Trait Anxiety Levels Before and After Antidepressant Treatment A 3-Wave Cohort Study Hermann Nabi, PhD,*Þ Marianna Virtanen, PhD,þ Archana Singh-Manoux, PhD,*Þ§|| Gareth Hagger-Johnson, PhD,|| Jaana Pentti, BSc,¶ Mika Kivima ¨ki, PhD,þ|| and Jussi Vahtera, MD, PhD,¶ # Abstract: The aim of this study was to examine change in ‘‘trait anxiety’’ levels assessed repeatedly before and after antidepressant treatment in a large cohort of men and women. A total of 18,732 par- ticipants of the Finnish Public Sector Study with no initial record of depression or self-reported doctor diagnosis of depression completed the short form of the Spielberger Trait-Anxiety Inventory in 2000Y2002 (T1), 2004Y2005 (T2), and 2008Y2009 (T3). We used prescription da- ta from the nationwide Drug Prescription Register to identify antide- pressant treatment between T1 and T2 (n = 710). Both men (A = 0.435, P G 0.001) and women (A = 0.300, P G 0.001) who received antide- pressant treatment had higher trait anxiety levels at T1. Mixed models analyses of repeated measures showed a small but statistically significant decrease in trait anxiety scores for the overall sample of men (A = 0.023, P = 0.033) and women (A = 0.011, P = 0.031) between T1 and T3. The interaction term between time and antidepressant treatment status sug- gested a greater decrease in trait anxiety levels among men receiving an- tidepressant treatment, with an adjusted excess decrease in mean trait anxiety scores of 0.163 (P = 0.012) between T1 and T3. We found some evidence suggesting that this is also the case in women, although the evi- dence in our data was less consistent for women. This large-scale study provides evidence suggesting that antidepressant treatment is associated with a reduction in trait anxiety levels, particularly in men. Key Words: antidepressant, trait anxiety, longitudinal studies (J Clin Psychopharmacol 2013;33: 371Y377) P sychological, social, physiological, and genetic factors are believed to determine the onset and progression of depression. 1 Antidepressants are widely used to improve symptoms of depressive disorders and are also increasingly used to treat anxiety disorders, such as generalized anxiety disorder, obsessive-compulsive disor- der, and posttraumatic stress disorder. 2 Besides alleviating depres- sive and anxiety-related symptoms, it has been suggested that these medications may also act on a range of detrimental psychological dispositions and, in this way, help improvewell-being. 3 An increasing number of studies have examined the poten- tial impact of antidepressants in the modulation of psychological traits, but the findings have been inconsistent. 3Y9 Methodological limitations may have contributed to these inconsistencies as most of the previous studies have been conducted in relatively small samples composed of clinically depressed patients 10Y12 where the depressed state of individuals is likely to influence their assess- ment of their own traits. 13 A stronger study design to explore the effect of antidepressants in modulating psychological traits, which are assumed to be relatively stable, 14 would therefore have the following key characteristics: a longitudinal design, a large sample size of adults initially free from clinically evident de- pression, and psychological traits measured before and after the use of antidepressants. We took advantage of data from the Finnish Public Sector Study, a large cohort study, to assess longitudinal changes in trait anxiety levels, assessed repeatedly before and after anti- depressant treatment. MATERIAL AND METHODS The Finnish Public Sector Study is an ongoing prospective study set up to examine the relation between behavioral and psychosocial factors and health outcomes. This cohort includes the entire public sector personnel of 10 towns (municipalities) and 21 hospitals in Finland including 151,618 employees with a minimum of 6-month job contract during any year between 1991 and 2005. 15 Cohort participants were successfully linked to em- ployers’ records and comprehensive national health registers through unique personal identification codes, which are assigned to all citizens in Finland. Baseline survey data were collected between 2000 and 2002 (time period T1) with a response rate of 68% (N = 48,598). In 2004Y2005 (T2) and 2008Y2009 (T3), follow-up questionnaires were sent to all identifiable respondents of the baseline survey still alive. A total of 35,914 (response rate, 77%) and 35,253 (response rate, 76%) employees responded to these surveys, respectively; 29,507 participants responded to all 3 surveys. We used register data covering a 4-year period pre- ceding the date of response to the baseline survey in 2000Y2002 to exclude those with antidepressant prescriptions, psychotherapy, long-term sickness absence (Q90 days), temporary disability pension or hospitalization due to depression, or special reim- bursement for drugs used to treat mental disorders (N = 2376). We excluded 4226 employees from one town, where prescription data were not available in the national prescription register because the ORIGINAL CONTRIBUTION Journal of Clinical Psychopharmacology & Volume 33, Number 3, June 2013 www.psychopharmacology.com 371 From the *INSERM, U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health; †Universite ´ de Versailles St Quentin, UMRS 1018, Villejuif, France; ‡Finnish Institute of Occupational Health, Helsinki, Finland; §Centre de Ge ´rontologie, Ho ˆpital Ste Pe ´rine, AP-HP, Paris, France; ||De- partment of Epidemiology and Public Health, University College London, United Kingdom; ¶Finnish Institute of Occupational Health; and #Depart- ment of Public Health, University of Turku, and Turku University Hospi- tal, Turku, Finland. Received November 16, 2011; accepted after revision August 17, 2012. Reprints: Hermann Nabi, PhD, INSERM, U1018, Ho ˆpital Paul Brousse/ Ba ˆtiment 15/16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France (e-mail: Hermann.Nabi@sinserm.fr). The Finnish Public Sector Study is supported by the Academy of Finland (projects 124271, 124322, 129262, and 132944) and the participating organizations. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0271-0749 DOI: 10.1097/JCP.0b013e31828b26c2 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.