Causes Of Generalized Anxiety Disorder (GAD)

Causes Of Generalized Anxiety Disorder site

Verified by World Mental Healthcare Association

Generalized anxiety disorder (GAD) is a very commonly occurring anxiety disorder. Understanding the causes of generalized anxiety disorder can help us better understand the condition and accordingly aid treatment.

GAD is a mental disorder characterized by chronic worrying. According to research 1 Newman, M. G., Shin, K. E., & Zuellig, A. R. (2016). Developmental risk factors in generalized anxiety disorder and panic disorder. Journal of affective disorders206, 94–102. https://doi.org/10.1016/j.jad.2016.07.008 , a number of different factors, such as genetic predisposition and environment, tend to influence the development of this condition, although the root cause of generalized anxiety disorder is still unknown. According to experts, some of the main causes of generalized anxiety disorder are as follows:

10 Major Risk Factors For Generalized Anxiety Disorder

1. Biological Causes Of Generalized Anxiety Disorder

Certain factors, such as heredity, neurotransmitters, comorbid illnesses, etc. have been indicated in the development of generalized anxiety disorder. The biological causes of generalized anxiety disorder have been discussed below:

A. Heredity

A person’s genetics can significantly influence their chances of developing GAD. You are 5 times more likely to have GAD if any of your family 2 McLaughlin, K. A., Behar, E., & Borkovec, T. D. (2008). Family history of psychological problems in generalized anxiety disorder. Journal of clinical psychology64(7), 905–918. https://doi.org/10.1002/jclp.20497 members are affected by it. A 2017 study 3 Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience19(2), 159–168. https://doi.org/10.31887/DCNS.2017.19.2/kdomschke revealed that GAD has a moderate genetic risk of approximately 30%. Studies 4 Davies, M. N., Verdi, S., Burri, A., Trzaskowski, M., Lee, M., Hettema, J. M., Jansen, R., Boomsma, D. I., & Spector, T. D. (2015). Generalised Anxiety Disorder–A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression. PloS one10(8), e0134865. https://doi.org/10.1371/journal.pone.0134865 have also found that first degree relatives, such as a parent, sibling, or child, of a person with GAD are more likely to suffer from mood & anxiety disorders in general.

Researchers are yet to identify any specific genes associated with the disorder. However, a 2015 study 5 Davies, M. N., Verdi, S., Burri, A., Trzaskowski, M., Lee, M., Hettema, J. M., Jansen, R., Boomsma, D. I., & Spector, T. D. (2015). Generalised Anxiety Disorder–A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression. PloS one10(8), e0134865. https://doi.org/10.1371/journal.pone.0134865 indicates a possible involvement of the RBFOX1 gene in the development of GAD.

Read More About Genetics Here

B. Brain chemistry and structure

It was found that an imbalance in certain brain chemicals 6 Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. The Psychiatric clinics of North America32(3), 549–575. https://doi.org/10.1016/j.psc.2009.05.004 , like noradrenaline, serotonin, and GABA 7 Nuss P. (2015). Anxiety disorders and GABA neurotransmission: a disturbance of modulation. Neuropsychiatric disease and treatment11, 165–175. https://doi.org/10.2147/NDT.S58841 can lead to the development of anxiety disorders such as GAD, as these chemicals are involved in regulating and controlling mood.

Various other biological processes 8 Maron, E., & Nutt, D. (2017). Biological markers of generalized anxiety disorder. Dialogues in clinical neuroscience19(2), 147–158. https://doi.org/10.31887/DCNS.2017.19.2/dnutt can also influence anxiety and fear. The amygdala 9 Makovac, E., Watson, D. R., Meeten, F., Garfinkel, S. N., Cercignani, M., Critchley, H. D., & Ottaviani, C. (2016). Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety. Social cognitive and affective neuroscience11(11), 1719–1728. https://doi.org/10.1093/scan/nsw091 , a part of the limbic system in the brain, is supposed to be involved in the regulation of our behavioral & emotional responses.

People suffering from generalized anxiety disorder tend to have higher amygdala activity 10 Monk, C. S., Telzer, E. H., Mogg, K., Bradley, B. P., Mai, X., Louro, H. M., Chen, G., McClure-Tone, E. B., Ernst, M., & Pine, D. S. (2008). Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Archives of general psychiatry65(5), 568–576. https://doi.org/10.1001/archpsyc.65.5.568 , leading them to judge a stimulus as threatening even when its not.

Research 11 Schienle, A., Ebner, F., & Schäfer, A. (2011). Localized gray matter volume abnormalities in generalized anxiety disorder. European archives of psychiatry and clinical neuroscience261(4), 303–307. https://doi.org/10.1007/s00406-010-0147-5 also indicates that higher gray matter volumes for certain areas of the brain are involved in anticipatory anxiety, worrying and emotion regulation. GAD patients also show significant volume reductions 12 Moon, C. M., Kim, G. W., & Jeong, G. W. (2014). Whole-brain gray matter volume abnormalities in patients with generalized anxiety disorder: voxel-based morphometry. Neuroreport25(3), 184–189. https://doi.org/10.1097/WNR.0000000000000100 in the brain areas of hippocampus, midbrain, thalamus, insula, and superior temporal gyrus, as compared to others.

C. Other medical illnesses

Several medical conditions are comorbid 13 Culpepper L. (2009). Generalized anxiety disorder and medical illness. The Journal of clinical psychiatry70 Suppl 2, 20–24. https://doi.org/10.4088/jcp.s.7002.04 with generalized anxiety disorder. Certain chronic gastrointestinal diseases, cardiovascular diseases, respiratory illnesses, etc. are associated with higher levels of anxiety.

2. Psychological Causes Of Generalized Anxiety Disorder

Quite a few psychological factors relating to the inner dynamics of an individual can lead to the development of GAD Some of these factors are:

A. Personality traits

It has been found that certain personality traits, such as neuroticism 14 Sharma S. C. (2003). Generalized anxiety disorder and personality traits. Kathmandu University medical journal (KUMJ)1(4), 248–250. have a strong positive association with generalized anxiety disorder. Other traits related to neuroticism are also predicted to be risk factors for anxiety disorders such as GAD.

B. Negative cognitions

Certain “cognitive distortions” arising from faulty beliefs can eventually lead to the development of GAD, according to the cognitive model 15 Wells, A. (2004). A Cognitive Model of GAD: Metacognitions and Pathological Worry. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 164–186). The Guilford Press. Available from: https://psycnet.apa.org/record/2004-16375-007 . This results in a cycle of negative thinking that can cause significant distress and anxiety.

Read More About Cognitive Behavioral Therapy here

C. Personal conflicts and stressors

As per psychodynamic theories 16 Psychodynamic models of anxiety | 43 | Anxiety and the anxiety Disorde. Available from: https://www.taylorfrancis.com/chapters/edit/10.4324/9780203728215-43/psychodynamic-models-anxiety-robert-michels-allen-frances-katherine-shear , certain conflicting impulses, instincts, and mental processes within a person can lead to stress and the eventual development of generalized anxiety disorder.

3. Social and Environmental Causes Of Generalized Anxiety Disorder

Apart from biological and psychological factors, complex environmental 17 Hettema, J. M., Prescott, C. A., Myers, J. M., Neale, M. C., & Kendler, K. S. (2005). The structure of genetic and environmental risk factors for anxiety disorders in men and women. Archives of general psychiatry62(2), 182–189. https://doi.org/10.1001/archpsyc.62.2.182 and social elements also play a vital role in this disorder.

Some of the social causes of GAD are:

A. Trauma

Research 18 Fryers, T., & Brugha, T. (2013). Childhood determinants of adult psychiatric disorder. Clinical practice and epidemiology in mental health : CP & EMH9, 1–50. https://doi.org/10.2174/1745017901309010001 reveals that childhood trauma can make it more likely for a person to be affected by GAD. Physical and mental abuse often make people apprehensive of others, which can lead to severe anxiety in the future.

Uncertainty 19 Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews. Neuroscience14(7), 488–501. https://doi.org/10.1038/nrn3524 about a possible future threat that disrupts our ability to avoid it or mitigate its negative impact. Thus, victims of abuse often tend to misinterpret threats and incorrectly believe that certain interactions or experiences are dangerous and threatening when in reality they are not.

It was found that experiencing one or more negative life events 20 Gosselin, P., & Laberge, B. (2003). Les facteurs étiologiques du trouble d’anxiété généralisée: état actuel des connaissances sur les facteurs psycho-sociaux [Etiological factors of generalized anxiety disorder]. L’Encephale29(4 Pt 1), 351–361. in an unexpected way can significantly increase the risk of developing GAD. The most common environmental risk 21 Roomruangwong, C., Simeonova, D. S., Stoyanov, D. S., Anderson, G., Carvalho, A., & Maes, M. (2018). Common Environmental Factors May Underpin the Comorbidity Between Generalized Anxiety Disorder and Mood Disorders Via Activated Nitro-oxidative Pathways. Current topics in medicinal chemistry18(19), 1621–1640. https://doi.org/10.2174/1568026618666181115101625 factors for GAD include Early Life Time Trauma (ELT) and Psychological Stressors in Adulthood (PSA).

B. Learned behavior

Experts believe that if a person has interacted with a caregiver, parent, or family member with anxious behavior during childhood, they may have ‘learned’ the behavior by mirroring the role models around them.

Early social learning experiences greatly influence anxiety-related behavior well into adulthood. A 2010 study 22 Burstein, M., & Ginsburg, G. S. (2010). The effect of parental modeling of anxious behaviors and cognitions in school-aged children: an experimental pilot study. Behaviour research and therapy48(6), 506–515. https://doi.org/10.1016/j.brat.2010.02.006 found that irrespective of the gender of the parent, children experienced higher anxiety levels in the presence of an anxious relative even in a non-anxious environment.

Parents with GAD tend to manipulate 23 Aktar, E., Nikolić, M., & Bögels, S. M. (2017). Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty. Dialogues in clinical neuroscience19(2), 137–147. https://doi.org/10.31887/DCNS.2017.19.2/eaktar the ability of their children to identify potential threats in the environment by communicating to them that the world is unsafe. They may indirectly teach their children that worry can help them prepare for uncertainty. This can significantly alter their cognitive styles leading them to develop GAD as well.

C. Financial issues

Several socio-economic factors have been identified in the etiology of GAD. A strong correlation has been found between low levels of education and unemployment 24 Ansseau, M., Fischler, B., Dierick, M., Albert, A., Leyman, S., & Mignon, A. (2008). Socioeconomic correlates of generalized anxiety disorder and major depression in primary care: the GADIS II study (Generalized Anxiety and Depression Impact Survey II). Depression and anxiety25(6), 506–513. https://doi.org/10.1002/da.20306 and generalized anxiety disorder. A 2022 study also found perceived financial decline 25 Jung, Y. H., Jang, B. N., Park, M., & Park, E. C. (2022). Association between family financial decline due to COVID-19 and generalized anxiety disorder among Korean adolescents. Journal of affective disorders309, 411–417. https://doi.org/10.1016/j.jad.2022.04.154 in the family to also be associated with symptoms of GAD.

Other GAD risk factors relating to the environment include:

  • Interpersonal conflicts 26 Shafiei, M., Rezaei, F., & Sadeghi, M. (2022). The role of childhood traumas, interpersonal problems, and contrast avoidance model in development of the generalized anxiety disorder: A structural equation modeling. Psychological trauma : theory, research, practice and policy14(3), 377–385. https://doi.org/10.1037/tra0001117
  • Domestic violence 27 Tambs, K., Czajkowsky, N., Røysamb, E., Neale, M. C., Reichborn-Kjennerud, T., Aggen, S. H., Harris, J. R., Ørstavik, R. E., & Kendler, K. S. (2009). Structure of genetic and environmental risk factors for dimensional representations of DSM-IV anxiety disorders. The British journal of psychiatry : the journal of mental science195(4), 301–307. https://doi.org/10.1192/bjp.bp.108.059485 and abuse
  • Influence of social media 28 Seabrook, E. M., Kern, M. L., & Rickard, N. S. (2016). Social Networking Sites, Depression, and Anxiety: A Systematic Review. JMIR mental health3(4), e50. https://doi.org/10.2196/mental.5842
  • Loss of a loved one
  • Other adverse experiences, etc.

4. Lifestyle Causes Of Generalized Anxiety Disorder

Apart from the potential causes of generalized anxiety disorder mentioned above, certain lifestyle-related factors can also influence the onset of this condition, such as:

A. Diet

A diet 29 Weng, T. T., Hao, J. H., Qian, Q. W., Cao, H., Fu, J. L., Sun, Y., Huang, L., & Tao, F. B. (2012). Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents?. Public health nutrition15(4), 673–682. https://doi.org/10.1017/S1368980011003077 consisting of fast foods and excessive meat has been seen to be associated with increased risk of anxiety disorders including GAD. In fact, avoiding consumption of gluten and artifical sweeteners has been recommended to help reduce the risk of anxiety disorders 30 Norwitz, N. G., & Naidoo, U. (2021). Nutrition as Metabolic Treatment for Anxiety. Frontiers in psychiatry12, 598119. https://doi.org/10.3389/fpsyt.2021.598119 .

B. Substance use

Substance abuse 31 Munir, S., & Takov, V. (2019). Anxiety, Generalized Anxiety Disorder (GAD). Nih.gov; StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/ is considered to be one of the main etiological factors for GAD. Studies 32 Smith, J. P., & Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive behaviors35(1), 42–45. https://doi.org/10.1016/j.addbeh.2009.07.002 show that comorbid generalized anxiety disorder (GAD) and alcohol use disorders (AUD) are prevalent among many patients. Smoking 33 Brady, K. T., Haynes, L. F., Hartwell, K. J., & Killeen, T. K. (2013). Substance use disorders and anxiety: a treatment challenge for social workers. Social work in public health28(3-4), 407–423. https://doi.org/10.1080/19371918.2013.774675 has also been found to be associated with anxiety disorders.

Moreover, regular addictive substances like caffeine and nicotine can also increase feelings of worry, nervousness and anxiety. According to a 2015 study 34 Richards, G., & Smith, A. (2015). Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. Journal of psychopharmacology (Oxford, England)29(12), 1236–1247. https://doi.org/10.1177/0269881115612404 , weekly consumption of coffee, tea, cola, and energy drinks can significantly influence the development of stress and anxiety, even in children. However, the effects tend to vary among men and women.

Certain work environments 35 Melchior, M., Caspi, A., Milne, B. J., Danese, A., Poulton, R., & Moffitt, T. E. (2007). Work stress precipitates depression and anxiety in young, working women and men. Psychological medicine37(8), 1119–1129. https://doi.org/10.1017/S0033291707000414 demand high levels of performance and productivity, causing severe stress 36 Vignoli, M., Muschalla, B., & Mariani, M. G. (2017). Workplace Phobic Anxiety as a Mental Health Phenomenon in the Job Demands-Resources Model. BioMed research international2017, 3285092. https://doi.org/10.1155/2017/3285092 among employees. The fear of unemployment can also significantly heighten anxiety levels.

A 2014 study 37 Cheung, C. K., Cheung, H. Y., & Wu, J. (2014). Career unreadiness in relation to anxiety and authoritarian parenting among undergraduates. International journal of adolescence and youth19(3), 336–349. https://doi.org/10.1080/02673843.2014.928784 found that ‘career unreadiness’ can possibly increase anxiety levels in university students. Researchers 38 Fan, L. B., Blumenthal, J. A., Watkins, L. L., & Sherwood, A. (2015). Work and home stress: associations with anxiety and depression symptoms. Occupational medicine (Oxford, England)65(2), 110–116. https://doi.org/10.1093/occmed/kqu181 have found that work stress, coupled with ‘home stress’ can lead to generalized anxiety in the working population.

Read More About Stress Here

5. Other GAD Risk factors

Certain other factors can also contribute to generalized anxiety disorder, such as:

  • Gender 39 Gregory, K. D., Chelmow, D., Nelson, H. D., Van Niel, M. S., Conry, J. A., Garcia, F., Kendig, S. M., O’Reilly, N., Qaseem, A., Ramos, D., Salganicoff, A., Son, S., Wood, J. K., Zahn, C., & Women’s Preventive Services Initiative (2020). Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women’s Preventive Services Initiative. Annals of internal medicine173(1), 48–56. https://doi.org/10.7326/M20-0580 : Women have a higher risk of developing GAD.
  • Age 40 Lieb, R., Becker, E., & Altamura, C. (2005). The epidemiology of generalized anxiety disorder in Europe. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology15(4), 445–452. https://doi.org/10.1016/j.euroneuro.2005.04.010 : GAD is more common among people over the age of 20.
  • Quality of relationships 41 Priest J. B. (2013). Anxiety disorders and the quality of relationships with friends, relatives, and romantic partners. Journal of clinical psychology69(1), 78–88. https://doi.org/10.1002/jclp.21925 , etc.

Takeaway

The causes of generalized anxiety disorder are quite myriad. We may not be able to control the various factors that influence the onset of GAD. However, we can take certain steps to cope with the symptoms so that we can effectively overcome the condition in the long run.

If you think you are suffering from GAD, then it is advised that you consult a doctor or a mental health professional immediately. With accurate diagnosis and treatment, you can live a healthier, anxiety-free life.

At A Glance

  1. The exact cause of generalized anxiety disorder (GAD) is still unknown.
  2. Several risk factors, including heredity and environment, have been indicated in the etiology of GAD.
  3. Some biological causes of generalized anxiety disorder include genes and brain chemistry.
  4. Psychological factors such as personality traits and cognitions can also influence the onset of GAD.
  5. Certain social factors indicated in the development of GAD include trauma and financial problems.
  6. Other lifestyle causes of generalized anxiety disorder include diet, substance use, and work stress.

References:

  • 1
    Newman, M. G., Shin, K. E., & Zuellig, A. R. (2016). Developmental risk factors in generalized anxiety disorder and panic disorder. Journal of affective disorders206, 94–102. https://doi.org/10.1016/j.jad.2016.07.008
  • 2
    McLaughlin, K. A., Behar, E., & Borkovec, T. D. (2008). Family history of psychological problems in generalized anxiety disorder. Journal of clinical psychology64(7), 905–918. https://doi.org/10.1002/jclp.20497
  • 3
    Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience19(2), 159–168. https://doi.org/10.31887/DCNS.2017.19.2/kdomschke
  • 4
    Davies, M. N., Verdi, S., Burri, A., Trzaskowski, M., Lee, M., Hettema, J. M., Jansen, R., Boomsma, D. I., & Spector, T. D. (2015). Generalised Anxiety Disorder–A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression. PloS one10(8), e0134865. https://doi.org/10.1371/journal.pone.0134865
  • 5
    Davies, M. N., Verdi, S., Burri, A., Trzaskowski, M., Lee, M., Hettema, J. M., Jansen, R., Boomsma, D. I., & Spector, T. D. (2015). Generalised Anxiety Disorder–A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression. PloS one10(8), e0134865. https://doi.org/10.1371/journal.pone.0134865
  • 6
    Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. The Psychiatric clinics of North America32(3), 549–575. https://doi.org/10.1016/j.psc.2009.05.004
  • 7
    Nuss P. (2015). Anxiety disorders and GABA neurotransmission: a disturbance of modulation. Neuropsychiatric disease and treatment11, 165–175. https://doi.org/10.2147/NDT.S58841
  • 8
    Maron, E., & Nutt, D. (2017). Biological markers of generalized anxiety disorder. Dialogues in clinical neuroscience19(2), 147–158. https://doi.org/10.31887/DCNS.2017.19.2/dnutt
  • 9
    Makovac, E., Watson, D. R., Meeten, F., Garfinkel, S. N., Cercignani, M., Critchley, H. D., & Ottaviani, C. (2016). Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety. Social cognitive and affective neuroscience11(11), 1719–1728. https://doi.org/10.1093/scan/nsw091
  • 10
    Monk, C. S., Telzer, E. H., Mogg, K., Bradley, B. P., Mai, X., Louro, H. M., Chen, G., McClure-Tone, E. B., Ernst, M., & Pine, D. S. (2008). Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Archives of general psychiatry65(5), 568–576. https://doi.org/10.1001/archpsyc.65.5.568
  • 11
    Schienle, A., Ebner, F., & Schäfer, A. (2011). Localized gray matter volume abnormalities in generalized anxiety disorder. European archives of psychiatry and clinical neuroscience261(4), 303–307. https://doi.org/10.1007/s00406-010-0147-5
  • 12
    Moon, C. M., Kim, G. W., & Jeong, G. W. (2014). Whole-brain gray matter volume abnormalities in patients with generalized anxiety disorder: voxel-based morphometry. Neuroreport25(3), 184–189. https://doi.org/10.1097/WNR.0000000000000100
  • 13
    Culpepper L. (2009). Generalized anxiety disorder and medical illness. The Journal of clinical psychiatry70 Suppl 2, 20–24. https://doi.org/10.4088/jcp.s.7002.04
  • 14
    Sharma S. C. (2003). Generalized anxiety disorder and personality traits. Kathmandu University medical journal (KUMJ)1(4), 248–250.
  • 15
    Wells, A. (2004). A Cognitive Model of GAD: Metacognitions and Pathological Worry. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 164–186). The Guilford Press. Available from: https://psycnet.apa.org/record/2004-16375-007
  • 16
  • 17
    Hettema, J. M., Prescott, C. A., Myers, J. M., Neale, M. C., & Kendler, K. S. (2005). The structure of genetic and environmental risk factors for anxiety disorders in men and women. Archives of general psychiatry62(2), 182–189. https://doi.org/10.1001/archpsyc.62.2.182
  • 18
    Fryers, T., & Brugha, T. (2013). Childhood determinants of adult psychiatric disorder. Clinical practice and epidemiology in mental health : CP & EMH9, 1–50. https://doi.org/10.2174/1745017901309010001
  • 19
    Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews. Neuroscience14(7), 488–501. https://doi.org/10.1038/nrn3524
  • 20
    Gosselin, P., & Laberge, B. (2003). Les facteurs étiologiques du trouble d’anxiété généralisée: état actuel des connaissances sur les facteurs psycho-sociaux [Etiological factors of generalized anxiety disorder]. L’Encephale29(4 Pt 1), 351–361.
  • 21
    Roomruangwong, C., Simeonova, D. S., Stoyanov, D. S., Anderson, G., Carvalho, A., & Maes, M. (2018). Common Environmental Factors May Underpin the Comorbidity Between Generalized Anxiety Disorder and Mood Disorders Via Activated Nitro-oxidative Pathways. Current topics in medicinal chemistry18(19), 1621–1640. https://doi.org/10.2174/1568026618666181115101625
  • 22
    Burstein, M., & Ginsburg, G. S. (2010). The effect of parental modeling of anxious behaviors and cognitions in school-aged children: an experimental pilot study. Behaviour research and therapy48(6), 506–515. https://doi.org/10.1016/j.brat.2010.02.006
  • 23
    Aktar, E., Nikolić, M., & Bögels, S. M. (2017). Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty. Dialogues in clinical neuroscience19(2), 137–147. https://doi.org/10.31887/DCNS.2017.19.2/eaktar
  • 24
    Ansseau, M., Fischler, B., Dierick, M., Albert, A., Leyman, S., & Mignon, A. (2008). Socioeconomic correlates of generalized anxiety disorder and major depression in primary care: the GADIS II study (Generalized Anxiety and Depression Impact Survey II). Depression and anxiety25(6), 506–513. https://doi.org/10.1002/da.20306
  • 25
    Jung, Y. H., Jang, B. N., Park, M., & Park, E. C. (2022). Association between family financial decline due to COVID-19 and generalized anxiety disorder among Korean adolescents. Journal of affective disorders309, 411–417. https://doi.org/10.1016/j.jad.2022.04.154
  • 26
    Shafiei, M., Rezaei, F., & Sadeghi, M. (2022). The role of childhood traumas, interpersonal problems, and contrast avoidance model in development of the generalized anxiety disorder: A structural equation modeling. Psychological trauma : theory, research, practice and policy14(3), 377–385. https://doi.org/10.1037/tra0001117
  • 27
    Tambs, K., Czajkowsky, N., Røysamb, E., Neale, M. C., Reichborn-Kjennerud, T., Aggen, S. H., Harris, J. R., Ørstavik, R. E., & Kendler, K. S. (2009). Structure of genetic and environmental risk factors for dimensional representations of DSM-IV anxiety disorders. The British journal of psychiatry : the journal of mental science195(4), 301–307. https://doi.org/10.1192/bjp.bp.108.059485
  • 28
    Seabrook, E. M., Kern, M. L., & Rickard, N. S. (2016). Social Networking Sites, Depression, and Anxiety: A Systematic Review. JMIR mental health3(4), e50. https://doi.org/10.2196/mental.5842
  • 29
    Weng, T. T., Hao, J. H., Qian, Q. W., Cao, H., Fu, J. L., Sun, Y., Huang, L., & Tao, F. B. (2012). Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents?. Public health nutrition15(4), 673–682. https://doi.org/10.1017/S1368980011003077
  • 30
    Norwitz, N. G., & Naidoo, U. (2021). Nutrition as Metabolic Treatment for Anxiety. Frontiers in psychiatry12, 598119. https://doi.org/10.3389/fpsyt.2021.598119
  • 31
    Munir, S., & Takov, V. (2019). Anxiety, Generalized Anxiety Disorder (GAD). Nih.gov; StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/
  • 32
    Smith, J. P., & Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive behaviors35(1), 42–45. https://doi.org/10.1016/j.addbeh.2009.07.002
  • 33
    Brady, K. T., Haynes, L. F., Hartwell, K. J., & Killeen, T. K. (2013). Substance use disorders and anxiety: a treatment challenge for social workers. Social work in public health28(3-4), 407–423. https://doi.org/10.1080/19371918.2013.774675
  • 34
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