Generalized anxiety and C-reactive protein levels: a prospective, longitudinal analysis

Psychol Med. 2012 Dec;42(12):2641-50. doi: 10.1017/S0033291712000554. Epub 2012 Apr 30.


Background: Generalized anxiety disorder (GAD) is highly co-morbid with depression. Depression is associated with elevated levels of the inflammation marker C-reactive protein (CRP), cross-sectionally and over time. To date, no studies have looked at the association between CRP and GAD.

Method: A total of nine waves of data from the prospective population-based Great Smoky Mountains Study (n=1420) were used, covering children in the community aged 9-16, 19 and 21 years old. Structured interviews were used at each assessment to assess GAD symptoms, diagnosis and cumulative episodes. Blood spots were collected and assayed for high-sensitivity CRP levels.

Results: GAD was associated with increased levels of CRP in bivariate cross-sectional analyses. These bivariate associations, however, were attenuated after accounting for demographic, substance-use and health-related covariates. In longitudinal models, there was little evidence that CRP predicted later GAD. Associations from GAD to later CRP were attenuated in models adjusted for health-related coavariates and there was evidence that the GAD-CRP association was mediated by body mass index (BMI) and medication use.

Conclusions: Similar to depression, GAD was associated with elevated levels of CRP, but the effect of GAD on CRP levels was explained by the effect of GAD on health-related behaviors such as BMI and medication use. This study suggests differences in the association between inflammation and depression and GAD.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / immunology*
  • Anxiety Disorders / psychology
  • C-Reactive Protein / analysis*
  • Child
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / immunology
  • Depressive Disorder / psychology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • North Carolina
  • Prospective Studies
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / immunology
  • Somatoform Disorders / psychology
  • Statistics as Topic
  • Young Adult


  • C-Reactive Protein