A diagnosis of generalised anxiety disorder need not be a life sentence, a large Canadian study suggests.
"It's so exciting," said lead author Esme Fuller-Thomson, director of the Institute for Life Course and Aging at the University of Toronto.
People with generalised anxiety disorder worry excessively for long periods, and most days they struggle to control their discomfort, according to the Anxiety and Depression Association of America. Anxiety affects an estimated 31% of US adults, is almost twice as common in women than men, and often goes hand-in-hand with major depression.
Fuller-Thomson's team combed data from a 2012 Canadian mental health survey of just over 21 000 people in search of factors associated with "complete mental health." Of those surveyed, about 2 100 had generalised anxiety disorders.
Surprisingly high numbers
Researchers defined complete mental health as being free of current mental illness, being able to function well and feeling good about oneself, relationships and community connections.
Of those with a history of anxiety, 72% were in remission; 58% were free of all mental illness for the past year; and 40% met the criteria for complete mental health.
Among the larger group of respondents who had never had a generalised anxiety disorder, 76% were said to have complete mental health.
"I didn't expect the numbers to be so high," Fuller-Thomson said. "It did surprise me."
The study did not look at the types of treatment respondents tried – that information wasn't available, Fuller-Thomson said – so no conclusions could be drawn about which might be most successful.
Researchers did examine a host of variables that affected respondents, both positively and negatively. These included sex, race, age, education, income and marital status; presence or history of physical and sexual abuse, domestic violence, substance abuse, insomnia and debilitating pain; and use of religion as a coping mechanism.
The paper was published online in the Journal of Affective Disorders.
Religion and spirituality
Dr Ken Duckworth is a psychiatrist and medical director of the National Alliance on Mental Health who was not involved in the study. He called the findings "a breath of fresh air".
Duckworth said large studies that look at the same variables over time are rare in the treatment of mental illness in the United States. But Canada's national health care system means gathering that data would be easier, he added.
So which respondents with a history of anxiety had better odds of attaining complete mental health?
The study pointed to those who were white, female, married, in good or excellent physical health and without a major depressive disorder. Those who were more likely to attain complete mental health also had no history of alcohol or drug dependence; were not obese; and did not suffer chronic insomnia.
Also key: They used religion or spirituality to cope and had someone to confide in.
"There is hope," Fuller-Thomson said. "There is a great deal of recovery, even for people who have suffered for a decade or more."
Negative coping strategies
Negatives for regaining complete mental health included chronic insomnia, difficulty performing daily activities, and a history of a major depressive disorder or substance abuse.
Fuller-Thomson said the study shows health care providers should consider a patient's physical health and sleep habits when treating anxiety. Interestingly, "poverty was not a major player" affecting the group with a history of anxiety disorders, she said.
While she said negative coping strategies like alcohol and drugs are "really very harmful", Fuller-Thomson added that having a confidant and not being disabled had the most positive effect.
"Social support is so key," Fuller-Thomson said. "People who are isolated don't do well."
Childhood experiences also played a big part in respondents' recovery chances, the study found.
Those who had repeatedly witnessed domestic violence or had been physically abused had lower odds of attaining complete mental health. Fewer than 5% of respondents who had been sexually abused had done so.
Duckworth said he looks forward to a follow-up that examines the same variables along with treatment methods, such as counselling, medication and behaviour modification.
"Is it age or treatment [that caused improvement]?" he said. "Is it socioeconomic status or treatment? How important are the individual factors? I'm sure they're all significant."
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