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Generalized Anxiety Disorder in Canadian Adults: to what Extent Might Social Support Subdomains and Negative Social Interactions Predict Psychological Distress?

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Abstract

Generalized anxiety disorder (GAD) may involve persistent and unwarranted anxiety, fear, and rumination, combined with various somatic symptoms (e.g., fatigue, dizziness, muscle tension, and nausea) which may compel many to withdraw socially. While studies report an inverse relationship between social support and psychological distress among adults with GAD, those that assess the distinct influence of negative social relations, particularly by sex are limited. The primary aims of this study were to (a) assess and compare respondents with a lifetime of GAD in terms of levels of perceived social support (using the Social Provisions Scale − 10 Items (SPS-10) Scale), negative social interactions (using the Negative Social Interaction (NSI) Scale) and psychological distress (using the Kessler Psychological Distress Scale (K10)), and (b) determine whether SPS-10 subdomains and NSIs predict psychological distress. Compared with a matched sample without GAD, respondents with GAD were more likely to be single, divorced, and have lower incomes. Respondents with GAD also had lower overall SPS-10 scores, and lower scores for each subdomain (i.e., ‘guidance’, ‘reliable alliance’, ‘reassurance of worth’, ‘attachment’, and ‘social integration’), and higher NSI and K10 scores. Although no difference in psychological distress was observed between men and women with GAD, men had lower SPS-10 scores (overall and for each subdomain), while women had higher NSIs scores. A subsequent hierarchical regression for respondents with GAD revealed that ‘social integration’ and ‘reassurance of worth’ predicted lower psychological distress, while higher NSI scores predicted higher psychological distress. Finding implications and future research are discussed.

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Data Availability

The datasets generated and/or analyzed during the current study are available in the Data Centre, Faculty of Arts & Sciences, University of Toronto (https://datacentre.chass.utoronto.ca/).

Abbreviations

β :

Beta weights in hierarchical regression

B:

Unstandardized regression coefficient in hierarchical regression

CCHS-MH:

Canadian Community Health Survey - Mental Health

CBT:

Cognitive Behavioural Therapy

CAPI:

Computer Assisted Personal Interviewing

d :

Cohen’s D, effect size

df :

Degrees of freedom

DSM:

Diagnostic and Statistical Manual of Mental Disorders

ICD-10:

International Classification of Diseases 10th Revision

K10:

Kessler Psychological Distress Scale

M:

Mean

NSIs:

Negative social interactions

p :

Probability

SD:

Standard Deviation

SE:

Standard error of the estimate

SSRIs:

Selective Serotonin Reuptake Inhibitors

SNRIs:

Serotonin-Norepinephrine Reuptake Inhibitors

SPS-10:

Social Provisions Scale-10 Items Scale

SPSS:

Statistical Package for the Social Sciences

t :

T test value

WHO-CIDI:

World Health Organization version of the Composite International Diagnostic Interview

References

  1. Hoge EA, Ivkovic A, Fricchione GL. (2012) Generalized anxiety disorder: diagnosis and treatment BMJ, 345:e7500. https://doi.org/10.1136/bmj.e7500.

  2. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027–35. https://doi.org/10.1016/j.jpsychires.2011.03.006.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Vesga-López O, Schneier FR, Wang S, Heimberg RG, Liu SM, Hasin DS, Blanco C. Gender differences in generalized anxiety disorder: results from the national epidemiologic survey on alcohol and related conditions (NESARC). JCP. 2008;69(10):1606.

    Google Scholar 

  4. Culpepper L, Conner K. Effective recognition and treatment of generalized anxiety disorder in primary care. Prim Care Companion J Clin Psychiatry. 2004;6:35–41.

    Article  Google Scholar 

  5. Preti A, Demontis R, Cossu G, Kalcev G, Cabras F, Moro MF, Romano F, Balestrieri M, Caraci F, Dell’Osso L, Di Sciascio G, Drago F, Hardoy MC, Roncone R, Faravelli C, Gonzalez CIA, Angermayer M, Carta MG. The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews. BMC Psychiatry. 2021;21:1–8. https://doi.org/10.1186/s12888-021-03042-3.

    Article  Google Scholar 

  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Author; 2014.

    Google Scholar 

  7. Allgulander C. Generalized anxiety disorder: a review of recent findings. JECM. 2012;4(2):88–91. https://doi.org/10.1016/j.jecm.2012.01.006.

    Article  Google Scholar 

  8. Bruce S, Yonkers K, Otto M, Eisen J, Weisberg R, Pagano M, Shea T, Keller M. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162(6):1179–87. https://doi.org/10.1176/appi.ajp.162.6.1179.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE. What is an anxiety disorder? Depress Anxiety. 2009;26:1066–85. https://doi.org/10.1002/da.20633.

    Article  PubMed  Google Scholar 

  10. Blair KS, Blair RJR. A cognitive neuroscience approach to generalized anxiety disorder and social phobia. Emot Rev. 2012;4(2):133–8. https://doi.org/10.1177/1754073911430251.

    Article  Google Scholar 

  11. Swee MB, Hudson CC, Heimberg RG. Examining the relationship between shame and social anxiety disorder: a systematic review. Clin Psychol Rev. 2021;90:1–13. https://doi.org/10.1016/j.cpr.2021.102088.

    Article  Google Scholar 

  12. Cramer V, Torgersen S, Kringlen E. Quality of life and anxiety disorders: a population study. J Nerv Ment. 2005;193(3):196–202. https://doi.org/10.1097/01.nmd.0000154836.22687.13.

    Article  Google Scholar 

  13. Panayiotou G, Karekla M. Perceived social support helps, but does not buffer the negative impact of anxiety disorders on quality of life and perceived stress soc. Psychiatry Psychiatr Epidemiol. 2013;4:283–94. https://doi.org/10.1007/s00127-012-0533-6.

    Article  Google Scholar 

  14. Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007;27(5):572–81. https://doi.org/10.1016/j.cpr.2007.01.015.

    Article  PubMed  Google Scholar 

  15. Bereza BG, Machado M, Einarson TR. disorder Clin Ther. 2009;31(6):1279–308. https://doi.org/10.1016/j.clinthera.2009.06.004. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety.

  16. Borwin B, Michaelis S, Wedekind D. Treatment of anxiety disorders. DCNS. 2017;19(2):93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow.

    Article  Google Scholar 

  17. Walker EA, Roy-Byrne PP, Katon WJ, Li L, Amos D, Jiranek G. Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry. 1990;147(12):1656–61. https://doi.org/10.1176/ajp.147.12.1656.

    Article  CAS  PubMed  Google Scholar 

  18. Puca F, Genco S, Prudenzano MP et al. (1999). Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy: the Italian/collaborative group for the study of psychopathological factors in primary headaches Cephalalgia, 19(3):159–64. https://doi.org/10.1046/j.1468-2982.1999.1903159.x.

  19. Maier W, Falkai P. The epidemiology of comorbidity between depression, anxiety disorders and somatic diseases. Int Clin Psychopharmacol. 1999;14(2):51–6.

    Google Scholar 

  20. Moffitt T, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory A, Poulton R. Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry. 2007;64(6):651–60. https://doi.org/10.1001/archpsyc.64.6.651.

    Article  PubMed  Google Scholar 

  21. Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB. Frequency and patterns of psychiatric comorbidity in a sample of primary care patients with anxiety disorders. Compr Psychiatry. 2004;45(2):129–37. https://doi.org/10.1016/j.comppsych.2003.09.005.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Simon N. Generalized anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse. JCP. 2009;70(2):10–4. https://doi.org/10.4088/JCP.s.7002.02.

    Article  Google Scholar 

  23. Bomyea J, Lang AJ, Craske MG, Chavira D, Sherbourne CD, Rose RD, Golinellz D, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Suicidal ideation and risk factors in primary care patients with anxiety disorders. Psychiatry Res. 2013;209(1):60–5. https://doi.org/10.1016/j.psychres.2013.03.017. http://dx.doi.org.qe2a-proxy.mun.ca/.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Reinhold JA, Mandos LA, Rickels K, Lohoff FW. Pharmacological treatment of generalized anxiety disorder. Expert Opin Drug Deliv. 2011;12(16):2457–67.

    CAS  Google Scholar 

  25. Bruce SE, Machan JT, Dyck I, Keller MB. Infrequency of pure GAD: impact of psychiatric comorbidity on clinical course. Depress Anxiety. 2001;14(4):219–25. https://doi.org/10.1002/da.1070.

    Article  CAS  Google Scholar 

  26. Stefan S, Cristea IA, Szentagotai Tatar A, David D. Cognitive-behavioral therapy (CBT) for generalized anxiety disorder: contrasting various CBT approaches in a randomized clinical trial. J Clin Med. 2019;75(7):1188–202. https://doi.org/10.1002/jclp.22779.

    Article  Google Scholar 

  27. Borkovec TD, Ruscio AM. Psychotherapy for generalized anxiety disorder. JCP. 2001;62(11):37–42.

    Google Scholar 

  28. Vasiliadis HM, Chudzinski VG, Gontijo-Guerra S, Préville M. Screening instruments for a population of older adults: the 10-item Kessler psychological distress scale (K10) and the 7-item generalized anxiety disorder scale (GAD-7). Psychiatry Res. 2015;228:89–94. https://doi.org/10.1093/geront/gnv482.03.

    Article  PubMed  Google Scholar 

  29. Caron J. A validation of the social provisions scale: the SPS-10 items. Sante Ment Que. 3013;38(1):297–318. https://doi.org/10.7202/1019198ar.

    Article  Google Scholar 

  30. Collins RC. (2021) Generalized anxiety disorder and psychological distress in a Canadian adult sample: exploring the role of social support. Dissertation, Memorial University of Newfoundland.

  31. Sangalang CC, Gee GC. Depression and anxiety among asian Americans: the effects of social support and. Strain Soc Work. 2012;57(1):49–60. https://doi.org/10.1093/sw/swr005.

    Article  PubMed  Google Scholar 

  32. St-Jean-Trudel E, Guay S, Marchand A. The relationship between social support, psychological stress and the risk of develo** anxiety disorders in men and women: results of a national study can. J Public Health. 2009;100:148–52. https://doi.org/10.1007/BF03405526.

    Article  Google Scholar 

  33. Maheux A, Price M. The indirect effect of social support on post-trauma psychopathology via self-compassion. Pers Individ Differ. 2016;88:102–7. https://doi.org/10.1016/j.paid.2015.08.051.

    Article  Google Scholar 

  34. Statistics Canada. Canadian community health survey (CCHS) - mental health. Ottawa: Statistics Canada; 2013.

    Google Scholar 

  35. World Health Organization. (1992) International classification of diseases and related health problems (10th rev). Geneva: World Health Organization.

  36. Kessler R, Barker P, Colpe L, Epstein J, Gfroerer J, Hiripi E, Zaslavsky A. (2003) Screening for serious mental illness in the general population Arch Gen Psychiatry 60(2):184–189. https://doi.org/10.1001/archpsyc.60.2.184 National Institute of Mental Health (2023, March 17) Mental Health Information. https://www.nimh.nih.gov/health.

  37. National Institute of Mental Health (2023, March 17) Mental Health Information. https://www.nimh.nih.gov/health.

  38. Lin S. Generalized anxiety disorder during COVID-19 in Canada: gender-specific association of COVID-19 misinformation exposure, precarious employment, and health behavior change. J Affect Disord. 2022;302:280–92. https://doi.org/10.1016/j.jad.2022.01.100.

    Article  CAS  PubMed  Google Scholar 

  39. Lin S. The loneliness epidemic, intersecting risk factors and relations to mental health help-seeking: a population-based study during COVID-19 lockdown in Canada. J Affect Disord. 2023;320:7–17. https://doi.org/10.1016/j.jad.2022.08.131.

    Article  PubMed  Google Scholar 

  40. Studart-Botto P, Léda-Rêgo G, Abbade P, Bandeira ID, Miranda-Scippa A. Social support among individuals with bipolar disorder during euthymic phase: a systematic review. Clin Psychol Psychother. 2023;30(2):270–80. https://doi.org/10.1002/cpp.2805.

    Article  PubMed  Google Scholar 

  41. Owen R, Gooding P, Dempsey R, Jones S. The reciprocal relationship between bipolar disorder and social interaction: a qualitative investigation. Clin Psychol Psychother. 2017;24(4):911–8. https://doi.org/10.1002/cpp.2055.

    Article  PubMed  Google Scholar 

  42. Asher M, Asnaani A, Aderka IM. Gender differences in social anxiety disorder: a review. Clin Psychol Rev. 2017;56:1–12. https://doi.org/10.1016/j.cpr.2017.05.004. Epub 2017 May 30. PMID: 28578248.

    Article  PubMed  Google Scholar 

  43. Nolen-Hoeksema S. Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol. 2012;8(1):161–87. https://doi.org/10.1146/annurev-clinpsy-032511-143109.

    Article  PubMed  Google Scholar 

  44. Ociskova M, Prasko J, Vrbova K, Kasalova P, Holubova M, Grambal A, Machu K. Self-stigma and treatment effectiveness in patients with anxiety disorders – a mediation analysis. Neuropsychiatr Dis Treat. 2018;14:383–92. https://doi.org/10.2147/NDT.S152208. http://dx.doi.org.qe2a-proxy.mun.ca/.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Newman MG, Castonguay LG, Borkovec TD, Fisher AJ, Nordberg SS. An open trial of integrative therapy for generalized anxiety disorder psychotherapy (Chicago, Ill. Psychol Psychother. 2008;45(2):135–47. https://doi.org/10.1037/0033-3204.45.2.135.

    Article  Google Scholar 

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  1. Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John’s, NL, Canada

    Ken Fowler

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KF devised the study, developed the overall design, performed statistical analyses/interpreted the findings, and drafted the final manuscript.

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Fowler, K. Generalized Anxiety Disorder in Canadian Adults: to what Extent Might Social Support Subdomains and Negative Social Interactions Predict Psychological Distress?. Psychiatr Q 94, 655–673 (2023). https://doi.org/10.1007/s11126-023-10055-6

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