Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Short communication The association between an anxiety disorder and cancer in medical history N. Zeynalova a , S. Schimpf b , C. Setter c , M. Yahiaoui-Doktor a , S. Zeynalova a,d, ⁎ , F. Lordick b , M. Loeffler d , A. Hinz e a Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Härtelstraße 16-18, D-04107 Leipzig, Germany b University Cancer Center Leipzig, University Medical Center Leipzig, Liebigstreet 20, 04103 Leipzig, Germany c Department of Radiation Oncology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany d LIFE – Leipzig Research Center for Civilization Diseases, Universität Leipzig, Philipp-Rosenthal-Straße 27, D-04103 Leipzig, Germany e Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany ABSTRACT Background: : Cancer patients can feel depression and anxiety any time after a cancer diagnosis. The Generalized Anxiety Disorder Scale (GAD-7) is an instrument for the assessment of anxiety. The main objective of this work was to compare general anxiety levels between cancer survivors and individuals without a history of cancer in a population-based study (LIFE-ADULT) with 10,000 participants. Methods: : All participants (18–80 years) completed the GAD-7 and other psychological and medical questionnaires. A score of 10 or greater for GAD-7 (of total 21) indicates a probable generalized anxiety disorder. Results: : 954 participants reported a diagnosis of cancer in their medical history. In the multivariate analysis an anxiety disorder was associated with prior cancer diagnosis (OR: 1.8; 95% CI [1.4–2.4]), age -every additional year- (OR: 0.983; [0.976–0.991]), female gender (OR: 1.8; [1.5–2.2]) and low socioeconomic status (OR: 2.0; [1.7–2.5]) all p < 0.001. There were no significant associations between general anxiety and other comorbidities, such as myocardial infarction (OR: 1.0; p = 0948), stroke (OR: 1.4; p = 0.237) or diabetes (OR: 1.0; p = 0.326). There was also no significant difference in anxiety disorder among cancer survivors regarding the time passed since the initial cancer diagnosis (OR: 1.1; [0.6–1.9], p = 0.804 comparing 5–10 years after a diagnosis of cancer vs. ≤5 years and OR: 0.6; [0.4–1.1], p = 0.107 comparing >10 vs. ≤5 years). Limitations: This study has a cross-sectional character, therefore, causal conclusions cannot be drawn. Conclusion: : Cancer survivors may require screening for anxiety disorders and long-term professional psychosocial support. 1. Introduction Cancer patients can feel depression, anxiety, and other emotional problems at any time after a cancer diagnosis. Physicians and other healthcare professionals cannot prevent all negative physical con- sequences of cancer and its treatment, but they play a key role in re- cognising depression or anxiety in their patients and offering appro- priate treatment (Andersen et al., 20). Efforts should be made to improve treatment of anxiety in the long- term in cancer survivors (Mitchell et al., 2013). Female and younger cancer patients are more likely to meet the criteria for an anxiety dis- order (Spencer et al., 2010) and might need a long-term professional psychosocial support. The main aim of the present work was to examine whether there are any differences regarding general anxiety levels be- tween cancer survivors and individuals without a history of cancer, also considering other life-threatening or chronic comorbidities. Data were derived from the population-based cohorts of the LIFE-Adult-Study. LIFE is the Leipzig Research Centre for Civilization Diseases. 2. Methods LIFE Adult is a population-based study whose participants are a representative sample of Leipzig's inhabitants (Loeffler et al., 2015). Leipzig is a German city with about 550,000 inhabitants. All study participants (18–80 years of age) underwent an extensive core assess- ment programs (5–6 h) including structured medical interviews, med- ical and psychological questionnaires, physical examination, and bio specimen collection. The two questionnaires considered here were the Generalized Anxiety Disorder Scale GAD-7 (Spitzer et al., 2006; Löwe et al., 2008; Hinz et al., 2017; Beard and Bjorgvinsson, 2014) and one on self-re- ported medical history. The GAD-7 was designed to identify a general anxiety disorder and categorize its severity. GAD-7 total score ranges from 0 to 21. Higher GAD-7 scores suggest more anxiety symptoms. A sum score of ≥10 indicates at least moderate symptoms. History of cancer and other diseases were ascertained as part of the self-reported medical history questionnaire. https://doi.org/10.1016/j.jad.2018.12.019 Received 12 July 2018; Received in revised form 7 November 2018; Accepted 15 December 2018 ⁎ Corresponding author at: Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany. E-mail address: samira.zeynalova@imise.uni-leipzig.de (S. Zeynalova). Journal of Affective Disorders 246 (2019) 640–642 Available online 17 December 2018 0165-0327/ © 2018 Elsevier B.V. All rights reserved. T