The DOI matches its Crossref record; 35 of the 36 references it cites were found in a registry or an index.
Joint hypermobility syndrome is a risk factor trait for anxiety disorders: a 15-year follow-up cohort study
Abstract
Objective The objective of the study was to assess whether joint hypermobility syndrome (JHS) is a risk factor for developing anxiety disorders using a 15-year prospective cohort study.Method The initial cohort recruited 158 subjects aged 16 to 20 years from the general population in a Spanish rural town. The cohort was studied at baseline and at a 15-year follow-up. Joint hypermobility syndrome was assessed using Beighton's criteria, and the psychiatric disorders were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders. Subjects with anxiety disorders at baseline were excluded from the follow-up.Results Joint hypermobility syndrome at baseline was found in 29 of 158 subjects (21.1%). Cumulative incidence of panic/agoraphobia disorder at follow-up, as main diagnosis, was significantly higher for the JHS group (41.4%) than for the control group (1.9%), with a relative risk of 22.3 [95% confidence interval (CI) 4.6-108.7, P<.0001] (Number Needed to Treat [NNT] 3, 95% CI 2.9-2.3). Incidence of social phobia and simple phobia was also significantly higher for the JHS group [relative risk (RR)=6.52, 95% CI 1.7-24.2, P<.001 and RR=3.31, 95% CI 1.1-9.6, P=.02, respectively]. Moreover, anxiolytic drug use was nearly fourfold higher among JHS compared to non-JHS subjects.Conclusion Joint hypermobility syndrome was associated with higher risk of developing anxiety disorders. If replicated, these findings may give enhanced value to JHS assessment in clinical and general population studies.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“EDS and HSD have been associated with increased risk of conditions such as depression and anxiety as well as interpersonal issues when compared to the general population [17–21].”
From Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review (2023) · cites this paper as [18]
In the citing paper
“This observation is striking as such an association is widely reported in adults.10 13 42”
From Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study (2022) · cites this paper as [42]
In the citing paper
“Adults with asymptomatic GJH had higher anxiety scores42,43 and more specific anxiety as state, trait anxiety, social anxiety, and severity of fears than controls without asymptomatic GJH.33, 34, 35, 36”
From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [35]
In the citing paper
“Contradictory results were found on the frequency of fears in healthy adults with asymptomatic GJH compared to peers without asymptomatic GJH.34,35”
From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [35]
In the citing paper
“and represents a risk factor trait for developing anxiety disorders (Bulbena et al., 2011).”
From Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility (2014) · cites this paper as Bulbena et al., 2011
In the citing paper
“The association between joint hypermobility and the clinical expression of anxiety is now robustly established (Bulbena et al., 2011; Bianchi Sanches et al., 2012).”
From Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility (2014) · cites this paper as Bulbena et al., 2011
In the citing paper
“In a long term population cohort study with 15 years of follow up, those patients with HSD/hEDS defined by Brighton criteria performed at the time of recruitment (29 of the 137 subjects) had a relative risk of panic disorder or agoraphobia 22 times greater than that of the non‐HSD/hEDS patients. 18”
From Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know (2022) · cites this paper as [18]
In the citing paper
“Previously described in BJHS, higher rates of anxiety and depression may be due to pain-related fear and fear avoidance, but studies are scarce to clarify this relationship.[8,35,36]”
From Hypermobility spectrum disorders: A review (2023) · cites this paper as [36]
Citations
Cites
(1988) · NFER-Nelson eBooks · Cited by 5,560
Hulley, S. B. (1997) · Cited by 1,753
Articular mobility in an African population.
Beighton, P., Solomon, L., & Soskolne, C. L. (1973) · Annals of the Rheumatic Diseases · doi:10.1136/ard.32.5.413 · Cited by 1,727
Prevalence and incidence studies of anxiety disorders: A systematic review of the literature
Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006) · The Canadian Journal of Psychiatry · doi:10.1177/070674370605100206 · Cited by 1,114
Psychometric properties of the Liebowitz Social Anxiety Scale
HEIMBERG, R. G., HORNER, K. J., JUSTER, H. R., SAFREN, S. A., BROWN, E. J., SCHNEIER, F. R., & LIEBOWITZ, M. R. (1999) · Psychological Medicine · doi:10.1017/s0033291798007879 · Cited by 968
(2000) · PubMed · Cited by 738
Anxiety sensitivity and panic disorder
McNally, R. J. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01475-0 · Cited by 717
Kirby, R. S. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.01.010 · Cited by 681
(1988) · American Journal of Psychiatry · doi:10.1176/ajp.145.8.976 · Cited by 641
Validity of the scaled version of the General Health Questionnaire (GHQ-28) in a Spanish population
Lobo, A., Perez-Echeverria, M. J., & Artal, J. (1986) · Psychological Medicine · doi:10.1017/s0033291700002579 · Cited by 535
Dysautonomia in the joint hypermobility syndrome
Gazit, Y., Nahir, A. M., Grahame, R., & Jacob, G. (2003) · The American Journal of Medicine · doi:10.1016/s0002-9343(03)00235-3 · Cited by 390
The ESEMeD/MHEDEA 2000 investigators, Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., de Girolamo, G., de Graaf, R., Demyttenaere, K., et al. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0047.2004.00331.x · Cited by 313
Hakim, A., & Grahame, R. (2003) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2003.08.001 · Cited by 289
Gratacòs, M., Nadal, M., Martín‐Santos, R., Pujana, M. Á., Gago, J., Peral, B., Armengol, L., Ponsa, I., Miró, R., Bulbena, A., et al. (2001) · Cell · doi:10.1016/s0092-8674(01)00447-0 · Cited by 216
Self-citationClinical assessment of hypermobility of joints: assembling criteria.
Bulbena, A., Duró, J. C., Porta, M. S., Faus, S., Vallescar, R., & Martín‐Santos, R. (1992) · PubMed · Cited by 199
Self-citationLewkonia, R. M. (1987) · Archives of Disease in Childhood · doi:10.1136/adc.62.1.1 · Cited by 180
MOORE, M. (1976) · The Lancet · doi:10.1016/s0140-6736(76)92514-9 · Cited by 167
Cuestionario de ansiedad estado-rasgo: manual
Spielberger, C. D., Cubero, N. S., Gorsuch, R. L., & Lushene, R. E. (1982) · Dialnet (Universidad de la Rioja) · Cited by 136
Association Between Joint Hypermobility Syndrome and Panic Disorder
Martín‐Santos, R., Bulbena, A., Porta, M. S., Gago, J., Balaguer, L. M., & Duró, J. C. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.11.1578 · Cited by 136
Self-citationBobes, J., Badia, X. C., Luque, A., García, M., González, M. P., & Dal−Ré, R. (1999) · PubMed · Cited by 131
Anxiety disorders in the joint hypermobility syndrome
Bulbena, A., Duró, J. C., Porta, M., Martín-Santos, R., Mateo, A., Molina, L., Vallescar, R., & Vallejo, J. (1993) · Psychiatry Research · doi:10.1016/0165-1781(93)90008-5 · Cited by 118
Self-citationAnxiety Sensitivity Index: normative data and its differentiation from trait anxiety
Sandín, B., Chorot, P., & McNally, R. J. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00009-7 · Cited by 86
JOINT HYPERMOBILITY SYNDROME AND ANXIETY DISORDERS
Bulbena, A., Duró, J. C., Mateo, A., Porta, M. S., & Vallejo, J. (1988) · The Lancet · doi:10.1016/s0140-6736(88)90514-4 · Cited by 77
Self-citationIs Joint Hypermobility Related to Anxiety in a Nonclinical Population Also?
Bulbena, A., Agulló, A., Pailhez, G., Martín-Santos, R., Porta, M., Guitart, J., & Gago, J. (2004) · Psychosomatics · doi:10.1176/appi.psy.45.5.432 · Cited by 76
Self-citationHärter, M. C., Reuter, K., Weisser, B., Schretzmann, B., Aschenbrenner, A., & Bengel, J. (2002) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2002.30924 · Cited by 64
Age effects on the clinical presentation of alcoholics at a psychiatric hospital
Cornelius, J. R., Fábrega, H., Maher, P. J., Jones-Barlock, A., Salloum, I. M., Ulrich, R. F., & Mezzich, J. E. (1997) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(97)90029-8 · Cited by 57
The relationship between frequency and intensity of fears and a collagen condition
Bulbena, A., Gago, J., Sperry, L., & Bergé, D. (2006) · Depression and Anxiety · doi:10.1002/da.20160 · Cited by 35
Self-citationAnxiety disorders: a conceptual history
Berrios, G. E. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00036-1 · Cited by 35
What can be learnt from the natural history of anxiety disorders?
Rubio, G., & López-Ibor, J. J. (2006) · European Psychiatry · doi:10.1016/j.eurpsy.2006.09.007 · Cited by 29
The long-term treatment outcomes of depression and anxiety comorbid with substance abuse
BOVASSO, G. B. (2001) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02287233 · Cited by 21
“Connective tissue” between panic disorder and dysautonomia
Bulbena, A., Pailhez, G., & Gago, J. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2003.11.032 · Cited by 18
Self-citationRacial effects on the clinical presentation of alcoholics at a psychiatric hospital
Cornelius, J. R., Fábrega, H., Cornelius, M. D., Mezzich, J. E., Maher, P. J., Salloum, I. M., Thase, M. E., & Ulrich, R. F. (1996) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(96)90569-6 · Cited by 16
Joint Hypermobility in Schizophrenia: A Potential Marker for Co-Morbid Anxiety
Bulbena, A., Sperry, L. D., Anguiano, B., Pailhez, G., & Gago, J. (2007) · The Open Psychiatry Journal · doi:10.2174/1874354400701010031 · Cited by 14
Self-citationNo evidence for DNA copy number change associated with the DUP25 cytogenetic phenotype
Hollox, E. J., & Armour, J. A. L. (2003) · European Journal of Human Genetics · doi:10.1038/sj.ejhg.5201074 · Cited by 6
The relativity of relative risks: disadvantage or opportunity?
Neeleman, J. (2003) · The British Journal of Psychiatry · doi:10.1192/bjp.182.2.101 · Cited by 6
Research works printed but not linked: 2
- Rotés, 1957, La laxitud articular como factor de alteraciones del aparato locomotor, Rev Esp Reumatol, 1, 59
- Bulbena, 2004, Anxiety disorder and joint laxity: a definitive link., Neurol Psychiatry Brain Res, 11, 137
Cited by
Sorted by citations
Moreno-Peral, P., Cerón, S. C., Motrico, E., Morejón, A. R., Fernández, A., García‐Campayo, J., Roca, M., Serrano‐Blanco, A., Rubio-Valera, M., & Bellón, J. Á. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.06.021 · Cited by 198
Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain
Kumar, B., & Lenert, P. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.02.013 · Cited by 153
Psychiatric and psychological aspects in the Ehlers–Danlos syndromes
Bulbena, A., Baeza‐Velasco, C., Bulbena‐Cabré, A., Pailhez, G., Critchley, H., Chopra, P., Mallorquí‐Bagué, N., Frank, C., & Porges, S. (2017) · American Journal of Medical Genetics Part C: Seminars in Medical Genetics · doi:10.1002/ajmg.c.31544 · Cited by 149
Self-citationCederlöf, M., Larsson, H., Lichtenstein, P., Almqvist, C., Serlachius, E., & Ludvigsson, J. F. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0922-6 · Cited by 144
“The same authors recently reported that hypermobility was linked to a 22-fold increased risk of panic/ agoraphobia disorders and a 4-fold increase in the use of anxiolytic drugs in patients with hypermobility [10].”
BackgroundSmith, T. O., Easton, V., Bacon, H., Jerman, E., Armon, K., Poland, F., & Macgregor, A. J. (2014) · Rheumatology · doi:10.1093/rheumatology/ket317 · Cited by 130
Metadata
- Authors
- Bulbena, A., Gago, J., Pailhez, G., Sperry, L., Fullana, M. A., & Vilarroya, O.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- Corresponding author
- Pailhez, Guillem
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-07
- Volume
- 33
- Issue
- 4
- Pages
- 363-370
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2002588000
- Cited by
- 113
- References
- 36
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 8 · 2021: 6 · 2020: 7 · 2019: 7 · 2018: 2 · 2017: 12 · 2016: 6 · 2015: 14 · 2014: 16 · 2013: 8 · 2012: 5
- FWCI
- 6.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- joint hypermobility syndrome, anxiety disorders, panic disorder, agoraphobia, social anxiety disorder, specific phobia, Beighton criteria, risk factors
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Female, Follow-Up Studies, Humans, Joint Instability, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Spain, Cohort Studies, Epidemiologic Studies, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
