Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review

Abstract

Background: The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. The aim of this review was to identify the psychosocial and biological factors that have been considered to explain this gender and sex difference in prevalence and determine whether these factors are related to any anxiety comorbidity differences between men and women. Methods: Following the PRISMA guidelines, we carried out a systematic review of studies published between 2008 and 2021 in PsycINFO and PubMed databases. Empirical and review studies evaluating psychosocial and biological factors that could influence the difference in prevalence and comorbidity between men and women were included. A qualitative narrative synthesis was performed to describe the results. Results: From 1012 studies, 44 studies were included. Retrieved articles were categorized depending on their object of study: psychosocial factors (n = 21), biological factors (n = 16), or comorbidity (n = 7). Results showed that differences in anxiety between women and men have been analyzed by psychosocial and biological factors but rarely together. Among the psychosocial factors analyzed, masculinity may be a protective factor for anxiety development, while femininity can be a risk factor. In the studies that took biological factors into account, the potential influence of brain structures, genetic factors, and fluctuations in sexual hormones are pointed out as causes of greater anxiety in women. Concerning comorbidity, the results noted that women tend to develop other internalizing disorders (e.g. depression), while men tend to develop externalizing disorders (e.g. substance abuse). Conclusions: For an accurate understanding of differences between women and men in anxiety, both biological and psychosocial factors should be considered. This review highlights the need to apply the biopsychosocial model of health and the gender perspective to address differences in anxiety between sexes.

Treatment Course Comparison Between Anxiety-Related Disorders in Adult Outpatients

“…, Bandelow and Michaelis, 2015; Farhane-Medina et al, 2022; Kessler et al, 1994; Kessler et al, 2005b; Pesce et al, 2015; Michael et al, 2007), which is confirmed in our results (for both total group and disorder groups). This sex difference can probably be explained by psychosocial and biological factors, although more research is needed on this (Farhane-Medina et al, 2022). Further, previous studies have primarily documented lower prevalence rates of anxiety disorders in minority groups ( e.g.…”

“…For example, anxiety-related disorders are generally more common in women than in men ( e.g. , Bandelow and Michaelis, 2015; Farhane-Medina et al, 2022; Kessler et al, 1994; Kessler et al, 2005b; Pesce et al, 2015; Michael et al, 2007), which is confirmed in our results (for both total group and disorder groups). This sex difference can probably be explained by psychosocial and biological factors, although more research is needed on this (Farhane-Medina et al, 2022).…”

Gender Differences in Fears Related to Low-Risk Papillary Thyroid Cancer and Its Treatment

“…It is a normal adaptive response, which may prompt defensive physiological and behavioral changes, but it may become maladaptive or persistent, relating to anxiety and stress-related disorders . Epidemiologic literature consistently suggests that women are at higher risk of anxiety as well as trauma and stress-related disorders and may experience more adverse symptomatic expression of their anxiety compared with men …”

Factors Affecting Anxiety and Depression Among Pediatric Residents in Dr. Soetomo General Hospital in Surabaya, Indonesia

“…The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. Women experience higher rates of anxious-depressive symptoms compared to men, with these symptoms also being more severe (25)(26)(27). AlJahwari in Oman studied the anxiety symptoms among residents physicians resulting in 251, 68.2% (n = 173) of the study being female residents and 31% (n = 78) male residents (24).…”