the anxiety disorder first.

Those with both anxiety disorders and physical conditions were more likely to have a poorer quality of life as well as be disabled (unable to perform normal daily activities) at some point.
Although the researchers point out a need for future studies (particularly as the age range in this study was 18-65), they did offer some possibilities for why anxiety disorders and physical conditions may be so closely connected:
A physical illness, particularly if life-threatening, may cause increased anxiety eventually leading to an anxiety disorder.

An anxiety disorder may lead to an increased chance of illness as the result of biological changes caused by the anxiety disorder.

An anxiety disorder may lead to another disorder, such as substance abuse, which in turn causes a physical illness.

A medication for a physical illness may bring on or increase anxiety symptoms.

There may be common genetic, environmental, and/or personality factors that connect anxiety disorders and certain physical conditions.
Whatever the reasons are for these connections, the researchers make clear that physicians need to assess for anxiety as well as depression when treating patients for physical conditions. "Although there have been increased efforts to recognize and treat depression in the medically ill, our findings underscore the need to create similar programs to recognize and treat anxiety disorders in the medically ill," the researchers wrote in the Archives of Internal Medicine.

References:
1) "Facts About Anxiety Disorders." 11 May 2006. National Institute of Mental Health. Accessed 20 Oct 2006 .
2) Sareen, Jitender, et al. "Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions." Archives of Internal Medicine 166(2006): 2109-2116.

Updated: October 23, 2006