The anxiety puzzle: why are women in deprived areas more likely to suffer?

A major survey of more than 20,000 people in the UK has found that women living in poor areas are almost twice as likely to develop clinical anxiety as women in richer areas. Interestingly, living in poorer or richer areas made no difference to the levels of generalised anxiety disorder experienced by men.

Generalised anxiety disorder (GAD) is one of the most common mental health conditions in modern society. It is debilitating, and associated with a high use of health services. If untreated, it can lead to the development of major depression and substance abuse, and it places individuals at a high risk of suicide.

Environmental impacts

Despite these serious risks, very little research has been done on the factors in society that give rise to this disorder. Much of the work on mood and mental illness has focused on depression, while anxiety has been largely neglected. Those studies which have looked at the risk factors for anxiety disorders have tended to focus on the effect of low personal income, low levels of education, or poor health behaviours (such as smoking, drinking and physical inactivity).

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So far, very little work has been done on the impact of the environment in relation to anxiety, even though it is widely recognised as an important contributor to health in general, and can affect a very large number of people. In particular, living in poverty has been linked to a range of chronic medical conditions – including depression – and mortality. So could there be a link between poverty and anxiety?

Now, for the first time, I and researchers in the Department of Public Health and Primary Care at the University of Cambridge have shown that British women living in deprived areas are almost twice as much at risk of experiencing GAD, compared with women living in areas that are not deprived. This association persisted even after we accounted for individual circumstances, such as socio-economic status and existing medical conditions. It is also remarkable that the link between deprivation and clinical anxiety does not seem to exist among men.

Why is it so?

These findings are intriguing, and several explanations can be put forward. Deprivation – which we measured based on factors such as the local unemployment rate, barriers to housing and services, crime, and other dimensions – can lead to stress, which can trigger mental health problems. It may be that women are more affected by the stress that comes with living in poverty, compared with men.

Women tend to be more embedded in their local communities and spend more time in the surrounding environment than men, perhaps due to their greater uptake of part-time work and domestic or child-rearing duties. This means that they may be more exposed to the strain and stresses that come with living in deprived conditions.

Women may also perceive the environment differently from men. Neighbourhood safety and fear of being assaulted seem to be much more of a concern for women. If women perceive a neighbourhood to be unsafe, they may restrict leisure activities, such as walking, and this can have further negative effects on their mental health.

Finally, both genders may experience and manifest the effects of stress in different ways. One study has shown that women who are highly distressed tend to develop internalising disorders, while men are more prone to drinking abuse and antisocial problems.

The National Institute for Health and Care Excellence (NICE) and the World Health Organisation (WHO) have emphasised the need to reduce social and health inequalities. Our findings add detail to this call, showing that environmental characteristics should inform mental health policy, but also that investments made to improve local areas will not benefit all parts of the population in the same way. Gender is clearly an important factor when it comes to assessing the impacts of our environment, and promoting good mental health.

Olivia Remes received a PhD studentship from the UK National Institute for Health Research (NIHR).