Learn what causes stress and anxiety and how to manage them. are generally used on a short-term basis due to the risk of addiction. Other factors that can increase your risk of developing an anxiety disorder include: Stress: Everyone encounters stress. This increases the risk of their anxiety or depression going unrecognised and . Coping with Stress and Intro to Mindfulness online courses developed by the.
Anxiety in Stress Developing Risk Increases
Exogenous nicotine administration to isolated cell lines in vitro reduces antioxidant constituents e. Investigations into the effects of nicotine on oxidative stress in CNS cells have been more limited. In a study that utilized chronic nicotine exposure administered for 10 days, results demonstrated increased levels of TBARS and HNE 4-hydroxynonenal in the brain Bhagwat et al.
Cigarette smoke can also increase levels of brain heat shock protein 70 kDa Anbarasi et al. Only one study to our knowledge has simultaneously assessed the association between cigarette smoke exposure, anxiety symptoms, and brain oxidative stress markers. In this study, rats exposed to cigarette smoke showed increased markers of brain lipid peroxidation and decreased plasma ascorbic acid.
When rats were additionally treated with pecan nut shell extract, a substance with antioxidant properties, improvements were demonstrated in anxiety symptoms interpreted as withdrawal symptoms and markers of lipid peroxidation Reckziegel et al. Mitochondria are important sources of oxidative stress and many abnormalities in mitochondrial function have been found in psychiatric disorders for review see Manji et al.
Although still requiring much investigation, multiple factors support a role for mitochondrial dysfunction in increasing anxiety. First, patients exhibiting mitochondrial disorders commonly demonstrate psychiatric symptoms including increased anxiety Miyaoka et al.
Second, recent investigations have discovered decreased levels of glycolysis enzymes coupled with increased expression of components associated with the electron transport chain in high-anxiety trait animal models, potentially increasing vulnerability to production of ROS and subsequent cellular damage Filiou et al. These results were coupled with observations of altered levels of proteins associated with neurotransmission in high-anxiety mice thought to be consequent to mitochondrial protein alteration Filiou et al.
Third, mitochondria-targeted antioxidant SkQ1 has been associated with decreased expression of anxiety behaviors in rats Stefanova et al. Finally, mutant mice with reduced function of Bcl-2, a key modulator of mitochondrial function, demonstrate increased anxiety behavior Einat et al.
Exposure to cigarettes can lead to mitochondrial dysfunction Miro et al. However, chronic cigarette smoking was not associated with derangement of mitochondrial function in a separate study, but did prevent exercise-induced improvement in mitochondrial function Speck et al.
A potential explanation for absence of demonstrable mitochondrial dysfunction in this study may relate to the use of SWISS mice in the experimental design that were demonstrated to be highly resistant to cigarette smoke-induced oxidative stress Rueff-Barroso et al. Given these preliminary results, investigation of therapies that promote mitochondrial function in patients with anxiety disorders would be fruitful. These studies should take in account smoking status. Increasing evidence supports a role for NTs and neurogenesis in development of anxiety disorders and anxiety symptoms, although certain mediators may exert varying effects on different anxiety symptoms.
Animal models have demonstrated stress-related changes to neurogenesis in areas associated with mood and anxiety disorders including the hippocampus Cirulli et al. Exposure to neonatal stress can reduce expression of hippocampal BDNF via altering gene expression Roth et al.
In addition, altered levels of BDNF and their Trk B receptors may occur in dopaminergic pathways projecting from the ventral tegmental area in the midbrain to the nucleus accumbens Yu and Chen Changes in BDNF appear associated with increased anxiety behaviors.
Intrahippocampal injections of BDNF in rats lead to an increase in anxiety assessed by facilitatory avoidance and the light—dark test. This was blocked by a 5HT1a antagonist suggesting a modulatory role of serotonin Casarotto et al.
Social deprivation stress leads to the development of anxiety in mice, and this appears to be modulated by reductions in BDNF Berry et al. In a cross-sectional study of a healthy population, plasma BDNF levels were negatively associated with somatization, obsessive—compulsiveness, interpersonal sensitivity, and anxiety Bhang et al.
NGF is increased under conditions of stress in both animal models and humans Aloe et al. Interestingly, animal models demonstrate that increases in release of NGF are most marked under conditions of stressful behavioral interactions between animals, with lesser increases seen under physical restraint stress Aloe et al.
Further evidence suggests that levels of fibroblast growth factor 2 FGF2 in the hippocampus are decreased in animals with higher anxiety and lower response to novelty Perez et al. Exercise also appears able to protect against the negative effect of maternal deprivation on expression of these NTs Uysal et al. Cigarette smoking and nicotine in particular appear to exert effects on expression of NTs, although the literature is sparse and heterogeneous. For example, cigarette smoking and repeated nicotine exposure has been associated with decreased expression of BDNF in animal models Yeom et al.
In addition, plasma levels of BDNF are significantly lower in smokers than nonsmokers in human studies, with levels increasing with greater duration of smoking abstinence Kim et al. However, other results have suggested that nicotine exerts a positive effect on BDNF levels. The neurotrophic augmenting effects of nicotine in this situation is hypothesized to underpin a therapeutic benefit of cholinergic stimulation on Parkinson's disease by protecting dopaminergic neurons from damage.
In a further study, traumatic brain injury revealed a positive effect of chronic cigarette smoking on BDNF expression Lee et al. Nicotine exposure has also been associated with significant increases in NGF French et al. Differences in NT expression in response to cigarette smoking are likely dependent upon numerous factors, including the relative roles of nicotine and other components of cigarette smoke e.
Given the key role of NTs in brain neurodevelopment, distortion to different NTs in early development may facilitate disordered growth in brain architecture Abreu-Villaca et al.
Such effects may leave the overall system more vulnerable to disorders such as increased anxiety. If exposure occurs later, alterations to NTs may undermine normal compensatory and protective mechanisms available to neuronal cells, leaving cells at greater risk of damage or induced apoptosis.
Future studies should evaluate the roles of nicotine and other constituents of cigarette smoke on the levels of NTs correlated with anxiety and depressive behaviors in animal models, taking into account the different stages of development at which exposure can occur. The study of epigenetic changes in anxiety disorders is a relatively new field, although some preliminary evidence suggests that cigarette smoke may lead to changes in gene expression predisposing to increased anxiety.
For example, smoking has been associated with epigenetic regulation of MAO-B via a reduction in methylation of its gene promoter. This change leads to increased production of MAO-B persisting long after smoking is ceased Launay et al. In addition, prenatal exposure to environmental tobacco smoke has been demonstrated to modify expression of genes controlling key functions such as synaptic function, neurogenesis, axonal growth, and cellular survival in the developing hippocampus Mukhopadhyay et al.
Data from cardiovascular research have also demonstrated the potential of gestational cigarette smoke exposure to upregulate expression of genes associated with production of proinflammatory substances in developing primates, which may increase vulnerability to vascular disease in later life Villablanca et al.
In depression, preliminary research has identified interrelationships between levels of gene methylation and inflammatory mediators that may contribute to pathogenesis via alteration of tryptophan metabolism Uddin et al.
Investigation of epigenetic changes may provide insights into how cigarette smoking can impact gene expression in potentially contributing to pathogenesis of anxiety disorders, although empirical data are currently very limited. One potential genetic influence that could be explored is the role of prototoxin gene LYNX2. Loss of LYNX2 was associated with increased glutamatergic activity and increased anxiety behaviors in one study, suggesting a possible role in controlling anxiety responses Tekinay et al.
Further studies are required to assess whether LYNX2 functioning may affect the alterations to nAChRs provoked by prolonged nicotine exposure in smokers.
The above findings summarized in Fig. Cigarette smoking can modulate all of these pathways, potentially distorting cellular functioning and neuronal architecture predisposing to higher vulnerability to developing anxiety disorders.
Multiple pathways that are associated with development of anxiety disorders are affected by cigarette smoke and nicotine, including diverse neurotransmitter systems, inflammation and the immune system, oxidative and nitrosative stress, neurotrophins and neurogenesis, mitochondrial function, and epigenetic influences.
It is possible these pathways may underpin how exposure to cigarette smoke could increase anxiety symptoms and expression of anxiety disorders. Cigarette smoke is known to be deleterious to neurodevelopment Picciotto et al. During early neurodevelopment, cigarette exposure can be direct e.
Given the diversity of active compounds in cigarette smoke, we focus here primarily on the specific influence of nicotine Newman et al. However, as cigarette smoke contains many substances that either directly e. Nicotine readily crosses the placenta and enters the fetal blood stream in utero Lambers and Clark Exposure in utero has also been associated with later behavioral and social problems Nicoll-Griffith et al. Nicotine's action as a specific agonist of nAChRs is facilitated by the very early expression prior to neurulation of these receptors in the developing CNS Atluri et al.
Cholinergic inputs are critical during brain development, underwriting many key processes including axonal and synaptic growth, promoting neurogenesis, facilitating planned apoptosis, and initiating the switch between neuronal replication and differentiation Slotkin Increasing evidence suggests nicotine agonism of nAChRs may exert deleterious neurodevelopmental effects.
Given the rapid rate of neurodevelopment in utero, deleterious effects will likely be most significant during this time, but might continue to occur at any time when there is significant development e. Agonism of nAChRs by nicotine is more prolonged than that exerted by acetylcholine in normal cholinergic transmission due to differences in concentration and clearance. Nicotine presented in utero is usually present in higher concentrations, and is more slowly cleared, than endogenous acetylcholine DeBry and Tiffany As consequence, nicotine can induce enhanced nAChR activation, facilitating adaptive effects such as receptor desensitization, and if excessive, direct toxicity DeBry and Tiffany Animal models have demonstrated that nicotine exposure leads to quite profound distortion of early neural development characterized by increased apoptosis and enlargement of intercellular spaces Roy et al.
Even though substantial recovery appears to occur such that brains with grossly distorted architecture in utero do not appear grossly abnormal in adolescence or adulthood, there remain long-lasting effects of nicotine exposure to neuronal architecture, cellular functioning and survival, and DNA expression and regulation. For example, prenatal nicotine exposure has been associated with persisting alterations in cellular architecture in the hippocampus Roy et al.
Many effects have demonstrated persistence into adolescence. For example, decreased synaptic activity in noradrenergic and dopaminergic neurons evident in the early postnatal period of rats exposed to nicotine prenatally has been demonstrated to reemerge with pubertal onset Navarro et al.
Prenatal exposure to nicotine also causes ongoing alteration to nAChRs that extend in adolescence Gold et al. In addition, genetic profiling studies have revealed that adolescent genes coding for the ventral tegmental area, some of which encode for neurite development, psychological disorders, development disorders, and nervous system development, appear more vulnerable to long-term effects of chronic nicotine exposure than adult genes Doura et al.
Evidence supports that exposure to nicotine prenatally and during early postnatal life leads to increased anxiogenic behaviors in rats Eppolito et al. Interestingly, measures of increased anxiety behavior in the Elevated Plus Maze in those rats exposed to prenatal nicotine were present in adulthood but not in adolescence, and although the result was more prominent in female rats, males also demonstrated the response Eppolito et al.
The exposure to nicotine before and shortly after birth was associated with impairment to fear extinction Eppolito et al. This may suggest that exposure to nicotine in high-activity neurodevelopmental periods may exert more deleterious effects than in adulthood.
It is possible that chronic administration of nicotine, via altered nAChR activity, may influence gene expression and plasticity in the medial PFC and amygdala Brown and Kolb ; Li et al. This interaction may underpin the lack of extinction learning displayed in rats that are exposed to chronic nicotine Eppolito et al.
Nicotine induces production of oxidative stress markers and reduces antioxidant defenses, contributing a major proportion of the net oxidative stress from cigarette use Bhagwat et al. Nicotine increases lipid peroxidation markers that can be prevented by coadministration of free radical scavenger vitamin E Qiao et al. It is possible that the balance between damaging and protective effects of nicotine may depend upon the degree of stimulated oxidative stress — a small amount of oxidative stress could have positive effects in stimulating normal cellular processes, but significantly increased oxidative stress could overwhelm protective mechanisms leading to direct cellular damage Newman et al.
Nicotine has demonstrated adverse neurobiological effects during adolescence, with these effects seemingly dependent on only early small and infrequent exposure to nicotine Abreu-Villaca et al. In keeping with this hypothesis, administration of nicotine for 1 week to adolescent rats resulted in a significant increase in TBARS with effects that would have been observed at low levels of exposure Qiao et al.
Other mechanisms of nicotine-induced damage may include upregulation of mRNA expression encoding proteins associated with cell death and cell differentiation. For example, increased levels of such proteins p53 and reduction of DNA were found in the hippocampus, cortex, and midbrain in adolescent rats Trauth et al.
These effects were not of the same magnitude as those seen with nicotine exposure in utero Levin and Slotkin It is possible that exacerbated expression of these growth-supporting factors via nicotine's agonism of nAChRs may interfere with normal neurodevelopmental processes.
As nicotine's stimulation of nAChRs is potentially more prolonged than normal cholinergic transmission, expression of NTs may be higher than required for normal neurodevelopment, with this higher expression leading to disordered development of neuronal architecture Abreu-Villaca et al.
Such effects may predispose an increased risk of developing anxiety and other psychiatric disorders in later life. A number of these insights may have treatment implications for anxiety-based disorders and symptoms. It is hypothesized that adaptation and desensitization of nAChRs may underpin the effect of cigarettes on anxiety and mood regulation Mineur and Picciotto , based on the association between higher smoking rates and mood dysregulation e.
Many of these effects apply to increased anxiety, suggesting that certain central nAChRs may serve as a new potential treatment target.
Numerous studies have demonstrated potential for use of centrally acting nAChR antagonists in anxiety treatment.
For example, the nAChR antagonist mecamylamine has produced anxiolytic improvement in multiple animal models Newman et al. Mecamylamine was demonstrated to be a useful augmentation agent to SSRI treatment of major depression George et al. The anxiolytic effects of nAChR antagonism have also been confirmed using an alternative agent, lobeline Roni and Rahman Human data on the use of nAChR antagonist for anxiety are scarce.
A possible insight comes from the use of bupropion, which blocks reuptake of noradrenaline and dopamine but in addition exerts a noncompetitive antagonist effect at several subtypes of nAChRs Arias Bupropion has demonstrated significant anxiolytic effects equivalent to the action of SSRIs in treatment of patients with major depressive disorder, and this effect on nAChRs may underpin part of this effect, although other explanations are possible e. Future randomized studies will provide insight into therapeutic possibilities exploiting modification of nAChRs in treating anxiety disorders.
For example, the tetracyclic antibiotic minocycline, which exerts strong anti-inflammatory effects, has been shown to potentially modulate anxiety behaviors after cardiac arrest Neigh et al. In addition, inhibition of COX2 has been shown in animal models to prevent anxiety development Casolini et al. Antioxidant treatments, such as n -acetylcysteine, have shown some promise in augmentation of treatment in mood disorders Berk et al.
Further research exploring the effects of agents that influence the identified pathways may provide important new avenues for therapy for pathological anxiety. In addition, such work will be important in further understanding the biological pathways facilitating development and reinforcement of cigarette smoking.
These efforts may assist the development of more advanced treatments for smoking cessation, particularly in patients with anxiety disorders who exhibit poor rates of success to traditional cessation strategies Piper et al. A number of interpretational caveats must be considered when considering the evidence presented. First, the literature discussed above is drawn from a variety of sources, utilizing differing measures of anxiety e. Studies also employed various confounders and other study designs which make cross-comparisons difficult.
Where possible, we have discussed individual anxiety disorder diagnoses noting the significant distinctions between different disorder groups. In particular, evidence suggests that different anxiety disorder subtypes display significantly different rates of smoking Kalman et al. However, the scant literature available for some pathways prevented an analysis by disorder subtype, with most evidence on potential pathway effects drawn from cross-sectional investigations of animal models.
The cross-sectional nature of this literature impeded conclusions regarding causation, and it is possible that observations highlighted e. In addition, there currently exists a paucity of research assessing a particular pathway in concert with smoking and anxiety. Few prospective data are available assessing the impact of changes to specific systems on anxiety symptoms in response to cigarette smoking.
In addition, aside from the inherent difficulties in translating animal model data to humans, many of the above associations displayed variability in results depending upon study variables, including animal model used or experimental design.
In addition, much of the literature has focused solely on the role of nicotine and not the other known toxic ingredients of cigarette smoke including free radicals and metals. There was also significant variability in expression and function of these systems between different groups e.
Understanding reasons underpinning differential expression between groups may help clarify further key elements to anxiety development. Women, for example, are known to exhibit higher rates of anxiety disorders, which likely relates to a combination of biological e. The acute and long-term effects of any agent that causes a robust homeostatic adaptation are often quite different; this needs to be taken into account in interpretation of acute data, and in extrapolating to management strategies.
Future research efforts in this area should attempt to address some of these challenges. First, it would be useful to ascertain the effects of nicotine versus other cigarette constituents to the above pathways in humans.
The use of populations with high consumption of Snus, such as Norway, presents as opportunity for such analyses to be conducted prospectively, and combined with follow-up behavioral assessments, serum analysis of relevant markers e. Such studies could be extended over time to investigate specific changes between different anxiety disorders e.
It is likely that interindividual differences in genetics and epigenetic alterations will also complicate these effects, and as such further exploration of this evolving area will be of foremost importance. Given that effects on multiple pathways may exert incremental increases in risk for developing anxiety, triangulation of potential effects involving a combination of animal and human models will likely be required as power to detect small effects will only be found in very large studies.
Many studies have suggested that cigarette smoking may increase the risk of developing increased anxiety, although confirmation of this causality is yet to be confirmed. Ingredients that are present in cigarette smoke, including nicotine and other toxic chemicals, exert influences on all of these pathways.
These effects may at least partially underpin the biological mechanisms through which smoking may contribute to increased anxiety, and potentially serve as a useful framework for further research efforts.
Similar pathways are likely to be operative in other states characterized by fight, flight, freeze responses such as anger, mood disorders e. The exposure to nicotine and other cigarette ingredients may also exert neurodevelopment influences capable of changing anxiety trajectories, underscoring the importance of reducing exposure to cigarette during gestation and throughout childhood.
Centrally, nAChRs appear to be a crucial mediator of the anxiety-modifying effects of cigarette smoke and may represent a future therapeutic target for anxiety disorders. In addition, anti-inflammatory and antioxidant agents may assist in improving anxiety symptoms, as they may do in depression. Further studies addressing this area may elicit insights into new therapeutic opportunities. All authors read and approved the final manuscript. National Center for Biotechnology Information , U.
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This article has been cited by other articles in PMC. Abstract Multiple studies have demonstrated an association between cigarette smoking and increased anxiety symptoms or disorders, with early life exposures potentially predisposing to enhanced anxiety responses in later life. Anxiety, anxiety disorder, cigarette, epigenetic, inflammation, mitochondria, neurodevelopment, neurotransmitters, neurotrophins, nicotine, nitrosative stress, oxidative stress.
Introduction Cigarette smoking is the single biggest contributor to death and morbidity worldwide Gellert et al. Clinical Studies Cigarette smoking as risk factor for anxiety disorders — epidemiological studies In addition to many studies demonstrating a cross-sectional relationship between cigarette smoking and anxiety disorders, numerous population-based studies Breslau and Klein ; Johnson et al.
Neurotransmitter systems The importance of specific neurotransmitter systems has been extensively demonstrated in anxiety disorders, with current first-line pharmacological therapies interacting predominantly with the serotonergic, noradrenergic, cannabinoid, cholinergic, and dopaminergic systems. Inflammation and cell-mediated immune activation Inflammation and activation of cell-mediated immune functions appears to be associated with psychiatric disorders Dantzer et al.
Oxidative and nitrosative stress Free radicals are by-products of oxidative phosphorylation that, at low or moderate concentrations, participate in normal cellular processes such as signaling pathways, mitosis, apoptosis, and responses to injury or infection Valko et al.
Mitochondrial function Mitochondria are important sources of oxidative stress and many abnormalities in mitochondrial function have been found in psychiatric disorders for review see Manji et al.
Neurotrophins and neurogenesis Increasing evidence supports a role for NTs and neurogenesis in development of anxiety disorders and anxiety symptoms, although certain mediators may exert varying effects on different anxiety symptoms.
Epigenetic effects The study of epigenetic changes in anxiety disorders is a relatively new field, although some preliminary evidence suggests that cigarette smoke may lead to changes in gene expression predisposing to increased anxiety. Open in a separate window. Increasing the Risk of Anxiety Disorders? Therapeutic Implications for Anxiety Disorders A number of these insights may have treatment implications for anxiety-based disorders and symptoms.
Limitations and Directions for Future Research A number of interpretational caveats must be considered when considering the evidence presented. Conclusion Many studies have suggested that cigarette smoking may increase the risk of developing increased anxiety, although confirmation of this causality is yet to be confirmed.
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Preferential effects of nicotine and 4- N-methyl-N-nitrosamine 3-pyridyl butanone on mitochondrial glutathione S-transferase A4—4 induction and increased oxidative stress in the rat brain.
The Children's Depression Inventory CDI; Kovacs, is the most widely used self-report measure of depressive symptoms in children and adolescents. The CDI is a item self-report measure of depressive symptoms that has been standardized on children and adolescents aged 7 years to 17 years. Each item consists of three statements representing different levels of severity of a specific symptom of depression e. The CDI has sound psychometric properties, including internal consistency, test—retest reliability, and discriminant validity Kovacs, ; Reynolds, The item pertaining to suicidal ideation was removed from the measure at the request of school officials and the human subjects committee.
Participants completed study questionnaires during their homeroom period on 2 consecutive days at Time 1 and Time 3. The Time 2 assessment consisted of fewer questionnaires and was completed in 1 day. All questionnaires used in the present analyses were administered at Time 1.
Because of our hypothesis that anxiety sensitivity would mediate the longitudinal relation between stressful life events and increases in symptomatology over time, we assessed anxiety sensitivity at Time 2 and the symptomatology questionnaires at Time 3.
Four months elapsed between the Time 1 November and Time 2 March assessments, and 3 months elapsed between Time 2 and Time 3 June assessments. This time frame was chosen to allow the maximum time between assessments and to ensure that all assessments occurred within the same academic year. Given the transient nature of the school population, data collection within 1 academic year was necessary to avoid high attrition. Homeroom teachers and one member of the research team were present in the classroom during the assessment period.
Participants were assured of the confidentiality of their responses and the voluntary nature of their participation. The role of stressful life events in the development of anxiety sensitivity was examined by conducting linear regression analyses examining stressful life events at Time 1 as a predictor of anxiety sensitivity at Time 2, including a covariate for Time 1 anxiety sensitivity. Separate regression equations were estimated for the four facets of anxiety sensitivity disease concerns, unsteady concerns, fear of mental incapacitation, and fear of publicly observable symptoms.
Next, we examined whether certain types of stressful life events were uniquely predictive of increased anxiety sensitivity. We examined the role of health-related stressful life events and events related to family discord as predictors of anxiety sensitivity. The hypothesis that anxiety sensitivity mediated the longitudinal relation between stressful life events and symptoms of anxiety was evaluated with two mediation approaches. First, procedures outlined by Baron and Kenny were used: After examining the full mediation model, mediation effects were examined separately for each of the facets of anxiety sensitivity that were found to significantly increase as a result of stressful life events, to determine which facets of anxiety sensitivity were driving mediation effects.
The predictive specificity of anxiety sensitivity was examined with a covariance analysis strategy, consistent with previous investigations of the specificity of anxiety sensitivity to anxiety symptom development among adults Schmidt et al.
Separate regression equations were examined for symptoms of anxiety and depression. In the first regression analysis, anxiety symptoms were examined at Time 3 as the dependent variable. Time 1 anxiety symptoms were added at Step 1 to create residualized change scores, followed at Step 2 by symptoms of depression at Time 1 and Time 3 to account for changes in depression.
Each of the four facets of Time 1 anxiety sensitivity was added at Step 3. This analysis strategy identified the impact of each facet of anxiety sensitivity on symptoms of anxiety after accounting for changes in depression over time Schmidt et al. The second set of regression equations examined depressive symptoms at Time 3 as the dependent variable and followed the same stepped approach as the anxiety analysis.
Analyses were first conducted to determine whether participants who did not complete all three assessments differed from those who did complete the baseline and two follow-up assessments. Univariate analyses of variance were conducted for continuous outcomes, with attrition as a between-subjects factor and with demographic factors, each of the psychopathology outcomes, stressful life events, and anxiety sensitivity as dependent variables.
Chi-square analyses were performed for dichotomous outcomes. This analysis was conducted with AMOS 6. We conducted a confirmatory factor analysis on the continuously scored CASI, using the four previously identified lower order factors Silverman et al. We then constrained the factor loadings from Time 1 to be equal to the factor loadings at Time 2 and compared this model with the unconstrained model.
Table 1 displays the mean and standard deviation of Time 1 stressful life events, anxiety sensitivity at Time 1 and Time 2, and anxiety and depression symptoms at the Time 1 and Time 3 assessments, along with the zero-order correlations among variables.
As expected, anxiety sensitivity demonstrated significant concurrent associations with symptoms of anxiety and depression both at Time 1 and at Time 3 see Table 1. The four facets of anxiety sensitivity were then examined in separate regression analyses. Next, we examined whether certain types of stressful life events were differentially predictive of increases in each of the facets of anxiety sensitivity. The impact of health-related stressful life events, involving serious illness or death, was examined first.
To ensure that the longitudinal association between stressful life events and anxiety is not an artifact of the association between anxiety sensitivity and anxiety, we added a covariate for Time 1 anxiety sensitivity to the model. Disease concerns and mental incapacitation concerns, the two facets of anxiety sensitivity that increased as a result of stressful life events, were examined separately as mediators of the relation between stressful life events and increases in anxiety symptoms.
Mediation was also supported for the mental incapacitation facet of anxiety sensitivity. The general factor Anxiety Sensitivity—Total accounted for 1. Thus, the association between anxiety sensitivity and anxiety symptoms was driven largely by the general anxiety sensitivity factor and, to a lesser degree, the facet reflecting concerns about feeling unsteady.
See Table 2 for all beta weights and step statistics. Of the variability in depression that was accounted for by anxiety sensitivity, less than. In sum, anxiety sensitivity was prospectively associated with symptoms of anxiety but not with depression.
In the current investigation, we sought to address several gaps in the literature on anxiety sensitivity among adolescents. The first goal was to examine stressful life events as a contributor to increased anxiety sensitivity.
As hypothesized, the experience of stressful life events was longitudinally associated with increases in anxiety sensitivity. To our knowledge, this study is the first to identify stressful life events as a factor associated with the development of anxiety sensitivity in adolescents.
Although previous studies have identified uncued panic attacks as a factor predicting increased anxiety sensitivity among adults Schmidt et al. As such, these findings provide novel information regarding the development of anxiety sensitivity among adolescents, providing evidence for the role of environmental factors.
What are the pathways that explain the association between stressful life events and the formation of negative beliefs about the consequences of anxiety symptoms?
A similar process may lead to the development of elevated anxiety sensitivity, wherein stressful life events increase attention to bodily cues of anxiety and anxiety-related cognitions. This increased attention, paired with greater focus on the causes and consequences of anxiety symptoms, may lead to the development of negative beliefs about the consequence of anxiety symptoms.
Anxiety sensitivity, in fact, shares many features with certain types of repetitive self-focused thought Watkins, These processes each may lead to similar cognitions and self-statements during periods of self-focus e. As such, it is likely that similar environmental events i. We also examined the association between specific types of stressful life events—including those related to physical health and family discord—and the subsequent development of anxiety sensitivity.
The results documented that these two types of stressors were differentially associated with certain facets of anxiety sensitivity. In particular, health-related stressors were predictive of fears of disease and mental incapacitation, whereas stressors associated with family discord predicted fears of unsteadiness, mental incapacitation, and social concerns.
To our knowledge, this is the first study to document associations between specific stressors and unique facets of anxiety sensitivity. Given the novelty of these results, little is known regarding the reasons underlying the differential associations between types of stress and anxiety sensitivity. However, existing research on stressful life events points to several possibilities. For example, the perception that stressors portend danger is uniquely associated with the development of anxiety disorders Brown, Health-related stressors may be particularly likely to elicit feelings of impending danger, which could in turn lead to greater attention to, and fears surrounding, the anxiety symptoms that result from these stressors.
These types of stressors may be particularly likely to increase attention to symptoms that appear to portend disease or health problems. Moreover, stress associated with dysfunctional family relationships can disrupt the normative development of social competence Repetti et al. These hypotheses should be pursued in future studies examining relations between the type and meaning of stress and the development of anxiety sensitivity during adolescence.
These findings extend the literature on stress and adolescent psychopathology in several important ways. Adolescence represents an important period in which to examine mechanisms linking stress to the development of psychopathology. Adolescence is characterized by higher risk for the development of psychopathology Hankin et al. The relation between stress and psychopathology among children and adolescents is well-established Grant et al.
Our findings suggest one intrapersonal mechanism linking stress to anxiety symptomatology. Specifically, elevated perceptions of anxiety symptoms as dangerous and portending negative physiological consequences served as a mechanism underlying the relation between stressful life events and anxiety symptoms.
The global anxiety sensitivity factor, as well as concerns about disease and mental incapacitation, mediated the association between stress and the development of anxiety symptoms.
These results have potentially important treatment implications. In particular, they suggest that preventive interventions that focus on attenuating anxiety sensitivity may help to reduce stress-related psychiatric morbidity in adolescents. Evidence-based treatments such as cognitive-behavioral Barlow, and emotion regulation Mennin, interventions may be particularly effective in enabling adolescents to more adaptively challenge and manage their negative beliefs about the harmfulness of anxiety symptoms following stressful experiences.
Stress inoculation training Meichenbaum, represents an additional evidence-based intervention that may prove effective in decreasing adolescents' anxiety sensitivity following stress. This training teaches a variety of coping skills that are applied and practiced with target fears, which could include beliefs about the deleterious consequences of anxiety symptoms subsequent to life stressors.
A final contribution of this study was the examination of differential relations between anxiety sensitivity and depressive and anxious symptoms in adolescents. Prior research examining the predictive specificity of anxiety sensitivity has been inconsistent, with some research documenting that the association between anxiety sensitivity and depressive symptoms disappears after anxiety symptoms are added to the model Pollock et al.
Existing studies among adolescents have relied exclusively on cross-sectional data Weems et al. Anxiety sensitivity was associated longitudinally with the development of anxiety symptoms in our sample, and this association was explained largely by the general anxiety sensitivity factor.
Concerns about feeling unsteady also contributed to the longitudinal relation between anxiety sensitivity and anxiety symptoms. In contrast, anxiety sensitivity was not associated longitudinally with symptoms of depression when covariates for anxiety were included in the model. These findings indicate that anxiety sensitivity serves as a unique vulnerability factor for anxiety, but not depressive symptoms, among adolescents.
This study had a number of important methodological strengths that contribute to our understanding of anxiety sensitivity among adolescents and that expand on the literature examining mechanisms linking stressful life events and adolescent psychopathology. A large sample with substantial racial and ethnic diversity participated.
However, limitations of the current study must also be acknowledged. The first is our use of self-reported symptomatology. Our use of a self-report checklist of stressful life events represents an additional limitation.
It is important to note that the questionnaire in our study is among the most widely used self-report measures of stressful life events in adolescence Hammen, Additionally, the stressors measured are predominantly external, environmental changes or conditions and, consequently, are not confounded with subjective appraisals of the stressor Grant et al.
Further, stress checklists represent the most reliable methodology for assessing stress in large community samples in which stressor interviews are prohibitive in time and cost Grant et al. Nevertheless, stressor interviews, which capture more objective indices of stressors as well as the level of threat associated with these stressors, would represent a methodological improvement and should therefore be used in future studies Hammen, In particular, stressor interviews could establish timing of stressor onset and duration of stressors in relation to the development of anxiety sensitivity and anxiety disorders, an important avenue for further study.
In addition, the stress measure we used did not allow us to examine trajectories of stressful life events over time, given that it asked about stressful life events in the preceding 6 months, and our assessment intervals were spaced at shorter intervals.
Future research examining trajectories of stressful life events may help us to further elucidate the relation between stress and anxiety sensitivity to determine whether chronic versus episodic stress is more strongly related to the development of anxiety sensitivity.
Finally, these results warrant replication. We identified a sample on the basis of the willingness of the school district to participate and the diversity of the student body. Replication is necessary to ensure that these findings generalize to other samples of adolescents.
In sum, the current study identified stressful life events as a factor related to the development of elevated anxiety sensitivity among adolescents. Specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety.
It's easier to treat if you get help early. The causes of anxiety disorders aren't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety.
Inherited traits also can be a factor. For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem. Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:.
There's no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:. Anxiety disorders care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
This content does not have an English version. This content does not have an Arabic version. Overview Experiencing occasional anxiety is a normal part of life. Request an Appointment at Mayo Clinic.
Stressful Life Events, Anxiety Sensitivity, and Internalizing Symptoms in Adolescents
Anxiety sensitivity represents a robust risk factor for the development of that stressful life events were longitudinally associated with increases in anxiety. Social deprivation stress leads to the development of anxiety in mice, . to increase the risk of developing anxiety in later life (Bandiera et al. People need to find ways to reduce chronic stress and anxiety in their lives or they may be at increased risk for developing depression and.