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Depression, Anxiety Powerful Predictors of Poor Health

January 02, 2019

Anxiety and depression are as predictive of poor physical health as obesity and smoking are and, consequently, should be better addressed during routine visits to primary care providers, suggests a study published online in Health Psychology.

“Anxiety and depression symptoms are strongly linked to poor physical health, yet these conditions continue to receive limited attention in primary care settings compared to smoking and obesity,” said researcher Andrea Niles, PhD, of the University of California San Francisco and the San Francisco VA Medical Center. “To our knowledge, this is the first study that directly compared anxiety and depression to obesity and smoking as prospective risk factors for disease onset in long-term studies.”

Using health data for 15,418 older adults over a 4-year period, researchers found participants with high levels of anxiety and depression (16% of the study population) had a 65% increased risk of a heart condition, 64% increased risk of stroke, 50% increased risk of high blood pressure, and 87% increased risk for arthritis, compared with participants without anxiety and depression.

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“These increased odds are similar to those of participants who are smokers or are obese,” said Aoife O’Donovan, PhD, also of the University of California San Francisco and the San Francisco VA Medical Center “However, for arthritis, high anxiety and depression seem to confer higher risks than smoking and obesity.”

Symptoms such as headache, stomach upset, back pain, and shortness of breath were strongly associated with stress and depression. Odds for headache were 161% higher in older adults with stress and depression compared with older adults who were obese or smoked.

High levels of anxiety and depression were not associated with cancer incidence, however. Although that finding is consistent with previous studies, it does contradict an idea common among patients.

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“Our findings are in line with a lot of other studies showing that psychological distress is not a strong predictor of many types of cancer,” Dr. O’Donovan said. “On top of highlighting that mental health matters for a whole host of medical illnesses, it is important that we promote these null findings. We need to stop attributing cancer diagnoses to histories of stress, depression, and anxiety.”

—Jolynn Tumolo


Niles AN, O'Donovan A. Comparing anxiety and depression to obesity and smoking as predictors of major medical illnesses and somatic symptoms. Health Psychology. 2018 December 17;[Epub ahead of print].

Leigh S. Depression, anxiety may take same toll on health as smoking and obesity [press release]. San Francisco, California: University of California San Francisco; December 17, 2018.

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