Media Release: European College of Neuropsychopharmacology (ECNP)
“For the science and treatment of disorders of the brain”

Anxiety - a risk factor for death from cancer in men
Embargo until: Tuesday 20th September, 00.01 CET (Vienna)

Men who suffer from anxiety are more than twice as likely to die from cancer as men who don’t. However, anxiety is not associated with increased cancer deaths in women, according to a large British and European study presented at the ECNP meeting in Vienna.
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.

Notes for Editors
Please mention the European College of Neuropsychopharmacology Congress in any stories which result from this press release.

Olivia Remes
Professor David Nutt
ECNP Press Officer, Tom Parkhill tel +39 349 238 8191 (Italy)

Abstract: Generalized anxiety disorder and excess cancer deaths: findings from a large, longitudinal study
O. Remes1 N. Wainwright2 P. Surtees3 L. Lafortune1 K.T. Khaw1 C. Brayne1
1University of Cambridge, Public Health and Primary Care, Cambridge, United Kingdom 2None retired., None, Cambridge, United Kingdom 3None - retired., None, Cambridge, United Kingdom
Introduction: Generalized anxiety disorder is a common and persistent disorder, and is associated with increased risk for disability and suicide. This condition can lead to serious impairment in social and occupational functioning, and once it develops, it increases the risk for major depression, substance misuse, and serious physical medical conditions [1–3]. Previous studies have assessed whether anxiety contributes to excess mortality from principal causes of death, with mixed findings [4,5]. For the first time, we examine whether generalized anxiety disorder contributes to excess deaths from cancer using a large, longitudinal population-based study.
Methods: We used data from over 15,000 British participants over the age of 40 years from the European Prospective Investigation into Cancer-Norfolk study. We used health and lifestyle questionnaires to capture information on demographics, behavioural risk factors, and medical history. We linked participant records to death certificates from the UK Office of National Statistics to identify cancer deaths. Underlying cause of death on these certificates was coded according to the Ninth and Tenth Revisions of the International Classification of Diseases (ICD) (cancer: ICD-9 codes 140–208 and ICD-10 codes C00-C97).
Generalized anxiety disorder was diagnosed according to the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Generalized anxiety disorder in the past year was measured in 1996–2000, and deaths from all cancers in these participants were recorded between 2000 and 2015. To determine the association between generalized anxiety disorder and cancer mortality, Cox proportional hazards regression was conducted, while adjusting for important covariates.
Results: We found that 2.4% (215/8,799) women and 1.8% (126/7,139) of men had generalized anxiety disorder. Men with generalized anxiety disorder were over twice as likely to die from cancer over the 15-year follow-up period, but this association between anxiety and excess cancer deaths did not exist in women (HR = 2.14, 95% CI: 1.32, 3.46 versus HR = 1.03, 95% CI: 0.60, 1.76). The association with cancer mortality in men persisted after we adjusted for age, marital status, education level, social class, major depressive disorder, chronic physical conditions, disability, smoking, alcohol intake, and physical activity level.
Conclusions: Generalized anxiety disorder is a debilitating and impairing condition and has been linked to high risk of suicide. To our knowledge, this is the first study to show that this condition is associated with cancer mortality in men. This result suggests that health care professionals should take into consideration the presence of generalized anxiety disorder in this population to prevent further sequelae. Future research should assess the mechanisms underpinning the link between clinical anxiety and cancer mortality in men. Other studies with larger samples should investigate whether different cancer sub-types are associated with different mortality risks. Pharmacologic and behavioural treatment exists for anxiety, and further research is required to determine whether the administration of various treatment packages to men with anxiety contributes to reduced cancer mortality outcomes.
[1] Nepon, J., Belik, S.L., Bolton, J., Sareen, J., 2010. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anx 27, 791–798.
[2] Stein, M.B., Sareen, J., 2015. Generalized anxiety disorder. New Engl J Med 373, 2059–2068.
[3] Hoge, E.A., Ivkovic, A., Fricchione, G.L., 2012. Generalized anxiety disorder: diagnosis and treatment. BMJ 345, e7500.
[4] Denollet, J., Maas, K., Knottnerus, A., Keyzer, J.J., Pop, V.J., 2009. Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women. J Clin Epidemiol 62, 452–6.
[5] Holwerda, T.J., Schoevers, R.A., Dekker, J., Deeg, D.J., Jonker, C., Beekman, A.T., 2007. The relationship between generalized anxiety disorder, depression and mortality in old age. Int J Geriatr Psychiatry 22, 241–9.