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Cited by 150Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional Development

Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research

Open access
Wilmer, M. Taylor, Anderson, Kelley, Reynolds, Monique·2021·Current Psychiatry Reports
DOI 10.1007/s11920-021-01290-4PMC PMC8493947
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Abstract

Purpose of Review: Anxiety disorders are highly prevalent conditions that have a detrimental impact on quality of life (QOL), particularly when left untreated. In the present review, we summarize recent literature, published within the last 3 years, on QOL in anxiety disorders, with a focus on factors that may play a role in the relationship between anxiety and QOL. Recent Findings: We organize our findings into four categories: (1) subjective distress, (2) behavioral responses, (3) functional impairment, and (4) clinical factors. Results indicate that greater anxiety symptom severity is linked with poorer QOL, and cognitive behavioral therapies for anxiety yield positive effects on QOL. Additional transdiagnostic mechanisms are highlighted, including anxiety sensitivity, distress tolerance, emotion regulation, and avoidant coping. We examine the role of functional impairment, and we discuss factors related to treatment, including comorbidity and longitudinal effects. We also consider early research from the COVID-19 pandemic. Summary: Understanding the underlying factors that contribute to QOL detriments provides important insight into the impact of anxiety disorders and identifies targets for enhancing QOL through treatment. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Crossref · 10.1007/s11920-021-01290-4

Cites

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Claims the paper makes

45 of 108 cited sources checked · 17 supported · 2 flagged · accuracy not yet measured

  • Findingcitation

    In a network analysis of individuals with generalized anxiety disorder, strong connections were found between GAD and satisfaction with working ability and ability to engage in daily activities.

    “Additionally, a network analysis of individuals with GAD demonstrated strong connections between GAD and two areas of QOL: satisfaction with working ability and ability to engage in daily activities [54].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [54] Barthel AL, Pinaire MA, Curtiss JE, Baker AW, Brown ML, Hoeppner SS, et al. Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: a complex network analysis. J Affect Disord. 2020;277:1013–21. https://doi.org/10.1016/j.jad.2020.08.077. source

      The Discussion (page unavailable) says the strongest connection was between the two quality-of-life areas—satisfaction with working ability and ability to engage in daily activities—not between GAD and each area. It explicitly distinguishes that connection from anxious symptom relationships. (LLM, conf=0.88)

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  • Findingcitation

    Individuals with current or remitted anxiety disorders report poorer quality of life than healthy controls.

    “whereas individuals with current and remitted anxiety disorders reported poorer QOL than healthy controls [24].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [24] Seidl E, Venz J, Ollmann TM, Voss C, Hoyer J, Pieper L, et al. How current and past anxiety disorders affect daily life in adolescents and young adults from the general population-an epidemiological study with ecological momentary assessment. Depress Anxiety. 2021;38:272–85. https://doi.org/10.1002/da.23133. source
  • Findingcitation

    Greater anxiety symptom severity is associated with poorer quality of life in adolescents, adults, and older adults with anxiety.

    “Specifically, anxiety symptom severity was inversely associated with QOL among adolescents with anxiety [12–14], adults with anxiety [15–21], and older adults with anxiety [22].”
    Quote in the paperSubstantial claim4 of 10 sources checked
    • cites [12] Alsamghan AS. Social anxiety symptoms and quality of life of secondary school students of Abha. Saudi Arabia J Genet Psychol. 2021;182:18–30. https://doi.org/10.1080/00221325.2020.1837065. source
    • cites [13] Jenkins PE, Ducker I, Gooding R, James M, Rutter-Eley E. Anxiety and depression in a sample of UK college students: a study of prevalence, comorbidity, and quality of life. J Am Coll Health 2020:1–7. https://doi.org/10.1080/07448481.2019.1709474. source
    • cites [14] Raknes S, Pallesen S, Himle JA, Bjaastad JF, Wergeland GJ, Hoffart A, et al. Quality of life in anxious adolescents. Child Adolesc Psychiatry Ment Health. 2017;11:33. https://doi.org/10.1186/s13034-017-0173-4. source
    • cites [15] Fidry M, Zugliani MM, do Valle CR, Martins RM, Cabo MCD, Nardi AE, et al. Quality of life in panic disorder: the influence of clinical features and personality traits. Trends Psychiatry Psychother 2019;41:387–93. https://doi.org/10.1590/2237-6089-2019-0008. source
    • cites [16] Hempel ME, Taylor JE, Connolly MJ, Alpass FM, Stephens C v. Scared behind the wheel: what impact does driving anxiety have on the health and well-being of young older adults? Int Psychogeriatr 2017;29:1027–34. https://doi.org/10.1017/S1041610216002271. source
    • cites [17] Holubova M, Prasko J, Ociskova M, Kantor K, Vanek J, Slepecky M, et al. Quality of life, self-stigma, and coping strategies in patients with neurotic spectrum disorders: a cross-sectional study. Psychol Res Behav Manag. 2019;12:81–95. https://doi.org/10.2147/PRBM.S179838. source

      In “QOL will correlate negatively with severity of disorder” (page unavailable), the paper reports that disorder severity correlated negatively with most quality-of-life domains in a sample with a mean age of about 48. This supports the adult portion of the citing sentence, but the sample included several neurotic-spectrum diagnoses and the reported measure was overall disorder severity, not specifically anxiety symptom severity. The citation is in the adult group [15–21], so it need not support the separate adolescent and older-adult claims. (LLM, conf=0.84)

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    • cites [18] Joseph N, Rasheeka VP, Nayar V, Gupta P, Manjeswar MP, Mohandas A. Assessment of determinants and quality of life of university students with social phobias in a coastal city of south India. Asian J Psychiatr. 2018;33:30–7. https://doi.org/10.1016/j.ajp.2018.02.008. source
    • cites [19] Politis S, Bellos S, Hadjulis M, Gournellis R, Petrikis P, Ploumpidis D, et al. Epidemiology of panic disorder and subthreshold panic symptoms in the Greek general population. Psychiatriki. 2020;31:201–15. https://doi.org/10.22365/jpsych.2020.313.201. source

      In “Comorbidity, quality of life and use of health services” (page unavailable), adults with full panic disorder had lower quality-of-life scores than those with subclinical panic disorder (0.52 versus 0.64), supporting the adult portion of the association. The paper compares panic-disorder categories rather than measuring anxiety symptom severity across anxiety disorders; it does not establish the association separately for adolescents or older adults. (LLM, conf=0.85)

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    • cites [20] Stephens AN, Collette B, Hidalgo-Munoz A, Fort A, Evennou M, Jallais C. The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life. J Transp Health. 2020;19: 100929. source
    • cites [21] Yu W, Singh SS, Calhoun S, Zhang H, Zhao X, Yang F. Generalized anxiety disorder in urban China: prevalence, awareness, and disease burden. J Affect Disord. 2018;234:89–96. https://doi.org/10.1016/j.jad.2018.02.012. source
  • Findingcitation

    In community samples, individuals with moderate to high anxiety symptoms have severe quality-of-life impairments.

    “Research within community-based samples underscores the severity of QOL impairments for individuals with moderate to high levels of anxiety symptoms (e.g., [14])”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Raknes S, Pallesen S, Himle JA, Bjaastad JF, Wergeland GJ, Hoffart A, et al. Quality of life in anxious adolescents. Child Adolesc Psychiatry Ment Health. 2017;11:33. https://doi.org/10.1186/s13034-017-0173-4. source

      The Discussion and ‘HRQoL and high anxiety level’ sections report poor health-related quality of life among adolescents with medium and high anxiety symptoms in a community sample. The cited study supports the finding for adolescents, but the claim’s unqualified reference to ‘individuals’ extends beyond the population studied. Page numbers were not provided in the supplied passages. (LLM, conf=0.82)

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  • Findingcitation

    Individuals with anxiety disorders report greater perceived quality-of-life detriments in the social domain, including smaller social networks, fewer social activities, and less social support than non-anxious individuals.

    “Individuals with anxiety disorders endorsed greater perceived QOL detriments in the social domain, reporting a smaller social network, fewer social activities, and less social support than non-anxious individuals [51].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [51] Saris IMJ, Aghajani M, van der Werff SJA, van der Wee NJA, Penninx B. Social functioning in patients with depressive and anxiety disorders. Acta Psychiatr Scand. 2017;136:352–61. https://doi.org/10.1111/acps.12774. source
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    Findingcitation

    In some samples, only individuals with comorbid disorders report poorer quality of life than healthy controls, whereas individuals with a single anxiety disorder do not.

    “Within some samples, only individuals with comorbid disorders reported poorer QOL than healthy controls, whereas individuals with a single anxiety disorder did not [62, 63].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [62] Preti A, Demontis R, Cossu G, Kalcev G, Cabras F, Moro MF, et al. 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;21:48. https://doi.org/10.1186/s12888-021-03042-3. source

      The Results (Table 4; page not provided) report poorer quality of life relative to matched controls even for people with GAD without comorbidity. The Discussion likewise says GAD has a severe impact independently of comorbidity, contrary to the claim that only people with comorbid disorders report poorer quality of life. (LLM, conf=0.90)

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    • cites [63] Sancassiani F, Romano F, Balestrieri M, Caraci F, di Sciascio G, Drago F, et al. The prevalence of specific phobia by age in an Italian Nationwide Survey: how much does it affect the quality of life? Clin Pract Epidemiol Ment Health. 2019;15:30–7. https://doi.org/10.2174/1745017901915010030. source

      The Results report that people with specific phobia and a comorbid disorder had poorer quality of life than controls without specific phobia, while those with specific phobia alone did not (Table 4; p < 0.001 and p = 0.809, respectively). However, the Methods say the controls were selected for not having specific phobia, not for being healthy or free of other disorders. The finding also concerns specific phobia rather than single anxiety disorders generally. Page numbers are unavailable in our copy. (LLM, conf=0.83)

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    Premisecitation

    Anxiety sensitivity is associated with anxiety and depressive disorders and with higher disability.

    “Anxiety sensitivity is a correlate of both anxiety and depressive disorders and is associated with higher levels of disability [25–27].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [25] Hovenkamp-Hermelink JHM, van der Veen DC, Oude Voshaar RC, Batelaan NM, Penninx B, Jeronimus BF, et al. Anxiety sensitivity, its stability and longitudinal association with severity of anxiety symptoms. Sci Rep. 2019;9:4314. https://doi.org/10.1038/s41598-019-39931-7. source

      The Introduction (page unavailable) says elevated anxiety sensitivity predicts diagnoses, particularly anxiety and depressive disorders. The paper does not report an association between anxiety sensitivity and higher disability; its reference to disability concerns anxiety disorders, not anxiety sensitivity. (LLM, conf=0.87)

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    • cites [26] Hendriks SM, Spijker J, Licht CM, Beekman AT, Hardeveld F, de Graaf R, et al. Disability in anxiety disorders. J Affect Disord. 2014;166:227–33. https://doi.org/10.1016/j.jad.2014.05.006. source
    • cites [27] Keough ME, Schmidt NB. Refinement of a brief anxiety sensitivity reduction intervention. J Consult Clin Psychol. 2012;80:766–72. https://doi.org/10.1037/a0027961. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Quality of life improves significantly after cognitive behavioral therapy for anxiety disorders.

    “Meta-analytic research has further demonstrated that QOL improves significantly following cognitive behavioral therapy (CBT), the gold standard treatment for anxiety disorders [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Hofmann SG, Wu JQ, Boettcher H. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. J Consult Clin Psychol. 2014;82:375–91. https://doi.org/10.1037/a0035491. source

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    Premisecitation

    Distress tolerance is associated with lower anxiety symptoms and higher quality of life in prior studies.

    “Distress tolerance is associated with lower anxiety symptomatology and higher QOL in prior studies [32, 33]”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [32] Bernstein A, Marshall EC, Zvolensky MJ. Multi-method evaluation of distress tolerance measures and construct(s): concurrent relations to mood and anxiety psychopathology and quality of life. J Exp Psychopathol. 2011;2:386–99. https://doi.org/10.5127/jep.006610. source
    • cites [33] Keough ME, Riccardi CJ, Timpano KR, Mitchell MA, Schmidt NB. Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity. Behav Ther. 2010;41:567–74. https://doi.org/10.1016/j.beth.2010.04.002. source

      The Results and Discussion report that greater distress tolerance was associated with lower anxiety symptomatology. The paper does not report an association between distress tolerance and quality of life (searched: quality of life, QOL, wellbeing, functioning), so that part of the citing sentence is unsupported by this source. The indexed passages provide section labels but no page numbers. (LLM, conf=0.89)

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    Premisecitation

    Comorbidity in anxiety disorders is associated with more severe symptoms, a more chronic course, and greater functional impairment.

    “Comorbidity in anxiety disorders is associated with more severe symptoms, a more chronic course, and greater functional impairment [11, 26, 28].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [11] Penninx BWJH, Pine DS, Holmes EA, Reif A. Anxiety disorders. The Lancet. 2021;397:914–27. https://doi.org/10.1016/s0140-6736(21)00359-7. source

      The Comorbidity and differential diagnosis section says anxiety–depression comorbidity signifies higher severity, burden, and chronicity than either disorder alone. The Abstract likewise links comorbidity to more severe symptoms and greater clinical burden. Neither passage specifically establishes greater functional impairment, so that part of the claim is more specific than the evidence. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [26] Hendriks SM, Spijker J, Licht CM, Beekman AT, Hardeveld F, de Graaf R, et al. Disability in anxiety disorders. J Affect Disord. 2014;166:227–33. https://doi.org/10.1016/j.jad.2014.05.006. source
    • cites [28] Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, et al. Long-term disability in anxiety disorders. BMC Psychiatry. 2016;16:248. https://doi.org/10.1186/s12888-016-0946-y. source

  • May combine two claims.

    Findingcitation

    Among individuals with generalized anxiety disorder, less emotion regulation flexibility results in poorer quality of life and greater emotional distress.

    “Among individuals with GAD, less emotion regulation flexibility resulted in poorer QOL and greater emotional distress [48].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [48] Conroy K, Curtiss JE, Barthel AL, Lubin R, Wieman S, Bui E, et al. Emotion regulation flexibility in generalized anxiety disorder. J Psychopathol Behav Assess. 2020;42:93–100. https://doi.org/10.1007/s10862-019-09773-8. source

      The Discussion reports that low and moderate emotion regulation flexibility were associated with more anxiety and depression symptoms and lower quality of life than high flexibility. But its limitations section explicitly says the cross-sectional study cannot establish causation, so “resulted in” overstates the finding. (LLM, conf=0.91)

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    Premisecitation

    Maladaptive coping behaviors provide short-term relief but maintain or worsen anxiety over time.

    “These behaviors can provide relief in the moment but ultimately maintain or worsen anxiety over time [39].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] Spinhoven P, van Hemert AM, Penninx B. Experiential avoidance and bordering psychological constructs as predictors of the onset, relapse and maintenance of anxiety disorders: one or many? Cognit Ther Res. 2017;41:867–80. https://doi.org/10.1007/s10608-017-9856-7. source

      The Discussion says excessive avoidance may impede control or habituation of anxiety and contribute to chronicity. The paper describes avoidant coping as an attempt to manage emotions, but does not establish that it provides relief in the moment; it also presents the maintaining effect as a possibility rather than an inevitable outcome. Page numbers were not provided in our copy. (LLM, conf=0.84)

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    Findingcitation

    Individuals with anxiety disorders who used cannabis but did not meet criteria for cannabis use disorder reported poorer quality of life than non-cannabis users in mental health and role functioning, while non-cannabis users did not differ from those with comorbid cannabis use disorder.

    “finding that individuals with anxiety disorders who used cannabis (but did not meet criteria for cannabis use disorder) reported poorer QOL than non-cannabis users in the areas of mental health and role functioning, but non-cannabis users did not differ in QOL compared to those with comorbid cannabis use disorder [47].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [47] Feingold D, Rehm J, Factor H, Redler A, Lev-Ran S. Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: a 3-year population-based longitudinal study. Depress Anxiety. 2018;35:490–501. https://doi.org/10.1002/da.22735. source

  • May combine two claims.

    Findingcitation

    Individuals with panic disorder or subthreshold panic symptoms are more likely to use medical and psychological health services and report poorer quality of life than individuals without panic symptoms.

    “Specifically, individuals with PD or subthreshold panic symptoms were more likely to utilize medical and psychological health services, and endorsed poorer QOL, compared to individuals without panic symptoms [19].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [19] Politis S, Bellos S, Hadjulis M, Gournellis R, Petrikis P, Ploumpidis D, et al. Epidemiology of panic disorder and subthreshold panic symptoms in the Greek general population. Psychiatriki. 2020;31:201–15. https://doi.org/10.22365/jpsych.2020.313.201. source

  • May combine two claims.

    Findingcitation

    One randomized controlled trial found that anthroposophic art therapy reduced symptom severity and improved quality of life among women with anxiety.

    “One RCT demonstrated a positive effect of anthroposophic art therapy on reducing symptom severity and improving QOL among women with anxiety [84].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [84] Abbing A, Baars EW, de Sonneville L, Ponstein AS, Swaab H. The effectiveness of art therapy for anxiety in adult women: a randomized controlled trial. Front Psychol. 2019;10:1203. https://doi.org/10.3389/fpsyg.2019.01203. source
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    Findingcitation

    A study of internet-delivered CBT for social anxiety disorder, panic disorder, and obsessive-compulsive disorder found a small non-significant effect on quality of life, although the sample size was small.

    “In contrast, a small non-significant effect was found in a study on iCBT for SAD, PD, and OCD, although sample size was small [83].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [83] Matsumoto K, Sutoh C, Asano K, Seki Y, Urao Y, Yokoo M, et al. Internet-based cognitive behavioral therapy with real-time therapist support via videoconference for patients with obsessive-compulsive disorder, panic disorder, and social anxiety disorder: pilot single-arm trial. J Med Internet Res. 2018;20: e12091. https://doi.org/10.2196/12091. source

  • May combine two claims.

    Findingcitation

    Symptom severity moderates the relationship between treatment type and quality-of-life improvement: individuals with greater symptom severity experience greater QOL improvements following CBT, whereas those with lower symptom severity experience greater QOL improvements following acceptance and commitment therapy.

    “Interestingly, research points to symptom severity as a moderator of treatment type and QOL improvement, such that individuals with greater symptom severity experienced greater QOL improvements following CBT, whereas individuals with lower symptom severity experienced greater QOL improvements following acceptance and commitment therapy (ACT; [73]).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [73] Mesri B, Niles AN, Pittig A, LeBeau RT, Haik E, Craske MG. Public speaking avoidance as a treatment moderator for social anxiety disorder. J Behav Ther Exp Psychiatry. 2017;55:66–72. https://doi.org/10.1016/j.jbtep.2016.11.010. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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    Findingcitation

    Anxiety symptom severity is negatively correlated with quality of life among individuals under COVID lockdown conditions, with females, older individuals, unemployed individuals, and individuals with or caring for a chronic medical condition experiencing lower quality of life.

    “Supporting prior research, anxiety symptom severity was negatively correlated with QOL among individuals under COVID lockdown conditions, with females, older individuals, unemployed individuals, and individuals with or a caretaker for a chronic medical condition experiencing lower levels of QOL [87, 88].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [87] Ferreira LN, Pereira LN, da Fe BM, Ilchuk K. Quality of life under the COVID-19 quarantine. Qual Life Res. 2021;30:1389–405. https://doi.org/10.1007/s11136-020-02724-x. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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    • cites [88] Ozturk Copur E, Karasu F. The impact of the COVID-19 pandemic on the quality of life and depression, anxiety, and stress levels of individuals above the age of eighteen. Perspect Psychiatr Care. 2021. https://doi.org/10.1111/ppc.12730. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • May combine two claims.

    Findingcitation

    CBT and pharmacotherapy both yield small to moderate positive effects on quality-of-life outcomes.

    “CBT and pharmacotherapy both yield small to moderate positive effects on QOL outcomes [8, 65].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [8] Hofmann SG, Wu JQ, Boettcher H. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. J Consult Clin Psychol. 2014;82:375–91. https://doi.org/10.1037/a0035491. source

      The Discussion reports moderately strong positive effects of CBT on quality of life in patients with anxiety disorders. The paper does not establish a quality-of-life effect for pharmacotherapy; it says reviews of other active interventions are needed. Thus it supports the CBT part, but not the pharmacotherapy part, of the cited sentence. (LLM, conf=0.86)

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    • cites [65] Hofmann SG, Wu JQ, Boettcher H, Sturm J. Effect of pharmacotherapy for anxiety disorders on quality of life: a meta-analysis. Qual Life Res. 2014;23:1141–53. https://doi.org/10.1007/s11136-013-0573-8. source

  • May combine two claims.

    Findingcitation

    Virtual reality CBT yields quality-of-life improvements for individuals with social anxiety disorder and specific phobia, although sample sizes were small.

    “The impact of treatment has also extended to CBT that incorporates virtual reality exposures (VR-CBT), which yielded QOL improvements for individuals with SAD [74] and SP [75, 76], although sample sizes were small.”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [74] Geraets CNW, Veling W, Witlox M, Staring ABP, Matthijssen S, Cath D. Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder: a pilot study. Behav Cogn Psychother. 2019;47:745–50. https://doi.org/10.1017/s1352465819000225. source
    • cites [75] Costa RTD, Carvalho MR, Ribeiro P, Nardi AE. Virtual reality exposure therapy for fear of driving: analysis of clinical characteristics, physiological response, and sense of presence. Braz J Psychiatry. 2018;40:192–9. https://doi.org/10.1590/1516-4446-2017-2270. source
    • cites [76] Lindner P, Miloff A, Bergman C, Andersson G, Hamilton W, Carlbring P. Gamified, automated virtual reality exposure therapy for fear of spiders: a single-subject trial under simulated real-world conditions. Front Psychiatry. 2020;11:116. https://doi.org/10.3389/fpsyt.2020.00116. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Experiential avoidance of anxiety-provoking stimuli is not a significant correlate of quality of life among individuals with anxiety disorders after accounting for positive and negative affect.

    “However, other recent publications yield a contrasting pattern, finding that experiential avoidance of anxiety-provoking stimuli was not a significant correlate of QOL among individuals with anxiety disorders after accounting for positive and negative affect [38•].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    When individuals with generalized anxiety disorder were treated with emotion regulation therapy, improvements in emotion regulation via attention allocation correlated with improved functioning but not improved quality of life.

    “However, when individuals with GAD were treated using emotion regulation therapy (ERT), improvements in emotion regulation via attention allocation were correlated with improved functioning but not improved QOL [4, 50].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] McKnight PE, Monfort SS, Kashdan TB, Blalock D v, Calton JM. Anxiety symptoms and functional impairment: a systematic review of the correlation between the two measures. Clin Psychol Rev 2016;45:115–30. https://doi.org/10.1016/j.cpr.2015.10.005. source
    • cites [50] Renna ME, Seeley SH, Heimberg RG, Etkin A, Fresco DM, Mennin DS. Increased attention regulation from emotion regulation therapy for generalized anxiety disorder. Cogn Ther Res. 2017;42:121–34. https://doi.org/10.1007/s10608-017-9872-7. source

  • May combine two claims.

    Findingcitation

    Adults with generalized anxiety disorder show more impairment in work productivity and activity and lower quality of life compared with adults without GAD.

    “Adults with GAD also demonstrated more impairment in work productivity and activity in addition to lower QOL compared with adults without GAD [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Yu W, Singh SS, Calhoun S, Zhang H, Zhao X, Yang F. Generalized anxiety disorder in urban China: prevalence, awareness, and disease burden. J Affect Disord. 2018;234:89–96. https://doi.org/10.1016/j.jad.2018.02.012. source

  • May combine two claims.

    Findingcitation

    Adults with generalized anxiety disorder report low quality of life and greater healthcare resource utilization in the past six months.

    “Similarly, adults with GAD endorsed low QOL as well as greater healthcare resource utilization in the past 6 months [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Yu W, Singh SS, Calhoun S, Zhang H, Zhao X, Yang F. Generalized anxiety disorder in urban China: prevalence, awareness, and disease burden. J Affect Disord. 2018;234:89–96. https://doi.org/10.1016/j.jad.2018.02.012. source

  • May combine two claims.

    Findingcitation

    Genetic vulnerability to anxiety disorders is negatively correlated with vulnerability to quality of life, suggesting common genetic components may underlie the link between these constructs.

    “Specifically, a genetic vulnerability to anxiety disorders was negatively correlated with vulnerability to QOL, suggesting that common genetic components may underlie the link between these two constructs [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Ohi K, Otowa T, Shimada M, Sasaki T, Tanii H. Shared genetic etiology between anxiety disorders and psychiatric and related intermediate phenotypes. Psychol Med. 2020;50:692–704. https://doi.org/10.1017/S003329171900059X. source

  • May combine two claims.

    Findingcitation

    CBT yields decreased symptom severity and improved quality of life for children and adults with anxiety disorders.

    “Recent research has replicated prior findings, confirming that CBT yields decreased symptom severity and improved QOL for children and adults with anxiety disorders [38•, 42, 66–69].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38•, 42, 66–69]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    For individuals in remission from anxiety disorders 2-14 years after treatment, quality of life remained improved, whereas the majority of those who remained symptomatic reported severely impaired quality of life.

    “Likewise, for individuals in remission from anxiety disorders 2–14 years following treatment, QOL remained improved, whereas the majority of individuals who remained symptomatic following treatment reported severely impaired QOL [2•].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Social and environmental support is negatively predictive of anxiety and positively predictive of quality of life.

    “External factors also played a protective role, such that social and environmental support was negatively predictive of anxiety and positively predictive of QOL [91].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [91] Liu C, Lee YC, Lin YL, Yang SY. Factors associated with anxiety and quality of life of the Wuhan populace during the COVID-19 pandemic. Stress Health. 2021. https://doi.org/10.1002/smi.3040. source

  • May combine two claims.

    Findingcitation

    Individuals with social anxiety disorder who were treatment refractory to medication showed positive changes in quality of life following cognitive therapy, and these gains were maintained at 1-year follow-up.

    “Individuals with SAD who were treatment refractory to medication yielded positive changes in QOL following cognitive therapy, and these gains were maintained at 1-year follow up [69].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Yoshinaga N, Kubota K, Yoshimura K, Takanashi R, Ishida Y, Iyo M, et al. Long-term effectiveness of cognitive therapy for refractory social anxiety disorder: one-year follow-up of a randomized controlled trial. Psychother Psychosom. 2019;88:244–6. https://doi.org/10.1159/000500108. source

  • May combine two claims.

    Premisecitation

    Anxiety disorders have a significant negative impact on quality of life across the lifespan, especially when untreated.

    “Anxiety disorders are highly prevalent conditions that have a detrimental impact on quality of life (QOL), particularly when left untreated.”
    • Also stated in: § Introduction · plain
      “As a result, anxiety disorders have a significant and detrimental impact on QOL across the lifespan, particularly when left untreated [5, 6].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Mendlowicz M v, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry 2000;157:669–82. https://doi.org/10.1176/appi.ajp.157.5.669. source
    • cites [6] Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007;27:572–81. https://doi.org/10.1016/j.cpr.2007.01.015. source

  • May combine two claims.

    Premisecitation

    Heightened negative affect and dampened positive affect are core components of anxiety and depressive disorders.

    “Emotion processing deficits, including heightened negative affect and dampened positive affect, are core components of anxiety and depressive disorders [35]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Gross JJ, Jazaieri H. Emotion, emotion regulation, and psychopathology. Clinical Psychological Science. 2014;2:387–401. https://doi.org/10.1177/2167702614536164. source

  • May combine two claims.

    Premisecitation

    A large proportion of individuals with an anxiety disorder meet criteria for an additional psychiatric disorder, most often another anxiety disorder (48-68%) or a depressive disorder (81%).

    “A large proportion of individuals with an anxiety disorder meet criteria for an additional psychiatric disorder, most often another anxiety disorder (48–68%) or depressive disorder (81%; [1, 60]).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21:169–84. https://doi.org/10.1002/mpr.1359. source
    • cites [60] Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72:341–8. https://doi.org/10.4088/JCP.10m06176blu. source

  • May combine two claims.

    Premisecitation

    Treatment for anxiety disorders produces moderate quality-of-life improvements, but not all individuals respond, and treatment-refractory individuals exhibit particularly low quality of life and increased rates of suicide.

    “Although treatment for anxiety disorders produces moderate QOL improvements, not all individuals respond to these front-line interventions, and those who are treatment refractory exhibit particularly low QOL and increased rates of suicide [85].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] Bystritsky A. Treatment-resistant anxiety disorders. Mol Psychiatry. 2006;11:805–14. https://doi.org/10.1038/sj.mp.4001852. source

  • May combine two claims.

    Interpretationreasoning

    Ways in which individuals with anxiety disorders experience and respond to their emotions differ from non-anxious individuals and may partly explain their lower quality of life.

    “These findings suggest that ways in which individuals with anxiety disorders experience and respond to their emotions are different from non-anxious individuals and may partly explain their reported lower levels of QOL.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The experience of anxiety may be heightened, triggering increased distress and negative affect, which anxious individuals have difficulty downregulating; in an attempt to cope, they avoid or use safety behaviors, which disrupts occupational, social, and physical functioning.

    “It may be that the experience of anxiety is heightened, triggering increased distress and negative affect, which anxious individuals then have difficulty downregulating. In an attempt to cope, these individuals avoid or use safety behaviors, which in turn disrupts their occupational, social, and physical functioning.”
    Quote in the paperSubstantial claim
30 of 30

  • The paper relies on this without support.

    No prior review has articulated specific correlates of quality of life in anxiety disorders.

    “Although prior reviews have highlighted the nature of QOL impairments among anxiety disorders, no review has yet articulated specific correlates of QOL.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conclusion duplicates one category and omits another

    Minor

    The conclusion lists behavioral responses twice among the review's four areas, while the abstract names clinical factors as the fourth area.

1 of 1

Cites

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2 of the 97 references couldn’t be matched to a known paper.

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Related

Authors
Wilmer, M. T., Anderson, K., & Reynolds, M.
Corresponding author
Wilmer, M. Taylor
ORCID
Venue
Current Psychiatry Reports
Publisher
Springer Science and Business Media LLC
Published
2021-10-06
Volume
23
Issue
11
Pages
77-77
ISSN
  • 1523-3812 (ISSN-L)
  • 1535-1645
DOI
10.1007/s11920-021-01290-4
PMC
PMC8493947
OpenAlex
W3202592694
Cited by
150
References
97
Citations by year
2026: 44 · 2025: 49 · 2024: 34 · 2023: 17 · 2022: 6
FWCI
2.33
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Psychiatry Reports (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
anxiety disorders, quality of life, anxiety symptom severity, cognitive behavioral therapy, anxiety sensitivity, distress tolerance, emotion regulation, avoidance coping, functional disability, comorbidities, COVID-19 pandemic, transdiagnostic mechanisms
MeSH terms
COVID-19, SARS-CoV-2, Anxiety Disorders, Humans, Quality of Life, Pandemics

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