Systematic review and meta-analysis of the association between peripheral inflammatory cytokines and generalised anxiety disorder
Open accessAbstract
Objective Inflammation has been implicated in the aetiology of mental illness. We conducted the first systematic review and meta-analysis of the association between peripheral markers of inflammation and generalised anxiety disorder (GAD). Design Systematic review and meta-analysis of studies measuring peripheral cytokine levels in people with GAD compared with controls. Data sources MEDLINE (1950–), EMBASE (1947–), PsycINFO (1872–) and Web of Science (1945–) databases up until January 2018. Eligibility criteria Primary, quantitative research studies of people with a diagnosis of GAD assessed using a standardised clinical interview that measured peripheral inflammatory markers. Data extraction and synthesis Two independent reviewers extracted data and assessed study quality. Meta-analysis using a random-effects model was conducted for individual cytokines where data from three or more studies were available. Results 14 of 1718 identified studies met the inclusion criteria, comprising 1188 patients with GAD and 10 623 controls. In total 16 cytokines were evaluated. Significantly raised levels of C reactive protein (CRP), interferon-γ and tumour necrosis factor-α were reported in patients with GAD compared with controls in two or more studies. Ten further proinflammatory cytokines were reported to be significantly raised in GAD in at least one study. However, 5 of 14 studies found no difference in the levels of at least one cytokine. Only CRP studies reported sufficient data for meta-analysis. CRP was significantly higher in people with GAD compared with controls, with a small effect size (Cohen’s d=0.38, 0.06–0.69), comparable with that reported in schizophrenia. However, heterogeneity was high (I 2 =75%), in keeping with meta-analyses of inflammation in other psychiatric conditions and reflecting differences in participant medication use, comorbid depression and cytokine sampling methodology. Conclusion There is preliminary evidence to suggest an inflammatory response in GAD, but it remains unclear whether inflammatory cytokines play a role in the aetiology. GAD remains a poorly studied area of neuroinflammation compared with other mental disorders, and further longitudinal studies are required.
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Generalized anxiety disorder has been associated with elevated levels of C-reactive protein and proinflammatory cytokines.
“Generalized anxiety disorder (GAD) has been associated with elevated levels of C-reactive protein (CRP) and proinflammatory cytokines.”
From Inflammatory markers changes following acceptance-based behavioral psychotherapy in generalized anxiety disorder patients: Evidence from a randomized controlled trial (2024) · cites this paper as Costello et al., 2019
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“In GAD patients, raised levels of C-reactive protein (CRP) and some peripheral cytokines have been associated with measures of anxiety severity (Khandaker et al., 2016; Tang et al., 2018; Costello et al., 2019).”
BackgroundBiopsychosoziale Therapie der generalisierten Angststörung: Ein integratives Behandlungskonzept
Egle, U. T., Bättig, I., Neufeld, J., Ballweg, T., & Cattapan, K. (2022) · Psychotherapeut · doi:10.1007/s00278-021-00567-6
- Authors
- Costello, H., Gould, R. L., Abrol, E., & Howard, R.
- Affiliations
- University College London (GB)
- Corresponding author
- Costello, Harry
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-07
- Volume
- 9
- Issue
- 7
- Pages
- e027925
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6661660
- OpenAlex
- W2964215777
- Cited by
- 248
- References
- 61
- Citations by year
- 2026: 26 · 2025: 53 · 2024: 42 · 2023: 38 · 2022: 37 · 2021: 34 · 2020: 17 · 2019: 1
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health Research
- Topics
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- generalized anxiety disorder, inflammatory cytokines, neuroinflammation, C-reactive protein, interferon-gamma, TNF-α
- MeSH terms
- Anxiety Disorders, Humans, Inflammation, Biomarkers, Cytokines
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