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Title: Risk factors and outcomes associated with generalised anxiety disorder : findings from a large population study
Author: Remes, Roxana-Olivia
ISNI:       0000 0004 7653 4316
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2019
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Scientific interest in the clinical implications, public health importance, and risk factors of anxiety disorders has grown substantially in the past two decades. Despite this, the evidence base on anxiety is insufficient to inform health care planning and policy-making. Further research on the outcomes and risk factors associated with anxiety disorders, and ways of mitigating these risks is needed. One of the aims of this thesis was to provide an overview of the existing literature on the prevalence of anxiety in adults living in countries across the globe, and to describe the prevalence in the context of various health states and life stages. Because generalised anxiety disorder is one of the most common psychiatric conditions in the population, the remainder of the thesis focused on this disorder and aimed to explore its links with health service use and mortality. Risk for this condition was also explored and area deprivation was studied as a possible determinant. Since depression is commonly studied alongside anxiety, the relationship between the residential environment and major depressive disorder was also assessed. Finally, to provide insight into the mitigation of risks of generalised anxiety disorder, a study of coping mechanisms was undertaken. Primary study findings from this thesis are based on the European Prospective Investigation of Cancer in Norfolk, a large, population study of British people over the age of 40. Results from the systematic review showed that anxiety is common in population sub-groups around the world, with women, younger people, and those suffering from chronic physical conditions, such as cancer and cardiovascular disease being particularly affected. Results from the primary studies of the thesis showed that generalised anxiety disorder is associated with increased risk for deaths, though it is not significantly associated with non-psychiatric hospital admissions. Results from the risk factor analyses showed that living in a deprived area is associated with generalised anxiety disorder in women and major depressive disorder in men. The risk mitigation analysis indicated that sense of coherence is an important coping mechanism that can protect against generalised anxiety disorder among women living in disadvantaged circumstances. My work has shown novel associations and attempted to provide a more complete picture of one of the most common psychiatric conditions in the population by focusing on several angles: health outcomes, risk factors, and ways of mitigating risks.
Supervisor: Brayne, Carol Sponsor: National Institute for Health Research
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: Health services ; Ecologic-level ; risk factors