Anxiety: Risk factor for death from cancer in men

Generalized anxiety disorder (GAD) is a common mental health problem that is disabling, debilitating, and leads to increased risk of suicide. Affecting around 5% of the adult population*, it is characterized by excessive, uncontrollable worry about many areas of life, and those affected can experience symptoms, such as, muscle tension, insomnia, inability to concentrate, and restlessness. Previous studies have looked at whether anxiety is associated with early death from major causes of disease, but findings have been mixed or have varied.

Using data from 15,938 British participants from the European Prospective Investigation into Cancer-Norfolk study, researchers were able to link men and women with GAD in the 1996-00 period to death records over the subsequent 15 years, thus identifying those GAD sufferers who went on to die of cancer.

They found that 126 out of 7139 men and 215 out of 8799 women had GAD, and over a period of 15 years, 796 men and 648 women died from cancer. Over the 15 year follow-up period, they found that men with GAD were twice as likely to die of cancer as men who did not have anxiety (Hazard Ratio, 2.14 (95% CI: 1.32, 3.46)). This association was not found with women (Hazard Ratio 1.03 (95% CI: 0.60, 1.76)). Future research should determine whether anxiety is associated with specific cancer types in men.

Lead researcher Olivia Remes said: "In the past there have been inconclusive studies of the relationship between cancer and anxiety. However our study is the largest one to look at this relationship. We found that men with generalized anxiety disorder are over twice as likely to die of cancer as men without this condition. This holds true even after taking account of a range of additional factors, such as age, major chronic diseases, serious mental illnesses, smoking, alcohol, physical activity, and medications. Women did not show this association between anxiety and cancer.

The work shows that anxiety is associated with cancer deaths in men. We can't say that one causes the other; it is possible that men with anxiety have lifestyles or other risk factors that increase cancer risk that we did not account for completely however this association does raise questions, and society may need to consider anxiety as a warning signal for poor health. Researchers, policy-makers and clinicians don't give enough importance to anxiety, and this needs to change; a large number of people are affected by anxiety and its potential effects on health are substantial. With this study, we show that anxiety is more than just a personality trait, but rather, it is a disorder that may be associated with risk of death from conditions, such as, cancer."

Commenting, Professor David Nutt Ex-President of the ECNP, (Imperial College) said: "As a psychiatrist who used to run one of the very few clinics in the UK specialised in the treatment of people with severe anxiety disorders these results do not surprise me. The intense distress that these people suffer often on a daily basis is usually associated with a great deal of bodily stress, that is bound to have a major impact on many physiological processes including immune supervision of cancerous cells. As the authors point out other factors such as self-medication with tobacco and alcohol are also likely to be involved. I fully support the authors' statement that much more information and investment need to be given to the diagnosis and treatment of anxiety disorders."

The study was funded by the Medical Research Council and Cancer Research UK. Olivia Remes received funding from the National Institute for Health Research.