Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study

<p><b>Objectives:</b> Growing evidence indicates that inflammatory processes may play a role in the pathogenesis of anxiety disorders. Nevertheless, much remains to be learned about the involvement of inflammation, including C-reactive protein (CRP), in specific anxiety disorders. This study examines the relation between anxiety disorders and CRP.</p> <p><b>Methods:</b> Associations of serum CRP with anxiety disorders were determined in a large population study (<i>n</i> = 54,326 participants, mean age = 47 years; 59% female), the LifeLines cohort. Depressive and anxiety disorders (generalized anxiety disorder, social anxiety phobia, panic disorder with or without agoraphobia and agoraphobia without panic disorder) were assessed using the Mini-International Neuropsychiatric Interview.</p> <p><b>Results:</b> Anxiety disorders, with the exception of social anxiety disorder, were significantly associated with increased CRP. After adjusting for demographics, life style factors, health factors, medication use, depression, and psychological stressors, CRP remained significantly associated with panic disorder with agoraphobia (β = 0.01, <i>P</i> = .013). Moreover, CRP levels were significantly higher in people with panic disorder with agoraphobia compared to other anxiety disorders, independent of all covariates (<i>F</i> = 3.00, df = 4, <i>P</i> = .021).</p> <p><b>Conclusions:</b> Panic disorder with agoraphobia is associated with increased CRP, although the effect size of this association is small. This indicates that neuroinflammatory mechanisms may play a potential role in its pathophysiology.</p

Odds ratio of symptom profile class membership in depressed MI patients compared to patients from primary and mental health care, controlled for age and sex.

<p>Note: The odds ratios represent group differences in the odds of being classified as having the specific symptom profile. For each comparison, the myocardial infarction (MI) patients group is the reference group.</p

Group description – demographic characteristics, vascular risk factors and depression characteristics for depressed myocardial infarction, primary care and mental health care patients.

<p>Abbreviations: PC primary care, MHC mental health care, HSD honestly significant difference, CVD cerebro vascular disease, BMI body mass index, CIDI total number of depressive symptoms (range: 5–9) as established by composite interview diagnostic instrument, COG cognitive/affective, SOM somatic. Group differences were tested by means of ANOVA and χ²-test as appropriate.</p

Group differences in cognitive/affective and somatic symptoms, comparing MI patients with first onset depression, depressed primary care and mental health care patients.

<p>* Means adjusted for age, sex and somatic symptom levels different at p<0.05, Bonferroni corrected.</p

The three different symptom profiles of depression established by latent class analysis.

<p>The three different symptom profiles of depression established by latent class analysis.</p

The hypothesized associations between age of depression onset, myocardial infarction and cognitive/affective symptom levels in depressed patients.

<p>N.B. White arrows denote a positive association and black arrows denote a negative association. Cognitive vulnerability is included as a potentially influential but in our study unmeasured factor.</p