Modifiable risk and protective factors for anxiety disorders among adults: A systematic review

Psychiatry Res. 2020 Mar;285:112705. doi: 10.1016/j.psychres.2019.112705. Epub 2019 Dec 4.


Anxiety disorders are highly prevalent in the general population and associated with high rates of impairment and disability. This burden highlights the need to identify risk factors that individuals can modify without professional intervention. A systematic review was conducted to identify studies that examined modifiable risk and protective factors for anxiety disorders among adults in the general population. Searches were conducted in PubMed, PsycINFO and MEDLINE using medical subject headings and text words related to risk factors, protective factors, and each anxiety disorder. Screening, data extraction, and quality assessment were performed by three study authors. Modifiable risk and protective factors from 19 studies across seven countries were identified. Risk factors identified included cigarette smoking, alcohol use, cannabis use, negative appraisals of life events, avoidance, and occupational factors. Protective factors included social support, coping, and physical activity. Cigarette smoking was the most studied risk factor. Support was found for cigarette smoking as a risk factor for agoraphobia and panic disorder. Mixed results were found for generalized anxiety disorder and specific phobia. Across disorders, smoking frequency was associated with greater risk. Results indicate an important gap in the literature in that few studies have examined modifiable risk factors for anxiety disorders.

Keywords: Anxiety disorders; Protective factors; Risk factors; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Agoraphobia / epidemiology
  • Agoraphobia / prevention & control
  • Agoraphobia / psychology
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / prevention & control*
  • Anxiety Disorders / psychology*
  • Avoidance Learning / physiology*
  • Cigarette Smoking / epidemiology
  • Cigarette Smoking / prevention & control
  • Cigarette Smoking / psychology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Occupational Health / trends*
  • Panic Disorder / epidemiology
  • Panic Disorder / prevention & control
  • Panic Disorder / psychology
  • Prevalence
  • Protective Factors
  • Retrospective Studies
  • Risk Factors
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / prevention & control*
  • Substance-Related Disorders / psychology*